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Reducing the symptoms of lymphoedema: Is there a role for aromatherapy?


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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.
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European Journal of Oncology Nursing (2006) 10, 140149
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
Skin care;
Randomized con-
trolled trial
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
¨len versus
1462-3889/$ - see front matter &2005 Elsevier Ltd. All rights reserved.
Corresponding author. Tel.: +44 1202 442135; fax: +44 1202 442825.
E-mail address: (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,
1999;Woods, 2003).
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
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).
Study objective
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
(Chart 1).
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
(Diagram 2).
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
Table 1 Baseline characteristics of participants.
Aromatherapy Base cream
Mean (standard
61.1(11.2) 60.2(12.6)
Women 40 37
Men 0 4
Arm (unilateral) 30 31
Lower limbs
10 10
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.
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.
Ethical considerations
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).
Sample size
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-
cance test.
Statistical analyses
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
statistical power.
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
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.
An antiseptic.
A mild diuretic.
Has a stimulating effect on the
lymphatic system (often used to
relive cellulitis, fluid retention
and oedema).
Black pepper Relieves muscular aches, pains
and stiffness.
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
-test for
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.
Baseline characteristics
Eighty-one participants between the ages of 25 and
80 were randomized into the study as detailed in
Table 1.
Only one participant withdrew due to a skin
reaction. Other reasons for withdrawal included
non-attendance, concurrent illness and one preg-
Limb volume
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
the w
-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)
(Table 3).
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
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)
Month 1
Month 2
Month 3
Month 6
base cream alone
Graph 1 Change in MYMOP2 symptom 1 scores over time
for the two groups.
Month 1
Month 2
Month 3
Month 6
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
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
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
Month 1
Month 2
Month 3
Month 6
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,
improvement continued.
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
entirely eliminated.
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
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,
albeit exclusive.
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.
Avis, A., 2003. Complementary Therapies in Nursing, Midwifery
and Health Visiting Practice. RCN Guidance on Integrating
Complementary Therapies into Clinical Care. Royal College of
Nursing, London.
Badger, C., Preston, N., Seers, K., Mortimer, P., 2004. Physical
therapies for reducing and controlling lymphoedema of the
limbs. The Cochrane Database of Systematic Reviews, Issue 3.
Art. No. CD003141.pub2. DOI:10.1002/14651858.CD003141.
Box, R.C., Reul-Hirche, H.M., Bullock-Saxton, J.E., Furnival,
C.M., 2002. Physiotherapy after breast cancer surgery:
results of a randomized controlled study to minimize
lymphoedema. Breast Cancer Research and Treatment 75,
British Lymphology Society, 1999. Manual Lymphatic Drainage
(MLD) and Simple Lymphatic Drainage (SLD)Guidelines for
Health Professionals. British Lymphology Society, Caterham,
Corner, J., 1995. An evaluation of the use of massage and
essential oils on the wellbeing of cancer patients. Interna-
tional Journal of Palliative Nursing 1, 6773.
Davis, P., 2000. Aromatherapy An AZ. The C.W. Daniel Company
Ltd, Saffron Walden, UK.
Erikson, V.S., Pearson, M.L., Ganz, P.A., Adams, J., Kahn, K.L.,
2001. Arm oedema in breast cancer patients. Journal of the
National Cancer Institute 93 (2), 96111.
Fellowes, D., Barnes, K., Wilkinson, S., 2004. Aromatherapy and
massage for symptom relief in patients with cancer. The
Cochrane Database of Systematic Reviews, Issue 3. Art. No.
CD002287.pub2. DOI:10.1002/14651858.CD002287.pub2.
Hardy, D., Taylor, J., 1999. An audit of non-cancer-related
lymphoedema in a hospice setting. International Journal of
Palliative Nursing 5 (1), 1827.
Hare, M., 2000. The lived experience of breast cancer related
lymphoedema. Cancer Nursing Practice 0 (0), 1219.
