Morphological characteristics and healing process of pressure ulcers in terminal cancer patients and identification of worsening factors

Abstract

　Objective: The aims of this study were to describe the characteristics and morphological changes of deteriorated pressure ulcers in patients with terminal cancer and to identify the prognostic factors of pressure ulcer deterioration.
　Methods: Pressure ulcers that developed on the sacrum or coccyx of 19 patients with terminal cancer were followed longitudinally and analyzed qualitatively to categorize the wound healing type. Moreover, the symptoms of cancer, management of cancer, and health conditions were compared between patients with deteriorated pressure ulcers and those with well-healed ones.
　Results: Seven of 19 pressure ulcers did not occur over the crista sacralis mediana, and the number of deteriorated pressure ulcers that occurred over this area was significantly smaller than the number of well-healed ones（p = 0.006）. On the basis of qualitative analysis, the wound healing process of deteriorated pressure ulcers was characterized by prolonged inflammation around the wounds, wounds with an advanced depth, and wounds with both advanced depth and large size. All the patients with deteriorated pressure ulcers died during the study period. Prognostic factors for pressure ulcer deterioration were renal failure（p = 0.0006）, sitting without assistance（p = 0.006）, and walking without assistance（p = 0.002）.
　Conclusion: Deterioration of pressure ulcers occurred in patients with terminal cancer accompanied by the advancement of cancer, and this deterioration might not be avoidable. However, pressure ulcer deterioration induced by mechanical loading, occurring during sitting or transferring, might be avoidable with adequate care.