LYMPHEDEMA - University of British Columbia lymphedema in palliative care sarah buddingh smith, bsc,

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  • LYMPHEDEMA IN PALLIATIVE CARE

    SARAH BUDDINGH SMITH, BSC, MPT

    BC CANCER PHYSIOTHERAPIST

    SARAH.BUDDINGHSMITH@BCCANCER.BC.CA

  • 2

    • Lymphedema Education Benchmark Statements

    • Interprofessional roles in best practice

    • Research update on effective treatment

    • Advanced cancer & edema at end of life

    • Referrals & resources

    OBJECTIVES

  • 3

    • Lymphedema Education Benchmark Statements

    • Interprofessional roles in best practice

    • Research update on effective treatment

    • Advanced cancer & edema at end of life

    • Referrals & resources

    OBJECTIVES

  • 4

    BENCHMARK 1: LYMPH SYSTEM ANATOMY & PHYSIOLOGY

  • 5

    BENCHMARK 2: PATHOPHYSIOLOGY OF LYMPHEDEMA

    Planas-Paz and Lemmert 2013

    RISK FACTORS FOR LYMPHEDEMA:

    • Cancer • Surgical resection • Radiation • Tumor compression

    • Venous insufficiency

    • Obesity

    • Immobility

    • High exposure to mosquito bites

  • 6

    BENCHMARK 3: OTHER CAUSES OF EDEMA

    •Cellulitis

    •Deep vein thrombosis

    •Other vascular disorders

    •Systemic disorders, e.g. cardiac, liver or renal

  • 7

    BENCHMARK 3: EDEMA IN END OF LIFE

    •Advanced Cancer

    • Metastases

    • Drugs

    • Hypoalbuminaemia

    • Ascites

    •System Failure

    • Chronic heart failure

    • End stage renal disease

    • End stage chronic respiratory disease

    • Advanced liver disease

    • Advanced neurological disease

  • 8

    BENCHMARK 4: FEATURES OF LYMPHEDEMA

    Principles and Practice of Lymphedema Surgery. July 2015.

  • 9

    • Lymphedema Education Benchmark Statements

    • Interprofessional roles in best practice

    • Research update on effective treatment

    • Advanced cancer & edema at end of life

    • Referrals & resources

    OBJECTIVES

  • 10

    BENCHMARK 5: PATIENT EDUCATION

    • Use BC Cancer handout

    • With damaged lymph

    nodes, always at risk

    • No cure, only self-

    management

    • Early detection is key

    • Treatment available

  • 11

    BENCHMARK 6: LYMPHEDEMA MANAGEMENT

    •Complex Decongestive

    Therapy (CDT)

    •Two phases:

    • Intensive

    •Maintenance

  • 12

    MANUAL LYMPHATIC DRAINAGE

    Lymphedema: Diagnosis and Therapy, 4th edition.

  • 13

    COMPRESSION

  • 14

    SKIN CARE

  • 15

    EXERCISE

  • 16

    SURGERY

    MD Anderson

    • Surgical Reduction

    • Bypass lymphatic obstruction

    • Liposuction

    • VGH developing a surgical

    program

  • 17

    • Lymphedema Education Benchmark Statements

    • Interprofessional roles in best practice

    • Research update on effective treatment

    • Advanced cancer & edema at end of life

    • Referrals & resources

    OBJECTIVES

  • 18

    • Multifactorial edema

    • Patient directs priorities

    • Focus on quality of life

    • Refer to Allied Health

    ADVANCED CANCER & END OF LIFE

  • 19

    • What region of the body?

    • Head & Neck

    • Genital

    • Widespread

    • Venous compression from a

    tumor?

    • Cellulitis?

    • Fungating wound?

    • Paralysis?

    END OF LIFE ALGORITHM

  • 20

    SUBCUTANEOUS LYMPHATIC DRAINAGE

    Jacobsen & Blinderman (2011)

    • Severe refractory lymphedema due to obstructive cancer

    • Genitalia, lower abdomen, legs

    • Pitting edema, no fibrosis

    • #17 Gauge dialysis catheter(s)

    • Urinary leg drainage bag

    • Monitor for fever and

    hypotension

    • VGH PCU and BC Cancer

    can perform

  • 21

    • Lymphedema Education Benchmark Statements

    • Interprofessional roles in best practice

    • Research update on effective treatment

    • Advanced cancer & edema at end of life

    • Referrals & resources

    OBJECTIVES

  • 22

    • www.bccancer.bc.ca

    Search “lymphedema”

