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European Journal of Oncology Nursing (2006) 10, 140–149
Reducing the symptoms of lymphoedema: Is there a
role for aromatherapy?
Janet Barclay, Jenny Vestey, Anita Lambert, Claire Balmer
Dorset Cancer Centre, Poole Hospital, Longﬂeet Road, Poole BH15 2JB, UK
Summary Lymphoedema is a chronic and debilitating condition caused by
lymphatic insufﬁciency, which may have serious physical, social and psychological
implications for the patient. It is usually managed by a combination of strategies
aimed at protecting and decongesting the oedematous limb(s) and stimulating the
development of supplementary lymphatic pathways to control swelling in the long-
term. However, it is not known which therapies are the most effective. Anecdotally,
the addition of aromatherapy oils to massage cream may have a positive effect on
symptom relief in people with cancer, although evidence is again lacking. This paper
describes a randomized trial of self-massage and skin care using a cream containing
aromatherapy oils versus self-massage and skin care using a cream without
aromatherapy oils on objective limb volume measurements and symptom relief as
measured by the Measure Yourself Medical Outcome Proﬁle 2 (MYMOP2) in a sample
of people with lymphoedema. Results indicate that self-massage and skin care
signiﬁcantly improved patient-identiﬁed symptom relief and wellbeing for this
sample. It also slightly, but not signiﬁcantly reduced limb volume. However,
aromatherapy oils, carefully chosen on the basis that they should beneﬁt this group,
did not appear to inﬂuence any improvement in these measures.
&2005 Elsevier Ltd. All rights reserved.
Zusammenfassung Das Lympho¨dem stellt ein chronisches und sehr belastendes
Leiden dar, das die Folge einer Insufﬁzienz des Lymphgefa¨ßsystems ist und
schwerwiegende ko¨rperliche, soziale und seelische Folgen fu¨r die betroffenen
Patienten hat. Die Behandlung besteht in der Regel aus einer Kombination von
Maßnahmen, welche darauf abzielen, die o¨demato¨sen Extremita¨ten zu schu¨tzen und
abschwellen zu lassen; ferner haben diese Maßnahmen zum Ziel, die Entwicklung von
zusa¨tzlichen Lymphgefa¨ßen zu fo¨rdern, um das Lympho¨dem langfristig beherrschen
zu ko¨nnen. Bislang ist noch unklar, welche Therapien am wirksamsten sind. Der
Zusatz von aromatherapeutischen O
¨len zu Massagecremes kann zu einer Linderung
der Symptome fu¨hren, wobei jedoch entsprechende wissenschaftliche Daten bislang
noch fehlen. In diesem Artikel wird eine randomisierte Studie vorgestellt, in
der folgende therapeutische Maßnahmen verglichen wurden: Selbstmassage und
Hautpﬂege mit einer Salbe mit Zusatz von aromatherapeutischen O
ARTICLE IN PRESS
1462-3889/$ - see front matter &2005 Elsevier Ltd. All rights reserved.
Corresponding author. Tel.: +44 1202 442135; fax: +44 1202 442825.
E-mail address: firstname.lastname@example.org (C. Balmer).
Selbstmassage und Hautpﬂege mit einer Salbe ohne aromatherapeutische O
Outcome-Parameter waren objektive Messergebnisse des Umfangs der betroffenen
Extremita¨ten sowie die Linderung der Symptome gema¨ß Measure Yourself Medical
Outcome Proﬁle 2 (MYMOP 2) bei einer Stichprobe von Patienten mit Lympho¨dem.
Die Ergebnisse weisen darauf hin, dass Selbstmassage und Hautpﬂege in dieser
Stichprobe zu einer signiﬁkanten Besserung der von den Patienten angegebenen
Symptome sowie des Wohlbeﬁndens fu¨hrte. Daru¨ber hinaus kam es zu einer leichten,
jedoch nicht-signiﬁkanten Abnahme des Umfangs der betroffenen Extremita¨ten.
Sorgfa¨ltig ausgewa¨hlte, auf ihre potentiellen Vorteile fu¨r die untersuchten Patienten
gepru¨fte aromatherapeutische O
¨le hatten demgegenu¨ber offenbar keinerlei Einﬂuss
auf die Besserung der Outcome-Parameter.
&2005 Elsevier Ltd. All rights reserved.
