Topical Management of Bleeding From Malignant Wounds Caused by Breast Cancer: A Systematic Review

Context. Topical management is the main form of control of signs and symptoms regarding malignant wounds (MWs) arising from tumor progression on the skin. Nevertheless, few studies have explored this theme and evidence on the effectiveness of the methods used to control bleeding is unknown, leading to a lack of consensus to support clinical practice. Objectives. Identify and evaluate current evidence on topical MW hemostasis from breast cancer and suggest new topics for future research. Methods. This review was performed according to the Preferred Reporting Items for Systematic Reviews and MetaAnalyzes. Seven indexed databases were consulted using the terms: "breast neoplasms"; "breast cancer"; "malignant fungating wounds"; "malignant wounds"; "bleeding."Results. From the 112 articles identified in total, six were included in this review: a descriptive cohort study (n = 32), two case series (n = 21) and three case reports (n = 3). Fifty-six patients were exposed to 11 types of topical treatments using calcium alginate, surgical hemostats, adrenaline, nonadherent dressings, silver nitrate, modified Mohs Paste, and 10% formalin. There were no reports of significant adverse effects. Conclusion. Although studies have promoted positive results of topical hemostasis, scientific evidence is still weak and arises from studies with poor methodological quality. Randomized controlled trials were not identified. The results highlight the crucial need for pilot studies to evaluate effect size, study procedures, and measurable results. J Pain Symptom Manage 2021;61:1278e1286. Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine.