Lymphoedema

Ongoing assessment for toxicities/late effects

In patients with breast cancer ensure that follow-up care includes ongoing assessment and supportive care for possible long-term toxicities and late effects of adjuvant treatments (including secondary cancers, cardiovascular toxicity, lymphoedema, mental health (including distress, depression, anxiety, body image), sexual health, premature menopause, infertility, fatigue, weight gain, impaired cognitive function, musculoskeletal health, pain and neuropathy, and bone health).

Lymphoedema – Risk minimisation #1

For patients who have had treatment for breast cancer, give advice on skin care and how to prevent and manage infection that may cause or exacerbate lymphoedema.

Lymphoedema – Risk minimisation #2

When informing patients with breast cancer about the risk of developing lymphoedema or breast or chest wall oedema, advise them of the importance of using the treated arm in daily activities and of regular participation in physical activities and maintenance of a healthy weight to minimise the risk of lymphoedema/oedema. 

Treatment-related pain – Management

Where treatment-related pain is present, offer interventions such as paracetamol and non-steroidal anti-inflammatory drugs. Consider referral to a specialist practitioner (e.g. lymphoedema therapist, occupational therapist, or pain specialist) as appropriate, depending on the underlying cause of the pain. 

Lymphoedema management – Procedures on the treated side

Low risk medical procedures (such as injections, blood tests, or intravenous administration of medicines) can be performed on the arm of the treated side if needed, as such procedures will not cause or worsen lymphoedema. In patients with lymphoedema, blood pressure monitoring on the arm of the treated side should depend on clinical need.

Lymphoedema risk assessment and referral

Patients at higher risk of lymphoedema (e.g. those in whom axillary clearance or axillary radiation therapy is planned, or patients with lymphatic insufficiency) should be referred to a lymphoedema therapist for assessment prior to breast cancer treatment, and for regular monitoring after breast cancer treatment. Bioimpedance measurements may be part of the clinical assessment.

Fatigue management and referral

Offer therapy or referral, as appropriate, for factors that may impact on or cause fatigue (e.g. depression, sleep disturbance, pain, anaemia, lymphoedema, thyroid or cardiac dysfunction). For those patients who do not have an otherwise identifiable cause of fatigue, offer referral to appropriate assessment and treatment services (such as a psychologist). 

Lymphoedema risk information

Inform all patients with breast cancer about the risk of developing lymphoedema and provide relevant information before treatment with surgery or radiation therapy.

Lymphoedema management – Access to a lymphoedema therapist

Patients who have been treated for breast cancer who develop lymphoedema should have access to a lymphoedema therapist.