ABSTRACT
BACKGROUND: Complex decongestive therapy (CDT) is a regimen of physical treatment for lymphedema. Its effectiveness is unknown in advanced cancer patients. This study evaluates effectiveness of CDT in this population. METHOD: This is a prospective observational cohort study for 18 months of advanced cancer patients with lymphedema, who received three or more CDT interventions. Measurements were taken before the first (T1), third (T3), and sixth (T6) treatments as follows: limb volume using circumferential measurements, quality of life (QOL) using qualitative questions, skin quality using a locally developed scale measuring color, thickness, and texture. The treating physiotherapists collected data. Analysis was carried out using Microsoft Excel and SPSS. RESULTS: Twelve patients, age range 42-73 years (median 69.5) were included. Survival from last recorded treatment ranged from 3 to 262 days (median 40). At T3 (n = 21 limbs), volume reduction was significant (Wilcoxin Signed Rank Test Z = -2.5, p = 0.01, r = 0.5). At T6 (n = 13 limbs), volume reduction was significant (Z = -2.4, p = 0.013, r = 0.66). At both time points, there were significant reductions in abnormal skin thickness and surface, but not color. Improvements occurred independent of volume changes. QOL changes included better function, improved limb aesthetics, and less pain and tightness. CONCLUSION: For the first time, this study shows that CDT is effective for a cohort of palliative cancer patients with limited survival. Improvements in limb volume, skin quality, and lymphedema-related QOL were recorded. Valid skin and QOL measures need to be developed. Larger, blinded trials need to be conducted to determine which patients benefit from CDT.
Subject(s)
Lymphedema/etiology , Lymphedema/therapy , Neoplasms/complications , Palliative Care/methods , Physical Therapy Modalities , Adult , Aged , Female , Humans , Longitudinal Studies , Male , Middle Aged , Pilot Projects , Prospective Studies , Quality of Life , Treatment OutcomeSubject(s)
Biotechnology , Drug Industry , Biotechnology/organization & administration , Biotechnology/statistics & numerical data , Biotechnology/trends , Drug Industry/organization & administration , Drug Industry/statistics & numerical data , Drug Industry/trends , Employment , Humans , WorkforceABSTRACT
AIM: To profile a specialised palliative care physiotherapy service to community-dwelling patients. DESIGN: Retrospective audit. SETTING: Milford Care Centre, Limerick, Ireland. PARTICIPANTS: Patients referred to hospice-at-home physiotherapy during September 2010-February 2011. OUTCOME MEASURE: Edmonton Functional Assessment Tool (EFAT-2). RESULTS: 165 patients were referred, of whom 90% had cancer. Nurses referred 120 (73%). Referrals appeared to be increased by the presence of physiotherapists in the nursing bases. No asssessment was conducted for 55 referrals (33%), mainly owing to clinical deterioration. The remaining 110 patients were assessed, with 47 (43%) being contacted within 2 days of referral (mean 4 days, standard deviation 4.2, range 0-21 days). Physical function ranged from 0-18 (median 7, mode 4) on the EFAT-2 scale. The most commonly used treatments were exercises and advice/education. CONCLUSION: Referrals to the at-home physiotherapy service are heavily dependent on nurses and their understanding of the physiotherapy role. Patients tended to be relatively high functioning and tolerated numerous interventions.
