lymphedema - university of british columbia · lymphedema in palliative care sarah buddingh smith,...
TRANSCRIPT
![Page 1: LYMPHEDEMA - University of British Columbia · lymphedema in palliative care sarah buddingh smith, bsc, mpt bc cancer physiotherapist sarah.buddinghsmith@bccancer.bc.ca](https://reader034.vdocuments.site/reader034/viewer/2022042601/5f63711dc872cc085300282d/html5/thumbnails/1.jpg)
LYMPHEDEMAIN PALLIATIVE CARE
SARAH BUDDINGH SMITH, BSC, MPT
BC CANCER PHYSIOTHERAPIST
![Page 2: LYMPHEDEMA - University of British Columbia · lymphedema in palliative care sarah buddingh smith, bsc, mpt bc cancer physiotherapist sarah.buddinghsmith@bccancer.bc.ca](https://reader034.vdocuments.site/reader034/viewer/2022042601/5f63711dc872cc085300282d/html5/thumbnails/2.jpg)
2
• Lymphedema Education Benchmark Statements
• Interprofessional roles in best practice
• Research update on effective treatment
• Advanced cancer & edema at end of life
• Referrals & resources
OBJECTIVES
![Page 3: LYMPHEDEMA - University of British Columbia · lymphedema in palliative care sarah buddingh smith, bsc, mpt bc cancer physiotherapist sarah.buddinghsmith@bccancer.bc.ca](https://reader034.vdocuments.site/reader034/viewer/2022042601/5f63711dc872cc085300282d/html5/thumbnails/3.jpg)
3
• Lymphedema Education Benchmark Statements
• Interprofessional roles in best practice
• Research update on effective treatment
• Advanced cancer & edema at end of life
• Referrals & resources
OBJECTIVES
![Page 4: LYMPHEDEMA - University of British Columbia · lymphedema in palliative care sarah buddingh smith, bsc, mpt bc cancer physiotherapist sarah.buddinghsmith@bccancer.bc.ca](https://reader034.vdocuments.site/reader034/viewer/2022042601/5f63711dc872cc085300282d/html5/thumbnails/4.jpg)
4
BENCHMARK 1: LYMPH SYSTEM ANATOMY & PHYSIOLOGY
![Page 5: LYMPHEDEMA - University of British Columbia · lymphedema in palliative care sarah buddingh smith, bsc, mpt bc cancer physiotherapist sarah.buddinghsmith@bccancer.bc.ca](https://reader034.vdocuments.site/reader034/viewer/2022042601/5f63711dc872cc085300282d/html5/thumbnails/5.jpg)
5
BENCHMARK 2: PATHOPHYSIOLOGY OF LYMPHEDEMA
Planas-Paz and Lemmert 2013
RISK FACTORS FOR LYMPHEDEMA:
• Cancer• Surgical resection• Radiation• Tumor compression
• Venous insufficiency
• Obesity
• Immobility
• High exposure to mosquito bites
![Page 6: LYMPHEDEMA - University of British Columbia · lymphedema in palliative care sarah buddingh smith, bsc, mpt bc cancer physiotherapist sarah.buddinghsmith@bccancer.bc.ca](https://reader034.vdocuments.site/reader034/viewer/2022042601/5f63711dc872cc085300282d/html5/thumbnails/6.jpg)
6
BENCHMARK 3: OTHER CAUSES OF EDEMA
•Cellulitis
•Deep vein thrombosis
•Other vascular disorders
•Systemic disorders, e.g. cardiac, liver or renal
![Page 7: LYMPHEDEMA - University of British Columbia · lymphedema in palliative care sarah buddingh smith, bsc, mpt bc cancer physiotherapist sarah.buddinghsmith@bccancer.bc.ca](https://reader034.vdocuments.site/reader034/viewer/2022042601/5f63711dc872cc085300282d/html5/thumbnails/7.jpg)
7
BENCHMARK 3: EDEMA IN END OF LIFE
•Advanced Cancer
• Metastases
• Drugs
• Hypoalbuminaemia
• Ascites
•System Failure
• Chronic heart failure
• End stage renal disease
• End stage chronic respiratory disease
• Advanced liver disease
• Advanced neurological disease
![Page 8: LYMPHEDEMA - University of British Columbia · lymphedema in palliative care sarah buddingh smith, bsc, mpt bc cancer physiotherapist sarah.buddinghsmith@bccancer.bc.ca](https://reader034.vdocuments.site/reader034/viewer/2022042601/5f63711dc872cc085300282d/html5/thumbnails/8.jpg)
8
BENCHMARK 4: FEATURES OF LYMPHEDEMA
Principles and Practice of Lymphedema Surgery. July 2015.
