[Team medical care for lymphedema management from evidence-based medicine]

Lymphedema is divided into primary lymphedema due to inherited conditions, and secondary lymphedema arising from damage to the lymph nodes or vessels. The main cause of secondary lymphedema in Japan is cancer treatment such as lymph node dissection and/or irradiation. However, surgeons are not often interested in this non-fatal aftereffect of surgery. Therefore, there has been little research with a high level of evidence to reach a better evidence-based medicine(EBM)or understanding of the real incidence of lymphedema. Because of the delay of standardization of management, prophylactic instruction against lymphedema and the use of elastic garments and bandaging for the treatment of lymphedema have been covered by medical reimbursement since 2008. Doctors must now pay attention to the management of postoperative lymphedema. Prophylactic instructions are given to doctors, nurses, and physical therapists so that they may teach the prescribed points to patients independently. These medical staff are also supposed to be in charge of the treatment of lymphedema patients; however, only the costs of compression materials have been reimbursed as of 2013. A standard strategy based on the EBM should be performed as a team practice. A comprehensive program including lymphedema management is also introduced.