b'6. Skin Care and Prevention: Skin care is essential toOvert disease is managed conservatively through aavoid complications like cellulitis that can arise fromsuite of interventions that are collectively classed as lymphedema. Maintaining proper skin hygiene andComplete DecongestiveTherapy (CDT).preventing infections is critical and includes avoidingSurgical referral for debulking procedures orcuts, burns, and insect bites, keeping the skinmicrovascular lymphatic reconstruction is predicated moisturized, and avoiding dry and cracked skin. upon the judgment of appropriately trained 7. Weight Management: Maintaining a healthyclinicians.weight can help reduce the burden on theThese interventions are adequately supported by lymphatic system. Diet and nutrition guidance maythe data derived from more than 40 years of clinical be provided, and seeking out an experienced andobservation and investigation 34 .trained nutritionist may be of benefit. 8. Complete Decongestive Therapy (CDT): CDT is CHALLENGES ANDa comprehensive approach to lymphedema management that typically includes a combinationLIMITATIONSof manual lymphatic drainage, compression therapy, exercise, and skincare. It is often deliveredSeveral key challenges relate to the current status of in multiple sessions over several weeks. lymphedema (LE) treatment, research, and education.9. Surgical Options: such as surgical debulking Challenges:through liposuction (suction-assisted protein1. Lack of awareness and understanding among lipectomy or SAPL), lymphaticovenous anastomosis (LVA), or vascularized lymph node transfer (VLNT)healthcare providers. A study conducted in 2004may be considered in cases where lymphedema isby Dr. Stanley G. Rockson, Allan and Tina Neill recalcitrant to conservative management.Professor of Lymphatic Research and Medicine at 10. Psychosocial Support: Lymphedema can beStanford University School of Medicine, revealed that only 30 minutes or less of the medical school isolating, a burden with significant emotional andcurriculum across the U.S. was routinely devoted to psychosocial impact. Supportive care, counseling,the lymphatic system in the first two years of and addressing body image concerns are essentialmedical school training 24 . for holistic management. 2. Historical neglect of the lymphatic system in 11. Monitoring and Follow-up: Regular monitoring medical education. Unfortunately, there has not and follow-up appointments with healthcarebeen a change in lymphatic system education in the providers help assess progress, adjust treatmentmedical school curriculum over the last two decades plans as needed, and prevent complications. since the initial study was conducted.Two international organizations, The International3. Institutional pushback from journals and Society of Lymphology and the International Lymphoedema Framework, have supported theseassociations. Although involved in almost every approaches. It is important to note here that there issingle system in the body, lymphatics receiveno comparable approach that is directed specifically tovery little focus or emphasis across the research those living with lymphedema in the U.S., an importantcommunity. To better understand the population-public health goal that is not difficult to achieve withbased impact of lymphatic disease (LD) and the proper attention and resources. lymphedema, this must become a clear focusfor organizations with the resources to help leadBEST PRACTICES AMONGST SPECIALISTS this endeavor.The approaches summarized above are consistentlySuggestions for Addressing Challenges: practiced by lymphatic and vascular care specialists.To address the above challenges, the following steps This provider cohort generally includes vascularhave been proposed:medicine and surgical specialists but also embraces 1. Implement lymphedema education programs in a smaller cadre of practitioners in dermatology, oncology, cardiology, and physical medicine, medical schools.2. Advocate for more research funding.among others. The approach to the at-risk population includes3. Collaborate with patient advocacy groups to aggressive objective surveillance with both non- raise awareness.invasive and imaging techniques; when subclinical4. Include patient advocates in the decision-makingdisease is detected, aggressive preemptive measuresprocesses for clinical, institutional, and research are undertaken that can forestall or minimize clinicalefforts.disease expression. |National Indicator Report on Cancer-Related Lymphedema (LE)|16'