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 works to collect fluid from the tissue spaces and transport it for eventual return to the circulatory (blood) 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 is a condition that results from damage or impairment of the lymphatic system. People who have or have had cancer may be at risk for developing lymphedema1 because some of the treatments for cancer or cancer itself may impair the lymphatic system. For example, surgeries where they remove lymph nodes (lymph node dissections or sentinel node biopsies)1, radiation therapy2, and some tumours may lead to a reduction in the carrying or transport capacity of the lymphatic system.3

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.4 5 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 including a feeling of heaviness, pain, tightness, aching and impaired function of the involved limb.6

Vocational implications

Lymphedema may restrict the function of an arm or leg, cause discomfort and affect the appearance of your limbs. Your ability to perform your work duties may be impacted. For lymphedema in your arms, repeated lifting with a heavy limb may be difficult. Lifting items above your head may also pose a challenge. You may also experience reduced range of motion in your affected arm. For lymphedema in your legs, it may be harder to sit or stand for prolonged periods of time. If you consider needing temporary adjustment in your work role, you might need to educate your employer about lymphedema as many have never heard about this condition as a possible complication to cancer treatment.

What you 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 will need to wear a compression garment over the affected area. Speak to your healthcare team for more information about how you can best manage your lymphedema.

For people who have lymphedema or are at risk for developing lymphedema, there are some risk reduction practices that you should be aware of:

  1. Strive to obtain an optimal body weight. Obesity is a significant risk factor for lymphedema.
  2. Take good care of your skin to reduce your risk of infection.
  3. Lead an active lifestyle—gradual, paced exercise is good for you. Injuries and inflammation due to overuse should be avoided.
  4. If you wear a compression garment, ensure that it is well fitted.

Some tips for you to reduce your risk of lymphedema:

  • Exercise regularly.
  • Avoid constricting clothing.
  • Avoid injury to the skin of the affected area.
  • Avoid carrying a purse or heavy object on the affected side.
  • Keep the skin clean and report any redness, warmth, pain or increased swelling.

Here are some resources on lymphedema:

Many cancer centres across Canada provide some form of management for lymphedema—access the cancer centre nearest you and inquire about services. Lymphedema treatment may be offered through physiotherapy, occupational therapy, or by registered massage therapists or nurses.

An example of a cancer centre offering lymphedema care is the “McGill Lymphedema Research Program.”

Job accommodations

Modify your work tasks and how you work:

  • Wear a compression garment as it may help manage your swelling and offer a measure of protection for your skin.
  • Avoid risky work tasks that could cause trauma to your skin. Request alternative duties to work tasks that involve the use of sharp objects or tools, or extreme temperatures (boiling water, freezers).
  • Wear protective gloves for tasks that could place you at risk of breaking your skin.
  • If you are uncomfortable due to a swollen, heavy limb:
    • Reduce repetitive physical exertion.
    • Do tasks that are less physically demanding.
    • Use electric tools to replace manual effort.
  • Reduce repetitive tasks; vary these tasks with other duties.
  • Ensure that frequently used materials are within your reach.
  • Move heavy objects to waist height; slide them on a counter instead of picking them up if possible.
  • Negotiate tasks that involve heavy lifting.
  • Sit down when you’re able to if you work in a standing position. Use a stand-lean chair if possible; if not, keep a rest chair nearby.
  • Pace yourself. Work at a speed that is comfortable for you. Break up heavy and light tasks throughout the day. Complete heavy or the most important tasks when you have the most energy.

Modify your work environment:

  • Locate and ensure that a first aid kit is easily accessible from your workstation, complete with antiseptic to decrease risk of infection if your skin is broken.
  • Elevate swollen limbs when possible. Consider positional supports for a heavy limb, for example, pillows or Aussie bags and adjusting the height of your chair’s armrests. For legs, consider a desk set-up where you may be able to elevate your foot/ankle.
  • Avoid extreme heat or cold; optimize air quality.

Other general tips:

  • Gradually build up your strength and activity tolerance with a graduated exercise program (see your healthcare provider for guidance).
  • If your affected limb(s) does not fit into your work uniform, discuss alternative clothing with your manager.
  • Regular movement is important to encourage lymphatic flow. Take two minutes to stretch every hour.
  • For jobs that involve computer use and typing, consider using speech recognition software, alternatives to mice and/or switches accessed by other body parts as options for swollen hands.
  • Experiment with “building up” handles of tools with foam pipe insulation to increase the handle’s diameter, requiring less grip strength to hold on to.
  • Consult with your local occupational or physical therapist for mobility aid options.

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