Lymphoedema is a chronic, progressive condition
leading to swelling usually in the limbs and trunk. It
develops when the lymphatic system is unable to
keep up with the normal demands of tissue home-
ostasis, often because of damaged or abnormal
lymph glands (Hare, 2000;Badger et al., 2004;
Williams et al., 2004).
The main causes of lymphoedema are cancer and
cancer treatment, congenital abnormalities of the
lymphatic system, chronic venous disease and
ﬁlariasis, a parasitic infection endemic in parts of
Africa and India (Badger et al., 2004).
The incidence and prevalence of lymphoedema is
difﬁcult to determine, largely due to many varia-
tions in measuring techniques and diagnosis (Logan,
1995;Maguire, 2004). Moffatt et al. (2003)
surveyed healthcare providers in South West
London and found a crude prevalence of lymphoe-
dema from any cause of 1.33 per 100,000.
Unilateral lymphoedema of the arm has a much
higher incidence in women reﬂecting the damage
caused by surgery and radiotherapy to the axillary
lymphatic system in the treatment of breast cancer
(Badger et al., 2004;Williams, 2004). Again, its
true prevalence is unknown and estimates differ
signiﬁcantly (Petrek and Heelan, 1998;Erikson
et al., 2001). However, it is generally agreed that
at least a third of people who have been treated for
breast cancer will develop it (Maguire, 2004;
Howell and Watson, 2005). The ﬁgures for lym-
phoedema of the lower limb are even less reliable
but it appears to be a major problem (Badger et al.,
2004;Williams, 2004). Furthermore, lymphoedema
can develop years after the original damage to the
lymph nodes, often due to triggers such as infec-
tion, injury, late side-effects of radiotherapy or
tumour recurrence (Woods, 2003).
Lymphoedema can lead to signiﬁcant physical,
psychological, economic and social disruption
(Poole and Fallowﬁeld, 2002;Moffatt et al.,
2003;Williams et al., 2004;Howell and Watson,
2005). Swelling can interfere with mobility and
ability, cause pain, alter sensation, affect body
and self-image and lead to an increased risk of
infection (Badger et al., 2004). Furthermore, in
the case of lymphoedema secondary to cancer
treatment, it offers a constant reminder of the
individual’s disease (Maguire, 2004;Williams,
The treatment of lymphoedema is not a well-
researched area (Hare, 2000;Badger et al., 2004).
Its management involves decongesting and stimu-
lating the reduced lymphatic pathways and pro-
moting the development of collateral drainage
routes to control swelling in the long-term (Badger
et al., 2004). Early conservative treatment and a
combination of strategies is usually recommended,
including skin care, exercise, simple lymphatic
drainage (SLD) by self-massage, manual lymphatic
drainage (MLD) compression, education and psy-
chological support (British Lymphology Society,
Aromatherapy involves the therapeutic use of
essential plant oils and has existed for 5000 years
(Wheeler-Robins, 1999). It is increasingly being
used in the cancer care and dermatology settings
(Kite et al., 1998;Wilkinson et al., 1999;Steven-
son, 1999;Fellowes et al., 2004). Although the
positive effects of massage with aromatherapy in
lymphoedema management are often reported, a
literature search revealed only one previous study
speciﬁcally referring to aromatherapy massage for
lymphoedema (Kirshbaum, 1996). In this study,
massage with lavender oil was performed on eight
women with lymphoedema secondary to breast
cancer treatment. The reported results concen-
trated on subjective measurements such as pain
relief, relaxation and self-esteem, which all im-
proved. A noticeable reduction in swelling was also
ARTICLE IN PRESS
Reducing the symptoms of lymphoedema: Is there a role for aromatherapy? 141
Recent Cochrane reviews have evaluated thera-
pies for the reduction and control of lymphoedema
and cancer symptom relief using aromatherapy and
massage. The former was unable to conﬁrm which
physical therapy has the most important role in
reducing and controlling lymphoedema (Badger
et al., 2004). It also criticized studies for being
too small-scale, providing too little follow-up data
and concentrating on only one population (such as
women with lymphoedema secondary to breast
cancer). It concluded with a call for further
research, particularly randomized trials, to ﬁnd
the best approach to managing lymphoedema. The
latter was also unable to draw ﬁrm conclusions
about the beneﬁts of massage and aromatherapy
for people with cancer and again called for more
research (Fellowes et al., 2004).
