Early access to specialist lymphedema physiotherapy treatment should be funded by the government, according to the Australian Physiotherapy Association, who joined the Australian Lymphology Association in calling for change.

With around 1 in 6000 Australians born with lymphoedema, and around 20 per cent of cancer patients developing the condition due to treatment side effects, the funding would have a positive impact on thousands of people.

Lymphoedema is the accumulation of fluid in the body which causes uncomfortable swelling, impaired mobility and recurrent infections. It most frequently affects the arms and legs, but can also be present in the groin, head and neck regions.

Primary lymphoedema is a congenital condition in which the lymphatic vessels and nodes are not fully formed, while secondary lymphoedema occurs after damage to the lymphatic system, such as trauma, surgery or radiation therapy (often associated with cancer treatment). The condition is chronic and requires ongoing monitoring and self-management supported by qualified health professionals.

National Chair of the APA Cancer, Lymphoedema and Palliative Care group, Elise Gane, says that providing federal funding and early access to specialist lymphoedema physiotherapy treatment is essential to reduce the significant personal impact and wider socio-economic burden of this condition.

“Physiotherapy takes a biopsychosocial approach to managing lymphoedema - our treatment programs aim to address symptoms, such as pain, to reduce and then stabilise the volume of swelling, to facilitate exercise and physical, and to support patients and their families to manage the emotional side effects of having lymphoedema, which may be present alongside other diagnoses such as genetic conditions or cancer.”

The primary form of treatment is complex decongestive physiotherapy, which uses manual lymphatic drainage (a specialist form of massage) to shift lymph fluid and compression bandaging to reduce the size of the swollen area.

“With regular treatments, the volume of the swelling reduces and stabilises, to a point at which a compression garment can be prescribed.

“Compression garments are made from material similar to thick ladies hosiery, and can be custom-made to just about any part of the body.”

Ms Gane says there is significant evidence for the effect of compression with manual lymphatic drainage.

“Research groups around the globe are currently exploring the ways in which new imaging technologies can be used to optimise the use of manual lymphatic drainage - near-infrared fluorescence lymphatic imaging involves the injection of a dye into the affected body part; when the dye gets taken up by the lymphatic system, the lymph vessels can be visualised.

“This means there is potential for individualising the application of manual lymphatic drainage to each patient to make it even more effective.”

Currently, patients can access specialist lymphoedema services under the Chronic Disease Management, which entitles individuals with a chronic disease to up to five funded visits with health professionals per year.

However, Ms Gane says five visits per year is not frequently enough to manage lymphoedema, and the funding per visit provided does not reflect the high level of skill and knowledge being implemented by lymphoedema therapists.

“Funding for compression garments differs in each state and territory across Australia, however it is common to have patients paying out-of-pocket expenses for the customisation of garments or for extra garments that are required when their volume of swelling can change.

“Funding more of the products and services required by people with lymphoedema would enable individuals to see their specialist health professionals more often, and importantly when needed, as well as facilitating their own self-management of this chronic disease.

“Having appropriate compression garments available when needed would make their use more effective, and reduce out-of-pocket expenses.

Ms Gane says when people with lymphoedema can successfully self-manage, they are less likely to experience cellulitis, which often requires hospital admission. 

“On an individual level, having a person with lymphoedema self-managing successfully enables that person to participate more widely in the workplace, in the family, and in the community in general; and to live a physically active lifestyle with the aim of reducing the risks of other co-morbid disease.

“On a community level, there are clear economic benefits to having more people at work and to keeping people out of hospital.”