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      Lymphoedema management by independent hospices: a cohort study

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          Abstract

          Objectives

          To consider the type and cost of clinical services delivered for patients with lymphoedema.

          Design

          Clinical cohort.

          Setting

          Independent hospices in the North East of England.

          Participants

          All those attending lymphoedema services delivered by the independent hospice sector 2017/2018.

          Results

          13 914 lymphoedema appointments were recorded across four independent hospices. Twelve thousand nine hundred and sixty-five were attended, which equates to an approximate cost of £1.56 million. Those with lymphoedema were predominately aged over 65 (54.5%) years with females across all age groups being more predominant (3.3:1). Where the cause was recorded, 66% of activity related to lymphoedema was not secondary to cancer.

          Conclusion

          Independent hospices are providing a specialist lymphoedema service, which is high in volume and largely invisible. This service is delivered at not insignificant cost. In contrast to previous work, in the North East of England, lymphoedema sufferers are more likely to be female and not have the condition in association with cancer. The availability of rigorous data collection will allow the independent hospices to understand better the delivery and associated costs of lymphoedema services.

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          Most cited references2

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          Clinical practice guidelines for the care and treatment of breast cancer: 11. Lymphedema.

          To provide information and recommendations for women and their physicians when making decisions about the management of lymphedema related to breast cancer. Compression garments, pneumatic compression pumps, massage and physical therapies, other physical therapy modalities, pharmaceutical treatments. Symptom control, quality of life, cosmetic results. Systematic review of English-language literature retrieved primarily from MEDLINE (1966 to April 2000) and CANCERLIT (1985 to April 2000). Nonsystematic review of breast cancer literature published to October 2000. Pre- and postoperative measurements of both arms are useful in the assessment and diagnosis of lymphedema. Circumferential measurements should be taken at 4 points: the metacarpal-phalangeal joints, the wrists, 10 cm distal to the lateral epicondyles and 15 cm proximal to the lateral epicondyles. Clinicians should elicit symptoms of heaviness, tightness or swelling in the affected arm. A difference of more than 2.0 cm at any of the 4 measurement points may warrant treatment of the lymphedema, provided that tumour involvement of the axilla or brachial plexus, infection and axillary vein thrombosis have been ruled out. Practitioners may want to encourage long-term and consistent use of compression garments by women with lymphedema. One randomized trial has demonstrated a trend in favour of pneumatic compression pumps compared with no treatment. Further randomized trials are required to determine whether pneumatic compression provides additional benefit over compression garments alone. Complex physical therapy, also called complex decongestive physiotherapy, requires further evaluation in randomized trials. In one randomized trial no difference in outcomes was detected between compression garments plus manual lymph drainage versus compression garments alone. Clinical experience supports encouraging patients to consider some practical advice regarding skin care, exercise and body weight. [A patient version of these guidelines appears in Appendix 2.] An initial draft of this document was developed by a task force sponsored by the BC Cancer Agency. It was updated and revised substantially by a writing committee and then submitted for further review, revision and approval by the Steering Committee for Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. The steering committee was convened by Health Canada. COMPLETION DATE: October 2000.
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            Diagnosis and Treatment of Edema and Lymphedema in the Cancer Patient.

            Lymphedema occurs commonly in cancer survivors. It is crucial to properly assess cancer patients in order to distinguish lymphedema from general edema and to initiate evidence based treatment.
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              Author and article information

              Journal
              BMJ Support Palliat Care
              BMJ Support Palliat Care
              bmjspcare
              bmjspcare
              BMJ Supportive & Palliative Care
              BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
              2045-435X
              2045-4368
              December 2019
              3 October 2019
              : 9
              : 4
              : 389-396
              Affiliations
              [1 ] North East Quality Observatory Service , Gosforth, UK
              [2 ] Academic Health Science Network; North East and North Cumbria (AHSN NENC) , Newcastle, UK
              [3 ] Medical Director , Newcastle, UK
              [4 ] St Oswald's Hospice , Newcastle, UK
              Author notes
              [Correspondence to ] Professor Julia Newton, Medical Director, Newcastle, UK; julia.newton@ 123456ncl.ac.uk
              Author information
              http://orcid.org/0000-0002-1249-5253
              Article
              bmjspcare-2019-001896
              10.1136/bmjspcare-2019-001896
              6923951
              31582383
              080699cf-542f-42b1-9d92-e10c7ccac435
              © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

              This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

              History
              : 16 May 2019
              : 10 September 2019
              : 19 September 2019
              Funding
              Funded by: James Knott Trust;
              Award ID: Not applicable
              Categories
              Original Research
              1506
              Custom metadata
              unlocked

              skin care,lymphoedema,hospice care
              skin care, lymphoedema, hospice care

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