To assess the effectiveness, in terms of an objective
reduction in limb volume and patient-reported
symptom improvement and ‘well-being’, of
SLD and skin care/hydration by self-limb massage
using a base cream containing aromatherapy oils
versus a base cream alone, in the treatment of
Subjects and setting
All adult patients (X18 years) referred to the
Dorset Cancer Centre lymphoedema service with at
least one year’s history of symptomatic, clinically
diagnosed bilateral or unilateral stable lymphoe-
dema of the limb(s) and no evidence of acute
inﬂammation, thrombosis or recurrence were in-
vited to join the study (please see Table 1 for
referral criteria to service). They had to be able to
self-massage their appropriate limb(s) and had to
agree to avoid other aromatherapy-based treat-
ments and products during their treatment period.
Women who were pregnant or attempting concep-
tion and all subjects with any allergy or sensitivity
to aromatherapy or wheatgerm oils were excluded
All patients were randomized in the ‘maintai-
nence’ phase of management and none had a
change of therapy throughout the trial treatment.
All patients who agreed to the study signed a
consent form and were then randomly assigned one
of the two massage creams by an independent
colleague using a 50:50 card system. Randomiza-
tion was stratiﬁed to age and limb(s) affected
(upper or lower). Treatment started immediately
The Cancer Centre’s qualiﬁed complementary
therapist especially formulated the aromatherapy
cream. It consisted of wheatgerm oil with fennel,
sage, geranium, black pepper and juniper essential
oils in a base cream. These are thought to be
particularly helpful in stimulating the lymphatic
system and relieving skin conditions, as described
in Table 2 (Stevenson, 1999;Davis, 2000;Whichello
Brown, 2003). The standard massage agent con-
sisted of a simple base cream containing wheat-
germ oil. All patients performed daily SLD and limb
massage, following the principles of lymphatic
drainage, after instruction by the lymphoedema
nurse specialist. Exercise and skin care were
advised for all patients, as in standard lymphoede-
ma therapy, and the use of previously prescribed
compression garments continued if indicated.
There are rare reports of contact dermatitis
occurring with some aromatherapy oils (Wheeler-
Robins, 1999;Stevenson, 1999), so oils were
especially chosen. Because of the nature of
ARTICLE IN PRESS
Table 1 Baseline characteristics of participants.
Aromatherapy Base cream
Women 40 37
Men 0 4
Arm (unilateral) 30 31
Valid cases for
1 month 76
2 months 74
3 months 71
6 months 50
J. Barclay et al.142
lymphoedema, it was expected that subjects could
have sore and inﬂamed skin. However, they were
instructed to report any increased redness, itchi-
ness or inﬂammation immediately via a 24 h contact
number. Patients were warned that the increased
movement of ﬂuid produced by the massage may
lead to headache, nausea and tiredness.
Limb volume circumferences from a standardized
start point were measured at 4 cm segments using a
self-tensioning tape measure and recorded as an
absolute volume (ml). The truncated cone or
frustrum calculation was used to calculate volume.
ARTICLE IN PRESS
Chart 1 Referral criteria for lymphoedema service at the Dorset Cancer Centre.
Diagram 2 Flow diagram of progress through the trial phases.
Reducing the symptoms of lymphoedema: Is there a role for aromatherapy? 143
Such circumferential measurements are widely
used and are both valid and reliable (Howell and
Watson, 2005). These measurements were recorded
monthly for 3 months. If an improvement was not
seen in this time, patients were taken off the trial
and commenced standard treatment. If a change of
therapy was not indicated, patients were encour-
aged to continue their daily massage and were re-
assessed in a further 3 months (i.e. at 6 months).
Symptom improvement, activity and ‘well-being’
were measured using the ‘Measure Yourself Medical
Outcome Proﬁle 2’ (MYMOP2). Unlike many self-
completed ‘quality of life’ questionnaires, which
may not allow patients to express the outcomes
that are important to them, MYMOP2 (and its
predecessor, MYMOP) is an patient-generated ques-
tionnaire, which is responsive to changes that are
important to the individual (Paterson and Britten,
2000;Paterson, 2004). MYMOP and MYMOP2 have
been shown to be reliable, valid and highly
responsive to change in the primary care and
complementary therapy setting (Paterson, 1996;
Paterson and Britten, 2000) and in people with
acute exacerbations of chronic conditions (i.e.
chronic bronchitis) (Paterson et al., 2000). MYMOP2
was therefore considered a particularly relevant
tool to use to measure lymphoedema experience
which is often unique (Williams et al., 2004).
