Aims: Cancer-related lymphoedema and associated traditional therapy plans can be burdensome for individuals and health services, both during and long after active cancer treatment. Indocyanine Green lymphography (ICG-L) is a novel lymphatic imaging tool purported to inform cancer-related lymphoedema therapy. However, ICG-L impacts to individuals’ lymphoedema therapy planning is not yet well described. This study developed and applied a novel clinical decision support tool (ICG-TRANSLATE) designed to guide clinical decision making about lymphoedema management and enable consistent translation of ICG-L findings to lymphoedema therapy. This study aimed to describe changes to therapy plan features following ICG-L and application of ICG-TRANSLATE.
Methods: A Before-After design was used to describe changes in lymphoedema therapy plans by comparing therapy plan features of manual lymphatic drainage (MLD) and compression, informed by a traditional approach (not-ICG-L informed) and informed by ICG-L using ICG-TRANSLATE. Consecutive patients with cancer-related limb lymphoedema who underwent ICG-L were invited to participate. Therapy plan features (MLD pathway and compression prescription) were extracted from patient records and coded using a pre-determined framework by two researchers to enable comparison.
Results: A total of 25 patients with cancer-related upper (n=19) or lower-limb (n=6) lymphoedema consented to participate. Following ICG-L and ICG-TRANSLATE application, all participants demonstrated change to their initial, non-ICG informed plan in recommended MLD features including altered drainage end nodes, reduced trunk inclusion, individualised limb pathway and altered manual technique. Additionally, 88% (n=22) demonstrated changes to compression recommendations, including a reduction of garment limb coverage for 60% (n=15) of participants.
Conclusions: Traditional lymphoedema therapy planning requires advancement to incorporate evolving knowledge of lymphatic anatomy in cancer-related lymphoedema. ICG-L can inform individualised changes to personalise recommendations for lymphoedema therapy to account for individual lymphatic rerouting for people with cancer-related lymphoedema. ICG-TRANSLATE is proposed as a tool which may support ICG-L informed clinical decision making.