A recent study conducted by researchers at the Stanford University School of Medicine and published in PLOS ONE found that “patients with swelling caused by cancer-associated lymphedema can both reduce the severity of the disease and the overall cost of medical care by taking therapeutic steps at home.”

Kim Marshall, DPT, who has more than 10 years of experience as a Certified Lymphedema Therapist offers a nuanced perspective on the use of home pumps along with her philosophy of treating lymphedema patients based on a prospective surveillance model.

Home lymphedema pumps may not be the correct choice

“The use of a lymphedema pump remains controversial among lymphedema therapists,” Kim said. “It is costly and there are anecdotal reports that incorrect usage can actually cause the lymphedema to worsen by damaging the residual lymphatic vessels. That said, I do occasionally recommend pumps for patients that have a difficult time attending physical therapy. They can be a valuable tool for those patients.The issue seems to be compliance and the fact that patients have to use the pump for an hour on a daily basis. They seem to start strong but consistent usage tends to fade away.”

Identifying “At Risk” patients early reduces the need for daily lymphedema treatments

“The latest recommendation to effectively treat and manage lymphedema is through a prospective surveillance model which we use in Progressive Physical Therapy,” Kim added. “This approach involves early identification, through screening, of patients most likely to develop lymphedema. Patients are then educated on early signs of lymphedema such as a feeling of fullness in the arm or leg and which activities are high risk for contributing to increased swelling and need to be avoided. They are given a medical alert bracelet to use during medical procedures so that blood draws and blood pressure readings are taken on the uninvolved limb.”

“They are taught exercises that help promote circulation and lymphatic flow. If there is actually swelling in the arm or leg, they are fitted with a compression sleeve and how to put it on, take it off and when to wear it. Only in severe cases do we need to use the daily treatments which consist of manual lymph drainage and bandaging. Some patients need ongoing monitoring, the frequency of which depends on many factors, number of lymph nodes removed, whether they underwent radiation therapy, weight and age. In most cases, we can avoid the intensive therapy and costly use of bandages and pumps just by early identification of patients at risk.”

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