Lymphoedema better care is needed Dr Kristiana Gordon MBBS, FRCP, - - PowerPoint PPT Presentation

Lymphoedema – better care is needed

Dr Kristiana Gordon

MBBS, FRCP, MD(Res), CLT

Consultant & Reader in Dermatology & Lymphovascular Medicine St George’s Hospital, London

Key Messages

• Lymphoedema is a common, under-

recognised condition, and often mismanaged in the community.

• Treatment will improve quality of life and

prevent complications, including recurrent infections.

• Lymphoedema treatment should be made

available by all Clinical Commissioning Groups (CCGs) to improve care and save money. Community care is preferable.

Who gets Lymphoedema?

• It can affect newborns to the elderly – it does

not discriminate!

• It is chronic and incurable.

What is Lymphoedema?

• Lymphoedema is the swelling of any body site

(i.e. “chronic oedema”).

• It develops when the lymphatic system cannot

drain fluid properly from our tissues.

• There are many causes:

Ø > 1000 people/children affected by gene defects. Ø 25% of cases are due to cancer treatment. Ø Obesity, being immobile, inflammatory disease, blood pressure drugs, varicose veins, trauma...

How common is Lymphoedema?

• More than 423,000 people in the UK are living

with Lymphoedema

• It is as common as Alzheimer’s disease,

4 times as common as HIV, and 12 times as common as Multiple Sclerosis.

• 1 in 5 women with breast cancer will get it.

Can we treat Lymphoedema?

• No evidence based Drug treatment
• Physical Therapy:

Ø Initial reduction in swelling = compression bandaging, manual lymphatic drainage massage, exercise, skin care Ø Maintenance treatment = compression garments, skin care, exercise, weight control

Can we treat Lymphoedema?

• No evidence based Drug treatment
• Physical Therapy:

Ø Initial reduction in swelling = compression bandaging, manual lymphatic drainage massage, exercise, skin care Ø Maintenance treatment = compression garments, skin care, exercise, weight control

• Prevention of recurrent infection with physical

therapy and prophylactic antibiotics

Is Lymphoedema care available in your area?

• Terrible inequality of lymphoedema care

across the UK

• Many CCGs discriminate and only offer care to

patients with cancer-related lymphoedema

• Several CCGs have NO commissioned

lymphoedema services

• Inability to access lymphoedema care causes

unnecessary suffering, complications, and preventable costs to NHS

Why must we treat Lymphoedema?

• Lymphoedema is associated with many health

problems if left untreated: Ø cellulitis infections, often need hospital admission Ø wounds and leg ulcers Ø mobility problems, pain, psychological issues…

• Management of complications is costly to the NHS
• Early diagnosis and treatment is vital for achieving

the best outcomes for the patient and the NHS

Cost of Cellulitis to the NHS

• Cellulitis causes 400,000 bed days per year in UK
• Costing approx £250 million per year
• Cost savings can be made!
• The introduction of a London lymphoedema

service created 94% decrease in cellulitis incidence, with 87% reduction in hospital admissions that year.

• Potential NHS saving of more than £200 million

per year if we can deliver lymphoedema care to everyone.

Other savings to be made:

• Improved care of lymphoedema would reduce

the incidence of wounds / leg ulcers

• Reduction in GP footfall, community nursing

hours, wound care dressings and bandages.

• Less wastage of incorrect compression garments

provided by GPs and community nurses (estimated saving of £3 million per year)

What Needs to Happen:

• Sufficient numbers of Lymphoedema treatment

clinics within every CCG.

• No discrimination between cancer-related and non-

cancer related Lymphoedema. Equity is essential.

• This will improve care and save £millions for the NHS.
• Launch of the NLP Commissioning Guidance for

Lymphoedema Services in 2019.