# Regional disparities in lymphedema treatment and access to complex decongestive therapy: a nationwide survey in Japan

## TL;DR

A nationwide survey in Japan found significant regional disparities in access to lymphedema treatment, especially for complex decongestive therapy.

## Contribution

This study is the first to systematically analyze regional disparities in lymphedema treatment and CDT availability across Japan.

## Key findings

- Over 95% of facilities treat extremity lymphedema, but less than 30% treat head and neck lymphedema.
- The lowest-volume region for CDT inpatients had about 2% the rate of the highest-volume region.
- Outpatient CDT access in the lowest-volume region was one-third that of the highest-volume region.

## Abstract

Lymphedema has a significant impact on patient quality of life. However, it remains unclear whether the provision of lymphedema treatment in Japan is uniform across regions. This study aimed to clarify the current situation regarding lymphedema treatment with emphasis on complex decongestive therapies (CDT) availability and implementation in Japan.

A nationwide web-based survey was conducted. Respondents included healthcare professionals from designated cancer care hospitals and other medical institutions treating lymphedema in Japan. The distribution of variables, including the implementation of lymphedema treatment, was compared between designated cancer care hospitals and other facilities using the chi-square test. Japan was divided into nine regions to compare and analyze access to medical institutions providing CDT for lymphedema on both inpatient and outpatient bases.

Of the 372 facility responses analyzed, ˃95% reported treating secondary lymphedema of the extremities, whereas ˂30% treated head and neck lymphedema. The number of CDT inpatients per 100 000 people in the region with the lowest patient volume was approximately 2% of that in the region with the highest volume. Similarly, the number of CDT outpatients per 100 000 people in the lowest-volume region was one-third of that in the highest-volume region. There was no significant correlation between facilities with high outpatient numbers and those with low outpatient numbers (ρ =0.57, P-value = 0.11).

Eliminating regional disparities in access to lymphedema treatment facilities, particularly for inpatient CDT, would improve quality of life and enable patients to manage the condition regardless of where they live.

A nationwide survey revealed the current state of lymphedema treatment and regional characteristics of facilities implementing complex decongestive therapy for lymphedema.