Howell, D., Watson, M., 2005. Evaluation of a pilot nurse-
led, community-based treatment programme for lymphoe-
dema. International Journal of Palliative Nursing 11 (2),
Kite, S.M., Maher, E.J., Anderson, K., Young, T., Young, J., Wood,
J., Howells, N., Bradburn, J., 1998. Development of an
aromatherapy service at a cancer center. Palliative Medicine
12, 171180.
Kirshbaum, M., 1996. Using massage in the relief of lymphoede-
ma. Professional Nurse 11 (4), 230232.
Logan, V., 1995. Incidence and prevalence of lymphoedema: a
literature review. Journal of Clinical Nursing 4, 213219.
Maguire, D., 2004. Secondary lymphoedemanot a swell
condition. Australian Nursing Journal 11 (9), 13.
Moffatt, C.J., Franks, P.J., Doherty, D.C., Williams, A.F., Badger,
C., Jeffs, E., Bosanquet, N., Mortimer, P.S., 2003. Lymphoe-
dema: an underestimated health problem. Quarterly Journal
of Medicine 96 (10), 731738.
Paterson, C., 1996. measuring outcome in primary care: a
patient-generated measure, MYMOP, compared to the SF-36
Health Survey. British Medical Journal 312, 10161020.
Paterson, C., 2004. Seeking the patient’s perspective: a
qualitative assessment of EuroQol, COOP-WONCA charts and
MYMOP. Quality of Life Research 13, 871881.
Paterson, C., 2005. Measure Yourself Medical Outcome Profile (last accessed 13.06.05).
Paterson, C., Britten, N., 2000. In pursuit of patient-centred
outcomes: a qualitative evaluation of the ‘measure yourself
medical outcome profile’. Journal of Health Service Research
and Policy 5 (1), 2736.
Paterson, C., Langan, C.E., McKaig, G.A., Anderson, P.M.,
Maclaine, G.D.H., Rose, L.B., Walker, S.J., Campbell, M.J.,
2000. Assessing patient outcomes in acute exacerbations of
chronic bronchitis: the measure yourself medical outcome
profile (MYMOP), medical outcomes study 6 item general
health survey (MOS-6A) and EuroQol (EQ-5D). Quality of Life
Research 9, 521527.
Petrek, J.A., Heelan, M.C., 1998. Incidence of breast carcinoma-
related lymphoedema. Cancer 12, 27762781.
Poole, K., Fallowfield, L.J., 2002. The psychological impact of
post-operative arm morbidity following axillary surgery for
breast cancer: a critical review. Breast 11, 8187.
Richardson, J., 2000. The use of randomized control trials in
complementary therapies: exploring the issues. Journal of
Advanced Nursing 32 (2), 398406.
Stevenson, C.J., 1999. Aromatherapy in dermatology. Holistic
Health Consultant and Practitioner 16, 689694.
Wheeler-Robins, J.L., 1999. The science and art of aromather-
apy. Journal of Holistic Nursing 17 (1), 517.
Whichello Brown, D., 2003. Aromatherapy. Hodder and Stought-
on Educational, London, UK.
Wilkinson, S., Aldridge, J., Salmon, I., Cain, E., Wilson, B., 1999.
An evaluation of aromatherapy massage in palliative care.
Palliative Medicine 13, 409417.
J. Barclay et al.148
Williams, A.F., 2004. Understanding and managing lymphoedema
in people with advanced cancer. Journal of Community
Nursing 18 (11), 3040.
Williams, A.F., Moffatt, C.J., Franks, P.J., 2004. A phenomen-
ological study of the lived experiences of people with
lymphoedema. International Journal of Palliative Nursing 10
(6), 279286.
Woods, M., 2003. The experience of manual lymph drainage as
an aspect of treatment for lymphoedema. International
Journal of Palliative Nursing 9 (8), 336342.
Further reading
Forchuk, C., Baruth, P., Pendergast, M., Holliday, R., Bareham,
R., Brimner, S., Schulz, V., Chan, Y.C.L., Yammine, N., 2004.
