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Refractory lower limb edema in cancer: subcutaneous drainage
  1. Miguel Julião1,
  2. Patrícia Calaveiras1,
  3. Elisabeth Costa1,
  4. Daniela Runa1,
  5. Bridget Johnston2 and
  6. Eduardo Bruera3
  1. 1 Equipa Comunitária de Suporte em Cuidados Paliativos de Sintra, ACeS Sintra, Sintra, Portugal
  2. 2 University of Glasgow, Glasgow, UK
  3. 3 Palliative Care & Rehabilitation Medicine, UT M. D. Anderson Cancer Center, Houston, Texas, USA
  1. Correspondence to Professor Miguel Julião, Equipa Comunitária de Suporte em Cuidados Paliativos de Sintra, Sintra, Portugal; migueljuliao{at}

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Lower severe oedema is a common—although seldom recognised—condition faced by patients with advanced cancer effecting their physical and psychosocial comfort and quality of life and adding to their caregivers’ burden.1–3 High-dose oral or intravenous diuretics4 and mechanical approaches (such as massage, elevation and compression bandaging of the limbs) are still treatment options. However, they may be contraindicated in frail, bed-bound and dependent patients cared for in their homes, especially without competent caregivers or continued monitoring by health teams.2

The use of subcutaneous (S.C.) drainage of lower or upper limbs’ oedema5 has been reported as a viable option for patients with cancer receiving palliative care, when no treatments are possible or safe due to the nature of the disease or because they have failed.

Although the S.C. drainage approach can lead to relief, symptom control and quality of life improvement, there is still little evidence on this clinical procedure.1

To contribute to the clinical evidence on this particular procedure, we; therefore, report the case of a woman with advanced metastatic cancer for whom we performed S.C. controlled drainage of her lower limb oedema. Drainage of a large quantity of oedematous fluid over 4 days led to significant improvement in her comfort as well as the neurotoxicity related to jaundice.

Case description

A 48-year-old woman with advanced metastatic breast cancer was admitted to our home-based palliative care unit. She presented with metastatic disease to her lungs, liver and possibly pelvic lymph nodes (pelvic imaging was not performed due to the patient’s poor …

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  • Contributors All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by MJ, PC, EC and DR. The first draft of the manuscript was written by MJ, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.