Skip to main content
SpringerLink
Log in

Edema and Lymphedema

  • Living reference work entry
  • First Online:
Book cover Textbook of Palliative Care

  • 529 Accesses

Abstract

Edema or swelling is a common occurrence during the palliative care phase for many conditions. Various causes and forms of oedema are possible, with most palliative care patients suffering from a mixed form with lymphatic and venous contributions. Edema is most frequently present in the limbs but may be found in any region of the body, including the head and neck, trunk, and genitals. Edema can cause significant distress, reducing mobility and independence. Screening and assessment for oedema therefore should be comprehensive and systematic to ensure the underlying causes of the swelling are discovered. Furthermore, the treatment goals of the patient should be accounted for in determining the treatments offered. Various treatments, with particular focus on compression and exercises, may be used but often require modification from traditional usage in the palliative care setting. In this setting, treatment focus is often on symptom management rather than volume reduction.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  • Badger C, Preston N, Seers K, Mortimer P. Physical therapies for reducing and controlling lymphoedema of the limbs. Cochrane Database Syst Rev. 2004;(4):Cd003141.

    Google Scholar 

  • Bar-Sela G, Omer A, Flechter E, Zalman D. Treatment of lower extremity edema by subcutaneous drainage in palliative care of advanced cancer patients. Am J Hosp Palliat Care. 2010;27(4):272–5.

    Article  PubMed  Google Scholar 

  • Brake R, Jones ID. Chronic heart failure part 2: treatment and management. Nurs Stand. 2017;31(20):53–63.

    Article  PubMed  Google Scholar 

  • Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K. The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care. 1991;7(2):6–9.

    CAS  PubMed  Google Scholar 

  • Chang VT, Hwang SS, Feuerman M, Kasimis BS, Thaler HT. The memorial symptom assessment scale short form (MSAS-SF). Cancer. 2000;89(5):1162–71.

    Article  CAS  PubMed  Google Scholar 

  • Cheville AL, Andrews K, Kollasch J, Schmidt K, Basford J. Adapting lymphedema treatment to the palliative setting. Am J Hosp Palliat Care. 2014;31(1):38–44.

    Article  PubMed  Google Scholar 

  • Clemens KE, Jaspers B, Klaschik E, Nieland P. Evaluation of the clinical effectiveness of physiotherapeutic management of lymphoedema in palliative care patients. Jpn J Clin Oncol. 2010;40(11):1068–72.

    Article  PubMed  Google Scholar 

  • Czerniec SA, Ward LC, Refshauge KM, Beith J, Lee MJ, York S, et al. Assessment of breast cancer-related arm lymphedema – comparison of physical measurement methods and self-report. Cancer Investig. 2010;28(1):54–62.

    Article  CAS  Google Scholar 

  • Czerniec SA, Ward LC, Kilbreath SL. Breast cancer-related arm lymphedema: fluctuation over six months and the effect of the weather. Lymphat Res Biol. 2016;14(3):148–55.

    Article  PubMed  Google Scholar 

  • Dawson C, Paterson F, McFatter F, Buchanan D. Methadone and oedema in the palliative care setting: a case report and review of the literature. Scott Med J. 2014;59(2):e11–3.

    Article  PubMed  Google Scholar 

  • Deng J, Dietrich MS, Ridner SH, Fleischer AC, Wells N, Murphy BA. Preliminary evaluation of reliability and validity of head and neck external lymphedema and fibrosis assessment criteria. Eur J Oncol Nurs. 2016;22:63–70.

    Article  PubMed  Google Scholar 

  • Dylke ES, Ward LC, Meerkin JD, Nery L, Kilbreath SL. Tissue composition changes and secondary lymphedema. Lymphat Res Biol. 2013;11(4):211–8.

    Article  CAS  PubMed  Google Scholar 

  • Dylke ES, Schembri GP, Bailey DL, Bailey E, Ward LC, Refshauge K, et al. Diagnosis of upper limb lymphoedema: development of an evidence-based approach. Acta Oncol. 2016;55:1477–83.

    Article  CAS  PubMed  Google Scholar 

  • Ezzo J, Manheimer E, McNeely ML, Howell DM, Weiss R, Johansson KI, et al. Manual lymphatic drainage for lymphedema following breast cancer treatment. Cochrane Database Syst Rev. 2015;(5):Cd003475.

    Google Scholar 

  • Homsi J, Walsh D, Rivera N, Rybicki LA, Nelson KA, Legrand SB, et al. Symptom evaluation in palliative medicine: patient report vs systematic assessment. Support Care Cancer. 2006;14(5):444–53.

    Article  PubMed  Google Scholar 

  • International Lymphedema Framework. International Consensus: Best Practice for the Management of Lymphedema: www.lympho.org; 2006. Available from: http://www.woundsinternational.com/media/issues/210/files/content_175.pdf

  • International Lymphedema Framework. Compression Therapy: A position document on compression bandaging. Best Practice For the Managament of Lymphedema. 2nd ed. [Internet]. 2012. Available from: http://www.lympho.org/mod_turbolead/upload//file/Resources/Compression%20bandaging%20-%20final.pdf. 12 Apr 2017.