Furthermore, it is brief and simple to complete,
which enhances compliance and response and has
been validated in both the orthodox and comple-
mentary medical environments (Paterson, 2005)
MYMOP2 assessments took place at the same time
as the limb volume measurements.
Patients’ normal treatment was not compromised
in any way by their inclusion in this study. All were
given written and oral information to consider
before agreeing to take part and all gave written
consent. Previous research has shown that people
with cancer enjoy aromatherapy massage and may
gain psychologically from it (Kirshbaum, 1996;Kite
et al., 1998;Wilkinson et al., 1999;Fellowes et al.,
2004). The study was approved by the Dorset Local
Research Ethics Committee and Poole Hospital
Research Governance Department. All treatment
was administered and taught by qualiﬁed practi-
tioners following the hospital’s policy and Royal
College of Nursing guidelines (Avis, 2003).
No data were available on which to base a formal
sample size calculation. The study team felt that a
sample size of 80 was feasible. This is sufﬁcient to
detect a standardized effect size of 0.73 with 90%
power and 0.63 with 80% power (i.e. medium to
large differences), using a 5% two-sided signiﬁ-
Data were analysed using SPSS for Windows soft-
ware. A two-sided 5% signiﬁcance level was used.
The primary analysis was a comparison of the
aromatherapy with the basecream alone group. If
there was no statistically signiﬁcant difference
between the groups, we conducted further ana-
lyses exploring changes over the course of the study
using both groups combined in order to maximize
Upper limb volumes are summarized using
median values and ranges due to skewed distribu-
tion with outliers; lower limb volumes are summar-
ized as mean values and standard deviations
because they are approximately normally distrib-
uted. Participants tended to have lymphoedema
either in one arm or in both legs. Because of the
obvious difﬁculties in analyzing changes in leg
volume and changes in arm volume together,
participants were assessed simply on whether or
not they experienced a relative loss or gain in
ARTICLE IN PRESS
Table 2 Speciﬁc and relevant properties of the
essential oils used in the base cream (Davis, 2000;
Whichello Brown, 2003).
Essential oil Properties
Fennel A diuretic.
Useful in the treatment of
Sage A relaxing oil.
Soothes and cools inﬂamed skin.
Geranium An antidepressant.
A mild diuretic.
Has a stimulating effect on the
lymphatic system (often used to
relive cellulitis, ﬂuid retention
Black pepper Relieves muscular aches, pains
Instills positive thoughts and
Juniper An antiseptic.
A mild diuretic and detoxiﬁer.
J. Barclay et al.144
volume from baseline to 3 months. For participants
with lower limb volume, this was a loss or gain of
the mean of the right and left volumes (although
only one participant had a decrease in one limb and
gain in the other). This outcome was compared
between the two groups using the w
association, and within both groups combined using
the binomial test with a test proportion of 0.50.
MYMOP2 measures three patient identiﬁed vari-
ables: symptom 1, symptom 2 and activity, plus
wellbeing. The mean of the four scores produces a
proﬁle score. However, it was felt that this system
of scoring was somewhat crude as symptom 2 and
activity are optional and had not been scored by all
participants. Furthermore, as the developer herself
admits, a single score can result in loss of
information (Paterson and Britten, 2000). For this
reason, analysis concentrated on the obligatory
variables of symptom 1 and wellbeing. These have
been summarized as means and standard deviations
and compared between groups using the indepen-
dent samples t-test at each assessment point.
Within both groups combined, change in outcome
from baseline to each assessment point has been
tested using the paired t-test.
Eighty-one participants between the ages of 25 and
80 were randomized into the study as detailed in
Only one participant withdrew due to a skin
reaction. Other reasons for withdrawal included
non-attendance, concurrent illness and one preg-
In the aromatherapy group, 69% had a decreased
limb volume at 3 months compared with 57%
who received base cream SLD alone (P¼0:38 using
-test for association with continuity correc-
tion). With both groups combined, signiﬁcantly
more participants improved than got worse
(63% improved, P¼0:034 using the binomial test)
Symptoms and wellbeing
The addition of aromatherapy oils appeared to
make comparatively little difference in terms of
symptom relief or wellbeing (please see Graphs 1
and 2 and Table 4). The mean differences between
base cream alone and aromatherapy at 3 months
was 0.1 (95% conﬁdence interval; 0.5, 0.6) for
ARTICLE IN PRESS
Table 3 Absolute limb volumes after 3 months treatment.
