Primary Care newsletter

February 2010

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:

In this edition:


Latest news

Helping people who are worried about breast cancer running in their family


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

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.

Out of hours services

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

The OOH toolkit can be downloaded at or ordered in hardcopy or CD format from 0800 500 800.

Latest courses and events

Primary Care Conference - save the date

The 2009 Primary Care Conference

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.

Cancer: thriving and surviving

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

Calendar of health events 2010

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.


Featured article

Ten top tips - lymphoedema and chronic oedemas

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

  • Secondary to cancer or cancer treatment (‘secondary’ lymphoedema): It is important to remember that all those treated for cancer are at lifelong risk of developing lymphoedema. Generally those with higher risk are following: breast, gynaecological, prostate, head and neck and sarcoma cancer treatment.
  • Secondary to other conditions – such as trauma, surgery, severe burns, vascular disease, severe or recurrent cellulitis, paralysis/immobility.
  • Hereditary or congenital lymphoedema (‘primary’ lymphoedema) - occurs in men, women and children at different key stages of life.
  • Filariasis (mosquito transmitted parasite) usually occurs in developing countries but in UK with transient population we may begin to see more causes of Filariasis Find out more on the filariasis website.
  • At the end of life in advanced cancer or other life limiting conditions such as multiple sclerosis, motor neurone disease and organ failure.

Signs and symptoms

  • clothing or jewellery becoming noticeably tighter
  • feeling of heaviness, tightness or aching pain in swollen area (post cancer treatment this symptom alone may not represent lymphoedema as lymph node dissection is commonly associated with these sensations)
  • observable swelling
  • may present with cellulitis or fungal infection.

Referral resources

Treatments for lymphoedema

The treatments for lymphoedema are a combination of:

  • caring for the skin: daily moisturising and preventing trauma and cellulitis/ infection
  • use of compression, either in the form of stockings or arm sleeves, or in multi layered lymphoedema bandaging* (not the same as 4 layered bandaging)
  • exercise and positioning/elevation of legs in bed/when sitting for long periods
  • manual* or self lymphatic drainage: a light form of massage specifically to enhance lymphatic flow

* = 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

  • post cancer treatment: no BP or blood tests on at risk limbs
  • look after skin: protect from heat, trauma and infection
  • maintain healthy weight and exercise/mobilise regularly: avoid sleeping in a chair at night
  • avoid tight jewellery or clothing around affected area & surrounding quadrant.

For further information on this please visit the North London Cancer Network website.

Further information

Learn Zone

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.

Best wishes

Dr Kevin Bolster
Dr Terry Bowley
Dr Cathy Burton
Dr Charles Campion-Smith
Dr Duncan Leith
Dr David Linden
Dr Rosie Loftus (lead GP Adviser)
Dr David Plume
Dr Rhys Davies
Dr Kavi Sharma
Dr Lucy Thompson
Dr Hong Tseung
Dr Matthias Hohmann
Dr Bridget Gwynne

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