  • International Lymphedema Framework and Canadian Lymphedema Framework. The management of lymphoedema in advanced cancer and oedema at the end of life. International Lymphedema Framework Postiion Statement [Internet]. 2010. Available from: http://www.lympho.org/portfolio/the-management-of-lymphoedema-in-advanced-cancer-and-oedema-at-the-end-of-life/. 12 Apr 2017.

  • Jacobsen J, Blinderman CD. Subcutaneous lymphatic drainage (lymphcentesis) for palliation of severe refractory lymphedema in cancer patients. J Pain Symptom Manag. 2011;41(6):1094–7.

    Article  Google Scholar 

  • Kligman L, Wong RK, Johnston M, Laetsch NS. The treatment of lymphedema related to breast cancer: a systematic review and evidence summary. Support Care Cancer. 2004;12(6):421–31.

    Article  PubMed  Google Scholar 

  • Kovacs L, Eder M, Hollweck R, Zimmermann A, Settles M, Schneider A, et al. Comparison between breast volume measurement using 3D surface imaging and classical techniques. Breast (Edinburgh, Scotland). 2007;16(2):137–45.

    Article  Google Scholar 

  • Lamprou DA, Damstra RJ, Partsch H. Prospective, randomized, controlled trial comparing a new two-component compression system with inelastic multicomponent compression bandages in the treatment of leg lymphedema. Dermatol Surg. 2011;37(7):985–91.

    Article  CAS  PubMed  Google Scholar 

  • Lau KS, Tse DM, Tsan Chen TW, Lam PT, Lam WM, Chan KS. Comparing noncancer and cancer deaths in Hong Kong: a retrospective review. J Pain Symptom Manag. 2010;40(5):704–14.

    Article  Google Scholar 

  • Lawenda BD, Mondry TE, Johnstone PA. Lymphedema: a primer on the identification and management of a chronic condition in oncologic treatment. CA Cancer J Clin. 2009;59(1):8–24.

    Article  PubMed  Google Scholar 

  • McNeely ML, Magee DJ, Lees AW, Bagnall KM, Haykowsky M, Hanson J. The addition of manual lymph drainage to compression therapy for breast cancer related lymphedema: a randomized controlled trial. Breast Cancer Res Treat. 2004;86(2):95–106.

    Article  PubMed  Google Scholar 

  • Moffatt CJ, Franks PJ, Doherty DC, Williams AF, Badger C, Jeffs E, et al. Lymphedema: an underestimated health problem. QJM. 2003;96(10):731–8.

    Article  CAS  PubMed  Google Scholar 

  • Moffatt CJ, Edwards L, Collier M, Treadwell T, Miller M, Shafer L, et al. A randomised controlled 8-week crossover clinical evaluation of the 3M Coban 2 Layer Compression System versus Profore to evaluate the product performance in patients with venous leg ulcers. Int Wound J. 2008;5(2):267–79.

    Article  PubMed  Google Scholar 

  • Moffatt CJ, Franks PJ, Hardy D, Lewis M, Parker V, Feldman JL. A preliminary randomized controlled study to determine the application frequency of a new lymphoedema bandaging system. Br J Dermatol. 2012;166(3):624–32.

    Article  CAS  PubMed  Google Scholar 

  • Mosti G, Cavezzi A, Partsch H, Urso S, Campana F. Adjustable velcro compression devices are more effective than inelastic bandages in reducing venous edema in the initial treatment phase: a randomized controlled trial. Eur J Vasc Endovasc Surg. 2015;50(3):368–74.

    Article  CAS  PubMed  Google Scholar 

  • Munn LL, Padera TP. Imaging the lymphatic system. Microvasc Res. 2014;96:55–63.

    Article  PubMed  Google Scholar 

  • Nakajima N, Takahashi Y, Ishitani K. The volume of hydration in terminally ill cancer patients with hydration-related symptoms: a prospective study. J Palliat Med. 2014;17(9):1037–41.

    Article  PubMed  Google Scholar 

  • Nwosu AC, Morris L, Mayland C, Mason S, Pettitt A, Ellershaw J. Longitudinal bioimpedance assessments to evaluate hydration in POEMS syndrome. BMJ Support Palliat Care. 2016;6(3):369–72.

    Article  PubMed  PubMed Central  Google Scholar 

  • O’Connor NR, Kumar P. Conservative management of end-stage renal disease without dialysis: a systematic review. J Palliat Med. 2012;15(2):228–35.

    Article  PubMed  PubMed Central  Google Scholar 

  • Padera TP, Meijer EF, Munn LL. The lymphatic system in disease processes and cancer progression. Annu Rev Biomed Eng. 2016;18:125–58.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Partsch H, Flour M, Smith PC. Indications for compression therapy in venous and lymphatic disease consensus based on experimental data and scientific evidence. Under the auspices of the IUP. Int Angiol. 2008;27(3):193–219.

    CAS  PubMed  Google Scholar 

  • Partsch H, Damstra RJ, Mosti G. Dose finding for an optimal compression pressure to reduce chronic edema of the extremities. Int Angiol. 2011;30(6):527–33.

    CAS  PubMed  Google Scholar 

  • Portenoy RK, Thaler HT, Kornblith AB, Lepore JM, Friedlander-Klar H, Kiyasu E, et al. The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress. Eur J Cancer. 1994;30a(9):1326–36.

    Article  CAS  PubMed  Google Scholar 

  • Real S, Cobbe S, Slattery S. Palliative care edema: patient population, causal factors, and types of edema referred to a specialist palliative care edema service. J Palliat Med. 2016;19(7):771–7.

    Article  PubMed  Google Scholar 

  • Schmitz KH, Ahmed RL, Troxel A, Cheville A, Smith R, Lewis-Grant L, et al. Weight lifting in women with breast-cancer-related lymphedema. N Engl J Med. 2009;361(7):664–73.

    Article  CAS  PubMed  Google Scholar 

  • Steindal SA, Ranhoff AH, Bredal IS, Sorbye LW, Lerdal A. Last three days of life in the hospital: a comparison of symptoms, signs and treatments in the young old and the oldest old patients using the Resident assessment instrument for palliative care. Int J Older People Nursing. 2013;8(3):199–206.

    Article  Google Scholar 

  • Stromgren AS, Groenvold M, Pedersen L, Olsen AK, Sjogren P. Symptomatology of cancer patients in palliative care: content validation of self-assessment questionnaires against medical records. Eur J Cancer. 2002;38(6):788–94.

    Article  CAS  PubMed  Google Scholar 

  • Thomson M, Walker J. Collaborative lymphoedema management: developing a clinical protocol. Int J Palliat Nurs. 2011;17(5):231–8.

    Article  PubMed  Google Scholar 

  • Ward L, Kilbreath S, Cornish B. Bioimpedance analysis for early detection of lymphedema. In: Weissieder H, Schuchhardt C, editors. Lymphedema: diagnosis and therapy. 4th ed. Essen: Viavital Verlag; 2008. p. 502–17.

    Google Scholar 

  • Ward L, Winall A, Isenring E, Hills A, Czerniec S, Dylke E, et al. Assessment of bilateral limb lymphedema by bioelectrical impedance spectroscopy. Int J Gynecol Cancer. 2011a;21(2):409–18.

    Article  PubMed  Google Scholar 

  • Ward LC, Dylke E, Czerniec S, Isenring E, Kilbreath SL. Reference ranges for assessment of unilateral lymphedema in legs by bioelectrical impedance spectroscopy. Lymphat Res Biol. 2011b;9(1):43–6.

    Article  CAS  PubMed  Google Scholar 

  • Whitaker J, Williams A, Pope D, Elwell R, Thomas M, Charles H, et al. Clinical audit of a lymphoedema bandaging system: a foam roll and cohesive short stretch bandages. J Wound Care. 2015;24(3):83–4; 6–90; 2–4

    Article  CAS  PubMed  Google Scholar 

  • White C, McMullan D, Doyle J. “Now that you mention it, doctor ...”: symptom reporting and the need for systematic questioning in a specialist palliative care unit. J Palliat Med. 2009;12(5):447–50.

    Article  PubMed  Google Scholar 

  • Williams A. A review of the evidence for adjustable compression wrap devices. J Wound Care. 2016;25(5):242–7.

    Article  CAS  PubMed  Google Scholar 

  • Williams AF, Vadgama A, Franks PJ, Mortimer PS. A randomized controlled crossover study of manual lymphatic drainage therapy in women with breast cancer-related lymphoedema. Eur J Cancer Care. 2002;11(4):254–61.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia

    Elizabeth S. Dylke & Sharon L. Kilbreath

Authors
  1. Elizabeth S. Dylke
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sharon L. Kilbreath
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elizabeth S. Dylke .

Editor information

Editors and Affiliations

  1. HammondCare Learning and Research Centre, Greenwich Hospital, Greenwich, New South Wales, Australia

    Roderick Duncan MacLeod

  2. Vrije Universiteit Brussel, VUB-UGent End-of-Life Care Research Grou Vrije Universiteit Brussel, Brussels, Belgium

    Lieve van den Block

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Dylke, E.S., Kilbreath, S.L. (2018). Edema and Lymphedema. In: MacLeod, R., van den Block, L. (eds) Textbook of Palliative Care. Springer, Cham. https://doi.org/10.1007/978-3-319-31738-0_13-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-31738-0_13-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-31738-0

  • Online ISBN: 978-3-319-31738-0

  • eBook Packages: Springer Reference Biomedicine and Life SciencesReference Module Biomedical and Life Sciences

Publish with us

Policies and ethics

Search

Navigation