Loprinzi, et al. concluded that coumarin was not a safe and effective treatment for lymphedema. Therefore, diuretics should be used with caution and only for treatment of excess vascular fluid due to other causes. The nutritional status of the patient should be evaluated and supportive measures instituted as required. Hypoalbuminemia encourages fluid to pass into the interstitial tissues with excess protein and higher colloid osmotic pressure. Patients with lymphedema may experience pain as a result of pressure on nerve endings or as a result of atrophy or muscle contractures during movement.
Edematous tissues are less well nourished and more prone to necrosis during immobility.
Therefore, patients with lymphedema should be monitored for areas of skin breakdown, especially over bony prominences. Excess pressure on inguinal or pelvic lymphatics may indicate pelvic metastasis with subsequent interference of bladder emptying. Pressure, in conjunction with regular narcotics, may cause problems with bowel elimination. Patient bladder and bowel status should be monitored for signs of urinary retention or constipation. There are multiple psychosocial and adjustment issues faced by cancer patients and survivors with lymphedema.