Personalized care treats cancer swelling best

U. MISSOURI (US) — Cancer survivors with painful swelling would benefit more from individualized care focused on quality of life, rather than therapy based on symptoms alone.

Many insurance providers and health care professionals assess whether lymphedema patients need treatment based solely on how swollen their limbs are, says Jane Armer, professor of nursing at the University of Missouri and director of nursing research at Ellis Fischel Cancer Center. But several studies show that the volume of fluid doesn’t necessarily correspond with patients’ discomfort.

“Practitioners need to treat the swelling while considering patients’ distress. We don’t want to burden them with unnecessary or ineffective treatments,” Armer says. “Health care providers should focus on managing symptoms and choose carefully among various treatments to provide individualized care plans that comfort patients, which may require modifying existing protocols.”

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In a review of published literature, Armer and colleagues found that Complete Decongestive Therapy (CDT), a comprehensive approach for treating lymphedema involving skin care, exercise, manual lymphatic drainage, and compression of the swollen limbs, may be the best form of specialized lymphedema management.

“Patients have different medical needs and come from culturally diverse backgrounds. They have different goals, support systems, pain levels, and treatment tolerances. All these factors influence patients’ responses to care, which affects their well-being,” says co-author Marcia Beck, a graduate of University of Missouri who now works at Truman Medical Centers in Kansas City, Missouri.

“Caring for lymphedema patients should be flexible and adjusted to maintain patients’ quality of life,” says Ausanee Wanchai, another co-author who received her doctorate at MU and now teaches at Boromarajonani College of Nursing in Buddhachinnaraj, Thailand.

In a separate literature review, the researchers found that Intermittent Pneumatic Compression (IPC) therapy, in which sequential inflatable devices surrounding swollen limbs are used to increase lymphatic circulation, is beneficial as an adjunct therapy for chronic lymphedema patients who have limited or no access to medical care; patients can use the compression devices in their homes.

Further research is needed to demonstrate the usefulness of various lymphedema treatments, such as CDT and IPC, Armer says. The literature reviews were the third and fourth in a series of 12 to be published in conjunction with the American Lymphedema Framework Project (ALFP). As director of the ALFP, Armer works alongside clinical experts and investigators to increase awareness of lymphedema and related disorders.

Researchers at the University of Texas, NorthShore University HealthSystem, and Walter Reed Military Medical Center contributed to the review.

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