Management of lymphedema and edema in advanced cancer

Abstract

Lymphedema is a manifestation of lymphatic system insufficiency and deranged lymph transport. The frequency of secondary lymphedema following axillary or pelvic lymph node dissection in breast, gynecological, and other cancers is above 80% among all patients with lymphedema. If patients with lymphedema are not properly managed, lymphedema will become progressively worse, decreasing quality of life. Prevention, early diagnosis, and early treatment are crucial in the management of lymphedema. According to the consensus document of the International Society of Lymphology, combined physical therapy is backed by longstanding experience and generally involves a two-stage treatment program comprising intensive and supportive phases. The first intensive phase consists of skin care, manual lymph drainage, exercise, and compression applied with multi-layered bandage wrapping. The second supportive phase aims to conserve and optimize the results obtained in the first phase. On the other hand, the patient, their family, and medical professionals may give up on edema of the upper and lower extremities and lower part of the trunk with advanced cancer. However, complications can be minimized and comfort and support provided using the proper management of edema. Lymphedema control programs in Japan still lack comprehensive support. In 2006, the Cancer Control Act was enacted by the Japanese government. This act had a major impact on the promotion of lymphedema management. The National Health System started to cover elastic stockings and sleeves in 2008. The first clinical practice guidelines for lymphedema were published in 2008. The Lymphedema Educational Program was launched in 2009 as a project commissioned by the Ministry of Health, Labor and Welfare. A lymphedema certification course is also being established. Measures to address lymphedema have rapidly progressed over the last 10 years in Japan. We hope to continue this progress in the coming decade.