MQ Health - Macquarie University

Lymphoedema Clinic

Lymphoedema education

The ALERT (Australian Lymphoedema Education, Research and Treatment) program at Macquarie University is a comprehensive clinical, education and research program that aims to optimise positive outcomes for people living with lymphoedema through excellence in diagnosis, assessment and management of lymphoedema along the care continuum. We are a flagship program of the Faculty of Medicine & Health Sciences at Macquarie University.

At ALERT Education, we provide courses and skill-based workshops to health professionals in all aspects of lymphoedema management, from theory through to treatment intervention.  Course content is based on current scientific evidence and the latest in innovative resources and technology.

An overview of lymphoedema care

Lymphoedema is a chronic form of swelling and occurs when the body’s lymphatic system is not working correctly. There are two types of lymphoedema - primary and secondary.

Primary lymphoedema occurs due to a structural or functional abnormality within the lymphatic system and most commonly affects the lower limbs.

Secondary lymphoedema most commonly occurs in association with cancer care, venous leg ulcer care or obesity management.

For example, cancer care is an evolving area of diagnosis, research, treatment and survivorship management.  Breast cancer was the second most commonly diagnosed cancer in Australia in 2014. It was also the most commonly diagnosed cancer in females at this time.(1)  Secondary lymphoedema of the arm and breast is one side-effect of breast cancer treatment. Other types of lymphoedema affecting the lower limb/s can also occur after prostate, melanoma and gynaecological cancers.

Cellulitis is closely associated with lymphoedema. (2-3) Cellulitis is a major burden on healthcare and is classed as an acute reason for hospital admission that is potentially preventable.

Rehabilitation and lymphoedema therapy have been shown to be effective in reducing the severity of cellulitis and lymphoedema symptoms, and reducing lymphoedema incidence and the cost of care. (4-7)

The aims of lymphoedema treatment are to prevent progression of the condition, to reduce oedema and then to maintain the improvement. This includes the alleviation of associated symptoms, prevention of infection and improvement of function and quality of life. To do this effectively, health professionals are encouraged to undertake specialised training in lymphoedema management.

References:

1 Australian Institute of Health and Welfare Statistics (2018) Content accessed 20/10/2018. Available via: https://breast-cancer.canceraustralia.gov.au/statistics

2 Soo, JK.; et al  ( 2008) Lymphatic abnormalities demonstrated by lymphoscintigraphy after lower limb cellulitis.   British Journal of Dermatology, 158, 1350-1353

3 Dupuy, A.; et al  (1999)  Risk Factors for erysipelas of the leg (cellulitis): case-control study.  BMJ 318, 1591-1594 8 Cox, NH; (2006) Oedema as a risk factor for multiple episodes of cellulitis/erysipelas of the lower leg: a series with community follow-up.  British Journal of Dermatology, 155, 947-950y

4 Shiang-Ru Lu., et al (2015) Role of physiotherapy and patient education in lymphedema control following breast cancer surgery. Ther Clin Risk Manag. 2015; 11: 319–327.

5 Stout Gergich, N. L., et al (2008) Preoperative assessment enables the early diagnosis and successful treatment of lymphedema. Cancer, 112: 2809–2819. Free access via: http://onlinelibrary.wiley.com/doi/10.1002/cncr.23494/epdf

6 Stout N.L., et al (2012) Breast Cancer–Related Lymphedema: Comparing Direct Costs of a Prospective Surveillance Model and a Traditional Model of Care, Physical Therapy, Volume 92, Issue 1, Pp 152–163. Free access via: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258414/

7 Stout, NL., et al (2013) A systematic review of care delivery models and economic analyses in lymphedema: health policy impact (2004-2011). Lymphology. 46(1):27-41. Free access via: https://www.alfp.org/docs/27-41.Mar%202013.STOUT.PDF

What ALERT Education offers

Through the ALERT Education program, Macquarie University is the first university in Australia to offer lymphoedema accreditation courses via a continuing professional development program. Through the treatment and research arms of ALERT, we have access to a team of highly qualified and experienced health professionals and experts in lymphoedema.

Our students benefit from this expertise.

