Welcome to the new year edition of Macmillan Cancer Support's newsletter for GPs, to update you on activities in primary care. On behalf of the Macmillan GP Adviser team at Macmillan we would like to wish you a very Happy New Year. We would also like to welcome two new members to the team: Matthias Hohmann joins the team representing the EMNE region and Bridget Gwynne joins us from South Wales.
Further information on any topic mentioned here can be obtained from your local Macmillan GP Adviser or by contacting this email address: firstname.lastname@example.org
In this edition:
We have recently rebranded our OPERA (Online Personal Education and Risk Assessment) program, an online interactive tool that addresses the risk of familial breast cancer. Based on the NICE guidelines, you can access the program at www.macmillan.org.uk/opera.
OPERA's aim is to relieve the anxiety of those who worry unnecessarily, and to inform, support and signpost those individuals who may have an increased risk. We see the service very much as complementing the work of health professionals in this area, helping to reduce time spent dealing with these sorts of enquiries from concerned patients.
Following the distribution of the Macmillan Out of Hours Toolkit, we are looking to evaluate and develop the toolkit on a continual basis, starting with ways of promoting local OOH services to people affected by cancer. We would be really keen to hear your thoughts on this, and also what is currently happening in your area to communicate OOH services to users. You can send feedback to email@example.com.The OOH toolkit can be downloaded at www.macmillan.org.uk/learnzone or ordered in hardcopy or CD format from 0800 500 800.
Latest courses and events
Macmillan’s Primary Care Conference is an annual event offering the opportunity for all members of the Macmillan primary care community to meet; network; share good practice and feed back on local and national developments. This year’s event is planned to be held on 10-11 June. Venue and full conference agenda details will be confirmed shortly, but please make a note in your diaries.
We've just introduced a free online self-management course, suitable for people who have had a cancer diagnosis. The piloting of this course in the UK is part of a research study with Stanford University School of Medicine, for which Macmillan received funding from the Bonita Trust. It’s a six week course, covering topics such as diet, exercise and communicating with others. Since it is web-based, participants can access the course anytime in their preferred location, as well as share their views and support other participants through discussion boards. To find out more and sign up for the course, please go to https://macmillancancersupport.stanford.edu
The NHS have put together a useful calendar of key health events, which can be used to support health promotion activities. You can view the calendar on the NHS website.
by Jan Simmons, Macmillan Lymphoedema Project Lead, The North London Cancer Network
A more detailed version of this information is available on The North London Cancer Network website.
Lymphoedema develops from result of a failure in the lymphatic system either familial or when a previously healthy lymphatic system is traumatised, for example, by cancer surgery and radiotherapy & can affect any area of the body. This damage reduces the transport capacity of the lymphatic system to transport lymph, the fluid contained within the vessels. It is also marked by inadequate scavenging of plasma proteins by macrophages which heightens the risk of infection and can cause congestion and fibrosis of the subcutaneous tissues akin to honeycomb. This congestion in the interstitial spaces is the reason patients with lymphoedema are at greater risk of cellulitis and fungal infections and secondary skin changes in the affected area.
Chronic oedema usually affects the legs, is unrelieved by bed rest & generally results as a combination of factors such as a long term condition, immobility, vascular disease and obesity causing lymphatic failure in the long term
Causes of chronic oedema and lymphoedema
Signs and symptoms
Treatments for lymphoedema
The treatments for lymphoedema are a combination of:
* = only those appropriately trained in lymphoedema therapy can deliver these interventions
Treat cellulitis & fungal infections promptly
Consensual guidelines for cellulitis in lymphoedema have now been written and can be found on the British Lymphology Society website.
Surgery for lymphoedema is reserved for those who have severe complications of their condition, and who are unresponsive to the above therapies.
Diuretics are not useful in lymphoedema: Diuretics only remove excess fluid from the vascular system, not from the interstitial spaces where lymphatic oedema forms so should not be used to ‘treat’ lymphoedema.
Lymphoedema in children
Lymphoedema is very rare in children. All children should be thoroughly investigated and other potential diagnoses eliminated prior to a lymphoedema diagnosis. There are specialist centres for children to be referred in the UK (see referral resources).
General advice for those at risk of lymphoedema and chronic oedema
For further information on this please visit the North London Cancer Network website.
Learn Zone gives you free and easy access to a wide variety of online resources, e-learning programmes, professional development tools and information about Macmillan's latest learning and development opportunities.
Dr Kevin Bolster
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