Lymphedema - Strategies for management

An important sequela of cancer treatment is lymphedema. Management of this condition must be based on the physiologic functioning of the lymphatic sys tem and tailored to the individual patient's presentation of the disease. E arly diagnosis and treatment are essential to prevent worsening of the cond ition and to help assuage the psychologic impact of the disease. A review o f the normal and impaired lymphatic system is presented in this article. Cu rrent assessment and treatment options are described, including education o f patients in precautions, positioning, exercise, compression garments and bandages, pneumatic pumps, and lymphatic massage. Also included is a discus sion of the psychologic impact of the disease as well as management of psyc hologic symptoms. Various strategies for management of the physical aspects of lymphedema are available. Studies have shown that use of physical treat ments such as exercise, compression, and lymphatic massage are effective in reducing the amount of swelling in affected limbs. The specific type, amou nt, and combination of these treatments continues to be debated. The develo pment of lymphedema is commonly associated with significant psychologic dis tress that can impact on compliance with physical treatments. Because there is no consensus as to the optimal treatment approach for management of lym phedema, additional research must ensue to determine the efficacy of existi ng treatments and to develop new management techniques. Clinicians must be attuned to the signs and symptoms of lymphedema in order to make prompt ref errals for treatment. (C) 2001 American Cancer Society.