LYMPHEDEMAIN PALLIATIVE CARE

SARAH BUDDINGH SMITH, BSC, MPT

BC CANCER PHYSIOTHERAPIST

SARAH.BUDDINGHSMITH@BCCANCER.BC.CA

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• Lymphedema Education Benchmark Statements

• Interprofessional roles in best practice

• Research update on effective treatment

• Advanced cancer & edema at end of life

• Referrals & resources

OBJECTIVES

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• Lymphedema Education Benchmark Statements

• Interprofessional roles in best practice

• Research update on effective treatment

• Advanced cancer & edema at end of life

• Referrals & resources

OBJECTIVES

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BENCHMARK 1: LYMPH SYSTEM ANATOMY & PHYSIOLOGY

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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

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BENCHMARK 3: OTHER CAUSES OF EDEMA

•Cellulitis

•Deep vein thrombosis

•Other vascular disorders

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

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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

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BENCHMARK 4: FEATURES OF LYMPHEDEMA

Principles and Practice of Lymphedema Surgery. July 2015.

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• Lymphedema Education Benchmark Statements

• Interprofessional roles in best practice

• Research update on effective treatment

• Advanced cancer & edema at end of life

• Referrals & resources

OBJECTIVES

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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

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BENCHMARK 6: LYMPHEDEMA MANAGEMENT

•Complex Decongestive

Therapy (CDT)

•Two phases:

• Intensive

•Maintenance

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MANUAL LYMPHATIC DRAINAGE

Lymphedema: Diagnosis and Therapy, 4th edition.

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COMPRESSION

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SKIN CARE

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EXERCISE

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SURGERY

MD Anderson

• Surgical Reduction

• Bypass lymphatic obstruction

• Liposuction

• VGH developing a surgical

program

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• Lymphedema Education Benchmark Statements

• Interprofessional roles in best practice

• Research update on effective treatment

• Advanced cancer & edema at end of life

• Referrals & resources

OBJECTIVES

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• Multifactorial edema

• Patient directs priorities

• Focus on quality of life

• Refer to Allied Health

ADVANCED CANCER & END OF LIFE

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• What region of the body?

• Head & Neck

• Genital

• Widespread

• Venous compression from a

tumor?

• Cellulitis?

• Fungating wound?

• Paralysis?

END OF LIFE ALGORITHM

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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

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• Lymphedema Education Benchmark Statements

• Interprofessional roles in best practice

• Research update on effective treatment

• Advanced cancer & edema at end of life

• Referrals & resources

OBJECTIVES

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• www.bccancer.bc.ca

Search “lymphedema”

• Patient handout

• Symptom Management

Guideline #9

ONLINE: PROVIDER

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• www.lympho.org

• Position documents

• Lymphedema in

Advanced Cancer &

Edema at End of Life

ONLINE: PROVIDER

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Canadalymph.ca

BClymph.org

Cancer.ca

CancerConnection.ca

ONLINE: PATIENT

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• Public

• Cancer Center

• Hospital Outpatient Department

• Home Care

• Private Practice

• Physical Therapy

• Massage Therapy

REFERRALS

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St. Paul’s Hospital

Royal Jubilee Hospital

Surrey Memorial Hospital

Abbotsford Regional Hospital

REFERRALS: HOSPITALS IN BC

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• 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

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• 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