Lymphedema: Clinical Summary of the ONS Guidelines™ for Cancer Treatment-Related Lymphedema.

Secondary (acquired) lymphedema is a chronic condition lacking a known cure that most commonly results from cancer treatment, particularly for breast, gynecologic, prostate, and head and neck cancers; lymphoma; and melanoma, and affects an estimated 1 in 1,000 Americans. Lymphedema is characterized by an accumulation of protein-rich lymphatic fluid in the affected part of the body. It can potentially affect functioning, family roles and relationships, occupational roles, and productivity. The majority of strategies to prevent and manage lymphedema are nonpharmacologic, used alone or in combination with one another.

ONS Guidelines™ for Cancer Treatment-Related Lymphedema.

PURPOSE: Lymphedema is a chronic condition that may result from cancer-related surgery. The incidence of lymphedema varies greatly; however, patients remain at risk for life and may experience decreased quality of life and functional capacity. Providing recommendations for an evidence-based guideline for care of cancer treatment-related lymphedema will help to improve outcomes for patients with this chronic condition. METHODOLOGIC APPROACH: A panel of healthcare professionals with patient representation convened to develop a national clinical practice guideline on prospective surveillance, risk reduction, and conservative treatment of lymphedema. Systematic reviews of the literature were conducted and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology approach was used to assess the evidence. FINDINGS: The panel made multiple recommendations for patients who are at risk for or experiencing lymphedema. IMPLICATIONS FOR NURSING: Early diagnosis and treatment of lymphedema may mitigate symptoms. This evidence-based guideline supports patients, clinicians, and other healthcare professionals in clinical decision making. SUPPLEMENTARY MATERIAL CAN BE FOUND AT HTTPS: //onf.ons.org/supplementary-material-ons-guidelines-cancer-treatment-related-lymphedema.

Management of lymphedema for cancer patients with complex needs.

OBJECTIVES: The purpose of this paper was to discuss the management of lymphedema in patients with advanced disease. DATA SOURCES: Peer-reviewed literature. CONCLUSION: Management of lymphedema in patients with advanced cancer is complex because of multi-factorial issues. Basic components of skin care, compression, massage, and exercise can be applied for these patients. Key concepts are: 1) optimizing quality of life, 2) respecting patients' choices, and 3) providing psychological support to the patients and their families. IMPLICATIONS FOR NURSING PRACTICE: Management plans for patients with lymphedema in advanced disease should be flexible. Holistic and collaborative approaches are essential to achieve the goal of caring for these patients.

Palliative care for cancer-related lymphedema: a systematic review.

INTRODUCTION: Cancer-related lymphedema management in palliative care remains a challenge for health care professionals. We conducted a systematic review of the published literature related to the effectiveness of cancer-related lymphedema management in the palliative care setting. METHODS: Eleven major medical databases were searched. Manuscripts were selected for articles published from January 2004 to October 30, 2011, using search terms for lymphedema and palliative care. Eleven articles were selected based on defined eligibility criteria for final review and were categorized as lymphedema management in palliative care by topic experts. Articles were also rated for quality according to the Oncology Nursing Society Putting Evidence into Practice(®) classification. RESULTS: Five case studies were identified addressing closed-controlled subcutaneous drainage; one retrospective study on manual lymphatic drainage (MLD); two case studies on compression therapy; and three case studies on complete decongestive therapy (CDT). All studies were rated in the category of "effectiveness not established" due to study limitations in design and sample size. Few studies included objective measures of outcomes, and there were no randomized controlled trials. There is a need for larger, well-designed research studies to test the effectiveness of management of cancer-related lymphedema in palliative care.

Wearing masks in a pediatric hospital: developing practical guidelines.

During the outbreak of Severe Acute Respiratory Syndrome (SARS) in the spring of 2003, strict infection control measures were implemented in Toronto and surrounding hospitals. These measures included extreme restrictions on those who would normally accompany patients to the hospital, screening for SARS, and protective attire for hospital staff, including masks, face shields, goggles, gloves and gowns. At Toronto's Hospital for Sick Children (HSC), patients could only be accompanied or visited by one person, often only in patients' rooms. For the first four weeks, patients and their designated parent had to wear masks in almost all areas of the hospital. Staff wore masks (and other appropriate protective clothing) whenever in contact with patients and in many patient care areas. Although these barriers were an important part of containing SARS, their use created significant challenges for patients and staff. This article focusses on the use of infection control masks in routine pediatric healthcare and the tools developed by HSC staff to reduce the negative psychosocial impact on children and families.