    • Patient handout

    • Symptom Management

    Guideline #9

    ONLINE: PROVIDER

    http://www.bccancer.bc.ca/

  • 23

    • www.lympho.org

    • Position documents

    • Lymphedema in

    Advanced Cancer &

    Edema at End of Life

    ONLINE: PROVIDER

    http://www.lympho.org/

  • 24

    Canadalymph.ca

    BClymph.org

    Cancer.ca

    CancerConnection.ca

    ONLINE: PATIENT

  • 25

    • Public

    • Cancer Center

    • Hospital Outpatient Department

    • Home Care

    • Private Practice

    • Physical Therapy

    • Massage Therapy

    REFERRALS

  • 26

    St. Paul’s Hospital

    Royal Jubilee Hospital

    Surrey Memorial Hospital

    Abbotsford Regional Hospital

    REFERRALS: HOSPITALS IN BC

  • 27

    • Lymphedema significantly affects function

    and quality of life

    • Consider the lymph system when assessing edema

    • Management algorithms are available online

    • Educate patients on

    • Monitoring for signs & symptoms

    • Self management

    • Refer to your Allied Health colleagues

    CONCLUSION

  • 28

    • Lymphoedema Education Benchmark Statements https://www.lympho.org/lebs/

    • Lymphedema: Diagnosis and Therapy, 4th edition. Weissleder and Schuchhardt.

    • Best Practices for the Management of Lymphedema https://www.lympho.org/wp-

    content/uploads/2016/03/Best_practice.pdf

    • The Management of Lymphoedema in Advanced Cancer and Oedema at the End of Life

    https://www.lympho.org/wp-content/uploads/2016/03/Palliative-Document.pdf

    • Introduction to the Lymphatic System, National Cancer Institute

    https://training.seer.cancer.gov/anatomy/lymphatic/

    • Moore JE Jr, Bertram CD. Lymphatic System Flows. Annu Rev Fluid Mech. 2018;50:459–482.

    doi:10.1146/annurev-fluid-122316-045259 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5922450/

    • https://www.lymphcareusa.com/professional/lymph-a-what/what-is-lymphedema/what-causes-

    lymphedema.html

    • Moore JE Jr, Bertram CD. Lymphatic System Flows. Annu Rev Fluid Mech. 2018;50:459–482.

    doi:10.1146/annurev-fluid-122316-045259

    • Planas-Paz and Lammert 2013. Mechanosensing in Developing Lymphatic Vessels. Available from:

    https://www.researchgate.net/figure/Mechanotransduction-in-secondary-lymphedema-formation-a-

    hypothetical-model-a_fig2_258923453 [accessed 25 Sep, 2019]

    • Principles and Practice of Lymphedema Surgery. Cheng MH, Chang DW, Patel KM (Editors). Elsevier Inc, Oxford,

    United Kingdom. ISBN 978-0-323-29897-1. July 2015.

    • Self-Measured Arm Circumference in Women With Breast Cancer Is Reliable and Valid

    https://www.ncbi.nlm.nih.gov/pubmed/30289500

    • Jacobsen & Blinderman (2011). Subcutaneous Lymphatic Drainage (Lymphcentesis) for Palliation of Severe

    Refractory Lymphedema in Cancer Patients. https://doi.org/10.1016/j.jpainsymman.2010.09.015

    • Sellick. Subcutaneous Draining of Lower Extremity Edema in a Patient With Advanced Cancer Relieves Scrotal

    Swelling and Improves Mobility DOI: 10.1200/JOP.2017.025429 Journal of Oncology Practice 14, no. 1 (January

    01, 2018) 49-51.

    REFERENCES

    https://www.lympho.org/lebs/ https://www.lympho.org/wp-content/uploads/2016/03/Best_practice.pdf https://www.lympho.org/wp-content/uploads/2016/03/Palliative-Document.pdf https://training.seer.cancer.gov/anatomy/lymphatic/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5922450/ https://www.lymphcareusa.com/professional/lymph-a-what/what-is-lymphedema/what-causes-lymphedema.html https://en.wikipedia.org/wiki/International_Standard_Book_Number https://en.wikipedia.org/wiki/Special:BookSources/978-0-323-29897-1 https://www.ncbi.nlm.nih.gov/pubmed/30289500 https://doi.org/10.1016/j.jpainsymman.2010.09.015