![Page 9: LYMPHEDEMA - University of British Columbia · lymphedema in palliative care sarah buddingh smith, bsc, mpt bc cancer physiotherapist sarah.buddinghsmith@bccancer.bc.ca](https://reader034.vdocuments.site/reader034/viewer/2022042601/5f63711dc872cc085300282d/html5/thumbnails/9.jpg)
9
• Lymphedema Education Benchmark Statements
• Interprofessional roles in best practice
• Research update on effective treatment
• Advanced cancer & edema at end of life
• Referrals & resources
OBJECTIVES
![Page 10: LYMPHEDEMA - University of British Columbia · lymphedema in palliative care sarah buddingh smith, bsc, mpt bc cancer physiotherapist sarah.buddinghsmith@bccancer.bc.ca](https://reader034.vdocuments.site/reader034/viewer/2022042601/5f63711dc872cc085300282d/html5/thumbnails/10.jpg)
10
BENCHMARK 5: PATIENT EDUCATION
• Use BC Cancer handout
• With damaged lymph
nodes, always at risk
• No cure, only self-
management
• Early detection is key
• Treatment available
![Page 11: LYMPHEDEMA - University of British Columbia · lymphedema in palliative care sarah buddingh smith, bsc, mpt bc cancer physiotherapist sarah.buddinghsmith@bccancer.bc.ca](https://reader034.vdocuments.site/reader034/viewer/2022042601/5f63711dc872cc085300282d/html5/thumbnails/11.jpg)
11
BENCHMARK 6: LYMPHEDEMA MANAGEMENT
•Complex Decongestive
Therapy (CDT)
•Two phases:
• Intensive
•Maintenance
![Page 12: LYMPHEDEMA - University of British Columbia · lymphedema in palliative care sarah buddingh smith, bsc, mpt bc cancer physiotherapist sarah.buddinghsmith@bccancer.bc.ca](https://reader034.vdocuments.site/reader034/viewer/2022042601/5f63711dc872cc085300282d/html5/thumbnails/12.jpg)
12
MANUAL LYMPHATIC DRAINAGE
Lymphedema: Diagnosis and Therapy, 4th edition.
![Page 13: LYMPHEDEMA - University of British Columbia · lymphedema in palliative care sarah buddingh smith, bsc, mpt bc cancer physiotherapist sarah.buddinghsmith@bccancer.bc.ca](https://reader034.vdocuments.site/reader034/viewer/2022042601/5f63711dc872cc085300282d/html5/thumbnails/13.jpg)
13
COMPRESSION
![Page 14: LYMPHEDEMA - University of British Columbia · lymphedema in palliative care sarah buddingh smith, bsc, mpt bc cancer physiotherapist sarah.buddinghsmith@bccancer.bc.ca](https://reader034.vdocuments.site/reader034/viewer/2022042601/5f63711dc872cc085300282d/html5/thumbnails/14.jpg)
14
SKIN CARE
![Page 15: LYMPHEDEMA - University of British Columbia · lymphedema in palliative care sarah buddingh smith, bsc, mpt bc cancer physiotherapist sarah.buddinghsmith@bccancer.bc.ca](https://reader034.vdocuments.site/reader034/viewer/2022042601/5f63711dc872cc085300282d/html5/thumbnails/15.jpg)
15
EXERCISE
![Page 16: LYMPHEDEMA - University of British Columbia · lymphedema in palliative care sarah buddingh smith, bsc, mpt bc cancer physiotherapist sarah.buddinghsmith@bccancer.bc.ca](https://reader034.vdocuments.site/reader034/viewer/2022042601/5f63711dc872cc085300282d/html5/thumbnails/16.jpg)
16
SURGERY
MD Anderson
• Surgical Reduction
• Bypass lymphatic obstruction
• Liposuction
• VGH developing a surgical
program
![Page 17: LYMPHEDEMA - University of British Columbia · lymphedema in palliative care sarah buddingh smith, bsc, mpt bc cancer physiotherapist sarah.buddinghsmith@bccancer.bc.ca](https://reader034.vdocuments.site/reader034/viewer/2022042601/5f63711dc872cc085300282d/html5/thumbnails/17.jpg)
17
• Lymphedema Education Benchmark Statements
• Interprofessional roles in best practice
• Research update on effective treatment
• Advanced cancer & edema at end of life
• Referrals & resources
OBJECTIVES
![Page 18: LYMPHEDEMA - University of British Columbia · lymphedema in palliative care sarah buddingh smith, bsc, mpt bc cancer physiotherapist sarah.buddinghsmith@bccancer.bc.ca](https://reader034.vdocuments.site/reader034/viewer/2022042601/5f63711dc872cc085300282d/html5/thumbnails/18.jpg)
18
• Multifactorial edema
• Patient directs priorities
• Focus on quality of life
• Refer to Allied Health
ADVANCED CANCER & END OF LIFE
![Page 19: LYMPHEDEMA - University of British Columbia · lymphedema in palliative care sarah buddingh smith, bsc, mpt bc cancer physiotherapist sarah.buddinghsmith@bccancer.bc.ca](https://reader034.vdocuments.site/reader034/viewer/2022042601/5f63711dc872cc085300282d/html5/thumbnails/19.jpg)
19
• What region of the body?
