Megan Best, Edite Tang, Mark Buhagiar and Meera Agar. Journal of Lymphoedema, 2018, Vol 13, No 1

Main findings

• The International Lymphoedema Framework has proposed the term ‘oedema at the end of life’ (OATEOL) to cover all forms of oedema that develop as a result of multiple factors relating to terminal illness (International Lymphoedema Framework and Canadian Lymphedema Framework, 2010).
• It unlikely that pure lymphoedema exists in this population.
• Palliative care inpatients in two metropolitan palliative care units in Sydney, Australia. This was a cross-sectional, consecutive cohort study for the period of one calendar month (June 2013).
• All inpatients during the study period were screened for pitting lower-limb oedema through the normal process of admission to the unit. Pitting of the lower limb was assessed by applying sustained pressure for approximately 20 seconds against the medial malleolus and observing for persistent depression in the tissues after removal of pressure.
• Risk factor variables included medications at the time of admission that promote fluid retention, such as calcium blockers, NSAIDs, corticosteroids, or medications containing oestrogen; anticoagulant use and/or history of venous thromboembolic disease; cancer diagnosis; pelvic or abdominal involvement with tumour; past or current lower-limb cellulitis, ulcer or trauma; organ failure (renal, hepatic, cardiac); hypoalbuminaemia (serum albumin <32 g/L) if performed by the treating team within 3 days of admission; thyroid disease; and obesity. A global measure of functional status defined by Karnofsky (Australian) Performance Scale (AKPS) (Abernethy et al, 2005) was also collected to define level of immobility.
• 30 out of 59 had lower limb oedema.
• The most common risk factors were: cancer diagnosis (83%), medications that promote leg swelling through fluid retention (70%) and AKPS score <40 (63%).
• The prevalence of oedema is considerably higher than that of chronic oedema in the general community.
• The average number of risk factors per patient was 3.4. While some of these risk factors are unavoidable, such as diagnosis and disease distribution, others could conceivably be avoided. In view of the prevalence of OATEOL, more attention needs to be given to use of medications known to promote fluid retention in advanced disease. Similarly, this study supports initiatives to encourage exercise and weight control even in patients with life-threatening disease.
• Strengths of this study include a consecutive cohort, which reduces bias of the prevalence rate, and formal identification of the presence of oedema by a trained physiotherapist/medical officer. Limitations of this study included the small sample size and the age of the data.