Palliative Management of Squamous Cell Carcinoma using Active Leptospermum Honey

Squamous cell carcinoma of the oral cavity accounts for approximately 2- 3% of all malignancies and typically are advanced stage at the time of diagnosis.¹ Malignant wound occur in approximately 5-10% of cancer patients .^2,3 Palliative management of malignant malodorous wounds in the oral cavity can be difficult due the limited dressing and products that provide symptom management and are safe for ingestion.  The CWON was contacted for this case due to the patient and caregiver’s complaint of distressing odor from the oral cavity. The smell was reported by the visiting nurse as a “rotting flesh smell that permeated the entire house” and the family stated if something could not be done to control the odor they would have to consider moving the patient from the home.  Additionally, the nurse reported an external facial wound with bone protrusion that was “angry and inflamed” with “purulent drainage”.  Active Leptospermum Honey (ALH) was selected because it is safe for oral ingestion and it addressed the wound needs which include antimicrobial activity, deodorizing, and anti-inflammatory activity in the wound bed. ^2.3.4.5  ALH paste was applied twice daily to the oral cavity and ALH impregnated calcium alginate was selected for the external facial wound. After one week the nurse reported the odor could no longer be detected and drainage from the external wound was no longer purulent and redness and inflammation was decreased.  After 3 months, patient was discharged to self management with ALH and continued to report no odor, no noted inflammation, and no purulence.   ALH is a safe and effective option for palliative management of malodorous, malignant wounds in the oral cavity and in this case improved the quality of life for both the patient and the caregivers.