Postoperative arm massage: a support for women with lymph
node dissection. Cancer Nursing 27 (1), 2533.
Sieggreen, M.Y., Kline, R.A., 2004. Current concepts in lym-
phoedema management. Advances in Skin and Wound Care 17
(4), 174178.
Reducing the symptoms of lymphoedema: Is there a role for aromatherapy? 149
... 36 A study on aromatherapy and edema found that limb volume in primary or secondary lymphedema patients was reduced but not significantly with combination of five different herbs including juniper, black pepper, geranium, sage and fennel. 37 Interestingly, higher dosage of extract of French oak wood (Quercus robur) containing Robuvit resulted in more degree of reduction in edema volume and limb size. 38 Extract of Kampo therapy herbs reduced lower abdominal lymphedema volume in women who had prior gynecological surgery. ...
... 41 MYMOP2 survey was conducted to measure wellbeing and symptoms changes and significant improvement was observed after 6 months in the aromatherapy study. 37 Symptoms of BCRL patients improved after treatment with Linfadern. 40 A study found that 12-week treatment with Unguentum Lymphaticum ointment resulted in significant improvement in skin softness. ...
... 43 Although the main focus of herbal treatment in this systematic review was on oral herbal drugs, topical treatments 31,42,43 were included and even one study used aromatherapy and the topical ointment of herbs for lymphedema treatment. 37 These topical treatments were effective in lymphedema improvement. The follow-up period was different in the included studies. ...
Full-text available
Introduction Herbs have been reported to be effective in reducing lymphedema burden. This paper aimed to review literature reporting on herbs for lymphedema treatment. Methods A systematic review was performed using the PRISMA guideline. Clinical studies on herbal intervention and lymphedema were included. Evidence on the effectiveness of herbal interventions for desired outcomes including reduction of edema volume, other symptoms, quality of life and inflammation were collected and assessed in detail. Results In all twenty studies were included in this review. Of these 14 studies were randomized clinical trials and the rest were prospective pilot studies. Herbal treatment was reported for breast cancer-related lymphedema in most studies and coumarin was the most reported herb that used for lymphedema management. Edema volume reduction (17 out of 20) and symptoms improvement (15 out of 20) were the outcomes reported in most studies. Conclusion Phytochemicals can be a promising pharmacotherapy for lymphedema management. However, further evidence is needed to establish definite effectiveness for the use of herbal remedies for lymphedema management.
... 8 Today, aromatherapy is one of the important CIM treatments in nursing. 7,13 There it is striking increase in the study of use of aromatherapy for the general well-being of cancer patients, [14][15][16] particularly as an adjunctive treatment for symptoms of those undergoing cancer treatment. This is indicated by several literature reviews on the use of EO in oncology, [17][18][19] especially in combination with massage. ...
Introduction: Essential oil (EO) applications via inhalation and/or absorption through the skin-often referred to as aromatherapy-have particular relevance as complementary to cancer treatment and follow-up care. Aromatherapy is of particular interest for controlling symptoms and enhancing the general well-being of people with cancer. This is indicated by the increasing number of empirical studies on this topic. Although numerous reviews have summarized the extensive primary research about aromatherapy and cancer, no review on aromatherapy use targeting women with gynecologic and breast cancers currently exists. Our scoping review aims at giving an overview of the state of research about aromatherapy in this specific target group. By summarizing and describing study characteristics, based on methodological decisions and content, we intend to offer implications for future research, focused on the use of EO in women with gynecologic and breast cancers. Methods: A systematic scoping review was conducted, based on the literature, and using the extension of the PRISMA statement for scoping reviews (PRISMA-ScR). The databases PubMed and CINHAHL were searched in a multi-stage, iterative process taking the most relevant terms under consideration, given our research interest and Boolean operators. The included studies were analyzed and summarized through (1) a table matrix including categories of interest and (2) qualitative content analysis. Results: One hundred seventy studies were examined, and 10 were included in this review. They show high heterogeneity in how the term aromatherapy is defined, in content, research design, EO used, application, and outcomes. However, all 10 studies exclusively targeted women with breast cancer in different states of cancer treatment. Conclusions: Challenges of research within this field point to the heterogeneous use and classification of the term aromatherapy, the differentiation of the principle of action of EO, the lack of transparency in how EO are reported and described (e.g., botanical names, company, dosage, mixing ratios), and the need to include subjective perceptions. Ten implications for future research based on these challenges are given.