• Head & Neck
• Genital
• Widespread
• Venous compression from a
tumor?
• Cellulitis?
• Fungating wound?
• Paralysis?
END OF LIFE ALGORITHM
![Page 20: LYMPHEDEMA - University of British Columbia · lymphedema in palliative care sarah buddingh smith, bsc, mpt bc cancer physiotherapist sarah.buddinghsmith@bccancer.bc.ca](https://reader034.vdocuments.site/reader034/viewer/2022042601/5f63711dc872cc085300282d/html5/thumbnails/20.jpg)
20
SUBCUTANEOUS LYMPHATIC DRAINAGE
Jacobsen & Blinderman (2011)
• Severe refractory lymphedema due to obstructive cancer
• Genitalia, lower abdomen, legs
• Pitting edema, no fibrosis
• #17 Gauge dialysis catheter(s)
• Urinary leg drainage bag
• Monitor for fever and
hypotension
• VGH PCU and BC Cancer
can perform
![Page 21: LYMPHEDEMA - University of British Columbia · lymphedema in palliative care sarah buddingh smith, bsc, mpt bc cancer physiotherapist sarah.buddinghsmith@bccancer.bc.ca](https://reader034.vdocuments.site/reader034/viewer/2022042601/5f63711dc872cc085300282d/html5/thumbnails/21.jpg)
21
• Lymphedema Education Benchmark Statements
• Interprofessional roles in best practice
• Research update on effective treatment
• Advanced cancer & edema at end of life
• Referrals & resources
OBJECTIVES
![Page 22: LYMPHEDEMA - University of British Columbia · lymphedema in palliative care sarah buddingh smith, bsc, mpt bc cancer physiotherapist sarah.buddinghsmith@bccancer.bc.ca](https://reader034.vdocuments.site/reader034/viewer/2022042601/5f63711dc872cc085300282d/html5/thumbnails/22.jpg)
22
• www.bccancer.bc.ca
Search “lymphedema”
• Patient handout
• Symptom Management
Guideline #9
ONLINE: PROVIDER
![Page 23: LYMPHEDEMA - University of British Columbia · lymphedema in palliative care sarah buddingh smith, bsc, mpt bc cancer physiotherapist sarah.buddinghsmith@bccancer.bc.ca](https://reader034.vdocuments.site/reader034/viewer/2022042601/5f63711dc872cc085300282d/html5/thumbnails/23.jpg)
23
• www.lympho.org
• Position documents
• Lymphedema in
Advanced Cancer &
Edema at End of Life
ONLINE: PROVIDER
![Page 24: LYMPHEDEMA - University of British Columbia · lymphedema in palliative care sarah buddingh smith, bsc, mpt bc cancer physiotherapist sarah.buddinghsmith@bccancer.bc.ca](https://reader034.vdocuments.site/reader034/viewer/2022042601/5f63711dc872cc085300282d/html5/thumbnails/24.jpg)
24
Canadalymph.ca
BClymph.org
Cancer.ca
CancerConnection.ca
ONLINE: PATIENT
![Page 25: LYMPHEDEMA - University of British Columbia · lymphedema in palliative care sarah buddingh smith, bsc, mpt bc cancer physiotherapist sarah.buddinghsmith@bccancer.bc.ca](https://reader034.vdocuments.site/reader034/viewer/2022042601/5f63711dc872cc085300282d/html5/thumbnails/25.jpg)
25
• Public
• Cancer Center
• Hospital Outpatient Department
• Home Care
• Private Practice
• Physical Therapy
• Massage Therapy
REFERRALS
![Page 26: LYMPHEDEMA - University of British Columbia · lymphedema in palliative care sarah buddingh smith, bsc, mpt bc cancer physiotherapist sarah.buddinghsmith@bccancer.bc.ca](https://reader034.vdocuments.site/reader034/viewer/2022042601/5f63711dc872cc085300282d/html5/thumbnails/26.jpg)
