Looking outside the square for

Early Lymphoedema

ManagementPresented by

Judy Holland

Physiotherapist in Charge

Calvary Mater Newcastle

The Picture

HNELHD Demographics

– 850 000 residents

– 130000sq km

• 1 ½ Tasmania’s,

• around the size of

England

– 15, 000 staff

Lymphoedema Services

• Two major services

– Calvary Mater Newcastle : 4 trained therapist

offering 1 ½ FTE services. Treat all body parts

– John Hunter Hospital: 2 trained therapist

offering sporadic services. Legs only.

– Several rural services providing some

education and treatment.

Lymphoedema

Services and

Numbers

(CMN 2010)

Services that changed since

2010

349

39 149

36

20

2

1

13

The Problem in HNELHD

• Increasing awareness of lymphoedema

risk and referrals to support services.

• Reduction in rural services through

changes in therapist working in the area.

• Fear of treating lymphoedema patients by

many therapists.

• Antiquated knowledge.

More developments

• Listening post – (2011) repeated patient

reports at all sites, issues with

lymphoedema treatment access.

• Changes in radiotherapy treatment

location (2013) for northern HNELHD to

Tamworth with no supported

lymphoedema service

Solutions

• Good resource to support self

management principles.

• Improved early education self

management and recognition of

lymphoedema.

• Education of all staff involved in care on

self management principles to improve

support and identification of

lymphoedema.

Self Management Resource

• DVD production – In 2012, developed a

DVD with funds from the HNELHD Cancer

Network.

• Involved two patients (one axilla and one

groin dissection) and their experience and

story on how to introduce techniques into

their lives.

Early Education

• Lymphoedema education group conducted

at Calvary Mater Newcastle (CMN) since

2010.

• Grant from the Cancer Institute NSW to

install Telehealth facility into a

physiotherapy held education room.

• Conduct joint sessions with CMN and a

rural site – Tamworth, Taree,

Muswellbrook.

Tele-health Consults

• Assisted with some individual consults

with rural practitioners.

• Future - possible to follow up patients from

rural locations at their home – some

limitations due to the physical nature of the

condition/ treatment.

Staff Education

• Some staff currently attending the

sessions with the patients.

• Working with HETI in development of on-

line training modules.

• Presentation at nursing and allied health

education programs.

Feedback So Far

• 3 rural sessions conducted.

• Resounding positive feedback from

patients on the DVD and the Telehealth

session.

• First session established lymphoedema

patients – one negative feedback on not

meeting her needs.

Lessons Learned

• Cross discipline and across large

geographical zones making networking

very difficult – Cancer Network Executive.

• Clinical load and project development

don’t mix.

• Clear definition of target population and

objectives of the sessions.

Acknowledgements

• Cancer Network Hunter New England

Local Health District.

• Cancer Institute NSW

• Calvary Mater Physiotherapy Department

Thank you

Questions?