Numero 3 2025

La gestione multidimensionale del dolore nei pazienti con malignant fungating wounds: una revisione narrativa della letteratura

Redazione 6 Febbraio 2026

Daniela Nigrelli (1), Rosaria Blesi (2), Giuseppe Intravaia (3), Domenico D’Anna (3), Giuseppe Bianco (2), Antonio Terranova (2), Erasmo De Luca (2), Liboria M. Castelli (2), Tania L. Calafato (4), Giuliano Anastasi (5)*

  1. Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma Tor Vergata, Roma
  2. Azienda Ospedaliera Universitaria P. Giaccone, Università degli Studi di Palermo, sede di Palermo
  3. Società Assistenza Malato Oncologico Terminale (SAMOT Onlus), Palermo
  4. ASP Caltanissetta, Presidio Ospedaliero Sant’Elia, Università degli Studi di Palermo, sede di Caltanissetta
  5. Dipartimento Trauma, Azienda Ospedaliera Universitaria G. Martino, Messina

Abstract

Introduction: Malignant Fungating Wounds (MFWs) are devastating skin manifestations in the advanced stages of cancer, resulting from direct tumor infiltration or cutaneous metastases. These wounds are associated with a multitude of distressing symptoms (e.g., perilesional erythema, edema, bleeding, pruritus, malodor) that significantly affect patients’ and caregivers’ quality of life. Among these, pain is one of the most complex challenges in this population, involving nociceptive, neuropathic, and procedural components, intertwined with psychological and social factors. The current literature, however, remains fragmented, with a scarcity of specific randomized trials and a lack of validated pain assessment tools dedicated to this population. Aim: To synthesize the available literature regarding the assessment and management of pain in patients affected by MFW. Specific objectives include evaluating the psychosocial impact of pain on patient quality of life and examining the measurement instruments currently used. Method: A narrative literature search was conducted in PubMed, Medline, and Web of Science using a comprehensive search string incorporating a Boolean operator and keywords. The search was supplemented by consulting the bibliographies of selected articles and institutional websites. Result: Accurate MFW pain assessment and management demands specific tools and a multimodal, interdisciplinary approach. However, current nursing practice lacks validated scales for MFW-related pain, often relying on general instruments like NRS, VAS, and VRS. The intrinsic characteristics of these wounds increase procedural pain during care, further complicating management. MFWs also cause a severe psychosocial impact (e.g., anxiety, shame), which, coupled with pain, intensifies care complexity. The literature reveals significant gaps, including limited randomized trials and an absence of specific guidelines for MFW pain management. Conclusion: Improving clinical outcomes among patients affected by MFWs requires high-quality research, specialized training, and organizational models that integrate specialized pain assessment competencies and personalized care, enhancing patient dignity and quality of life.

Keywords: Pain management, wound care, assessment, palliative care, quality of life, nursing care.

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Bibliografia

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