Evaluation of the Clinical Effectiveness of Physiotherapeutic Management of Lymphoedema in Palliative Care Patients

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Abstract
Lymphoedema is a common sequela of cancer or its treatment that affects lymph node drainage. The physiotherapist, as member of the multiprofessional team in palliative care, is one of the keys to successful rehabilitation and management of patients with cancer and non-malignant motoneuron disease such as amyotrophic lateral sclerosis and palliative care needs. The aim of the study was to evaluate the frequency and effect of manual lymphatic drainage in palliative care patients with lymphoedema in a far advanced stage of their disease. Retrospective study (reflexive control design) of data of the 208 patients admitted to our palliative care unit from January 2007 to December 2007. Demographic and disease-related data (diagnosis, symptoms, Karnofsky performance status and effect of manual lymphatic drainage interventions) were documented and compared. Statistics: mean ± SD, median; Wilcoxon's test. Of the 208 patients, 90 who reported symptom load due to lymphoedema were included; 67 (74.4%) had pain, 23 (25.6%) dyspnoea due to progredient trunk oedema. Mean age 65.5 ± 13.0 years; 33 (36.7%) male; Karnofsky index 50% (30–80%), mean length of stay 15.6 ± 8.0 days. The mean number of physiotherapeutic treatment interventions was 7.0 ± 5.8. Manual lymphatic drainage was well tolerated in 83 (92.2%) patients; 63 of 67 (94.0%) patients showed a clinically relevant improvement in pain, and 17 of 23 (73.9%) in dyspnoea. The majority of the patients showed a clinical improvement in the intensity of symptoms after manual lymphatic drainage.