Baseline 3 months
Median upper limb volume (min. volume/max. volume) 107.0 (372.0/2421.0) 60.0 (334/2344)
Mean right lower limb volume (standard deviation) 6218.3 (1772.5) 6057.1 (2093.0)
Mean left lower limb volume (standard deviation) 6177.9 (1857.9) 5979.9 (2014.9)
base cream alone
Graph 1 Change in MYMOP2 symptom 1 scores over time
for the two groups.
base cream alone
Graph 2 Change in MYMOP2 well-being scores over time
for the two groups.
Reducing the symptoms of lymphoedema: Is there a role for aromatherapy? 145
symptom 1 (i.e. the improvement in the aro-
matherapy group was 0.1 points better than in
the basecream alone group) and 0.2 (0.9, 0.5)
for wellbeing (i.e. the improvement in the aro-
matherapy group was 0.2 points worse than in the
basecream alone group).
However, when both groups were combined, the
proﬁle scores revealed an overall reduction over
time (please see Graph 3).
By month two, there had been signiﬁcant
improvements from baseline in symptom 1 and
wellbeing scores for both groups combined, which
continued over time (please see Table 5).
For the study population, there was a reduction in
objective limb volume from baseline to 3 months
with self-massage. Furthermore, patient-identiﬁed
symptom relief and wellbeing signiﬁcantly in-
creased and this improvement continued to at least
6 months, in those who continued to self-massage.
This part of the analysis was conducted within
participants. There was no control group and the
possibility that the participants may have improved
ARTICLE IN PRESS
Table 4 Independent sample t-test comparing the mean change from baseline between the groups (BC ¼base cream, A ¼aromatherapy).
Symptom 1 Wellbeing
Mean (SD) Mean (SD) change from
P-value Mean (SD) Mean (SD) change from
BC BC & A BC BC & A BC BC & A BC BC & A
Baseline 2.5 (1.6) 2.9 (1.5) ¼¼ 2.2 (2.1) 2.3 (1.7) ¼¼
Month 1 2.4 (1.6) 2.5 (1.6) 0.1 (1.2) 0.4 (1.2) 0.22 2.1 (1.5) 2.4 (1.7) 0.1 (1.6) 0.1 (1.2) 0.68
Month 2 2.0 (1.5) 2.1 (1.5) 0.4 (1.3) 0.8 (1.1) 0.14 1.7 (1.3) 2.0 (1.3) 0.5 (1.7) 0.3 (1.1) 0.58
Month 3 1.6 (1.2) 2.0 (1.4) 0.8 (1.1) 0.8 (1.2) 0.85 1.5 (1.2) 1.9 (1.3) 0.7 (1.6) 0.4 (1.3) 0.54
Month 6 1.8 (1.3) 1.7 (1.4) 0.8 (1.6) 1.4 (1.2) 0.17 1.4 (1.3) 1.5 (1.3) 0.5 (1.5) 0.7 (1.1) 0.71
base cream alone
Graph 3 Change in MYMOP2 proﬁle scores over time for
the two groups.
Table 5 Changes from baseline in symptom and
well being for both groups combined.
Symptom 1 Wellbeing
Mean SD P-value Mean SD P-value
Month 1 0.3 1.2 0.07 0.0 1.4 0.93
Month 2 0.6 1.2 o0.001 0.4 1.4 0.02
Month 3 0.8 1.2 o0.001 0.6 1.4 0.002
Month 6 1.1 1.4 o0.001 0.6 1.3 0.003
J. Barclay et al.146
anyway cannot be excluded. However, the addition
of aromatherapy did not appear to make any
difference to these improvements. Aromatherapy
slightly reduced limb volume and symptoms but
these improvements were not statistically signiﬁ-
cant (the smallest P-value was 0.14). The limits for
the 95% conﬁdence intervals at 3 months suggest
that it is unlikely that aromatherapy is better than
basecream alone by more than 0.6 points on the
symptom scale and 0.5 points on the well-being
Nearly all patients approached agreed to take
part in the study. Richardson (2000) claims that a
patient’s motivation to follow a treatment regi-
men, particularly one that involves their own
participation, is inﬂuenced by preferences before
the treatment is started. If those who chose to take
part did hold a pre-existing bias, this may have
inﬂuenced the positive outcome. Unfortunately no
data was collected from those who refused to take
part, in which to discuss this. Although all patients
were taught how to self-massage by just one
lymphoedema specialist nurse and their technique
was checked at each monthly assessment, it is
impossible to know how effectively this was carried
out by each participant in their own environment.
