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Living well with Cancer

Living well with Cancer. Living well with Lymphoedema Norah Kyne, MISCP, CDT Therapist. University Hospital Galway. GUH Cancer Centre Annual Report 2012. Breast Medical Oncology

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Living well with Cancer

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  1. Living well with Cancer Living well with Lymphoedema Norah Kyne, MISCP, CDT Therapist

  2. University Hospital Galway

  3. GUH Cancer Centre Annual Report 2012 • Breast Medical Oncology • Urological Radiation Oncology • Upper GI Cancer Nursing • Colorectal Palliative Medicine • Skin Cancer Research • Lung and cardiothoracic Education and Training • Head and Neck Cancer Charity Support • Endocrine Stem Cell Unit • Haematological Clinical Trials • Radiology • Pathology

  4. Cancer and/or Neoplastic Diagnosis recorded 2012 • Gastrointestinal 363 • Breast 860 • Genitourinary 964 • Dermatology 1859 • Gynaecologic 96 • Lung and mediastinum 155 • Head and Neck 126 • Haematolymphoid 330 • Bone and soft tissue 67 • Other 84

  5. Physiotherapy management • Surgery - pre-operative as available, deep breathing exercises, anti – dvtexs, 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

  6. Scar impact

  7. Scar management • Location : • potential barrier for lymphatic drainage • does it limit joint mobility • Treatment (2-3 weeks post surgery as per Doctor’s protocol) Mobilization Prevent adherence and hypertrophy Scar products egmepiform(silicon) Foam (swell spot) Kinesotape (post 4 weeks/no radiation)

  8. Cording/Axillary Web

  9. Causes • Interruption to lymphatic vessels during biopsy or lymph node dissection - fibrosiss • Incidence : around 19% • Treatment : • Stretching and flexibility exercises • Manual therapy

  10. Definition of lymphoedema • Lymphoedema is the accumulation of protein rich fluid in tissues with inadequate lymphatic drainage. National Lymphoedema Network (May 2012)

  11. 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

  12. Most common presentations with secondary lymphoedemaUpper Limb 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

  13. Swelling in the arm is common, but the breast, chest and back areas can also develop lymphoedema

  14. Lower limb lymphoedemacancers in the pelvic region Incidence in Ireland 2008 – 2010 Cervix : 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 tumorsincidence of lymphoedema 21% Bladder : female – 124, male – 310 incidence of lymphoedema 16%

  15. Gynecological Cancer Secondary Lymphedema

  16. Upper limb or lower limbMelanoma Incidence of Melanoma in Ireland 2008 – 2010 Females : 463 Males : 349 • Sentinal node clearance : 1.7% • Axillary node clearance : 1 – 12%

  17. melanoma

  18. Head and Neck • Incidence of mouth and pharynx cancer in Ireland 2008-2010 • Females 119, Males 227

  19. Treating Lymphoedema CDT: Complete Decongestive Therapy

  20. Treatment of lymphoedema • 4 cornerstones of care: 1. Skin care 2. MLD/SLD 3. Compression via multilayer bandage or garments 4. Exercise

  21. CDT

  22. Benefits of CDT • Reduction 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

  23. Skin and nail care • Decrease risk of infection • Keep skin supple and clean • Avoid injury (nicks, bites, burns etc) • Clean all injuries immediately • Lotions – non perfumed

  24. Skin care : infection • Signs/symptoms • Red, warm/hot, pain, not feeling well, temperature, increased swelling • Go to GP or emergency department

  25. Manual Lymphatic Drainage MLD 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

  26. Manual Lymphatic Drainage

  27. Simple/self lymphatic drainage

  28. Self Lymphatic drainage:Deep breathing plus SLD

  29. Multi layer compression bandage • Reduce swelling and prevent re-accumulation of fluid • Provides a firm support for muscles, whose contractions against the lymph vessels enhance lymph flow

  30. Compression garments

  31. Exercise

  32. Exercise • Pumping action moves lymph through the lymphatic system • Deep breathing stimulates lymph flow • Maintains strong muscles which give protection • Wear well fitting garments • Improve sense of health and well-being • Walk, bicycle, swim, yoga, dance, housework ! • OVERALL IMPROVE YOUR QUALITY OF LIFE

  33. 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!

  34. Self management At discharge from treatment you should know Day time compression products Night time compression Skin care Exercise programme Self manual lymphatic drainage

  35. Self management Compression 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

  36. Compression garments

  37. Compression at night • Depends on stage of management of condition • In discussion with your therapist • Made to measure garments available

  38. Improved range of garments

  39. Exercise (NLN) • Start gradually/conservatively • Add exertion slowly and in small increments only if there has been no increase in lymphoedema after exercise to date • Stay well hydrated • Take periodic deep abdominal breaths – facilitate lymph drainage • Avoid temperature extremes • Modify moves to accommodate your own needs • Warm up, cool down, stretch

  40. 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.

  41. Self management

  42. 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

  43. 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

  44. Early symptoms • Swelling – you may notice clothes feeling tighter on affected side • A feeling of heaviness in the limb • Pain

  45. Be informed/education • The 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

  46. Information • National Lymphoedema Network • (www.lymphnet.org) • Lymphatic Research foundation • (www.lymphaticresearch.org)

  47. Current ServicesDCU/ICS research 2010, Living with Lymphoedema in Ireland :Patient and Service Provider Perspectives • Key Findings

  48. Service settings • Public • Private • Cancer Support centre • Hospice • Community

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