Oedema of advanced disease – aetiology, diagnosis, and palliative care management

Oedema in patients at the end of life is a common distressing symptom that is often poorly managed. Usually a high comorbidity with multiple oedema predisposing factors are observed. The primary aim of oedema management in a palliative setting is to improve the patient’s comfort, maintaining functional capacity and enhancing quality of life rather than to resolve the swelling completely. In progressive cases of longer prognosis, patients usually need complex decongestive therapy components of proven value in volume reduction, based on multilayer short-stretch limb compression bandaging occasionally combined with diuretics. For patients with a short life prognosis, in less advanced, stable oedema, it would be reasonable to start with a trial of limb elevation, manual lymphatic drainage, or kinesiotaping. In highly advanced lymphatic congestion with an increased risk of lymphorrhoea a trial of lymphacentesis should be considered. Even in advanced cases, decongestive or supporting care may reduce suffering and improve quality of life.