Lymphoedema in end-of-life care.

International Journal of Palliative Nursing, 2019 25(8) p.407-409
Todd, Marie

The author discusses some of the important issues to consider when caring for patients suffering from lymphoedema in the terminal stage of an illness. Topics covered include the complex interaction between symptoms, their causes, and their management, reluctance of many patients to admit that their condition is beyond treatment, and development of a comprehensive needs-based treatment plan.

Lymphoedema in advanced cancer: does subcutaneous needle drainage improve quality of life?

BMJ Supportive & Palliative Care, August 2019

Landers, Amanda; Holyoake, Julia

Lower limb lymphoedema in the palliative care population has limited treatment options. Subcutaneous needle drainage is an underused procedure that has previously been described in the literature for refractory lymphoedema. This study aimed to quantify the potential improvements to quality of life and the adverse outcomes for this group of patients.  The authors conclude that this intervention appears to improve quality of life in those with lower limb lymphoedema facing a life-limiting illness.

S.T.R.I.D.E. professional guide to compression garment selection for the lower extremities

Journal of Wound Care, 2019 28(Sup6a) p.1-44

Bjork, R; Ehmann, S.

The authors' intention is to propose a decision support system for choosing specific compression devices, which can be adjusted to counteract the individual signs and symptoms in an optimally adopted way. The document concentrates on compression devices which can be self-applied by the patients: compression stockings and adjustable wraps. The acronym 'S.T.R.I.D.E.', incorporating both textile characteristics and clinical presentation, stands for: Shape, Texture, Refill, Issues, Dosage and Etiology.

Fulltext available at the Journal of Wound Care website

Treatment for lymphedema following head and neck cancer therapy: A systematic review.

American Journal of Otolaryngology, 2019 May 30.
Tyker A, Franco J, Massa ST, Desai SC, Walen SG

The aim was to perform the first systematic review evaluating all established treatment modalities of head and neck lymphedema resulting from head and neck cancer therapy. Evidence for the efficacy of all types of lymphedema therapy is limited by paucity of large randomized controlled trials. While manual lymph drainage is best studied, liposuction and surgical treatments have also been effective in a small number of patients.

Upper extremity subcutaneous lymphatic drainage "lymphocentesis" for symptom relief in end-stage breast cancer

American Journal of Hospice & Palliative Medicine, 2019 36(2) p. 111-115

Liao, Pamela; Rossini, Kathleen; Sauls, Roberts

Subcutaneous drainage is a technique that has been used in some case reports for the lower extremity and sacrum with good results. This report describes an adapted technique of subcutaneous drainage for treating upper extremity lymphedema in the palliative setting.

Diuretics combined with compression in resistant limb edema of advanced disease-a case series report

Journal of Pain and Symptom Management 2018; vol. 55 (no. 4); p. 1179-1183
Gradalski, Tomasz

This was a prospective observational study of 19 patients with severe bilateral leg edema resistant to parenteral diuretic therapy.  Clinically meaningful results were reported  leading the author to conclude that the combination of compression therapy with hypersaline diuretics could be considered as a valuable option for refractory cases of limb edema in advanced disease.

The effect of relaxation techniques on edema, anxiety and depression in post-mastectomy lymphedema patients undergoing comprehensive decongestive therapy: A clinical trial

PloS One 2018 13 (1): e0190231

Bahareh Abbasi, Navid Mirzakhany, Leila Angooti Oshnari, Ashkan Irani, Samaneh Hosseinzadeh, Seyed Mehdi Tabatabaei, Shahpar Haghighat

This study aimed to assess the effects of relaxation techniques on the level of edema, anxiety and depression in women undergoing Comprehensive Decongestive Therapy (CDT).  It concluded that relaxation techniques reduced the anxiety and depression scores and the volume of edema in the patients with lymphedema.  Further studies are required to determine the cost-effectiveness of this intervention.

Fulltext available in PloS One 

The development of a 'wet leg' pathway for chronic oedema

International Journal of Palliative Nursing; 2018 24(1) p. 40-46
Morgan, Karen; Thomas, Melanie

This article presents the Chronic Oedema 'Wet Leg' Pathway which provides nurses and therapists with clear guidelines to support prompt, efficient and effective management of all patients with chronic oedema and wet legs. 