... Unless the patients' needs are met to their satisfaction, the compliance for follow-up will be poor. Satisfaction survey carried out as a part of understanding the effectiveness of complete decongestive therapy showed that satisfaction scores reported by upper limb LE patients were lower than those from lower limb LE patients, though there was no significant difference in volume reduction (Barclay J et al., 2006). The authors suggested best suitable consultation approach need to be devised for upper and lower limb LE. ...
Advocacy and training on "Home care" for filarial lymphoedma (FLE) patients are provided through morbidity management and disability prevention (MMDP) clinic commonly known as filariasis clinic and clinical improvement is assessed by follow-up visits. While the physicians aim at reducing the recurrent ADL (coined as ADLA in 1997) episodes, the patients expect reduction in LE volume. The objective of the present study was to know whether the MMDP clinic serves the primary expectation of the FLE patients. LE patients who attended the clinic for at least four follow-up consultations and had LE volume measurements at three points of time during the one year period of observation were considered for analysis. Clinical assessment was done for LE grading and LE volume was measured by water displacement volumetry. Sixty-three patients who fulfilled the follow up criteria were included. It was observed that the median LE volume was 914ml (IQR 269 - 1935) at first visit of the observation period which reduced to 645ml (IQR 215- 1666) and 752ml (IQR 215 - 1720) at first and second follow-up visits respectively. Over all, in short span of one year, 21 of the 63 patients (33.3%) who visited MMDP clinic at least four times in a year were benefitted through the MMDP advocacy and the National filariasis control programme need to emphasise on the importance of follow up visits to FLE patients.
... Although compression therapies have been shown to improve patient outcomes in LF endemic settings [40,41], they are expensive, impractical in most resource-poor rural settings, and may increase the risk of secondary infection [27]. Cost free, lymphatic stimulating activities such as deep abdominal breathing and self-massage are effective in improving lymphedema status, [13,[42][43][44], but are rarely included in management of LF-related lymphedema [45,46]. Furthermore, the inability to objectively and easily measure early improvement in lymphedema status, especially for more advanced cases, has potentially led to underreporting on the effectiveness of lymphedema self-care programs. ...
Full-text available
Background: Lymphatic filariasis (LF) is a major cause of lymphedema, affecting over 16 million people globally. A daily, hygiene-centered self-care protocol is recommended and effective in reducing acute attacks caused by secondary infections. It may also reverse lymphedema status in early stages, but less so as lymphedema advances. Lymphatic stimulating activities such as self-massage and deep-breathing have proven beneficial for cancer-related lymphedema, but have not been tested in LF-settings. Therefore, an enhanced self-care protocol was trialed among people affected by moderate to severe LF-related lymphedema in northern Bangladesh. Methods: Cluster randomization was used to allocate participants to either standard- or enhanced-self-care groups. Lymphedema status was determined by lymphedema stage, mid-calf circumference, and mid-calf tissue compressibility. Results: There were 71 patients in each group and at 24 weeks, both groups had experienced significant improvement in lymphedema status and reduction in acute attacks. There was a significant and clinically relevant between-group difference in mid-calf tissue compressibility with the biggest change observed on legs affected by severe lymphedema in the enhanced self-care group (∆ 21.5%, -0.68 (-0.91, -0.45), p < 0.001). Conclusion: This study offers the first evidence for including lymphatic stimulating activities in recommended self-care for people affected by moderate and severe LF-related lymphedema.
