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PEER REVIEW: LYMPHOEDEMA
Lymphoedema Treatment and Management Written by Dr Grainne Sheill, Clinical Specialist in Cancer Rehabilitation and Kelly Coghlan, Senior Physiotherapist, Early Detection Lymphoedema
Dr Grainne Sheill Cancer related lymphoedema is a chronic, progressive condition resulting from failure of the lymphatic system to drain fluid and proteins from tissue throughout the body and return it to the circulatory system. Lymphoedema usually affects a limb and can cause discomfort, pain, heaviness, limited motion, unsatisfactory appearance and impacts on quality of life. Cancer relatedlymphoedema is a well know side effect of surgery chemotherapy, radiation therapy and endocrine therapies, impacting up to 1490 new breast, gynaecological, melanoma, prostate and bladder cancers in Ireland annually. Over 15,000 people in Ireland are living with lymphoedema. Lymphoedema is progressive and if not treated, will become more complex with build up of fluid causing skin changes and reduced function which can lead to higher healthcare costs and hospitalization due to cellulitis. Lymphedema Stages
earliest point possible in the patient detect those with sub-clinical changes in limb volume and start journey and monitors patients lymphoedema education and lymphoedema, and also lipoedema, exercises as early as possible. in the long term. Although treatment The service uses a state-of-the-art is not a cure it can improve quality Lymphoedema Treatment and Management SOZO Bioimpedance Spectroscopy of life and prevent complications (BIS) to get pre-operative such as cellulitis which reduces and detect Specialist sub hospital admissions. Written by Dr measurements Grainne Sheill, Clinical inunnecessary Cancer Rehabilitation clinical changes in patients’ fluid The management of lymphoedema tissues after surgery. Patients involvesLymphoedema education, lymphatic Kelly Coghlan,and Senior Physiotherapist, Early Detection are provided with information drainage, the provision of garments early signs and and prescription of exercise. Cancer related lymphoedema ison a managing chronic, progressive condition resulting from failure of the lymphatic symptoms of lymphoedema, 4 cornerstones system to drain fluid and proteins from skin tissue throughout tolymphoedema the circulatory including care advice. Theythe body and return itof Kelly Coghlan management: reviewed postoperative at system. Lymphoedema usually are affects a limb and can cause discomfort, pain, heaviness, limited motion, different time points based on • Skin Care: moisturising vital to unsatisfactory appearance and their impacts onrisk, quality of by life. is arisk well know level of triaged theCancer related-lymphoedema avoid cracks and reduce In Ireland, 70% of lymphoedema Senior Physiotherapist. of infection effect of surgery chemotherapy, radiation therapy and endocrine therapies, impacting up to 1490 careside should be provided in the primary setting with non• Exercise: important for Over 15,000 newcare breast, gynecological, melanoma, and bladder in Ireland annually. The aimsprostate of this service are: cancers specialist services and 30% of muscle pump, weight control, in Ireland arecenters living with• lymphoedema. Lymphoedema is progressive and if not treated, will Prevent lymphoedema in carepeople should be in specialist mental health at high risk skin changes and reduced function which can lead (community assessment, becomebased) morefor complex with buildpatients up of fluid causing • Compression: bandaging in complex patients and intensive • Empower patients intensive phase, garments long to higher costs and hospitalization duetototake cellulitis. treatment. The healthcare structure of the greater control of their term. Correct garment helps national lymphoedema model of healthcare maintain/slow progression of Stages careLymphedema is depicted in Figure 1. condition • Move away from the traditional Early-Detection Lymphoedema • hospital centric model Stage 0: Subclinical/latent, undetectable by clinical examination. MLD: by a trained therapist, Service helps to reduce size of limb & Stage 1: Clinically visible oedema, spontaneously are soft, can have pitting. No pain • Piece together thereversible. fragmented Tissuesimprove skin condition. Also There is ongoing development of community services no skin changes & negative Stemmer’s sign. SLD which is a modified form early detection services nationally. of MLD which patients perform therapy. These services aim to detect • Providereversible, proactive planned Stage 2: Oedema is notsubspontaneously can be reversed with complete decongestive themselves. clinical lymphoedema which can be preventative care Pittingconservatively is difficult aswith tissues managed short are harder. Positive Stemmer’s sign. • Data driven platforms at Once the symptoms of termStage use of3: compression garments, Irreversible, severe oedema with subcutaneous and connective tissue fibrosis, limb national level lymphoedema are controlled skin care, exercise and education, disfigurement & skin changes. May include: hyperkeratosis, papillamatosis, pachydermia long term maintenance treatment and prevent chronic issues which • Cemented service based on all will begin with regular reviews, require complex treatment. stakeholder feedback measurement for new compression In Ireland, 70% of lymphoedema care should be provided in the primary care setting with non-specialist An early detection cancer garments at least every 6 months. Lymphoedema Treatment lymphoedema service Ourbased) service for works with patients to services and 30%was of care shouldService be in specialist centers (community assessment, complex established at the physiotherapy ensure they can self-manage their patients and intensive treatment. The structure of the national lymphoedema model of care is depicted The lymphoedema service in St department at St James’s Hospital lymphoedema which can often be James’s Hospital was established in 2020. The service reviews in Figure 1. a life-long diagnosis. in 2003. This service provides patients before and after their References available on request assessment and treatment at the cancer treatment in order to
Stage 0: Subclinical/latent, undetectable by clinical examination. Stage 1: Clinically visible oedema, spontaneously reversible. Tissues are soft, can have pitting. No pain no skin changes & negative Stemmer’s sign. Stage 2: Oedema is not spontaneously reversible, can be reversed with complete decongestive therapy. Pitting is difficult as tissues are harder. Positive Stemmer’s sign. Stage 3: Irreversible, severe oedema with subcutaneous and connective tissue fibrosis, limb disfigurement & skin changes. May include: hyperkeratosis, papillamatosis, pachydermia
Figure 1
AUGUST 2022 • HPN | HOSPITALPROFESSIONALNEWS.IE
