Objective To understand the change trajectory and influencing factors of wound symptom distress at different times after the diagnosis of malignant tumor wound. Methods A longitudinal study design was used to evaluate patients’ wound symptom distress at the time of pathological diagnosis （T1）,1 month after diagnosis （T2）,3 months after diagnosis（T3）,and 6 months after diagnosis （T4）. The distress in different periods was compared and the influencing factors of symptom distress were analyzed. Results The wound Symptom Intrusiveness score：T1 （49.20±13.78）,T2 （57.71±13.47）,T3 （45.58±13.69）,and T4 （43.79±12.98）. Treatment stage,gender,wound exudation,wound odor,wound pruritus and dressing change frequency were the influencing factors of wound symptoms distress. Conclusion The trajectory of wound symptom distress in patients with malignant fungating wounds firstly going high then becoming low. Early evaluation,continuous follow-up and whole process symptom management of patients with malignant fungating wounds should be strengthened to reduce wound symptoms and improve the quality of life of patients.