Lymphoedema Case studies for health and care professionals
Below are the summaries of a selection of lymphoedema case studies. The full versions of these can be found from page 52 of the Commissioning Guidance.
Delayed treatment incurs increased costs
A 61 year old woman presented at the lymphoedema clinic with moderate-severe leg lymphoedema and pain. She had difficulty finding clothes and shoes to fit and, due to the severity of her symptoms, was unable to work. She required a three week course of daily intensive lymphoedema treatment, at a cost of £14,500, followed by self-treatment.
Had she been appropriately treated at first presentation with mild post-surgical leg swelling, she could have been effectively managed with a self-treatment programme including hosiery at a cost of around £5,000. This would have saved the NHS around £9,500.
Timely treatment saves money
A 44 year old man had untreated bilateral leg swelling of many years duration. Over a two year period he was admitted to hospital three times for treatment of cellulitis, a potentially serious complication of lymphoedema. He then developed lymphorrhoea (leaking lymph), which was managed by the community nursing service, and was unable to work, with loss of income. He was then referred for lymphoedema treatment that effectively reduced and stabilised his symptoms, and improved his quality of life and ability to work.
Impact of specialist lymphoedema treatment
A young man, in his early 20’s, with cancer of the penis developed leg swelling shortly after his initial cancer treatment, and subsequent complications of lymphorrhoea (lymph leakage) and cellulitis (infection) in his scrotum. He was highly distressed and angry about his cancer diagnosis and the recommended lymphoedema treatment.
The specialist lymphoedema team worked with him to find solutions to his changing symptoms. They created personalised care interventions that provided education for self-management components, were responsive to his preferences regarding treatment strategies, and also provided psychosocial support. Key to this was extensive communication with the patient, his GP, cancer consultant nurse specialist and other members of the multi-disciplinary team.
Prescription errors cost money
A lady with breast cancer-related arm and hand swelling was self-managing her symptoms with compression hosiery. She was given the necessary information to obtain her hosiery on prescription from her GP. Unfortunately, the prescribed garment was the incorrect size and wrong style, covering only her arm and not her hand. As a result her hand swelled and she required a 2-week period of daily intensive treatment to regain satisfactory control of her swelling; she was unable to work during this period.
Timely provision of the correct garment would have been a cost saving of £1230 (based on BLS tariff guidance). In addition, the lady would have avoided the negative impact of increased hand swelling on her quality of life and loss of work time.
The importance of appropriate medical intervention
A 72 year old woman with head and neck cancer developed severe swelling of her face and tongue with recurrent cellulitis (infection). She required multiple treatments with antibiotics over the next 18 months. Medical opinion differed about the management of recurrent cellulitis.
Following referral to a national centre who commenced a prophylactic antibiotic regimen, cellulitis resolved with improvement in facial swelling and reduced pain. The lady was then able to engage with recommended lymphoedema treatment and undertake an effective self-management programme.
Early access to appropriate treatment of lymphoedema and advice regarding cellulitis management would have reduced the number of episodes of cellulitis and associated treatment costs, the morbidity to the patient and the economic and psychological burden on the patient and her family.