Guest Editor, Nicole Stout, DPT, Certified Lymphedema Therapist-LANA, FAPTA has produced a packed, special issue on Lymphedema management that advances our knowledge in this important topic for oncologic physical therapists and cancer rehabilitation. 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. Dr. Stout states, "20 years after the ACS seminal report, the horizon for the future of lymphedema management is bright and includes exciting emerging science including:
- 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 like 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"(See Indocyanine Green Demonstrating Positive Anatomical Changes One Year After Initiation of Conservative Therapy for Lymphedema: A Case Study ). Get informed about "Medication's Potential Impact on Breast Cancer-Related Lymphedema." Read about "Self-care in female cancer survivors with secondary lymphedema: characteristics of women needing support to perform self-care" and listen to Dr. Lindquist's podcast on the journal homepage to continue to translate your knowledge to practice for lymphedema management, and for lymphedema outcome measures in "What is Clinically Important in Lymphedema Management Outcomes? A Systematic Review", and read about a promising new outcome lymphedema measure in "Validation of the Lymphedema Life Impact Scale (LLIS) Version 2; A Condition-Specific Measurement Tool for Persons with Lymphedema."
"The prevalence, incidence and quality of life impact of lymphedema after treatment for vulvar or vaginal cancer" addresses survivors with secondary lymphedema that we know little about.
The Clinical Conversation column highlights an important tool in your toolbox, "Using Low Level Light Laser in Your Lymphedema Practice; Benefits and Cautions", as does the Industry news/ Technical note, "Relax Compression Garment from BSN Medical" for therapists seeing survivors with early stage, low level lymphedema – think prospective surveillance. For educators, "Integrating Edema Management into Entry-Level Doctor of Physical Therapy Curriculum: A Case Report" may assist you with incorporating this important addition to your curriculums. On a personal note – I hope you find something to delete from the curriculum to make room for this content given the number of cancer survivors with lymphedema.
Dr. Stout states "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, 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 copays 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."
To quote Dr. Stout, "The future is bright, the future is smart, and we must continue to seize on opportunities to advance novel approaches to lymphedema management." Lastly, read "My Story" by Kathy Bates and you will be inspired to continue to fight to serve these underserved cancer survivors. I hope you had an enjoyable holiday season and have a wonderful year. Please do not hesitate to contact me with any feedback you have on our journal.
Lucinda (Cindy) Pfalzer, PT, PhD