Lymphoedema management: an international intersect between developed and developing countries. Similarities, differences and challenges.

Abstract

Lymphoedema is a chronic swelling condition that contributes to disability, dysfunction and lost quality of life. Significant disparities exist worldwide regarding the availability of resources necessary to identify, treat and manage lymphoedema. This disparity transcends socio-economic status and is a common problem in both developed and developing countries. The overall impact of lymphoedema as a public health problem, however, is underestimated, principally due to the lack of epidemiologic data. These problems pose barriers to optimal identification and management of this disabling, lifelong condition. In 1997, the World Health Organization (50.29) resolved that lymphatic filariasis should be eliminated as a public health problem. A component of this strategy focuses on disability management for those suffering from lymphatic filariasis-related morbidity. This initiative has enhanced lymphoedema awareness in developing countries. However, significant deficits persist in health care providers' knowledge, educational initiatives and basic disease identification and treatment. In developed countries, lymphoedema continues to be an underrecognised condition and assumed to be only cancer-related. Health care resources allocated to treat and manage the disease are insufficient for basic and ongoing care, resulting in disease progression and disability. The International Lymphoedema Framework project, established in 2002, seeks to establish a consensus for best practices in the management of lymphoedema worldwide to reduce this disability burden. A basic global construct for lymphoedema management is needed to decrease morbidity and promote optimal disease management across all cultural and socio-economic boundaries. Many countries are unaware of the importance of lymphoedema management and have not defined a national strategy with respect to this problem. The objective of this article is to define similarities and differences in strategies for lymphoedema management between developed and developing countries and advocate for a cohesive and concerted approach to disease management.