Available in print in Arthur Rank Hospice Library, Cambridge

A meta-analysis of the effectiveness and safety of kinesiology taping in the management of cancer-related lymphoedema

European Journal of Cancer Care; Sep 2017; 26(5)

Gatt, M; Willis, S; Leuschner, S

This review aims to determine the effectiveness and safety of kinesiotaping (KT) in the management of CRL compared to compression bandaging or hosiery.  

The influence of Kinesiology Taping on the volume of lymphoedema and manual dexterity of the upper limb in women after breast cancer treatment

European Journal of Cancer Care, 2016, 25 (4) 647-660

J. Taradaj PT, T. Halski PT,  J. Rosinczuk, R. Dymarek, A. Laurowski and A. Smykla

In addition to evaluating the effect of kinesiology taping on the size of lymphoedema and manual dexterity  the authors also examined whether the application of KT can replace the traditional and standard multilayered bandaging in the treatment of upper extremity lymphoedema.  After 4-weeks of therapy, they concluded that taping was not an effective method of reducing lymphoedema II and III and cannot yet replace the traditional and standard multilayered bandaging in the treatment of upper extremity lymphoedema.

A review of the evidence for adjustable compression wrap devices

Journal of wound care, May 2016, vol. 25, no. 5, p. 242-247

Williams, A

Individuals with lymphoedema, venous ulceration and lipoedema often require long-term compression therapy to prevent and manage problems such as chronic ulceration and skin changes, persistent swelling and shape distortion. Adjustable compression wrap devices using hook and loop fasteners, commonly called VELCRO brand fasteners, present new opportunities for improving treatment outcomes, supporting patient independence and self-management in the use of compression therapy. This paper reports the findings of an evidence review of adjustable compression wrap devices in people with lymphoedema, chronic oedema, venous ulceration and lipoedema.

Complex decongestive lymphatic therapy with or without vodder ii manual lymph drainage in more severe chronic postmastectomy upper limb lymphedema: a randomized noninferiority prospective study

Journal of Pain and Symptom Management, Dec 2015, vol. 50, no. 6, p. 750-757

Gradalski, Tomasz, Ochalek, Katarzyna, Kurpiewska, Joanna

The purpose of this study was to compare the reduction in edema volume in more advanced (≥20% limb volume difference) postmastectomy arm lymphedema achieved by compression bandaging (CB) and physical exercises vs. the same management augmented by an additional 30 minutes of MLD (Vodder II method). A decrease of limb volume (15.6% in the CB group and 13.8% in the CDT group), edema volume (47.2% and 47.4%, respectively), and limb-related volume change (14.7% and 12.5%) during the intensive phase were observed. This improvement remained constant in both groups after six months of maintenance therapy. The health-related quality of life similarly showed improvement in both groups, with a high level of treatment satisfaction. These results indicate that parallel (immediate and delayed) results may be obtained by CDT without the use of Vodder MLD and CB may be an essential part of lymphedema management. 

Available in print in Arthur Rank Hospice Library, Brookfields Hospital

The management of secondary lower limb lymphoedema in cancer patients: a systematic review

Palliative Medicine, Feb 2015, vol. 29, no. 2, p. 112-119

Leung, Elaine Y L, Tirlapur, Seema A, Meads, Catherine

The authors evaluate the available evidence for the treatment of secondary lower limb lymphoedema in patients with malignancies.

Fulltext available in Palliative Medicine

Available in print in Arthur Rank House Library, Brookfields Hospital

Agreement between tele-rehabilitation involving caregivers and face-to-face clinical assessment of lymphedema in breast cancer survivors

Supportive Care in Cancer, January 2014, vol./is. 22/1(253-8)

Galiano-Castillo N, Ariza-Garcia A, Cantarero-Villanueva I, Fernandez-Lao C, Sanchez-Salado C, Arroyo-Morales M

This study aimed to determine the level of agreement between lymphedema assessment by tele-rehabilitation and by the traditional face-to-face method.  Thirty breast cancer survivors participated in a descriptive study of repeated measures using a crossover design. The preliminary findings support the use of an internet-based system to assess lymphedema in breast cancer survivors.