Full-text available Health Technology Assessment im Auftrag des IQWiG ThemenCheck Medizin HT19-01
Background: Since the 1990's aromatherapy has been a popular adjunct to nursing and midwifery care in a variety of health care settings. Objective: The scoping review seeks to identify and confirm the benefits of incorporating aromatherapy into holistic nursing and midwifery practice Design: A scoping review using PRISMA-ScR of experimental studies where care is provided to the patient by a registered nurse or midwife. Settings and participants: Any health care setting where nurses or midwives provide care. Review Methods: A multi- engine search using a range of MeSH and non-MeSH terms with the Boolean search [AND]. Inclusion criteria were; publication date from 2005–2021, study involved aromatherapy as an intervention, conducted in a clinical nursing or midwifery environment and the published article is available in full in English. Excluded were; single patient cases, animal studies, in vitro studies, use of essential oils internally or a whole plant extract was used or use was non-nursing/midwifery related. Results: 124 studies met the inclusion criteria (n = 19188), classified into seven themes. Conclusion: The evidence supports the use of aromatherapy within a range of nursing and midwifery practices enhancing a holistic model of care. Impact: This scoping review contributes evidence to support the inclusion of aromatherapy into holistic nursing and midwifery practice.
Full-text available
Pepper is one of the most popular spices over the world and is called the King of Spices. Its essential oils (EOs) could alleviate neuronal ailments due to the inhibitory effect against acetylcholinesterase (AChE). In this study, the chemical compositions of 26 EOs prepared from white and black pepper collecting from 6 different cultivars were analyzed by gas chromatography-mass spectrometry (GC-MS). A total of 133 compounds were identified in the white and black pepper EOs. Monoterpenes and sesquiterpenes were found to be riched in these EOs, of which α-pinene, β-pinene, sabinene, 3-carene, limonene, and ( E)- β-caryophyllene were the major constituents. Most of pepper EOs showed potential AChE inhibitory activity with half-maximal inhibitory concentration (IC 50 ) values in the range of 0.5-182.5 µg/mL. Comparison of chemical constitutes of pepper EOs from different cultivars suggested that α-pinene, β-pinene, and 3-carene with an IC 50 value of 3.2, 53.3, and 2.9 µg/mL, respectively, might be used as Quality-marker (Q-marker) of pepper oil in inhibiting AChE.
Context: There is little evidence of the effectiveness of aromatherapy massage in palliative care despite its popularity. Objectives: This study aimed to investigate the effects of a 30-minute single session of aromatherapy massage at night-time on quality of sleep and fatigue in palliative care. Methods: A randomized controlled trial from January 2018 to March 2019. After being stratified by sex, participants were randomly assigned to an aromatherapy massage group and a control group. The effects of aromatherapy massage were evaluated on the massage day and the next day using the Richards-Campbell Sleep Questionnaire (RCSQ) and the Brief Fatigue Inventory (BFI). Results: Of the 74 participants, data of 27 participants in the treatment group and 30 in the control group were analyzed. ANCOVA indicated that quality of sleep and fatigue did not improve owing to the aromatherapy massage, although usual fatigue in preceding 24 hours and enjoyment of life subscales of the BFI showed signs of contribution (p = 0.07 and p = 0.09, respectively). Post hoc analyses indicated that higher age and performance status were factors with moderate correlation with better sleep (p = 0.03, r = 0.45, and p = 0.03, r = 0.40, respectively), and that older patients tended to experience greater improvement in fatigue (p = 0.02, r = -0.47). Conclusion: A single aromatherapy massage session is no more effective than not having a massage in improving sleep quality in palliative care settings. However, older patients and those in poor health conditions may benefit from aromatherapy massage.
