From the Guidelines
The initial approach to managing lymphedema caused by lymphoma should involve referral to a therapist knowledgeable about the diagnosis and treatment of lymphedema, such as a physical therapist (PT), occupational therapist (OT), or lymphedema specialist. This recommendation is based on the guidelines from the American Cancer Society and American Society of Clinical Oncology, as outlined in a systematic review of rehabilitation and exercise recommendations in oncology guidelines 1.
Key Components of Lymphedema Management
- Referral to a specialist for proper assessment and treatment
- Assessment of fatigue, musculoskeletal symptoms, pain, and sexual health, and treatment of any causative factors
- Rehabilitation interventions such as counseling, physical activity, and therapeutic exercise
- Health promotion through a healthy weight, regular physical activity, and a balanced diet
Conservative Measures
Conservative measures and physical therapy are crucial in managing lymphedema caused by lymphoma. While the provided evidence does not specifically outline the components of complete decongestive therapy (CDT) or the use of compression garments, referral to a knowledgeable therapist is essential for personalized guidance on exercise, compression therapy, and skin care. Gentle resistance training, aerobic activities, elevation of the affected limb, and maintaining ideal body weight are generally recommended for improving lymph flow and overall health.
Importance of Specialist Referral
The emphasis on referral to a specialist underscores the complexity of lymphedema management and the need for tailored interventions. By referring patients to a therapist knowledgeable about lymphedema, healthcare providers can ensure that patients receive comprehensive care that addresses their specific needs, including physical therapy, education on self-care, and monitoring for potential complications such as infection. This approach prioritizes the patient's quality of life, morbidity, and mortality by addressing the underlying physiological issues associated with lymphedema.
From the Research
Initial Approach to Managing Lymphedema Caused by Lymphoma
The initial approach to managing lymphedema caused by lymphoma involves a comprehensive treatment plan that includes several components.
- The treatment plan typically consists of two phases: the acute "intensive" phase and the maintenance phase 2.
- In the acute phase, the individual is typically wrapped with medical short-stretch compression bandages, receives a therapeutic exercise routine, skin care, and education, and undergoes manual lymphatic drainage by a specially trained physical therapist or healthcare professional 2.
- The goals of the maintenance phase are for the individual to be able to wear a well-fitted appropriate gradient pressure garment during the day and compression bandaging (or a device that serves as an alternative to bandaging) at night, to maintain good skin care, to continue with therapeutic exercise, and to self-perform manual lymphatic drainage (or use a mechanical device that can perform manual lymphatic drainage) for the area of the body with impaired lymphatics 2.
Treatment of Lymphoma
Lymphoma is typically treated with chemotherapy, and the treatment plans differ between the main subtypes of lymphoma 3.
- Non-Hodgkin lymphoma is treated with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) with or without rituximab (R-CHOP), bendamustine, and lenalidomide 3.
- Hodgkin lymphoma is treated with combined chemotherapy with ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine), Stanford V (a chemotherapy regimen consisting of mechlorethamine, doxorubicin, vinblastine, vincristine, bleomycin, etoposide, and prednisone), or BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) with radiotherapy 3.
- Rituximab is a monoclonal antibody that has been registered for the treatment of B-cell lymphomas and has transformed the outcome of patients with B-cell lymphoma 4.
Lymphedema Management
Lymphedema is a chronic condition that can be managed with nonpharmacologic strategies, used alone or in combination with one another 5.
- The majority of strategies to prevent and manage lymphedema are nonpharmacologic, including compression bandages, therapeutic exercise, skin care, and education 2, 5.
- It is recommended for patients to maintain physical activity for its many health benefits and to facilitate muscle pumping to move lymphatic fluid throughout the body 2.