We pride ourselves on delivering excellence in lymphoedema education and this is supported by exceptional course feedback.

In 2017, 219 Allied Health professionals completed an ALERT Education course, and due to the sound evidence-based focus of our program, several leaders from other endorsed training programs across Australia attended our Advanced Lymphatic Anatomy course.

Access to the latest in evidence-based information

Our students benefit from the active lymphoedema research program conducted at ALERT.

The ALERT research program has been successful in publishing several scientific papers on lymphoedema and our team members have presented recently at several local and international conferences.

Therefore, our students have access to the latest in evidence-based information that guides lymphoedema diagnosis, assessment and management.

The ALERT program is involved in designing and conducting many research studies with the aim of achieving better outcomes in innovative management of early and advanced lymphoedema through conservative management and surgical treatment (namely liposuction, lymph node transfer and lymphovenous anastomosis).

In our research program, ALERT partners with academic institutions and corporate organisations both nationally and internationally. One example is our collaboration with Vanderbilt University on the PREVENT Randomised Control Trial investigating the early detection and management of breast cancer-related lymphoedema. We are the only site outside the US participating in this 5-year study and have contributed the highest number of study participants (450) to the total study cohort of 1,200 women.

More information on research projects can be found here.

State-of-the-art teaching resources

The ALERT Education team has access to the teaching resources that are part of the Faculty of Medicine and Health Sciences programs offered through Macquarie University.

For example, in our advanced workshop “Innovations in lymphoedema assessment and management: Understanding normal lymphatic anatomy and lymphoedema using ICG lymphography and lymphosomes”, students have access to the faculty anatomy laboratories and sophisticated  microscope technology and can see and experience real lymphatic flow in both animal and human models. Further information about this course can be accessed here.

Course delivery by leaders in the field of lymphoedema

Our courses feature a team approach from the ALERT team including Professor John Boyages (radiation oncologist), Associate Professor Hiroo Suami (world leader in lymphatic research), Dr Helen Mackie (rehabilitation specialist) and leading lymphoedema therapists.

The Lymphoedema Accreditation Course features three primary course instructors who bring over 56 years of combined experience in lymphoedema management:

  • Louise Koelmeyer - occupational therapist, lecturer and ALA and NLPR member
  • Sally Kava - occupational therapist, lecturer and ALA and NLPR member
  • Andrea Mangion - physiotherapist, lecturer and ALA and NLPR member

Students also benefit from lectures on lymphatic anatomy delivered by Associate Professor Hiroo Suami.

The ALERT Education team also utilises the clinical expertise of:

  • Ms Asha Heydon-White - lymphoedema physiotherapist, member of ALA and NLPR
  • Ms Robyn Ricketts - lymphoedema occupational therapist

We also invite other guests presenters to deliver course content  as required.

Courses offered in 2019

Lymphoedema Accreditation Course

This intensive 135-hour course meets the international standard for qualification as a lymphoedema therapist and is delivered a combination of online learning and 9 days of face-to-face instruction. This lymphoedema course is endorsed by the Australasian Lymphology Association (ALA), the peak professional association for lymphoedema.

2019 dates: 

eLearning from 7 January 2019. Face-to-face module from Tuesday 12 February - Friday 22 February 2019 (excluding 16-17 February).

eLearning from 12 August 2019. Face-to-face module from Tuesday 17 September - Friday 27 September 2019 (excluding 21-22 September).

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One-day advanced workshops

Innovations in lymphoedema assessment and management: Understanding normal lymphatic anatomy and lymphoedema featuring ICG lymphography and lymphosomes

This workshop explores lymphatic anatomy utilising the latest evidence in lymphatic imaging techniques, near-infrared fluorescence lymphatic imaging (ICG) and the concept of lymphatic territories (lymphosomes). This course is delivered by Associate Professor Hiroo Suami, world-expert in lymphatic research, and health professionals benefit from learning about lymphatic anatomy from a plastic surgeon who has published widely in this field over the last 10 years.

2019 dates:

Tuesday 9 July 2019, 8.30 am - 5.00 pm

Tuesday 3 December 2019, 8.30 am - 5.00 pm

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The ALERT Education program has two main sponsors: