Lymphoedema in palliative care
Lymphoedema is a form of peripheral oedema caused by inadequate lymphatic drainage. It usually affects the limbs, but can also affect the trunk, head or genital area. In patients with palliative care needs, lymphoedema is often associated with recurrent or advanced cancer, and results from obstruction or infiltration of lymph nodes or lymphatic ducts, or following surgery or radiotherapy.
Lymphoedema cannot be cured. Patients with lymphoedema can benefit from specialist intensive lymphoedema management; early referral is recommended to a specialist practitioner trained in lymphoedema therapy1 or to a lymphoedema clinic.
General management of lymphoedema is as for peripheral oedema; specific measures may include:
- lymphatic drainage, for example using specialist massage (manual lymphatic drainage) provided deep venous thrombosis (DVT) has been excluded, graded multilayer pressure bandagingGradalski, 2018Tennison, 2018 or drainage of fluid with needlesJacobsen, 2011; these methods should be used with caution in the presence of cellulitis
- maintenance of limb shape using custom-made compression garments
- education, motivation and psychosocial support to help a patient self-manage their lymphoedema and avoid complications.
Lymphoedema has a functional, social and psychological impact on the patient, and may cause distress.
Complications of lymphoedema may be reduced by meticulous skincare and avoiding the following on the affected limb: trauma, sunburn, venipuncture, injections and blood pressure monitoring. If complications occur, manage them promptly (eg antibiotics for cellulitis, bandaging for lymphorrhoea). Consider antibiotic prophylaxis for recurrent infection (eg 2 or more episodes of cellulitis in a year)Wilcock A, 2020. For information on managing an acute episode of cellulitis, and antibiotic prophylaxis, see the Antibiotic guidelines.
In the last days of life, intensive lymphoedema management is not appropriate; management should focus on:
- managing pain
- managing fluid leaks with bandaging or wrapping with large dressings or clean towels
- treating cellulitis with antibiotics, but only if appropriate for symptom management (see the Antibiotic guidelines)
- stopping drugs that may be contributing to the oedema.