The present study was carried out to investigate the effect of exposure of Cambodian black pepper essential oil on the human electroencephalographic (EEG) activity. In the EEG study, 20 men and 20 women healthy volunteers participated. The EEG readings were recorded from 32 electrodes placed on the scalp according to the International 10‐20 system and 25 EEG indices were analyzed. The essential oil of black pepper mainly contains β‐caryophyllene (30.53%), 3‐carene (19.85%), limonene (14.26%), β‐pinene (9.45%), and α‐pinene (5.25%). The EEG data showed that the exposure of black pepper essential oil exhibited different brain wave activity according to the gender. In women, a significant increase of spectral edge frequency 50% of alpha at C4 region was observed due to the exposure of black pepper essential oil. In the case of men, relative gamma, the ratio of sensorimotor rhythm to theta, spectral edge frequency 50%, spectral edge frequency 90%, and spectral edge frequency 50% of alpha significantly increased during the exposure of black pepper essential oil. The result revealed that the gender variation plays a major role in the EEG activity of black pepper essential oil and the exposure of black pepper essential oil may improve the cognitive functions. The essential oil of black pepper mainly contains β‐caryophyllene (30.53%), 3‐carene (19.85%), limonene (14.26%), β‐pinene (9.45%), and α‐pinene (5.25%). In the EEG study, the aroma of black pepper essential oil exhibited different brain wave activity according to the gender. When compared with women, relative gamma, the ratio of sensorimotor rhythm to theta, spectral edge frequency 50%, spectral edge frequency 90%, and spectral edge frequency 50% of alpha significantly increased during the exposure to black pepper essential oil aroma in men. The changes in EEG power spectrum values may associate with the improvement of certain cognitive functions.
The morbidity of non-cancer-related lymphoedema is becoming more generally recognized, but current treatment and research remain focused on cancer patients, particularly those with breast cancer. From the commencement of a new lymphoedema service at St Giles Hospice, Lichfield, Staffordshire, in 1994, referral of non-cancer patients was also encouraged. Over a 4-year period, 218 such patients were seen, accounting for 24% of the total cases referred to the clinic. The treatment outcomes of all patients were measured using simple assessment tools devised by the authors. This article presents a retrospective audit of the results achieved with the non-cancer patients. The results confirm that these patients also obtain benefits from treatment, with improvement in many aspects of the quality of their lives. They should therefore continue to be provided with opportunities for treatment.
Massage and aromatherapy are being used increasingly by nurses to enhance the wellbeing of patients in palliative care settings, yet little evaluation of these therapies has been undertaken. This article reports a quasi experimental study comparing the effects of an 8-week course of massage, with or without the addition of a blend of essential oils, on patients undergoing cancer treatment. Findings from the study suggest that massage has a significant effect on anxiety and this was found to be greater where essential oils were used, although the small sample prevented this from being established conclusively. Massage was reported to be universally beneficial by patients, it assisted relaxation and reduced physical and emotional symptoms. The authors call for more research to be conducted in this area with larger cohorts of patients. Copies of the full research report for this study may be obtained from the Macmillan Practice Development Unit, Centre for Cancer and Palliative Care Studies, Institute of Cancer Research/Royal Marsden NHS Trust, Fulham Road, London SW3 6JJ. Price £6.00.
The use of randomized control trials in complementary therapies: exploring the issues The current popularity of complementary therapies presents an interesting challenge to nurses and midwives. If they are to deliver such therapies themselves, or support patients in choosing appropriate therapies they will need to consider the professional and legal issues, in particular those regarding safety. Evidence for the effectiveness for complementary therapies is also a requirement in order that their integration into nursing practice can be justified. Purchasers are currently hampered by the lack of credible evidence for effectiveness and until that evidence is provided, access to such therapies through the National Health Service (NHS) will remain limited. The form that evidence should take has led to a lively debate about possible methodological approaches. There appears to be a clash between the medical profession and those working in the field of complementary therapy research, with the medical establishment advocating randomized control trials (RCTs). This contrasts with the view held by some advocates of complementary therapies that the RCT approach is reductionist and not applicable to such approaches. The pivot of the debate on the methodological approaches for evaluating complementary therapies is the contrast of two apparently different and diverse world-views, and the assertion that methods developed in one world-view are not transferable to the other. There is also some confusion within the field of complementary therapy over the applicability of RCTs to therapies such as acupuncture, and the mistaken assumption that trials which include a control group, are also required to be double-blind. This paper is based on the need for good quality evidence of effectiveness in complementary therapy. It will set out the concerns associated with the use of RCTs within complementary therapy, together with the benefits and limitations of this approach. The paper will go on to review research options and propose some suggestions for future methodological approaches.