Undoubtedly, the study was not blinded, as the
majority of participants would have been able to
smell the presence or absence of aromatherapy oils
in their cream. However, because of the inability to
demonstrate signiﬁcant differences in the aro-
matherapy versus basecream alone groups, it
seems unlikely that the aromatherapy caused a
placebo effect in this case.
Due to the difﬁculties in analyzing changes in
lower limb and upper limb volumes together, limb
volume was assessed by a simple loss or gain at 3
months. This did not take into account the relative
loss or gain from baseline and may be criticized as
unsophisticated. Although improvements from
baseline limb volume were seen in this population
at 3 months, they were not signiﬁcant. However,
Hardy and Taylor (1999) argue that, although limb
volume is the most commonly accepted outcome
measure, it should not necessarily be seen as the
most important gauge of treatment success or
failure. Furthermore, Box et al. (2002) found
disparities between objective measurements of
limb volume and subjective reporting of secondary
lymphoedema. They argue that subjective report-
ing should not be discounted because of the
psychological and emotional distress that lymphoe-
dema can cause and suggest that subjective reports
may actually precede objective increases in limb
volume. Furthermore, a very small change in
volume may have a great impact on mobility or
body image. The aromatherapy oils were chosen for
their particular lymphatic-stimulation, anti-inﬂam-
matory and analgesic properties and it may have
been prudent to have also included a measure of
skin condition or sensitivity to detect differences
between the two groups.
MYMOP2 appears to have been a successful tool
for assessing symptoms and wellbeing associated
with lymphoedema and its treatment. Patients
liked its brevity and felt it was more ‘personal’
because they were able to incorporate the symp-
toms and activities that concerned them. Compli-
ance was very good with 71 of the 81 providing
complete data at 3 months. Unfortunately, 21
patients withdrew at or after 3 months, the main
reason being a loss of enthusiasm due to little or no
subjective beneﬁt. Therefore valid data was only
available for 50 cases at 6 months and, as a result,
limb volume was not analysed at this time point.
However, participants were asked to complete a
MYMOP2 assessment at this time as symptom relief
and wellbeing had shown a more signiﬁcant
improvement at 3 months and, for these patients,
It may be argued that these improvements in
symptom relief and wellbeing were unlikely to be
of clinical signiﬁcance as they show only fractional
improvements on a seven-point scale. However,
even a small gain may be very relevant in this
population. Howell and Watson (2005) report an
overall worsening of quality of life in their pilot
study of women with lymphoedema secondary to
breast cancer and suggest that this may be due to
the realization over time that lymphoedema
requires life-long management and cannot be
The results of this study do not concur with other
randomized controlled trials of massage versus
massage with aromatherapy in the treatment of
people with cancer, which report more positive
effects for aromatherapy (Corner, 1995;Wilkinson
et al., 1999). This may have been due to this
speciﬁc population or the aromatherapy oils used
here. It may also have been due to the outcome
measures as Corner and Wilkinson and colleagues
concentrated more on anxiety-type symptoms
whereas this study assessed wellbeing and pa-
tient-identiﬁed symptoms which focused on pain
and discomfort, mobility and body image issues.
A criticism leveled at studies involving people
with lymphoedema is that they concentrate on
people who have cancer, particularly breast cancer
(Hardy and Taylor, 1999). This study’s population
included people with both benign and malignant
causes of lymphoedema. However, this also re-
duced the number in each causal group and
ARTICLE IN PRESS
Reducing the symptoms of lymphoedema: Is there a role for aromatherapy? 147
weakened analysis based on this. If this study’s
sample had been larger or had been drawn from a
population with only one type or site of lymphoe-
dema, the results may have been more meaningful,
Self-massage, following the principles of lymphatic
drainage, and skin care/hydration signiﬁcantly
improved patient-identiﬁed symptom relief and
wellbeing for this sample of people with primary
and cancer-related secondary lymphoedema. It
also slightly, but not signiﬁcantly reduced limb
volume. However, aromatherapy oils, carefully
chosen on the basis that they should beneﬁt this
group, did not appear to inﬂuence any improve-
ment in these measures.
Statistical advice was sought from Professor Peter
Thomas, health care statistician, at the Dorset
Research and Development Support Unit. We are
very grateful for his help and supervision. Thank
you very much to all the people referred to the
Dorset Cancer Centre Lymphoedema Service who
agreed to take part in this study.
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