The aims of lymphoedema treatment are to prevent progression of the condition, to reduce odema and then maintain the improvement. This includes the alleviation of associated symptoms, prevention of infection and improvement of function and quality of life (2). The NBOCC literature review states “research suggests that without treatment secondary lymphoedema may worsen” (1).
Lymphoedema cannot be cured but it can be improved and managed with appropriate intervention. The stage, location and severity of the lymphoedema together with the individual circumstances of the client will influence the most appropriate intervention. Early intervention is recommended.
Best practice management has a holistic multidisciplinary approach and is provided by qualified lymphoedema therapists. The treatment method is conservative and in Australasia is termed Complex Lymphoedema Therapy (CLT). Older alternative terminologies are Complex Physical Therapy (CPT) or Complex Decongestive therapy (CDT).
CLT consists of the following components
Manual Lymphatic Drainage (MLD)
Treatment is individualized for each client and not all components of treatment may be necessary in all cases. Those with mild lymphoedema may only require education, exercise and skin care whereas for more severe cases treatment may be longer and require two phases. Phase I is an intensive treatment provided by a trained lymphoedema therapist followed by Phase II, which is self management that the client continues at home. With improved health education people are reporting early limb changes promptly and this is contributing to a reduction in the need for intensive treatments
Skin care to optimise the condition of the skin, reverse skin changes and treat infections.
Manual Lymphatic Drainage (MLD) to enhance lymph flow. This precedes bandaging and directs lymph fluid to functioning lymphatic territories and helps to establish collateral drainage pathways.
Application of multi-layer compression bandaging.
Exercises to increase lymphatic and venous flow.
A compression garment is prescribed, following a successful reduction. This is essential to preserve the reduction achieved by treatment and to help prevent progression of the lymphoedema.
Education is incorporated to ensure that the client understands their condition and all parts of the intensive treatment as well as the importance of phase II.
Clients are educated by their therapist in the need for self-management to maintain the results achieved in Phase I. Without the active involvement of the client, the successful outcome of treatment may not be sustained.
The routine adopted may vary from person to person but will usually include daily skin care and prevention of infection, regular self massage, exercises and the wearing of the prescribed compression garment(s). Clients will be encouraged to practice self monitoring and adopt a healthy lifestyle that includes attention to diet, fitness and weight management.
At times this treatment may be offered in a modified form to accommodate particular individual needs.
The use of compression garments is one of the cornerstones of lymphoedema treatment. They enable medically appropriate pressure to be applied to the swollen region. This means that the pooling of fluid can be reduced, the limb size and shape preserved and the lymphatic circulation supported and improved. Compression garments provide graduated compression and are available in a variety of styles, sizes, colours and grades of compression (class 1-IV). Severe swelling usually requires stronger support than mild swelling.
Lymphoedema therapists are skilled at garment prescription and can advise on garment style and whether a pre-sized (Ready to Wear) garment or a custom made garment is required. Garment fabric may be constructed as a circular knit or a flat knit design. Most commonly garments are worn during the day and removed at night. Compression garments need to be replaced regularly in order to provide optimal support. Some people with mild lymphoedema may not require compression garments.
Surgical treatment of lymphoedema is limited. Liposuction, surgical reductions and micro-surgery to restore lymph flow have been trialled but are not common in Australia. Further information about these options can be provided by your Doctor.
A variety of other treatments such as laser therapy, taping, hyperbaric oxygen and certain medications have been used to treat lymphoedema. To date there is insufficient evidence about these therapies and further evaluation is required.
A variety of psychosocial issues may arise following a diagnosis of lymphoedema. These range from adjusting to a chronic illness to dealing with the day to day demands of self- management. This may have an impact on body image and quality of life. Depression and anxiety may result when there is a lack of support.
Effective treatment and management will involve psychosocial support and interventions that optimise quality of life and facilitate self-management (3).
National Breast and Ovarian Cancer Centre. Review of research evidence on secondary lymphoedema: Incidence, prevention, risk factors and treatment, NBOCC, Surry Hills, NSW, 2008. Document can be downloaded fromhttp://www.nbocc.org.au/breasthealth/careafter/lymphoedema.html
Lymphoedema Framework: Best Practice for the Management of Lymphoedema. International Consensus. London: MEP Ltd, 2006. Document can be downloaded from http://www.mepltd.co.uk/oneoffs.html Best practice for the management of lymphoedema consensus doc ILF