The challenges of managing complex lymphoedema/chronic oedema in the UK and Canada.

This article explores the professional challenges of treating patients with complex/severe forms of chronic oedema/lymphoedema with compression therapy. Four focus groups were held, two in the UK and two in Canada, to examine the challenges faced by practitioners in their everyday practice. A number of challenges were identified by participants in both countries and include the changing profile of lymphoedema/chronic oedema and how increasing complexity is outpacing the development of services and research-based guidelines. Focus groups also highlighted a lack of public awareness, poor professional knowledge, delayed diagnosis and inappropriate treatment as having a significant impact on practice. Other practice-related issues include a poor understanding of treatment options among practitioners, a lack of evidence-based practice as well as difficulties associated with managing psychosocial problems and of ensuring concordance with treatment. In Canada, services tend to be more rural and remote than in the UK, autonomous specialist practice is less developed and practitioners were generally less confident and felt more vulnerable than their UK colleagues. There is a need for integrated, multi-disciplinary services in both countries, with improved education and training, as well as the development of cost-effective compression bandaging systems that can make a major contribution to meeting the challenges of contemporary lymphoedema practice.

Understanding the management of lymphoedema for patients with advanced disease.

The problems associated with lymphoedema can be devastating, particularly for patients with lymphoedema and advanced disease. All lymphoedema treatment is palliative in nature as the underlying condition is incurable; however, much can be done to relieve the symptoms associated with the oedema. It is important to remember that the burden of treatment on the patient should not exceed the benefit gained and, therefore, treatment may have to be adapted and modified to suit patients individual needs. This article describes the classification, aetiology and nursing management of lymphoedema with an emphasis on the management of lymphoedema in the patient with advanced disease.

The management of chronic oedema in palliative care.

Chronic oedema is a broad term used to describe a range of conditions which may cause oedema in the limbs, trunk, head, neck and genitals. Lymphoedema is one type of chronic oedema. The problems associated with chronic oedema can be devastating and this is of particular importance for patients in the palliative phase of their disease. Community nurses have an important role to play in providing palliative care and helping to alleviate the troublesome symptoms these patients may experience. There are a range of treatments which may assist the patient; some of which require the skills of a specialist but, many of which, can be administered by a community nurse. The management of one particular aspect of chronic oedema is examined, namely lymphoedema caused by advanced cancer.

Classification, aetiology and nursing management of lymphoedema.

Lymphoedema is a common problem affecting at least 100,000 people in the United Kingdom. There is a lack of knowledge among healthcare professionals regarding lymphoedema and this has led to the condition often not being recognized early enough or being adequately managed. Lymphoedema is an incurable condition which will progress if it is not appropriately treated. Physical problems associated with lymphoedema may include pain, discomfort, heaviness of the limb and distortion in limb shape and size leading to reduced mobility and function. This has implications for lymphoedema patients who may experience a significant reduction in their quality of life because of this condition. Treatment, if commenced early, is straightforward and patients can be taught to carry out an effective programme of daily self-care. If, on the other hand, the lymphoedema is not recognized early or not properly treated, it can develop into a serious and highly debilitating condition.

The staging of lymphoedema and accompanying symptoms.

Community nurses are recognized as potentially having a much greater role to play in identifying, referring and helping in the long-term management of lymphoedema. This will require knowledge of all stages of the diagnostic and treatment process. In this article, the author discusses staging, or the assessment of the severity of the disease. Staging can be useful not only in deciding the best course of treatment for the individual, but also in measuring the progress of treatment.

Mouth care in cancer nursing: using an audit to change practice.

Patients with cancer face an assault on oral health from their disease and accompanying treatment options and are vulnerable to developing oral problems; therefore, the maintenance of oral health is particularly important. A study was carried out in one oncology unit within a large teaching hospital to measure the extent of oral problems in cancer patients, current mouth care practices and staff knowledge. The findings showed that oral problems were common, but were: (1) underreported by patients (2) underdiagnosed by doctors and nurses (3) inadequately treated, and (4) inadequately documented. Nursing staff were found to have knowledge deficits. Changes to practice as a result of these findings included the development of oral care guidelines; additionally, patient information leaflets and posters were produced and a staff education programme was introduced. A further audit found that there had been significant improvements in the diagnosis and treatment of oral problems and increased reporting of previously ignored problems by patients.