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Lymphedema Management

The Next Decades

Stout, Nicole L., DPT, CLT-LANA, FAPTA

doi: 10.1097/01.REO.0000000000000104
GUEST EDITOR'S MESSAGE
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Guest Editor of Rehabilitation Oncology, and is a project coordinator for Cancer Rehabilitation Initiatives at the Rehabilitation Medicine Department at Rehabilitation Medicine, Office of Strategic Research, National Institutes of Health Clinical Center, Bethesda, MD

Correspondence: Nicole L. Stout, DPT, CLT-LANA, FAPTA, Rehabilitation Medicine, Office of Strategic Research, National Institutes of Health Clinical Center, MSC 1604, 10 Center Dr, Bethesda, MD 20892 (Nlstout90@gmail.com).

The author is a paid consultant to Zansors LLC.

The author declares no conflicts of interest.

In 1998, the American Cancer Society (ACS) released a supplement issue to the journal Cancer that highlighted the workshop proceedings from an international group of subject matter experts in lymphedema management. It was a seminal publication that served as a catalyst in accelerating awareness in the United States. Twenty years on, the field of lymphology and lymphedema clinical management has become far more mainstream in medicine through improved NIH-funded research, the emergence of 2 journals specifically focused on lymphology and lymphatic research, and improved access to clinical care by specialists in this area of practice.

Clinically, the number of therapists nationwide with expertise in lymphedema management has markedly increased, making this service a commonality among hospital and health systems rather than an anomaly. National certification through the Lymphology Association of North America, the Oncology Section's Certificates of Achievement in Oncology Physical Therapy program, and a multitude of comprehensive training programs promote advanced skills in the rehabilitation community. Emerging practice guidelines have lead us to increasingly understand the onset of lymphedema related to cancer, promote early identification, and undertake efforts to proactively manage the condition at the earliest onset.

Twenty years after the ACS seminal report, the horizon for the future of lymphedema management is bright and includes exciting emerging science:

  • Imaging techniques that improve our understanding of the lymphatic system and may contribute to better clinical therapeutics.
  • Clinical trials studying drug mechanisms that have shown great promise in reversing lymphedema.
  • Sophisticated technologies that can improve clinical management through interventions such as low-level light laser and limb monitoring with wearable sensors and cloud-based apps.

It is exciting to see many of these topics reflected in this special issue. Laser therapy and near infrared imaging using indocyanine green are topics of interest in this issue that are paving the way to improved clinical management.

The true measure of our advancement is in how our patients are impacted by the evolution in the field. Decreased wait times to access therapy, more knowledgeable therapists, and better and higher-quality materials and treatment devices have emerged in the last decade. However, there are still significant barriers to care and clinical questions that we must set our sights on solving in the next decade:

  • - Payment still languishes for skilled therapy and for modalities and devices of greatest need for optimal lymphedema management.
  • - Access to specialty care may be limited by new and ever-changing health care plans with high co-pays and provider limitations.
  • - Telehealth and digital health interventions hold promising hope for our patients who are faced with day-to-day condition management but will require greater effort to become mainstream.

Wouldn't it be great if our patients could have a sensor patch to wear on their limb that would send data on tissue moisture, tissue tension, and meaningful tissue changes via Bluetooth to a platform that can analyze that information and send them back a report on how they may better tailor their day to support their limb?

Hey Alexa, how's the day look for my lymphedema?”... Well Nicole, according to your data from the last 24 hours, your L-Dex ratio is up just a bit and the weather is supposed to be hot and humid today, you also have an appointment at the gym on your schedule. You may want to take an extra set of bandages with you to put on after your work out to quell any effects from the day. And grab 2 extra glasses of water.

The future is bright, the future is smart, and we must continue to seize on opportunities to advance novel approaches to lymphedema management.

©2018 (C) Academy of Oncologic Physical Therapy, APTA