McGill

Lymphedema

Dr. Christine Maheu, RN, PhD

Dr. Christine Maheu is an Associate Professor in the Ingram School of Nursing, Faculty of Medicine, McGill University. Dr. Maheu is also an Affiliate Scientist at the University Health Network and the University of Toronto. At McGill University, she teaches research methods, supervises graduate students (masters, doctoral, post-doctoral), mentors practicing nurses and students in research, and conducts research in English and French. She has held research awards with the Canadian Institutes of Health Research, the Canadian Cancer Society, and the Canadian Partnership Against Cancer. These awards funded her research in psychosocial oncology, which focuses on developing and testing psychosocial interventions or measurements tools for various cancer populations. Additionally, in partnership with Ipsos Canada and funded by the Canadian Partnership Against Cancer, she is co-leading a nationwide survey of the needs of cancer patients for transition care from the end of their treatment to three years after their diagnosis. Dr. Maheu received awards for excellence in nursing research (2013, 2015, 2016) from Ovarian Cancer Canada, the Canadian Association of Nurses in Oncology, and the Quebec Association of Nurses in Oncology.

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Ms. Rosemary Cashman

Ms. Rosemary Cashman is a nurse practitioner at the BC Cancer Agency and an Adjunct Professor in the Faculty of Nursing at the University of British Columbia. Her professional experience includes the care of lymphoma, lung cancer and brain cancer patients. She co-chairs the Patient and Family Advisory Council, which guides the brain tumour care program at the BC Cancer Agency. She has authored book chapters and articles related to the care of brain tumour patients and their families. Ms. Cashman was involved in developing and implementing a rapid-access radiotherapy clinic for the palliative treatment of lung cancer and she continues to work in this clinic.

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Kyla Johnson, Occupational Therapist, Segal Cancer Centre, Jewish General Hospital

Ms. Kyla Johnson, M.Sc.A., originally from Edmonton, Alberta, Kyla Johnson works as an Occupational Therapist at the Segal Cancer Center of the Jewish General Hospital. She holds a Master of Science in Occupational Therapy from McGill University. Her goal as a rehabilitation professional in Oncology is to enable people with cancer to be able to do what they want and need to do, in all stages of their cancer experience. Kyla helps develop strategies and accommodations to facilitate a return to meaningful life roles, including work. She is specialized in cancer-related cognitive dysfunction and runs a weekly group teaching strategies to improve daily cognitive functioning. Kyla also leads a volunteer yoga class for young adults with cancer. She lives in Montreal, Quebec.

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Ms. Maureen Parkinson, Vocational Rehabilitation Counsellor, M.Ed. C.C.R.C

Ms. Maureen Parkinson is the province-wide vocational rehabilitation counsellor at the BC Cancer Agency. She has also been vocational rehabilitation counsellor at a public rehabilitation hospital and vocational rehabilitation consultant to insurance companies and the court system. She has instructed and facilitated Service-Canada-funded programs on job searching and career exploration. Ms. Parkinson has a Masters in Counselling Psychology, is a Canadian Certified Rehabilitation Counsellor, and completed the Certified Return to Work Coordinator Program through the National Institute for Disability Management and Research. She has developed return-to-work and job-search seminars for cancer patients and created the guidebook “Cancer and Returning to Work: A Practical Guide for Cancer Patients” as well as on-line articles about returning to work and school. She also co-authored a paper commissioned by the Canadian Association of Psychosocial Oncology, “Cancer and Work: A Canadian Perspective”.

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The lymphatic system is a part of the circulatory system and plays an important role in immunity. It also collects fluids from the tissue spaces and transports it for eventual return to the circulatory system. If the transport function of the lymphatic system is reduced, then swelling may occur in that region of the body. This specific type of swelling is known as lymphedema.

