Systematic Review of Quality of Life and Patient Reported Outcomes in Patients with Oncologic Related Lower Extremity Lymphedema

Abstract

Background: Lower limb lymphedema (LLL) is a common complication of cancer treatment. The disease is chronic and progressive with no cure. Although a common and significant source of morbidity, the impact of this condition on health-related quality of life (HRQOL) has only recently been addressed. In effort to identify valid treatment strategies for LLL, we performed a systematic review, identifying studies describing HRQOL outcomes in patients with LLL secondary to cancer. Methods and Results: Seven medical databases were searched to identify reports using validated Patient Reported Outcome (PRO) instruments on patients with cancer-related LLL. Studies were classified by levels of evidence set by the Agency for Healthcare Research and Quality (AHRQ) and evaluated using the Efficace criteria. 25 studies were identified, 6 met inclusion criteria. Levels of evidence included: no level I studies, level II (n = 3), level III (n = 1), and level 4 (n = 2). 50% of studies were compliant with the Efficace criteria. 5 PRO HRQOL instruments were used, but only 1 was specific to cancer-related lymphedema. Treatment strategies assessed included complete decongestive physiotherapy (CDP), exercise, and compression bandaging. CDP yielded significant enhancements in HRQOL. Conclusions: There is a deficit in high quality studies for HRQOL in patients with LLL secondary to cancer. Furthermore, of the studies present, most did not conform to guidelines set for assessment of HRQOL, nor did they use lymphedema condition specific PRO instruments. New measures specific to assessing LLL are necessary to gain more accurate evaluation of how this debilitating disorder affects HRQOL.

Recent progress in the treatment and prevention of cancer‐related lymphedema

“…Cemal et al recently conducted a systematic review of studies investigating the HRQOL of patients with lymphedema of the lower extremity related to cancer treatment. 131 The authors identified only 6 studies that met the review's inclusion criteria, which included the use of a validated patient-reported outcome questionnaire. None of the studies were considered as level I evidence, and only one study used a patient-reported outcome instrument that was specific to cancer-related lymphedema.…”

Sonographic Assessment of the Terminal Thoracic Duct in Patients with Lymphedema

“…[1] It arises most commonly as a consequence of cancer or the treatments of cancer. Upper extremity lymphedema is commonly associated with the treatment of breast cancer.…”

Symptom Frequency, Intensity, and Distress in Patients with Lower Limb Lymphedema

“…1,3 Secondary lymphedema is caused by various factors related to either lymphatic obstruction or lymphatic interruption due to inflammation, trauma, iatrogenic alterations of the lymph system (i.e., surgery or radiation), 3 or due to cancer therapy. 6,7,9,10 In developing countries, secondary lymphedema is predominantly caused by parasites, while in developed countries it most commonly occurs due to malignancies or malignancy-associated treatments. 2,3 Secondary lymphedema following cancer and related treatments is seen especially in patients with breast 11,12 and gynecological malignancies.…”