Limb edema in patients with advanced disease — a pilot study of compression therapy combined with diuretics

Introduction. Management of edema due to advanced disease is seldom recognized in palliative care. The purpose of this pilot study was to assess the effectiveness and tolerance of conservative edema therapy. Material and methods. Prospective analysis of limb volumes, edema symptom burden and quality of life (QoL) in 119 patients diagnosed with edema was performed. Eighteen patients in their last days of life complaining of edema were treated by limb elevation, supportive (palliative) bandaging, manual lymphatic drainage, Kinesio Taping and/or controlled subcutaneous needle drainage. Forty-six with longer prognosis were treated by one-week multilayer short-stretch limb bandaging and then re-evaluated. Twenty-eight of them with venous congestion resistant to previously given diuretics received additionally furosemide infusion in hypertonic saline. Subgroups analysis of the patients with diuretic therapy and primary lymphatic congestion was performed. Results. Within 46 patients re-evaluated the reduction of limb volume was accompanied by a decrease of edema symptom intensity and an improvement of QoL. Subgroup analysis revealed both volume and symptomatic improvement, equally effective in cases with suspected lymphatic congestion or when diuretics were added. Conclusion. Edema of advanced disease irrespective of the lymphatic component can be effectively managed conservatively with short–stretch limb bandaging. In cases resistant to oral diuretic fluid overload, parenteral hypersaline furosemide addition to the compression may be the safe therapeutic option enhancing treatment tolerance.