NICE Guidelines and Lymphoedema

Hi All

The NICE guidelines for both Advanced and Early + Locally advanced Breast Cancer have not long been published. Here’s the link in full (to the early + locally advanced) if anyone’s interested:

nice.org.uk/nicemedia/pdf/CG80FullGuideline.pdf

And here are some lymphoedema-relevant extracts:

The NICE guidance on ’Improving outcomes in breast cancer manual update’ (NICE 2002)recommended that ‘Cancer networks should agree guidelines for identification and management of lymphoedema’ and that ‘a lymphoedema service, staffed by trained nurses and physiotherapists, should be available for all patients who experience arm swelling or discomfort’.

'Although there is an expectation of delivery of these services for breast cancer patients, current provision of lymphoedema services is variable.

‘Inform all patients with early breast cancer about the risk of developing lymphoedema and give them relevant written information before treatment with surgery and radiotherapy.’

‘Give advice on how to prevent infection or trauma that may cause or exacerbate lymphoedema to patients treated for early breast cancer.
Ensure that all patients with early breast cancer who develop lymphoedema have rapid access to a specialist lymphoedema service’.

‘Observational evidence suggests that where information is provided to patients on lymphoedema, it is done so by different healthcare professionals, with no apparent dominant group’.
(Cordero et al., 2003; Coward, 1999; Karki et al., 2004 and Yik et al., 2001).

‘RCT evidence suggests that instructed physiotherapy or instructed exercise interventions are associated with improved patient compliance, a better range of arm movement and lower rates of lymphoedema compared to control arms in which patients receive booklets or other education for unsupervised exercise’.
(Beurskens et al., 2007; Box et al., 2002a; Cinar et al.,
2008; Gerber et al., 1992; Lauridsen et al., 2005; Na et al., 1999 and Wang et al., 2005).

Data from one RCT suggest that patients treated with zaltoprofen have improved range of shoulder movement during physiotherapy compared to patients in a control group (Hase et al., 2006).

Comments, thoughts, anyone? And has anyone been treated with zaltoprofen (presume it’s not dissimilar to ibuprofen)?.

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