1. Lymphoedema Physical and Psychological Aspects Eleni Peratopoulou / Tina Rossidou The Cyprus Anti-Cancer Society For more information contact: The Cyprus Anti-Cancer Society Eleni Peratopoulou – Physiotherapist, Lymphoedema Therapist Ph: + 357 22446327 Email: eleni.perry@anticancersociety.org.cy Tina Rossidou - Psychologist Ph: + 357 22446295 Email: tina.rossidou@anticancersociety.org.cy Web: http://www.anticancersociety.org.cy/ Introduction Lymphoedema is a swelling that develops as a result of an impaired lymphatic system. This may be a result of the lymphatic system not developing properly (primary lymphoedema) or through damage or trauma (secondary lymphoedema). It can appear at any time or age and can affect any part of the body; but is most commonly seen in an arm or a leg. Lymphoedema can cause both physical and psychological distress and it is important that both aspects are addressed and treated. The two phases of Complex Physical Therapy (C.P.T) are: Phase 1: reduce the swelling (a 3-4 week course of therapy) Phase 2: maintain the reduction Following a C.P.T. course, the patient feels better from the various symptoms which may include: Swelling Aching Heaviness Bursting sensation of the limb Feeling of pins and needles The range of movement of the limb affected by lymphoedema usually improves after C.P.T. Psychosocial Impact Lymphoedema has a profound psychological impact on the patient dealing with it. Little research has been conducted and little is often said about the many effects of lymphoedema. Coupling the physical difficulties, lymphoedema can cause social inhibitions, psychological distress, psychosexual problems and social anxiety. Lymphoedema can cause psychological distress: Depression Embarrassment, Self-Rejection and Self-Isolation Body-image distress Feelings of inferiority and inadequacy Feelings of hopelessness and helplessness Feelings of worthlessness and uselessness Sexual Dysfunction Anger, Despair, Humiliation Suspicion of others Social inhibitions due to self-consciousness Self-esteem issues Psychological pain associated with disfigurement, pain and physical disability Quality of Life Breast cancer survivors with arm lymphoedema have been found to be more disabled, experience a poorer quality of life, and have more psychological distress than do survivors without lymphoedema. In addition, women reporting swelling have reported significantly lower quality of life with multiple functional assessments. http://www.cancer.govhttp://www.cancer.gov Psychological Help is Available Individual and group therapy Support Groups We help people deal with fear, isolation, body-image, anger, depression, loss, despair, sadness, acceptance, and other distressing issues …many avoid social situations in which their lymphoedema causes a constant reminder of their cancer experience… Photos taken at the beginning of treatment and eleven days later... Massage is an important aspect of Complex Physical Therapy - Lymphoedema treatment Conclusion Lymphoedema is an important consideration for clinicians who care for cancer patients because of its relatively high frequency and significant functional and quality of life implications for patients. Lymphoedema is an independent predictor of decreased quality of life, and clinicians are urged to provide both physical and psychological therapies to patients. Physiotherapy Physiotherapy in Palliative Care is orientated to achieve the optimum quality of life as perceived by the patient. It aims to facilitate the patient’s ability to function with safety and independence while facing diminishing resources. A special physiotherapy treatment known as C.P.T. - Complex Physical Therapy- can assist Palliative Care patients suffering from lymphoedema and involves four components: 1.skin care and the treatment of any infection 2.a special form of massage 3.compression bandaging 4.special exercises which supplement the massage The therapist is administering compression bandaging to the patient Lymphoedema Clinic The Cyprus Anti Cancer Society operates a lymphoedema clinic since 2003 in Nicosia. It is housed at “Arodaphnousa” Palliative Care Centre and it is operated by the physiotherapy department. Most of the cases that we take care of in our clinic are women suffering from upper arm lymphoedema due to breast cancer and axillary lymph node removal, or following radiation treatment or a combination of both. All lymphoedema cases are referred to the clinic by the physician treating the patient. The multi-disciplinary team at the Palliative Care Centre Patient A.S.1: 03/11/2008Patient A.S.1: 14/11/2008