Fungating Wounds: Focusing on the Psychosocial Needs of the Patient

The term fungating wound is described as a neoplastic change of tissue structure at a tumor site.  This overgrowth of cells is a rare complication of cancer, creating an abnormal protrusion through the outer layer of the skin. Fungating wounds are superficial injuries to the skin that vary in character and presentation, ranging in appearance from intact bulbous lesions to open, necrotic, bleeding ulcers resembling a cauliflower.  Malodor, bleeding, edema, and excessive drainage may leave the patient with limited opportunities to self-care and a low sense of self.  Heavily soiled clothing and increased odor may increase the presence of the wound and reduce social interaction.  Fungating wounds can be disfiguring and painful, often requiring aggressive pain management and efforts to improve functionality of the affected site. Patients face significant stress, loss of dignity, decreased body image, and poor quality of life.  

Nursing management of fungating wounds demands a targeted approach to providing comfort, relieving pain, and preserving the patient’s dignity. Assessing the needs of the patient will be central to planning of the care process.  If pain is one of the greatest needs of the patient, it should be given high priority. However, the focus of treatment should not solely be pain control or containment of odor and drainage. Instead, the approach to care should be holistic, in that, the patient’s needs should be addressed in the context of mind, body, and spirit. Specifically, the nurse will need to assess the psychosocial aspect of care by evaluating the patient’s emotional and spiritual state; perception of body image; and self-care behaviors.  Having an increased understanding of these factors will allow better planning and ensure meeting the patient’s needs, thus providing an opportunity to improve outcomes. Three case studies focusing on psychosocial assessments of patients with fungating wounds are presented.