Literature Review:
Lymphoedema is a chronic condition associated with cancer treatment. It’s characterised by the accumulation of protein rich fluids and high inflammatory mediators in the tissues.
Breast cancer related lymphoedema occurs in 21% of breast cancer patients. The arm and/or breast and torso are affected. Gynaecological cancer related leg lymphoedema occurs in between 25-47% of patients while between 9-29% of melanoma survivors develop it.
Early detection of sub-clinical changes can reduce the risk of its clinical development and progression. This is most accurate if pre- and post-surgical measurements are taken as well as, education about risk factors that can improve self-efficacy and coping ability. Unfortunately, there are inconsistent early detection protocols which lead to needless fear or unnecessary risk.
There are recommendations to prevent lymphoedema onset and to slow or stop its progression. These include those relating to injections, blood draws or blood pressure measurements on the affected/at risk limb. Although this is reasonable advice there is limited supporting evidence. A study of over 3,000 patients found no association between insult to the affected/at risk arm in patients who had blood drawn, injection in the affected/at-risk arm, long flights, or blood pressure measures. There was a strong association with infection and increased body weight. However, if there is a possible risk then it’s imperative to avoid it or minimise it. Getting the balance right between risk and fear of developing lymphoedema is hard but education of the patient can go a long way. But, in addition, if we want to improve quality of life in cancer survivors; we need to develop a better action plan encompassing lymphoedema awareness, diagnosis, education, support and management.