Do Occupational Therapists Manage Lymphedema?
Yes, occupational therapists are explicitly recognized as appropriate specialists for the diagnosis and treatment of lymphedema, particularly in cancer survivors. 1
Guideline-Based Recommendation
The American Cancer Society and American Society of Clinical Oncology jointly recommend that primary care clinicians should refer patients with clinical symptoms or swelling suggestive of lymphedema to "a therapist knowledgeable about the diagnosis and treatment of lymphedema, such as a physical therapist, occupational therapist, or lymphedema specialist." 1
When to Refer to an Occupational Therapist
Refer immediately when patients present with:
- Any clinical symptoms or visible swelling suggestive of lymphedema 1
- Patient-reported sensations of heaviness, tightness, or numbness even without visible swelling (Stage 0 subclinical lymphedema) 2
- Functional limitations affecting fine motor hand function or range of motion in affected joints 1
- Difficulty with activities of daily living or instrumental activities of daily living due to swelling 3
What Occupational Therapists Provide
Complete decongestive therapy (CDT) is the cornerstone treatment, consisting of: 4
- Manual lymphatic drainage 4, 5
- Compression therapy (bandaging and garment fitting) 4, 6
- Therapeutic exercise programs 4, 6
- Skin care education 4, 6
- Self-management training 4, 6
Clinical Context and Scope
Occupational therapists are particularly valuable for addressing:
- Upper extremity lymphedema following breast cancer surgery and/or radiation (affecting over 40% of survivors to some degree) 1
- Functional restoration for work, leisure activities, and psychological wellbeing 4
- Custom compression garment fitting and adherence strategies 6
- Patient education on lifelong self-care and infection prevention 2
Evidence Quality
The recommendation for occupational therapy referral comes from high-quality guidelines published in CA: A Cancer Journal for Clinicians (2016), representing consensus from the American Cancer Society and American Society of Clinical Oncology. 1 This is reinforced by contemporary evidence showing that early intervention by specialized therapists may reverse or effectively manage early-stage lymphedema, while delayed treatment leads to irreversible fibroadipose tissue deposition. 2
Critical Pitfall to Avoid
Do not delay specialist referral. Lymphedema can develop immediately after treatment or years later, and early physiotherapy intervention is potentially reversible, whereas delayed treatment results in permanent tissue changes and increased complications. 2 The availability of qualified therapists varies by community, so identify local resources including certified lymphedema specialists, physical therapists, and occupational therapists with lymphedema training. 1