Palliative Care Edema: Patient Population,Causal Factors,and Types of Edema Referred to a Specialist Palliative Care Edema Service

Abstract

Abstract

Background:

Edema in palliative care patients is a common symptom, however, the research base for all aspects of its care is extremely poor.

Objective:

To evaluate a specialist palliative care edema service in order to report on the patient population referred, the types of edema encountered, and the causes of edema.

Design:

Prior to study, three different edema types were described for evaluation: lymphedema, nonlymphatic edema, and a combination of the two. Retrospective chart evaluation was completed from August 2013 through January 2014.

Subjects:

Patients with edema assessed by the specialist palliative care physiotherapy edema service.

Results:

Sixty-three cases were included, comprising 10.5% of all new palliative care referrals during the study period. Ninety-two percent (n = 58) had a diagnosis of cancer and 57% (n = 36) were female. Age ranged from 45–97 years. The most common edema type was a mixed edema (46%, n = 29), followed by lymphedema (27%, n = 18) and nonlymphatic edema (16%, n = 10). Lymphorrhea occurred in 9.5% of cases. The most common reasons for edema, based on clinical opinion, were blocked lymphatics (33%) and dependency from immobility (27%). The most common site for edema was in the lower limbs (89%, n = 56). The time lapse from the last treatment to death ranged from 1–225 days. Having a mixed edema type or lymphorrhea was a relatively poor prognostic sign.

Conclusions:

This is the first study to describe in detail the occurrence of edema in palliative care patients. Edema may be present for many months prior to death making the search for effective treatments imperative.