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Risk Reduction in the News – Response from the NLN Medical Advisory Committee
2012 Conference featured in Oncology Times
Clinical Trials - Patient Participation
NLN Position Papers: Risk Reduction, Risk Reduction Summary, Diagnosis and Treatment, Exercise, Training, Breast Cancer-Related Lymphedema, Supplement BC-Related LE
As a service to both lymphedema patients and therapists, the NLN has traditionally provided a guide to treatment resources in the quarterly Newsletter. Although the NLN can neither endorse services nor provide accreditation for these services, substantial effort is directed toward verification of accurate, up-to-date information.
If you peruse the Lymphedema Resource Guide, you will quickly be confronted with a bewildering array of terms, codes and abbreviations. To assist you in the all-too-important choice of a therapist for your condition, we provide the following background information:
Position statement of the National Lymphedema Network. (pdf, 128 kb)
Lymphedema therapists come to this field from a variety of backgrounds, including nursing, physical and occupational therapy, and massage therapy, among others. While the traditional training programs for these careers provide some background for treatment of lymphatic disorders, most therapists require supplemental training within programs devoted to the education of lymphedema therapists. These programs vary in the course content and the requisite hours of training. Since the care of lymphedema is quite complex, more training generally translates into better care. We feel that a minimum of 135 hours of intensive training is ideal, following guidelines established by the Lymphology Association of North America (LANA).
Training programs are categorized in the resource guide to indicate the extent of training delivered to the trainees. In addition, we feel that a good training program should incorporate approximately 1/3 of the training in theoretical instruction, including anatomy and physiology of the lymphatic system, and 2/3 significant "hands-on" mentoring be provided to the trainees. We make every attempt to ascertain that these minimal requirements are met by the programs listed in this Resource Guide, however, currently there are no government-recognized national standards for treatment or training in the United States.
The mainstay of lymphedema treatment is felt to be decongestive lymphatic therapy (CDT), which is comprised of several elements: 1) manual lymphatic massage 2) skin care 3) bandaging 4) exercises and 5) instruction in self-care. We feel that it is a minimal requirement that any treatment resource for lymphedema provide each element of this care to patients.
In addition, we feel that additional attributes characterize a treatment resource as a lymphedema center (vs. an independent therapist): to receive this designation, we feel that the organization should provide continuity of care (you should always have the ability to communicate with your therapist[s] about the status of your lymphedema and the potential need for reassessment or a change in therapy) and at least two (2) of the following attributes:
Therapeutic providers that certify such additional services have been designated as lymphedema treatment centers in the Resource Guide.
Independent lymphedema therapists also are required to provide all the basic elements of decongestive therapy (see above), as well as garment fitting (either by the therapist, who is certified, or by referral to a qualified, certified outside source) to be listed in the Resource Guide.
Excellence of care is the goal for both treatment facilities and independent therapists.
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