Lymphedema Treatment Starts With Education

To best manage lymphedema, patients must first have an under­standing of their disease, no matter what its type, according to Sherry Hite, an occupational therapy lead in the Department of Rehabilitation Services at City of Hope in Duarte, California.

At the 11th annual Joining FORCEs Against Hereditary Cancer confer­ence in San Diego, California, Hite discussed the treatment of lymphedema. Education plays a key role, she said: “Education needs to start early on and across disease groups that are [affected] by lymphedema.”

There are 2 types of lymphedema: primary, which is less common and arises from developmental abnormalities of the lymphatic system, and sec­ondary, the type seen in patients with cancer as it arises from trauma to the lymphatic system. Secondary lymphedema can be a result of surgery, radia­tion, cancer itself, obesity, or infection.

Although lymphedema is predominantly seen in patients with breast can­cer—including 20% of those who undergo axillary node dissection and 15% of individuals who have a sentinel lymph node biopsy followed by radiation— it can also occur in patients with gynecological cancers (20%), melanoma (16%), genitourinary cancers (13%), and head and neck cancer (75%).

The gold standard of treatment for lymphedema includes complete decongestive therapy, which combines:

• lymph node drainage (very light pressure and long, gentle, rhythmic strokes that promote proper drainage of fluid from the lymph node.
• bandages (multilayers worn 23 hours a day, 7 days a week during active treatment)
• garments (used in the second phase, when the limb is decon­gested and volume changes are minimal)

To reduce the risk of lymphedema, Hite recommended that patients avoid cuts, scratches, and insect bites; limb constric­tion; and extreme temperatures. She also advised keeping skin and cuticles well moisturized.