Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2023

Reducing the impact of lymphoedema: conservative management through to surgical approaches (#39)

Hildegard M Reul-Hirche 1 , Melanie Plinsinga 2 , Louise Koelmeyer 3 , Kira Bloomquist 2 4 , Debbie Geyer 5 6 , Sandi Hayes 2
  1. Royal Brisbane & Women's Hospital, Herston, QUEENSLAND, Australia
  2. Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
  3. Department of Health Sciences, Macquarie University, Sydney, New South Wales, Australia
  4. Center for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet , Copenhagen, Denmark
  5. Lymphoedema Association Australia, Carrum Downs, Victoria, Australia
  6. Cremorne Medical Practice, Sydney, New South Wales, Australia

Lymphoedema associated with cancer occurs due to disruption of normal lymphatic drainage pathways, which leads to stagnation of protein-rich lymph fluid and consequent swelling of the affected body part. If left untreated, the dormant protein initiates an inflammatory process and fibro-fatty changes to affected region emerges. Conservative management used a one size fits all approach. This consisted of an intensive phase of daily skin care, manual lymphatic drainage (MLD) and bandaging/garments over several weeks, followed by an extended maintenance period involving regular visits with a lymphatic therapist. This was supported by specific exercise and education. Today, conservative management has become more targeted and individualised. The advent of near-infrared fluorescent lymphatic imaging improved understanding of lymphatic drainage, with findings now used to guide MLD. Bandaging is now largely replaced by use of compression garments, with several grades of compression and types of garments available for use. Guidelines, which previously restricted physical activities, now support engagement in exercise of all types and intensities, and education, which was previously dogmatic with strict “Do’s and Don’ts” lists, now applies a more pragmatic and individual approach. The only surgical option available for people with cancer-related lymphoedema in the 1970s was radical debulking, consisting of removal of all affected tissue to the deep fascia and closure with skin graft. Today, surgical options include liposuction, lympho-vascular anastomosis, and reverse mapping during axillary node dissection. However, while considered effective for specific subgroups of patients, access to this type of treatment is largely restricted to those of higher socioeconomic status. Despite advancements in lymphoedema treatment over the past 40+ years, treatment remains costly, both in time and finances. Furthermore, access to a trained workforce is limited, particularly for those living outside major, metropolitan areas. This in turn has shifted research focus to prospective surveillance, early identification, and early treatment.