living well with cancer
Post on 03-Jan-2016
29 Views
Preview:
DESCRIPTION
TRANSCRIPT
Living well with CancerLiving well with
Lymphoedema
Norah Kyne, MISCP, CDT Therapist
University Hospital Galway
GUH Cancer Centre Annual Report 2012Breast Medical OncologyUrological Radiation OncologyUpper GI Cancer NursingColorectal Palliative MedicineSkin Cancer ResearchLung and cardiothoracic Education and
TrainingHead and Neck Cancer Charity
SupportEndocrine Stem Cell UnitHaematological Clinical TrialsRadiologyPathology
Cancer and/or Neoplastic Diagnosis recorded 2012
Gastrointestinal 363
Breast 860
Genitourinary 964
Dermatology 1859
Gynaecologic 96
Lung and mediastinum 155
Head and Neck
126Haematolymphoid
330Bone and soft tissue
67
Other 84
Physiotherapy managementSurgery - pre-operative as available, deep breathing exercises,
anti – dvt exs, posture, range of motion, scar management
Chemotherapy – management of fatigue, graduated
exercise programme
Radiation – range of motion, decreased skin mobility
Rehabilitation - depending on diagnosis
Lymphoedema management - based on
presentation of lymphoedema
Scar impact
Scar management
Location : potential barrier for lymphatic drainagedoes it limit joint mobility
Treatment(2-3 weeks post surgery as per Doctor’s protocol)MobilizationPrevent adherence and hypertrophyScar products eg mepiform(silicon)Foam (swell spot)
Kinesotape (post 4 weeks/no radiation)
Cording/Axillary Web
CausesInterruption to lymphatic vessels during
biopsy or lymph node dissection - fibrosiss
Incidence : around 19%
Treatment :Stretching and flexibility exercisesManual therapy
Definition of lymphoedema
Lymphoedema is the accumulation of protein rich fluid in tissues with inadequate lymphatic drainage.
National Lymphoedema Network (May 2012)
What can cause lymphoedema after cancer ?
Insult to the lymphatic system following
surgery and/or radiotherapy
Extent of surgery
Wound infection after surgery
BMI > 26
L
Incidence of breast cancer in Ireland from 2008 -2010
Females : 2,767 Males : 22
Arm lymphoedema 24-67% Breast lymphoedema 20-40% Trunk lymphoedema
Most common presentations with secondary lymphoedema
Upper Limb
Swelling in the arm is common, but the breast, chest and back areas can also develop lymphoedema
Lower limb lymphoedemacancers in the pelvic regionIncidence in Ireland 2008 – 2010Cervix : 308 incidence of lymphoedema 18%
Uterus : 389 incidence of lymphoedema 17%
Ovary : 345 incidence of lymphoedema 7%
Other gynaecological cancers : 99 (incidence of lymphoedema 47%)
Prostate : 3,014 incidence of lymphoedema 4%
Testes : 175 incidence of lymphoedema ?10%
Penile : 2% of all male tumors incidence of lymphoedema 21%
Bladder : female – 124, male – 310 incidence of lymphoedema 16%
Gynecological Cancer Secondary Lymphedema
Upper limb or lower limbMelanomaIncidence of Melanoma in Ireland 2008 –
2010
Females : 463 Males : 349
Sentinal node clearance : 1.7%
Axillary node clearance : 1 – 12%
melanoma
Head and NeckIncidence of mouth and pharynx cancer in
Ireland 2008-2010Females 119, Males 227
Treating LymphoedemaCDT:
Complete Decongestive Therapy
Treatment of lymphoedema4 cornerstones of care:
1. Skin care2. MLD/SLD3. Compression via multilayer bandage or garments4. Exercise
CDT
Benefits of CDTReduction of pain/discomfort
Reduced risk of infection/cellulitis
Maintain/improved skin texture
Improve motion and ability to perform daily
activities
Decrease fear and increase control over the
condition of lymphoedema – empower
Improve quality of life
Skin and nail careDecrease risk of infection
Keep skin supple and clean
Avoid injury (nicks, bites, burns etc)
Clean all injuries immediately
Lotions – non perfumed
Skin care : infectionSigns/symptomsRed, warm/hot, pain, not feeling well,
temperature, increased swellingGo to GP or emergency department
Manual Lymphatic DrainageMLD aims to redirect fluid from swollen areas to healthy lymphatic vessels, transporting it back to the normal circulatory system .
With gentle, light but precise hand movements applied to the skin.
This encourages the fluid away from congested areas by bypassing ineffective or injured lymph vessels. The treatment is very gentle and a typical session will involve drainage of the neck, trunk, and the affected extremity (in that order), lasting approximately 40 to 60 minutes.
The technique was pioneered by Doctor Emil Vodder in the 1930s for the treatment of chronic sinusitis and other immune disorders
Manual Lymphatic Drainage
Simple/self lymphatic drainage
Self Lymphatic drainage:
Deep breathing plus SLD
Multi layer compression bandageReduce swelling and prevent re-accumulation
of fluidProvides a firm support for muscles, whose
contractions against the lymph vessels enhance lymph flow
Compression garments
Exercise
ExercisePumping action moves lymph through the
lymphatic systemDeep breathing stimulates lymph flowMaintains strong muscles which give
protectionWear well fitting garmentsImprove sense of health and well-beingWalk, bicycle, swim, yoga, dance, housework !
