Improving Lymphedema Treatment, Therapies and Outcomes
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Improving Lymphedema Treatment, Therapies and Outcomes

August 8, 2023

As a young girl, Shelley DiCecco, PT, PhD, CLT-LANA, CI-CS, would often accompany her maternal grandmother to her cancer treatments, especially her chemotherapy.

DiCecco is shown standing with a female student at a conference in Nottingham, England.
In June 2023, DiCecco, along with a student, traveled to an international conference in Nottingham, England to present findings from one of her studies.

“I believe this sparked my love for oncology,” DiCecco said.

Her interest in oncology would later combine with interest in a condition that can be caused by cancer or cancer treatment—lymphedema. As a student, DiCecco had a clinical rotation at a clinic that specialized in lymphedema and pelvic health conditions (incontinence and pelvic pain diagnoses).

“Often lymphatic and pelvic dysfunctions can significantly impact one's basic needs and activities of daily living,” DiCecco explained. “Helping a patient regain these activities was so rewarding that I decided to pursue both of these areas when I began practicing and my desire to learn and do more has fueled my research interests.”

Now, as an assistant professor in the Doctor of Physical Therapy program at PCOM Georgia, DiCecco is conducting research aimed at increasing understanding of the lymphatic system's anatomy and pathology, analyzing current global treatment practices, and improving patient outcomes.

What is Lymphedema?

Lymphedema, according to the American Cancer Society, is a build-up of lymph fluid under the skin due to damage or a dysfunction with the lymphatic system; which can cause swelling and discomfort. While this often happens in the arms or legs, it can also occur in the face, neck, abdomen or genitals. The condition is often chronic and can sometimes cause serious issues for the patient.

“The lymphatic system is intrinsically involved with all systems of the body; yet, it is the least researched and understood by the medical community and patients,” DiCecco explained. “I have been working in this area with patient care for more than 20 years and only in the past decade has research and treatment options really started to advance.”

Part of DiCecco’s research is to quantify the average number of lymph nodes in the main draining regions of the body.

“This can help healthcare practitioners better select how many lymph nodes to remove during cancer treatments and to predict outcomes after treatments,” she said.

DiCecco is working with international therapists to evaluate the current knowledge and needs of healthcare practitioners worldwide in the different aspects of lymphedema including pediatrics, genital lymphedema and pregnancy concerns with lymphedema.

“These patients deserve options to minimize the impact lymphedema has on the quality of their daily life,” DiCecco added.

Improving Lymphedema Treatment

DiCecco is using different assessment techniques to evaluate current treatment options for males and females with genital lymphedema involvement. Her research is attempting to determine if tools used to treat lymphedema in other areas, like the breasts after breast cancer, could be used to address genital lymphedema.

Key Points
  • Lymphedema is swelling caused by lymph fluid buildup due to a dysfunction with the lymphatic system.
  • DiCecco's research aims to enhance lymphedema understanding, treatment, and patient outcomes.
  • Physical therapy can address the impact lymphatic and pelvic dysfunctions have on a patient’s quality of life.

“I am working with another colleague at PCOM to see how one's body build, especially adipose or fat tissue around the ribcage, can impact breathing,” DiCecco said.

Individuals with trunk lymphedema, lipedema, and general obesity often have adipose accumulation on the trunk and this could interfere with rib cage movement and muscle recruitment with breathing.

Upcoming research projects involve investigating current treatment options for orthopedic-related edema concerns as well as exploring how chronic diseases, like lymphedema and lipedema, impact mental and physical intimacy.

Passing the Torch

DiCecco has presented her research at local, national and international conferences. And while conducting the research is important, training new researchers and practitioners is also a priority for her.

“My main goal is for these future healthcare practitioners to recognize what lymphedema looks like and what treatment options are available for these individuals,” DiCecco said. “I also hope I can encourage a few to enter the field of lymphology, for I will need to retire one day and I need others to carry the torch!”

Her advice to novice researchers is to start small and think of basic questions to answer. DiCecco said a common mistake is trying to tackle a huge research question or project in an initial attempt at research.

“The research process then can become overwhelming and discouraging,” she said.

DiCecco encourages prospective researchers to start with something as simple as a literature review or case study, and then progress to larger or more involved studies. She also advises researchers to be open to including others.

“My research at PCOM is open to all students,” she said. “I love having PT, biomedical, and DO students on my teams. Everyone has different ways of looking at the research question and brings unique strengths to the projects.”

A self-described “why?” person who loves learning, DiCecco spent the early part of her career reading everything she could on different topics related to her patients and the field.

“As I matured as a healthcare practitioner, I realized there were still so many unanswered questions. So, I decided if I was not satisfied, I needed to do something about it and start my own research to help answer some of these questions,” she said. “I am so glad I did, for doing research brings on another entire level of satisfaction with my career!”

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