In a poster presentation at the 38th Annual Oncology Nursing Society Congress, Patrice Dillow, MSN, RN, APRN, WOCN, an oncology wound care specialist from the Cancer Treatment Centers of America (CTCA) in Zion, Ill., shared several case studies of oncology patients with clinically complex wounds who responded impressively to topical applications of Leptospermum honey, also known as MEDIHONEY (abstract 116590).
Many advanced wound care treatments are contraindicated in patients with cancer. Open wounds (e.g., at surgical or radiation sites) can be challenging to treat in this setting, often becoming chronic because of immune compromise related to the cancer itself and/or regimens used for cancer treatment. These patients also often have a high level of pain that must be managed with narcotics. They are often managed by wound, ostomy, and continence nurses (WOCNs) using a variety of dressings.
As Dillow explained in her poster, Leptospermum honey is ideally suited for wound healing. It creates an osmotic potential that reduces edema. It stimulates cytokine production from human monocytes, which promotes normal healing, and "it's an excellent debrider." It is available in a variety of forms, she said, and its use in the care of cancer patients is growing, both in pediatric and adult settings.
In her poster, she reported on results with six patients. (See the accompanying video.) The patients (five female, one male) ranged in age from 39 to 64. Most had two or three comorbidities in addition to cancer. Their chronic wounds included surgical-site wounds, radiation dermatitis, and tumor-related wounds. Four of the patients were treated with a hydrogel colloidal sheet impregnated with the honey. The other two were treated with a gel form of the honey and absorbent dressings, along with negative pressure therapy for excessive exudates.
The first case that Dillow described in her poster is that of a 50-year-old man with T2N2 stage IVA primary squamous cell subglottic cancer. His history included long-term tobacco use, asbestos exposure, and hypertension. Following surgical and reconstructive procedures on June 3, 2012, including a dermal graft implant to cover the trachea, he started radiation on July 25. Radiation fields were covered with Leptospermum honey-impregnated dressings to prevent radiation-induced desquamation. Despite receiving 14 radiation treatments in a three-week period, he had no signs of desquamation, and he was able to complete all 35 radiation treatments with no development of desquamation.
The second case is that of a 57-year-old postmenopausal breast cancer patient with ER/PR-positive and HER2-negative lobular carcinoma diagnosed in 2004, at which time she received two rounds of chemotherapy but no radiation. A recurrence in 2012 was diagnosed as stage IV because of skin involvement, and she was treated with a radical mastectomy followed by radiation treatment from July 9 to Aug. 22. She returned to the CTCA at the completion of treatment for postoperative care of radiation dermatitis with partial/full thickness tissue loss, starting treatment with Leptospermum honey-impregnated dressings. As the before and after photos in the poster illustrate, her skin and wound improved significantly after just one day of treatment, and she reported that her pain was significantly reduced. Her nonviable tissue was debrided, and she continued the honey treatment, with symptoms resolving within two weeks.
The third case is that of a 39-year-old woman with recurrent breast cancer following an initial diagnosis in 2006 of invasive ductal carcinoma. Followup in 2007 showed stage IV disease with metastasis to the liver. She was treated with chemotherapy and radiation therapy, and in mid-2012, she had surgery to reconstruct her right breast using tissue from her abdomen. The abdominal wound, which had a stratus type mesh implanted to aid closure, had poor healing with dehiscence, and she presented for operative wound care on Oct. 3. She was treated with Leptospermum honey gel applied to nonadherent woven gauze placed in the base of the wound and a negative pressure sponge placed over the gauze. Her wound improved rapidly, as seen in the four photos in the poster, and her wound was closed surgically on Nov. 9.
Leptospermum honey "is a scientifically proven advanced wound product," Dillow wrote in her poster. "Oncology nurses should consider this evidence-based alternative when dealing with clinically complex or chronic wounds."
Are you familiar with this type of wound care? If so, what results have you seen among your cancer patients?