26
St. Paul’s Hospital
Royal Jubilee Hospital
Surrey Memorial Hospital
Abbotsford Regional Hospital
REFERRALS: HOSPITALS IN BC
![Page 27: LYMPHEDEMA - University of British Columbia · lymphedema in palliative care sarah buddingh smith, bsc, mpt bc cancer physiotherapist sarah.buddinghsmith@bccancer.bc.ca](https://reader034.vdocuments.site/reader034/viewer/2022042601/5f63711dc872cc085300282d/html5/thumbnails/27.jpg)
27
• Lymphedema significantly affects function
and quality of life
• Consider the lymph system when assessing edema
• Management algorithms are available online
• Educate patients on
• Monitoring for signs & symptoms
• Self management
• Refer to your Allied Health colleagues
CONCLUSION
![Page 28: LYMPHEDEMA - University of British Columbia · lymphedema in palliative care sarah buddingh smith, bsc, mpt bc cancer physiotherapist sarah.buddinghsmith@bccancer.bc.ca](https://reader034.vdocuments.site/reader034/viewer/2022042601/5f63711dc872cc085300282d/html5/thumbnails/28.jpg)
28
• Lymphoedema Education Benchmark Statements https://www.lympho.org/lebs/
• Lymphedema: Diagnosis and Therapy, 4th edition. Weissleder and Schuchhardt.
• Best Practices for the Management of Lymphedema https://www.lympho.org/wp-
content/uploads/2016/03/Best_practice.pdf
• The Management of Lymphoedema in Advanced Cancer and Oedema at the End of Life
https://www.lympho.org/wp-content/uploads/2016/03/Palliative-Document.pdf
• Introduction to the Lymphatic System, National Cancer Institute
https://training.seer.cancer.gov/anatomy/lymphatic/
• Moore JE Jr, Bertram CD. Lymphatic System Flows. Annu Rev Fluid Mech. 2018;50:459–482.
doi:10.1146/annurev-fluid-122316-045259 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5922450/
• https://www.lymphcareusa.com/professional/lymph-a-what/what-is-lymphedema/what-causes-
lymphedema.html
• Moore JE Jr, Bertram CD. Lymphatic System Flows. Annu Rev Fluid Mech. 2018;50:459–482.
doi:10.1146/annurev-fluid-122316-045259
• Planas-Paz and Lammert 2013. Mechanosensing in Developing Lymphatic Vessels. Available from:
https://www.researchgate.net/figure/Mechanotransduction-in-secondary-lymphedema-formation-a-
hypothetical-model-a_fig2_258923453 [accessed 25 Sep, 2019]
• Principles and Practice of Lymphedema Surgery. Cheng MH, Chang DW, Patel KM (Editors). Elsevier Inc, Oxford,
United Kingdom. ISBN 978-0-323-29897-1. July 2015.
• Self-Measured Arm Circumference in Women With Breast Cancer Is Reliable and Valid
https://www.ncbi.nlm.nih.gov/pubmed/30289500
• Jacobsen & Blinderman (2011). Subcutaneous Lymphatic Drainage (Lymphcentesis) for Palliation of Severe
Refractory Lymphedema in Cancer Patients. https://doi.org/10.1016/j.jpainsymman.2010.09.015
• Sellick. Subcutaneous Draining of Lower Extremity Edema in a Patient With Advanced Cancer Relieves Scrotal
Swelling and Improves Mobility DOI: 10.1200/JOP.2017.025429 Journal of Oncology Practice 14, no. 1 (January
01, 2018) 49-51.
REFERENCES