From the Guidelines
For lymphedema of the leg, refer the patient 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 most recent and highest quality evidence from the American Cancer Society/American Society of Clinical Oncology guidelines, as outlined in a systematic review of rehabilitation and exercise recommendations in oncology guidelines 1.
Key Considerations for Referral
- The specialist should have expertise in the diagnosis and treatment of lymphedema, including manual lymphatic drainage, compression therapy, and exercise recommendations.
- Early referral is crucial as lymphedema is a progressive condition that becomes more difficult to manage over time.
- A multidisciplinary approach may be necessary in complex cases, potentially involving vascular surgeons, dermatologists, or infectious disease specialists.
Rationale for Recommendation
The guidelines recommend referral to a lymphedema specialist for multimodality treatments, including manual lymphatic drainage, exercise, and compression therapy 1. This approach is consistent with the goal of preventing complications such as infections, skin changes, and further progression of swelling, and improving the patient's quality of life.
Additional Considerations
- The patient should be assessed for fatigue, musculoskeletal symptoms, pain, and sexual health, and referred to appropriate specialists as needed.
- The patient should be counseled on health promotion, including achieving and maintaining a healthy weight, engaging in regular physical activity, and avoiding smoking.
From the Research
Lymphedema Referral Options
To manage lymphedema of the leg, patients can be referred to the following healthcare professionals:
- Certified lymphedema therapists, who are specifically trained in lymphedema management and can provide complete decongestive therapy (CDT) 2
- Physical and Rehabilitative Medicine physicians, who can address patients' needs and optimize treatment as part of a multidisciplinary approach 3
- Plastic Reconstructive Surgeons, who can perform microsurgical and reductive procedures as part of a comprehensive management plan 3
Key Components of Lymphedema Management
The essential components of CDT for lymphedema management include:
- Examination
- Compression
- Manual techniques (such as manual lymph drainage)
- Exercise
- Skin care
- Education
- Self-management 2 Adjunctive interventions and alternatives may complement CDT, and the individual's lymphedema etiology and presentation, comorbidities, and other pertinent clinical information will determine the components of CDT applied and the frequency and duration of care 2
Treatment Approaches
Complete decongestive physiotherapy (CDP) is a highly effective treatment for both primary and secondary lymphedema, consisting of a 2-phase non-invasive therapeutic regimen 4 Twice-weekly complete decongestive physical therapy can also be effective in managing secondary lymphedema of the lower extremities 5 Patient-education programs, including self-management, aim to improve patient autonomy and are an essential part of lymphedema management 6