Flinders Medical Centre Foundation
Flinders Medical Centre Foundation


Prof Neil Piller - Lymphodema Research

Name:      Professor Neil Piller

Lymphoedema Assessment Clinic, Department of Surgery

Major project:
There are many aspects to our major project objectives which aim to improve knowledge and awareness of the lymphatic system and of the often very significant impact that the necessary treatment of cancer can have on it.   Our major projects relate to the objective early recognition and detection of lymphoedemas, and to providing good science to support what a patient or health professional can do in terms of the targeted use of traditional (Manual Lymphatic Drainage, Bandaging and Garments) and emerging treatments (Low Level Laser, Electrical Stimulation, Hand Held Massage Units).

Our current major project involves the investigation of the impact of made to measure vs off the shelf bras and looks at attempting to answer the question “Do bras’ precipitate or worsen breast oedema and lymphoedema”. To date it seems many Bra’s exert unnecessarily high pressures on the rather delicate and superficial lymphatics and that for some women in the trial this leads to reduced breast tissue health through sub-optimal fluid clearance from them via the remaining lymphatics.  This is a long term study for which we have some interim data.
How long have you worked at Flinders?

I’ve been around in a teaching role in anatomy and physiology originally with SACAE, since 1978, but it was not until 1993 that together with Dr Stephen Birrell that we were able to establish the lymphoedema assessment clinic within Flinders Surgical Oncology. At the time it was the first undertaking targeted and sequenced treatment based on the collection of accurate information about the status of the lymphoedema. I’m now the coordinator of year 2 Doctor Patient and Society and the Year 1 and 2 Elective program in the GEMP.

What led you to this area of research?
In 1969 I was lucky enough to hear a presentation by the late Dr John Casley-Smith at the School of Medicine in Adelaide. He presented what appeared to be a hopeless picture (in terms of outcomes) for those who had a malformed (primary lymphoedema) lymphatic system or those who had a lymphatic system damaged by surgery, radiotherapy or filarial worms (secondary lymphoedema).  At that I decided that I’d like to make a difference to our knowledge of the lymphatic system, which is still seen as the less important (but its not!) cousin to the vascular system.

What other collaborations are you working on?
We have often overseas guest research fellows working on short term projects of mutual interest apart from our frequent clinical trials. Our immediate past ones have involved Mr Michael Bernas from Tucson (USA) looking at the benefits of a simplified lymphatic  massage program and Ms Joyce Bosman, from Groningen (Holland) looking at the impact of Lymph-taping on seroma formation following breast cancer related axillary clearance.  I’m currently on the international advisory boards of the World Alliance for Wound and Lymphoedema Care (which aims at holistic care) and the International Lymphoedema Framework (which aims to set international standards of recognition, treatment and practice for lymphoedemas). Hopefully our knowledge can be spread.

We (and other members of our group from the schools of medicine and nursing) continue to work with Lions International in our unique lymphoedema screening programs across SA, the NT and at times in other states. Early detection is the key to good outcomes.

Approximately when could we see your work in the mainstream health system?
The current investigation on the impact of external pressure (in this case bra’s), on lymph clearance from the breast and arm, still needs a greater longitudinal follow up period and further expansion of numbers to ensure that we are clear on the pros and cons of various bras, the pressures they extert and their designs. The work has applicability to other underwear and its impact, especially for those who have had groin clearances associated with bowel, prostate and other lower body cancers.

There is no doubt however that the superficial lymphatic system is susceptible to constant external pressure. If it’s in the wrong place (ie a shoulder strap of a bra or the elastic in underpants) it may just be the factor that causes the arm, breast or leg to swell unnecessarily.

What does an average day in your job at Flinders entail?
Usually in at 7.00-7.15am with the first couple of hours spent on emails. After that there is always the need to look toward further funds and while I’m fresh I like to get any applications under way. A lot of effort often gets little reward but we have to be there to be in with a chance. It’s not much good doing high quality research with out letting others know, so getting the papers in shape often takes up the later part of the morning.  I enjoy teaching and interacting with the students. At the moment I’m lucky to have a group who are taking an elective in lymphatics in health and disease, so this and the other teaching and subject administration and meeting takes up much of the afternoons.  Any research and the lymphoedema clinic is programmed about these meetings, but like most of us we are very lucky to have a wonderful team of unsung hero’s to make sure everything goes to plan. I leave work when I can, some days it feels like I haven’t!  Unfortunately, being an editor of 3 international journals also takes its toll of time (but its an essential role) and that means often after dinner I check on what others are trying to get into press and help them with making it better.  It’s still a great feeling and I still wake every morning – enthusiastic about going to work, and my wife is enthusiastic to see me go!

Have you had a Eureka moment or ever discovered anything by accident?
Yes, I have many of these, they occur in my dreams, but the morning shows reality, it’s a long hard slog to get to the truth. But we keep trying.

How would extra funding support your research?
Even though the lymphatic system is the sewer of the body and it’s of crucial importance that is works well, many forget about it, it’s not easy to see, it’s not a high pressure system (no fountain of blood if its damaged!), but if it does not work you get a swollen arm, leg, or breast. By then its too late! We have to know how to detect and respond to changes in lymph drainage before it’s clinically visible.

It’s clear that legs are the often forgotten victims of treatment for bowel, reproductive and prostate cancer.  It’s still not easy for us to get research funds for breast cancer related lymphoedema research but it’s even harder to get funds for research into leg lymphoedemas.  Poor legs, they are always in a dependant position, they usually have a tight elastic band at their tops (or tight clothes generally) and are chronically under cared for in terms of skin and nail care.

We would love to be able to look at those with leg lymphoedemas in the first instance and see just what impact clothing and skin care and position have on them. Maybe something simple can make a big difference, but we don’t have enough evidence to know what that might be!

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