Impact of a primary care lymphoedema service on cellulitis: audit and evaluation of economic implications in relation to diagnosis and history of cancer treatment.

Abstract

Question: what is the impact of a primary care lymphoedema service on cellulitis in relation to diagnosis and history of cancer? Design: A quantitative service evaluation with a retrospective, before and after study design. Participants: A total of 268 participants, taking part in the Lothian Primary Lymphoedema Service having experienced at least one episode of cellulitis. Intervention: Normal individualised treatment for lymphoedema including advice, education, exercises, manual therapy, compression therapy, psychosocial support, diet advice or and referral to weight management. Outcome measures: Limb Volume Pre- and Post-Treatment, measured using the tape measure method. Results: The 90 participants without a cancer diagnosis had a significantly higher pre-treatment limb volume (10195.06 ml (SD 4623.599) than the 42 participants with a previous cancer diagnosis (7922.18 ml (SD 5282.502) (95% CI 483.115 to 4062.465) .The groups did not differ significantly in their response to treatment. Participants with primary lymphoedema correlate negatively with a medium strength relationship for change in limb volume (Rp-bs= -.297) (95% CI -496 to 109). No other diagnosis had a statistically significant correlation with change in limb volume following treatment. Conclusion: Patient diagnosis and history of cancer affects their final outcome from the service. All secondary diagnoses correlate positively, if not significantly, with change in limb volume. Both cancer and non-cancer groups respond equally well to treatment. Patients with a cancer history have a significantly lower limb volume both entering the service and following treatment. Further longitudinal studies are required to investigate the effect diagnosis and early access to treatment have on patient outcome.