OVERALL IMPROVE YOUR QUALITY OF LIFE
CDT
CDT should be carried out by a certified
lymphoedema therapist
Number and frequency of treatment depends on
severity of lymphoedema
Access to service will influence management
Compression garments as appropriate are fitted
On discharge self – management is key!
Self management
At discharge from treatment you should
know
Day time compression products
Night time compression
Skin care
Exercise programme
Self manual lymphatic drainage
Self managementCompression garments daytime :Freedom of movement
Provide pressure to control lymphoedema
Strong but not too strong that it is difficult to
get on or off
Well fitted
No constrictions
Compression garments
Compression at night
Depends on stage of management of conditionIn discussion with your therapist Made to measure garments available
Improved range of garments
Exercise (NLN)
Start gradually/conservativelyAdd exertion slowly and in small increments
only if there has been no increase in lymphoedema after exercise to date
Stay well hydratedTake periodic deep abdominal breaths –
facilitate lymph drainageAvoid temperature extremesModify moves to accommodate your own
needsWarm up, cool down, stretch
Self management
Lymphoedema cannot be cured but it can be managed
Self management is critical to reduce exacerbations of lymphoedema, infections and other symptoms associated with lymphoedema.
Self management
Can you prevent lymphoedema ?No-one can prevent lymphoedema once lymph
nodes have been removed or if radiation over lymph nodes
It can occur at any stage after surgery /irradiation
The goal is to
Reduce your risk
Risk reduction(National Lymphoedema Network NLN )
Protect skin – insect repellent, sunscreen, nail care
Avoid injections - in at risk limb
Exercise – gradually build up duration and intensity;
monitor reaction of limb
Avoid prolonged extreme heat or cold – (>15 mins) eg
hot tub/sauna
Weight control – manage your weight and well being
Know your body – pay attention to areas at risk
If you notice early symptoms seek medical attention
Early symptoms
Swelling – you may notice clothes
feeling tighter on affected side
A feeling of heaviness in the limb
Pain
Be informed/educationThe Irish Cancer Society – www.cancer.ie
Irish Health – www.irishhealth.com
Lymphoedema Ireland – www.lymphireland.com
Manual Lymphatic Drainage Ireland – www.mld.com
Gary Kelly Cancer Support centre – www.gkcancersupport.com
LARCC(Lakelands area Retreat & Cancer Centre – http://larcc.ie/
Arc Cancer Support – www.arccancersupport.ie
InformationNational Lymphoedema Network
(www.lymphnet.org)
Lymphatic Research foundation
(www.lymphaticresearch.org)
Current ServicesDCU/ICS research 2010, Living with Lymphoedema in Ireland :Patient and Service Provider Perspectives
Key Findings
Service settings
Public
Private
Cancer Support centre
Hospice
Community
Lymphoedema PractitionersMost work in large public hospitals 62.8%
Profile of practitioners : physiotherapists 48.6%, breast
care nurse 13.1%, PT manager 10.3%, MLD therapist 10.3%, OT
6.5%, Lymph nurse specialist 1.9%, other 15%
28 practitioners in a dedicated service
No report of Social worker, Psychologist or
Psychiatrist in any service
Referral SystemsHospital oncology clinicHospital surgical clinicsHospital Physiotherapy clinicsHospital dermatology clinicsCommunity Physiotherapy clinicsGeneral PractitionersPatients self referringFamily/Friends of patientsOther (eg palliative care teams, Cancer Care
Centres etc
Areas providing lymphoedema servicesArea % general service
N= 108% dedicated serviceN = 18
Dublin 33.3 50
Cork 14.8 11.1
Donegal 9.3
Galway 6.5
Laois 3.7 5.6
Cavan 3.7
Tipperary 3.7
Wexford 2.8 11.1
Westmeath 2.8
Meath 2.8
Louth 2.8
Lymphoedema Services contArea % general service
n= 108% dedicated serviceN= 18
Limerick 1.9 5.6
Mayo 1.9
Monaghan 1.9
Wicklow 1.9
Waterford 0.9 5.6
Sligo 0.9
Clare 0.9
Kerry 0.9
Kildare 0.9
Current ServicesDCU/ICS research 2010
Some Key Findings
Lymphoedema services are insufficient and patchyKey challenges exist with regard to sustainability
of servicesDelays with garments may compromise service
provisionPatients identified eg barriers to treatment,
impact of lymphoedema on daily life, fear of uninformed health professional inadvertently worsening their condition
Future Services – Good news !More information/education to public about
lymphoedema
Physiotherapy training : Education about and management of lymphoedema is included at undergraduate level
HSE National Director of Quality and Patient Safety Philip Crowley – supported carrying out a survey of
current lymphoedema Services , awaiting feedback .
NCCP are establishing a group to look at lymphoedema prevention – Physiotherapist sitting on this group
Thank you for your attentionAny Questions ?
top related