​MEDIA RELEASE

Changi General Hospital introduces formal screening programme to enable early diagnosis of lymphoedema and improved patient outcomes

Proactive screening for patients identified to be at risk is complemented by personalised treatment plans for holistic, multi-disciplinary care.

Singapore, 26 November 2024 – In caring for patients with or at-risk of lymphoedema, Changi General Hospital (CGH) has introduced its integrated, multi-disciplinary Lymphoedema Service with a focus on early diagnosis and intervention, continual monitoring, and personalised care for patients. Through a formal screening programme, CGH's Lymphoedema Service takes on a holistic approach aimed at proactively managing lymphoedema to minimise disease progression and empowering patients in their treatment journey.

Lymphoedema, a condition characterised by limb swelling due to abnormalities in the lymphatic system, affects 1 in 1,000 people worldwide. Patients with conditions such as cancer or those who have experienced traumatic injuries such as road accidents are particularly vulnerable to lymphoedema, as lymph pathways may be damaged during cancer treatment or from injury.

Clinical Assistant Professor Jeremy Sun, Consultant, Department of Surgery and Director of Lymphoedema Service and Plastic Reconstructive and Aesthetic Surgery Service, CGH said, "People living with lymphoedema may face life-long challenges and poorer quality of life as they require long-term treatment to manage the condition. Regular monitoring and screening, early diagnosis, and early intervention are thus crucial to reduce the progression of lymphoedema. Patients who are in the early stages of the disease respond much better to treatment with conservative therapy or day surgery. In fact, about 50% of patients who are treated at early stages of lymphoedema are more likely to be weaned off compression altogether."

In September 2023, CGH established a formal screening programme that includes Indocyanine Green Lymphography (ICGL), an imaging technology that facilitates early detection of the condition by highlighting lymphatic dysfunction. Patients identified to be at risk of developing lymphoedema are referred to the screening programme, where they undergo regular ICGL and receive counselling and guidance on monitoring and care for their condition from the multi-disciplinary care team, comprising clinicians, specialist nurses, and therapists.

ICGL is a highly sensitive and quick to administer method to identify and diagnose even early-stage lymphoedema. A medical dye is injected under a patient's skin, mapping out the patient's lymphatic function through the spread of the dye that is visible when viewed with a special infrared camera. This enables clinicians to quickly and accurately diagnose lymphoedema and the condition's severity.

Left: Linear channels showing normal lymphatic flow in a foot.
Right: Patterns resembling white splashes show dermal backflow in the skin, indicating lymphoedema.

To date, CGH has screened more than 60 patients using ICGL, with more than 75% of them diagnosed with some form of lymphoedema.

A Journey of Continual Monitoring and Personalised, Collaborative Care

Beyond diagnosis, ICGL screening is carried out regularly for surveillance, enabling the care team to monitor patients' condition and progress over time. Patients benefit from timely adjustments to their care plans, avoiding complications before they arise. This structured surveillance approach supports proactive care, aligning with CGH's commitment to enhance long-term patient outcomes and minimise the need for invasive surgeries.

Ms Ong Ling, Nurse Clinician, Department of Specialty Nursing, CGH, said, "Throughout the patient's journey, the multi-disciplinary care team conducts collaborative consultations to review and refine care plans together with the patient. Specialist nurses help to identify at-risk patients, facilitate referrals for screening and diagnosis, and provide end-to-end, perioperative care for these lymphoedema patients, including wound management and medical advice. We also carry out quality of life assessments, ensuring that the patient's quality of life is not compromised throughout their recovery journey."

Individualised, non-surgical treatment options for lymphoedema include therapist-led combined decongestive therapy, manual lymphatic drainage, compression therapy, and exercise. Reflecting CGH's person-centred care approach, the care team engages the patient as an active partner in their treatment plan, empowering them to set realistic and meaningful goals for the management of their condition.

Ms Alicia Tan, Senior Physiotherapist, Department of Rehabilitative Services, CGH, said, "Our goal is to help patients balance the impact of treatment in managing the condition with their daily lives, considering factors like work or school commitments, social support, and personal goals. For example, some patients aim to manage swelling to minimise dependence on compression garments, while others want to attain a fully compression-free lifestyle. By working collaboratively with the patient, we can create a care plan that is meaningful and realistic, which also helps promote higher levels of compliance to their care plan, leading to improved patient outcomes."

For patients who do not see sufficient improvement after three to six months of therapy, surgical options to address their specific stage of lymphoedema are offered.

One surgical option is the Lymph Interpositional Flap Transfer (LIFT), introduced by CGH for individuals with moderate to severe lymphoedema. The procedure involves mapping out healthy lymphatic vessels with ICGL, then harvesting and transplanting the healthy lymphatic tissue to the affected area.

Clin Asst Prof Sun said, "By introducing healthy lymph vessels and tissues, our LIFT surgery seeks to restore disrupted lymphatic flow, provide long-term relief, and prevent further disease progression or recurrence."

To date, CGH has completed LIFT procedures on three patients with lymphoedema.

The personalised care approach was beneficial for Mr Lim, a 41-year-old cancer survivor who developed lymphoedema in 2021. Identified to be at risk of developing the condition following surgery and radiotherapy, Mr Lim was monitored regularly, and counselled on the implications of his condition when diagnosed. The CGH care team worked with him on a prescribed compression therapy plan that would suit his lifestyle while enabling him to manage his condition.

When his lymphoedema persisted, Mr Lim underwent two separate surgical reconstruction procedures to improve his care outcomes and restore good lymphatic flow in his limbs, chest, and back. In particular, his second surgery was performed as a day surgery, and Mr Lim was able to return to work the next day.

Mr Lim shared, "I've accepted the fact that I'm a cancer survivor and I have lymphoedema, possibly for the rest of my life. But I'm adapting to my 'new normal' and I'm grateful to the CGH care team for identifying and treating my post-cancer lymphoedema so that I can still work and live my live to the fullest."

For more information on CGH's Lymphoedema Service and formal screening programme, visit here.

Clin Asst Prof Jeremy Sun (centre) and Nurse Clinician Ong Ling (left) administer the Indocyanine Green Lymphography (ICGL) test as part of CGH’s programme to screen and diagnose lymphoedema.

Clin Asst Prof Jeremy Sun (left) uses an infrared camera to track real-time imaging flows of ICG dye that maps the patient’s lymphatic system during the ICGL test at CGH.

CGH Senior Physiotherapist Alicia Tan performs compression bandaging on a patient’s arm and hand to promote lymph flow and alleviate swelling as part of lymphoedema treatment.

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