BACKGROUND Of the 2 million breast carcinoma survivors, perhaps 15-20% are living currently with posttreatment lymphedema. Along with the physical discomfort and disfigurement, patients with lymphedema also must cope with the distress derived from these symptoms.METHODS To review the medical literature for the question of lymphedema incidence, a comprehensive, computerized search was performed. All publications with subject headings designating breast carcinoma-related lymphedema from 1970 to the present (116 reports) were found, and each summary or abstract was read. Of the 116 reports, 35 discussed the incidence of lymphedema. Of these, seven reports since 1990 from five countries with the most relevance to current patients were then chosen for greater analysis and comparison.RESULTSThe incidence of lymphedema ranged from 6% to 30%. The source of patients, length of follow-up, measurement techniques, and definition of lymphedema varied from report to report. In general, reports with shorter follow-up reported lower incidences of lymphedema.CONCLUSIONS The definitive study to determine the incidence of lymphedema has not been performed to date. There has been no prospective study in which patients have been followed at intervals with accurate measurement techniques over the long term. Cancer 1998;83:2776-2781. © 1998 American Cancer Society.
Lymphoedema is a significant health problem for some groups of patients and few health authorities have carried out a systematic health needs assessment for this client group. When planning and developing services, there is a need to demonstrate a knowledge of the literature relating to the incidence and prevalence of this condition. To facilitate interpretation of the literature, clarification of the difference between incidence and prevalence rates is included in this review. It is important that the differences between these rates is clearly understood when considering the nature of a chronic, progressive condition. The problems inherent in comparing results from studies which use different definitions of what constitutes 'lymphoedema', as well as different methods of measurement are acknowledged. A number of studies are examined and using information from this review, it is suggested that the prevalence rate of lymphoedema in women treated for breast cancer is in the region of 25-28%. Factors which influence the development of lymphoedema, and the controversy concerning axillary node sampling and dissection are discussed. The need to consider patients with lymphoedema due to very advanced cancer, and those with lower limb problems is also highlighted.
Lymphoedema of the arm is a complication of treatment for breast cancer. The condition often causes discomfort, reduced movement and changes in body image. Massage is one of the cornerstones of treatment. Aromatherapy massage is relaxing, increases patient comfort and promotes a therapeutic relationship between nurse and patient.
To assess the sensitivity to within person change over time of an outcome measure for practitioners in primary care that is applicable to a wide range of illness. Comparison of a new patient generated instrument, the measure yourself medical outcome profile (MYMOP), with the SF-36 health profile and a five point change score; all scales were completed during the consultation with' practitioners and repeated after four weeks. 103 patients were followed up for 16 weeks and their results charted; seven practitioners were interviewed. Established practice of the four NHS general practitioners and four of the private complementary practitioners working in one medical centre. Systematic sample of 218 patients from general practice and all 47 patients of complementary practitioners; patients had had symptoms for more than seven days. Standardised response mean and index of responsiveness; view of practitioners. The index of responsiveness, relating to the minimal clinically important difference, was high for MYMOP: 1.4 for the first symptom, 1.33 for activity, and 0.85 for the profile compared with < 0.45 for SF-36. MYMOP's validity was supported by significant correlation between the change score and the change in the MYMOP score and the ability of this instrument to detect more improvement in acute than in chronic conditions. Practitioners found that MYMOP was practical and applicable to all patients with symptoms and that its use increased their awareness of patients' priorities. MYMOP shows promise as an outcome measure for primary care and for complementary treatment. It is more sensitive to change than the SF-36 and has the added bonus of improving patient-practitioner communication.