Are there differences in patterns of care for upper-limb and lower-limb lymphoedema provided by professionals specialising in lymphoedema treatment?

Background - Approximately 30% of all patients with breast cancer, up to 60% of patients with cancer of the vulva, and 20% of patients with other gynaecological or urological cancers will develop lymphoedema following treatment. Several workshops and conferences held in Australia and worldwide recommended improvements in the diagnosis and treatment of lymphoedema, but the extent to which this had found reflection in clinical practice is unknown. Methods - Sixty-three health professionals (response rate 92.6%) known to treat lymphoedema patients were interviewed by telephone to assess their socio-demographic characteristics, common ways of receiving referrals, treatment and advice provided to lymphoedema patients, confidence in treatment and to determine if these factors differed by health professionals background or for patients with upper-limb lymphoedema (ULL) or lowerlimb lymphoedema (LLL)). Results - Sixty-three percent of the health professionals reached were physiotherapists, the majority were university-trained and had treated patients for lymphoedema for 20 years or more. Ninety-five percent of health professionals used circumferential measurements to establish lymphoedema status, and most health professionals advised patients to avoid scratches and cuts (100%), insect bites (98.4%), sunburn (98.4%) and excessive exercise (65.1%) on the affected limb. Health professionals reported that patients with LLL were less likely to present within the first 3 months of being symptomatic (p < 0.01), and patients with LLL were more likely to present with swelling (p = 0.001), heaviness (p = 0.003), tightness (p = 0.007) and skin problems (p < 0.001) compared to patients with ULL. Treatment and advice differed according to health professionals background, but not location of lymphoedema (ULL vs LLL). Conclusions - This survey illustrates that improvements can still be made with regards to standardising assessment, advice and treatment across professional groups. There is also suggestion that further educational efforts seem necessary to improve the early detection of LLL