Expert Strategies for Managing Lymphedema in Cancer Care

This MOH Talk was co-moderated by Dr Mohamed Omar Elfarok, consultant vascular and endovascular surgeon at the General Organization of Teaching Hospitals and Institutes in Cairo, Egypt, and Bethanie Noll, Clinical Specialist for SIGVARIS GROUP USA. Tracy Green, Clinical Manager for SIGVARIS GROUP UK brought in her perspective as a panelist with many years of experience working as a nurse specialized in lymphedema care in the NHS. Two eminent speakers discussed the important, underestimated and underdiagnosed topic of breast cancer lymphedema. The first speaker, Dr Linda T. Miller, founder and clinical director of the Breast Cancer Physical Therapy Center in Philadelphia, USA, shared her expertise in the management of breast cancer lymphedema.  

Edemas consist of a lymphatic and a venous component. A comprehensive breast cancer lymphedema programme should also include softening fibrous tissue by applying medical compression. Appropriately applied medical compression using various modalities and textiles impacts fibrosis and filtration by changing tissue pressure and minimising excess filtration.  The best short-term and long-term outcomes will be achieved by addressing skin fibrosis and managing filtration. 

Dr Vincent Singh Paramanandam, qualified cancer case specialist and certified lymphedema therapist at the University of Sydney, Australia, highlighted the advantages of combining two methods used to prevent chronic lymphedema: the prospective surveillance method and the prophylactic approach. The aim of prospective surveillance is to detect arm swelling at a subclinical stage and to intervene early, usually with compression sleeves. In the prophylactic approach, compression is provided immediately following breast cancer surgery to avoid arm swelling in women at high risk. 

A systematic literature review and meta-analysis indicated that participation in prospective surveillance with early management reduces the risk of chronic breast cancer related arm lymphedema. A randomised controlled trial demonstrated that the prophylactic use of compression sleeves reduced the incidence of arm swelling, delayed the onset of arm swelling, and did not negatively affect quality of life, physical function and breast or arm symptoms. A combined approach of educating women about lymphedema symptoms and prophylactic use of compression sleeves may prove beneficial for patients in low resource settings. 

Take home messages

• Arm swelling is common following axillary lymph node dissection due to breast cancer treatment. 
• Participation in prospective surveillance with early management reduces the risk of chronic breast cancer related arm lymphedema. 
• The prophylactic use of compression sleeves reduced the incidence of arm swelling, delayed the onset of arm swelling and did not negatively affect quality of life, physical function and breast or arm symptoms in a randomized, controlled clinical trial. 
• A combined approach of educating women about lymphedema symptoms and prophylactic use of compression sleeves may prove beneficial for patients in low resource settings.