Background
The presentation of complex lymphoedema in the palliative context requires an approach which is first and foremost responsive to the immediate and prioritized needs of the client. This approach may require modifications of the guidelines for lymphoedema management, as well as flexibility in the provision of treatment.

Case presentation
Our case describes a 55 year old woman with lung cancer who presents with complications of her advanced disease, including extensive oedema of her right upper limb.

Treatment
It was necessary to modify treatment in response to changing circumstances in the face of the client’s general deteriorating condition. Despite some potential contraindications to treatment, lymphoedema management was successfully undertaken.

Outcome
There was a dramatic reduction in the oedema of the client’s arm, which was then maintained with adjustable compression. There was a concurrent significant reduction in the levels of pain and the emotional distress associated with the oedematous limb.

Conclusion
This case outlines the challenges of supporting a client with refractory disease. Guided by the principles of palliative care, the lymphoedema therapist can contribute to the quality of life of the palliative client where oedema is a significant issue for the client. Responsiveness and sensitivity to the physical, emotional and psychosocial needs of the client and carers are required in tandem with flexibility with respect to the management of the oedema itself.