Advanced cancer presents complexities that can be difficult to manage with conventional lymphoedema treatments and a palliative approach to improve quality of life and comfort of patients may be required (ILF, 2010 & WHO, 2017).
Radiation induced angiosarcoma is a rare treatment complication arising
within the field of previous therapeutic irradiation affecting soft tissues
(Sarcoma UK, 2017).
Figure 1 illustrates Mrs D’s disease burden which contributed to
lymphatic obstruction, led to infection and contributed to her pain.
Mrs D an 88 year old lady presented with a history of left breast cancer and radiation induced angiosarcoma with left fungating tumour. She was in the terminal stages of cancer and referred to the clinic with 2 year history of previously untreated severe left arm lymphoedema following cellulitis.
The left (dominant) arm was painful, misshapen with severe skin folds and significant fibrosis was present.
Her mobility was limited with reduced range of movement throughout her arm. She was unable to wear traditional sari’s and her clothing had to be adapted. She was dependent on her daughter for all personal care.
Her goals were identified: to brush her hair, dress herself and eat independently
A treatment plan was identified and agreed with the patient and her daughter
Over 6 weeks this involved:
The Mobiderm armsleeve is a semi open garment with velcro fasteners
which allows for easy donning and conforms to variations in patients arm
Shape. The Mobiderm foam construct within the sleeve, applies a soft
pressure and provides microcirculation of the tissues. This can assist in
softening fibrosis and promoting lymphatic drainage.
Discussion and Implications for Practice
Palliative care management in lymphoedema is about being creative, adapting and tailoring our treatment options to suit our patients needs, exploring the market and using products we may not have previously considered
Feedback from Mrs D’s daughter ‘The sleeves in particular the Mobiderm, really helped my mother’s left arm and considerably reduced the swelling. That brought a lot of comfort to her in her last few days’.
This case highlights the important role lymphoedema therapists can play in maintaining a patient’s independence and comfort in end of life care
World Health Organisation (2017). Palliative care. Available at: http://www.who.int/cancer/palliative/en/. Accessed: 24 May 2017
The International Lymphoedema Framework (2010). The management of lymphoedema in advanced cancer and oedema at the end of life. Available at: http://www.lympho.org/portfolio/the-management-of-lymphoedema-in-advanced-cancer-and-oedema-at-the-end-of-life/. Accessed: 24 May 2017
Sarcoma UK (2017). Angiosarcoma. Available at https://sarcoma.org.uk/sarcoma-types/angiosarcoma. Accessed: 15 June 2017
Thank you to Mrs D and her daughter for allowing me the privilege of working with them during a very difficult time in their lives and consenting for her information to be used for educational purposes, to Haddenham Health Care for their expertise and providing the Mobiderm Autofit Sleeve to trial with patients in clinic and to my team from the Lymphoedema Service in Chelsea for their continuous support and sharing of knowledge.