Comprehensive approach to lymphedema treatment seems best
Although larger, well-designed studies are needed to test the effectiveness of management of cancer-related lymphedema in palliative care, one team of investigators was able to conclude from the published literature that emphasizing quality of life rather than focusing solely on reducing swelling appears to be key.
“Health-care providers should focus on managing symptoms and choose carefully among various treatments to provide individualized care plans that comfort patients, which may require modifying existing protocols,” advised Jane M. Armer, RN, PhD, director of nursing research at Ellis Fischel Cancer Center–University of Missouri Health Care in Columbia, Missouri, in a statement issued by the University of Missouri-Columbia.
Armer also pointed out that although many insurance providers and health care professionals assess whether lymphedema patients need treatment based only on how swollen the person's limbs are, several studies have shown that the volume of fluid does not necessarily correspond with patient discomfort.
As part of a team that conducted a systematic review of the published literature related to cancer-related lymphedema management in palliative care, Armer helped select 11 articles published from January 2004 through October 2011 based on defined eligibility criteria for final review. The articles also were rated for quality according to the Oncology Nursing Society Putting Evidence into Practice® classification.
As the investigators reported in Journal of Palliative Medicine (2012;15:821-827), the selected articles addressed closed-controlled subcutaneous drainage (five case studies), manual lymphatic drainage (MLD; one retrospective study), compression therapy (two case studies), and complete decongestive therapy (CDT; three case studies). There were no randomized controlled trials, and few studies included objective measures of outcomes. All of the studies were rated in the category of “effectiveness not established” due to limitations in study design and sample size.
Acknowledging these limitations, Armer's group found that CDT may be the best form of specialized lymphedema management. CDT is a comprehensive approach to lymphedema treatment that involves skin care, exercise, MLD, and compression of the swollen limbs.