Abstract
Dear Editor:
We read Hayashida et al.'s 1 published article with great interest. Recently, we shared the same need to introduce rice sheets in a malodorous malignant wound (MW) in a terminally ill patient admitted to our home-based palliative care unit.
Although not prevalent in cancer patients, MWs cause several problems, such as pain, bleeding, and odor, the latter being one of the most disturbing and significantly interfering in patients' quality of life and social relationships. 2
The main recommended treatments for malodorous wounds are topical therapy—using metronidazole or charcoal activated dressings3,4; or systemic antibiotics, although results are unclear whether metronidazole reduces the smell of MWs when taken orally. 5
Other topical compounds for controlling malodorous MWs exist, such as rice bran sheets applied over the gauze after change of wound dressings. 1
We report the case of M.J., a 54-year-old woman diagnosed with an extensive MW due to vulvar cancer, extended to her perineum, inguinal regions, and right thigh. After local radiotherapy in 2019, she developed severe radiodermatitis, which aggravated the wound smell, exudate, and necrotic tissue detachment. After her physical pain was effectively controlled with morphine, M.J. continued to feel depressed. Her main complaint during visits was the MW odor, and how it affected her relationships, self-esteem, causing social embarrassment, feelings of being a burden, and considerable challenges to her family caregivers during daily hygiene.
Acknowledging that M.J.'s severe frailty and low-performance status could lead to possible adverse events if using oral metronidazole reducing even further her quality of life, we decided to discuss with M.J. and her daughter, the possibility of using milled brown rice sheets (MBRSs) applied twice daily over the gauzes after the daily wound care using normal saline only. The reason we choose MBRSs was that rice bran is a rare by-product in our country, with expensive shipping costs and sold in large quantities only.
After receiving the procedure information and having time to pose her questions, M.J. agreed to initiate the MBRSs and provided verbal consent in the presence of her physician, nurse, and daughter. Following the work of Hayashida et al., 1 we used a numerical scale to monitor the odor intensity (0 = no odor, 1 = slight odor, 2 = moderate odor, 3 = strong odor, 4 = very strong odor, and 5 = overpowering odor), to be rated once daily, during eight days, by M.J., her caregiver, and health professional.
As given in Table 1, there were clinically relevant improvements in the assessment of the MW odor by all participants, decreasing from the highest scale level at baseline to the lowest level (no odor) from the third day onward. No side effects from MBRSs use were observed.
Malignant Wound Odor Improvement Measured by the Patient, Caregiver, and Health Professional
Measured using an odor intensity scale: 0 = no odor, 1 = slight odor, 2 = moderate odor, 3 = strong odor, 4 = very strong odor, and 5 = overpowering odor.
MBRSs, milled brown rice sheets; N/A, not assessed.
Our data suggest that the use of MBRSs is safe and effectively reduces disturbing odor from MWs. Future research in the field of oncology and palliative medicine is warranted to draw robust evidence on the effect of nonpharmacological natural compounds such as MBRSs for MWs' odor. Clinical trials to study the efficacy of MBRSs for reducing MWs' odor are needed and should include quality of life and psychosocial variables.
Footnotes
Funding Information
The authors received no financial support for this report.
Author Disclosure Statement
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.