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A Clinical Minute: For Cancer Patients, When Does the Wound Deserve the Same Attention as the Disease?
For individuals fighting cancer, nothing is more important than the curative treatment regimen. However, when a wound occurs, the focus shifts and the goal becomes managing the wound to enable continuation of curative treatment.
With its rich history, honey used for wound healing is reemerging in modern day medicine, particularly for patients with cancer. An online search for honey for wound management and cancer patients will produce numerous positive studies and reviews,1,2 including recommendations from prominent cancer institutions, such as Cancer Treatment Centers of America3 and Memorial Sloan Kettering,4 on the positive role of honey in wound management and nutrition. Oncology patients also like the idea of a product free of harsh chemicals because cancer treatments and medications can be toxic and debilitating.
MEDIHONEY® (Derma Sciences, Inc, Princeton, NJ) is composed of quality, sterilized, medical grade Leptospermum honey. Its efficacy is based on two unique mechanisms of action: high osmolarity and a low pH. The osmotic activity draws fluid from deeper tissue to the wound surface to promote removal of necrotic tissue,5,6 while the low pH helps create a more acidic wound environment that is conducive to healing.7-9
The following cases illustrate the use of MEDIHONEY® for wound management in patients undergoing treatment for cancer.
Case 1. In this case, a female patient with stage IV, recurrent breast cancer was treated for radiation-induced desquamation. She underwent a radical mastectomy with dehiscence and was closed with MEDIHONEY® Paste while undergoing therapy. Following 6 weeks of radiation, she presented with moist and dry desquamation to her anterior and lateral chest (see Figure 1) and subsequently requested MEDIHONEY®. We applied the new MEDIHONEY® HCS sheet dressing to the entire area (see Figure 2). On day 2 after application, the dressing was removed and dramatic improvement was noted, especially from 9 to 12 o’clock (see Figure 3). Treatment continued for 3 more days until complete resolution.
Case 2. Case 2 involves a female patient with recurrent stage IV metastatic breast cancer who had a dehisced abdominal wound. With recurrence, she also had a liver mass requiring treatment including chemotherapy, radiation, and a myocutaneous flap harvested from her abdominal wall to reconstruct her chest. When she presented for the dehiscence, there was an exposed white surgical mesh implant with yellow subcutaneous tissue just below the mesh and adjacent yellow slough (see Figure 4).
We impregnated MEDIHONEY® gel on a silicone mesh and applied it to the wound base and then initiated negative pressure wound therapy. Twelve days later, the mesh was no longer visible due to prominent tissue granulation (see Figure 5) and only minimal slough was present. Treatment was continued yielding a steady decrease in wound size, nonviable tissue was removed, and the wound edge advanced to the point the wound was ready to be grafted. On day 37, (see Figure 6), surgeons performed the graft, and the patient resumed her treatment regimen for the liver mass 4 weeks later.
Conclusion
For 2 years, I have achieved excellent results using MEDIHONEY® as a go-to wound management modality to promote debridement and wound healing and to treat and prevent radiation-induced desquamation. Occasionally, MEDIHONEY® was discontinued due to a patient’s hypersensitivity to smell, which randomly occurs in oncology patients. The addition of MEDIHONEY® to our wound care options has been appreciated by patients and met our clinical objectives to provide optimal wound healing and get patients back on track with their curative treatment.
For more cases on the use of MEDIHONEY® for wound management in oncology patients, visit the MEDIHONEY Power Webinar series at www.dermasciences.com/elearning-portal/ for a 30-minute case review by Pat Dillow, MSN, APRN, CWOCN.
A Clinical Minute is made possible through the support of Derma Sciences, Inc, Princeton, NJ. The opinions and statements provided in A Clinical Minute are specific to the respective authors and not necessarily those of OWM or HMP Communications. This article was not subject to the Ostomy Wound Management peer-review process.
1. Saha A, Chattopadhyay S, Azam M, Sur PK. The role of honey in healing of bedsores in cancer patients. South Asian J Cancer. 2012;1(2):66–71.
2. Bardy J, Molassiotis A, Ryder WD, Mais K, Sykes A Yap B, et al. A double-blind, placebo-controlled, randomised trial of active Manuka honey and standard oral care for radiation-induced oral mucositis. Br J Oral Maxillofac Surg. 2012 ;50(3):221–226.
3. Cancer Treatment Centers of America. It Takes a Team: Addressing Head and Neck Cancer Symtoms. Available at: www.cancercenter.com/community/newsletter/article/it-takes-a-team-addressing-head-and-neck-cancer-symptoms/. Accessed September 3, 2014.
4. Memorial Sloan Kettering. Complementary Therapies to Ease the Way During Cancer Treatment and Recovery. Available at: www.mskcc.org/cancer-care/patient-education/resources/complementary-therapies-ease-way-during-treatment-and-recovery. Accessed September 3, 2014.
5. Acton C, Dunwoody G. The use of medical grade honey in clinical practice. Br J Nurs. 2008;17(20):S38–S44.
6. Chaiken N. Pressure ulceration and the use of active Leptospermum honey for debridement and healing. Ostomy Wound Manage. 2010;56(5):12–14 .
7. Milne SD, Connolly P. The influence of different dressings on the pH of the wound environment. J Wound Care. 2014;23(2):53–57.
8. Gethin G, Cowman S. Changes in Surface pH when a Honey Dressing was Used. Presented at Wounds UK Conference. Aberdeen, UK. November 13-15, 2006.
9. Leveen H, Falk G, Borek B, Diaz C, Lynfield Y, Wynkoop B, Mabunda GA, et al. Chemical acidification of wounds. An adjuvant to healing and the unfavourable action of alkalinity and ammonia. Ann Surg. 1973;178(6): 745–750.
