Infected Cancerous abscess

[blimkafam]

I am a homecare nurse and occas. get oncology patients to care for. The latest one I am caring for was just released from the hospital for sepsis and on his discharge papers the culture shown positive for corynebacterium species, SPAR staph species, and gram negative rods to left neck wound ( which is the protruding oral cancer abscess). He was sent home on antibiotics via peg tube x 14 days and daily wound care with aquacel ag. Pt stated he had follow-up appt. with oncologist to determine when he can start chemotherapy. I told the pt he can not do chemotherapy while he has an infection, and explained why. While he was at the oncologist, the pt states he was told by the doctor that this is a cancerous tumor, it is dying tissue, any swab culture would show positive for infection but it really isnt. My question is, Is this correct? Their is no necrotic tissue, just very pink large draining tumor on the left side of jaw/neck area. Drainage is yellow/green, and he is occasionally running low-grade temp. of 99 - 100.3. I am not an oncology nurse and dont want to say something to the patient that is not correct but this just doesnt sound right to my med/surg. mind. Please help! thanks!

[mindlor]

I think this is a medical call that a doc will have to make.......

[Esme12, ASN, BSN, RN]

I think you need to check with his physician and I think you need to encourage the patient to follow his physician's advice.......any inflammatory response can cause a low grade temp. Place a call to the oncologist.......

[neuroms]

Post back up when you find out from the physician!

[caroladybelle, BSN, RN]

Your best source would be the MD.

Having said that, I have seen plenty of cases where chemo is started while the pt has an infection. If the lesion is a necrosis mass, and aggressive, it will often culture positive for some bacteria. Most surface dead/dying tissue does. Thus, chemo that can decrease the mass, allowing good noncancerous tissue to return will help clear it up. In addition, there are ways to titrate chemo, so there is less immunosuppression. Also, for many solid cancers, there are targetted chemo/biotherapy that have little immunosuppressive effects.

With an aggressive tumor, the sooner you start chemo, the greater the success rate. Sometimes one can't wait until the pt is in pristine condition to start chemo.

I am not familiar with those microbes specifically, but can vouch that chemo may start while the pt has infection. It is certainly not optimal but may have to be done