Lymphedema results from damage or impairment of the lymphatic system. People who have or have had cancer may be at risk for developing lymphedema because some of the treatments for cancer or cancer itself may impair the lymphatic system. For example, surgeries that remove lymph nodes (lymph node dissections or sentinel node biopsies), radiation therapy, and some tumours may lead to a reduction in the carrying or transport capacity of the lymphatic system. Lymphedema typically does not cause generalized swelling but rather shows up only in the region that may have been damaged. For example, somebody who had an axillary lymph node dissection for treatment of breast cancer may go on to develop lymphedema in the affected arm, hand or on the lateral trunk. Typically, we think of lymphedema affecting a limb—an arm or leg—but depending on where the lymphatic damage occurs, it can produce facial, genital or trunk swelling. In addition to visible swelling, many patients also report other symptoms of lymphedema – a feeling of heaviness, pain, tightness, aching and impaired function of the involved limb.

Vocational implications

Lymphedema may restrict the function of an arm or leg, cause discomfort and affect the appearance of the limbs. For lymphedema in the arms, repeated lifting with a heavy limb may be difficult. Lifting items above the head may also pose a challenge. Patients may also experience reduced range of motion in the affected arm. For lymphedema in the legs, it may be harder to sit or stand for prolonged periods. Patients who need temporary adjustments at work may need to educate their employers about lymphedema because many people have never heard about this possible complication of cancer treatment.

What patients can do

Treatment for lymphedema may include some or all of the following therapies: manual lymph drainage, compression therapy, skin care and exercise. Depending on the amount of swelling, people with lymphedema may need to wear a compression garment over the affected area. Encourage your patient to speak to their healthcare team for more information about how to best manage lymphedema.

Many cancer centres across Canada provide some form of management for lymphedema, for example, the McGill Lymphedema Research Program. Lymphedema treatment may be offered by physiotherapists, occupational therapists, registered massage therapists or nurses.

For patients who have lymphedema or are at risk for developing it, here are some risk reduction practices:

  • Strive to maintain an optimal body weight. Obesity is a significant risk factor for lymphedema.
  • Keep the skin clean and report any redness, warmth, pain or increased swelling.
  • Avoid injury to the skin to reduce risk of infection.
  • Lead an active lifestyle incorporating regular, gradually increased, paced exercise.
  • Avoid injuries and inflammation due to overuse of muscles.
  • Ensure compression garments are well fitted.
  • Avoid constricting clothing.
  • Carry a purse or heavy object on the non-affected side.

Resources on lymphedema:

Job accommodation ideas

There are several ways that jobs can be modified to accommodate lymphedema. Occupational or physical therapists can suggest mobility aid options.

Modify work tasks:

  • Avoid tasks that could cause trauma to the skin (e.g., tasks involving sharp objects or tools, or extreme temperatures such as boiling water or freezers).
  • Reduce tasks that involve heavy lifting.
  • If the patient works standing up, encourage them to sit down when possible. Use a stand-lean chair or keep a rest chair nearby.
  • The patient should work at a speed that is comfortable for them.
  • Take 2 minutes to stretch every hour to encourage lymphatic flow.
  • Switch heavy and light tasks throughout the day.
  • Complete heavy or the most important tasks when the patient has the most energy.

Modify equipment:

  • Use a compression garment to help manage swelling and protect the skin.
  • Wear protective gloves for tasks that could risk breaking the skin.
  • For jobs that involve computer use and typing, request speech recognition software, and alternatives to mice and/or switches accessed by other body parts.
  • Build up” handles of tools with foam pipe insulation to increase the handles’ diameter.

Accommodate heavy, swollen limbs:

  • Reduce repetitive physical exertion.
  • Request tasks that are less physically demanding.
  • Use electric tools to replace manual effort.
  • Vary repetitive tasks with other duties.
  • Ensure that frequently used materials are in reach.
  • Move heavy objects to waist height, so they can be slid across a counter instead of picked up.
  • If the affected limb(s) does not fit into the work uniform, request alternative clothing.

Modify the work environment:

  • Ensure that a first aid kit is easily accessible from the workstation. It should contain antiseptic to decrease risk of infection if skin is broken.
  • Request positional supports to elevate swollen heavy arms (e.g., pillows, Aussie bags, adjusting the height of armrests on chairs).
  • Request a footrest to elevate swollen feet/ankles.
  • Avoid extreme heat or cold.
  • Optimize air quality.

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