Systematic review: conservative treatments for secondary lymphedema

Abstract

BackgroundSeveral conservative (i.e., nonpharmacologic, nonsurgical) treatments exist for secondary lymphedema. The optimal treatment is unknown. We examined the effectiveness of conservative treatments for secondary lymphedema, as well as harms related to these treatments.MethodsWe searched MEDLINE®, EMBASE®, Cochrane Central Register of Controlled Trials®, AMED, and CINAHL from 1990 to January 19, 2010. We obtained English- and non-English-language randomized controlled trials or observational studies (with comparison groups) that reported primary effectiveness data on conservative treatments for secondary lymphedema. For English-language studies, we extracted data in tabular form and summarized the tables descriptively. For non-English-language studies, we summarized the results descriptively and discussed similarities with the English-language studies.ResultsThirty-six English-language and eight non-English-language studies were included in the review. Most of these studies involved upper-limb lymphedema secondary to breast cancer. Despite lymphedema's chronicity, lengths of follow-up in most studies were under 6 months. Many trial reports contained inadequate descriptions of randomization, blinding, and methods to assess harms. Most observational studies did not control for confounding. Many studies showed that active treatments reduced the size of lymphatic limbs, although extensive between-study heterogeneity in areas such as treatment comparisons and protocols, and outcome measures, prevented us from assessing whether any one treatment was superior. This heterogeneity also precluded us from statistically pooling results. Harms were rare (< 1% incidence) and mostly minor (e.g., headache, arm pain).ConclusionsThe literature contains no evidence to suggest the most effective treatment for secondary lymphedema. Harms are few and unlikely to cause major clinical problems.

Terapia complexa descongestiva com uso de material alternativo na redução e controle do linfedema em pacientes de área endêmica de filariose: um ensaio clínico

“…The publications on lymphedema treatment received much criticism regarding methodological rigor, lack of standardized protocols and uncontrolled studies 9,30,31 . Most clinical trials focus on results and discussion on reducing lymphedema volume, without more detailed analysis, and assess few variables in addition to limb volume.…”

“…Frequently the literature has reported the difficulties in relating results of statistical tests with what would in fact be clinically significant 7,[27][28][29][30][31] . Although is not clear in the literature that volume change metrics are minimally important for patients, CDT appears as an alternative to reduce the suffering of patients with peripheral lymphedema, since there is a reduction in varied percentages, even if they are not statistically significant signifiers.…”

The management of secondary lower limb lymphoedema in cancer patients: A systematic review

“…1,3 Moreover, previous reports suggested that clinicians had often shown inadequate knowledge and lack of interest in the evidence-based management of lymphoedema, 15 particularly lymphoedema secondary to non-breast malignancies. [16][17][18][19] Standardised assessments of LLL exist (e.g. the International Society of Lymphology lymphoedema staging system 10 ) and are routinely used by specialist management units of lymphoedema.…”

The validity of an adjustable compression velcro wrap for the treatment of patients with upper limb lymphedema secondary to breast cancer: a pilot study

“…7 When analyzing the diagnostic of lymphedema, most of the studies considered differences between homolateral and contralateral limbs above 10% and/or 200 mL, as was proposed in the present study.…”