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The treatment of lymphedema related to breast cancer: a systematic review and evidence summary

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Abstract

Goals of work

To provide an evidence summary report on the question: What are the treatment options for women with lymphedema following treatment for breast cancer?

Methods

Cancer Care Ontario’s Supportive Care Guidelines Group (SCGG) employed systematic review methodology to produce an evidence summary on this topic. Evidence-based opinions were formulated to guide clinical decision making, and a formal external review process was conducted to validate the relevance of these opinions for Ontario practitioners.

Results

The systematic review search strategy identified ten randomized controlled trials which form the basis of this evidence summary report. Four key opinions offered by the SCGG are outlined below. Responses from the practitioner feedback process supported the validity of these opinions in Ontario. (1) There is some evidence to suggest that compression therapy and manual lymphatic drainage may improve established lymphedema, but further studies are needed. Compression garments should be worn from morning to night and be removed at bedtime. Patients should be advised that lymphedema is a lifelong condition and that compression garments must be worn on a daily basis. Patients can expect stabilization and/or modest improvement of edema with the use of the garment in the prescribed fashion. (2) There is no current evidence to support the use of medical therapies, including diuretics. (3) Additional efforts to define relevant clinical outcomes for the assessment of patients with lymphedema would be valuable. (4) These opinions are appropriate for patients with more than mild lymphedema, where the signs and symptoms are considered significant from the patients’ perspective.

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Notes

  1. Two additional clinical practice guidelines, one by the New Zealand Guidelines Group (NZGG) on surgical management of breast cancer, and one by the National Breast Cancer Centre in Australia on management of early breast cancer surgery, were identified online at the time of our search but are no longer electronically accessible.

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Acknowledgements

The Supportive Care Guidelines Group would like to thank Ms. Lyn Kligman, Dr. Rebecca Wong, Ms. Mary Johnston, and Ms. Nancy Laetsch for taking the lead in drafting and revising this evidence summary report.

Author information

Authors and Affiliations

  1. Pain and Symptom Management Team, Supportive Care Program, London Regional Cancer Centre, 790 Commissioners Rd East, London, Ontario, N6A 4L6, Canada

    Lyn Kligman

  2. Department of Radiation Oncology, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada

    Rebecca K. S. Wong

  3. Cancer Care Ontario Program in Evidence-Based Care, McMaster University, 1280 Main Street West, DTC, 3rd Floor, Hamilton, Ontario, L8S 4L8, Canada

    Mary Johnston & Nancy S. Laetsch

Authors
  1. Lyn Kligman
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  2. Rebecca K. S. Wong
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  3. Mary Johnston
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  4. Nancy S. Laetsch
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Consortia

Members of the Supportive Care Guidelines Group of Cancer Care Ontario’s Program in Evidence-based Care

Corresponding author

Correspondence to Rebecca K. S. Wong.

Additional information

A complete list of Supportive Care Guidelines Group members is available at: http://www.cancercare.on.ca/access_1222.htm.

This work is presented on behalf of the members of the Supportive Care Guidelines Group of Cancer Care Ontario’s Program in Evidence-based Care. A complete list of the members is available at http://www.cancercare.on.ca/access_1222.htm.

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Kligman, L., Wong, R.K.S., Johnston, M. et al. The treatment of lymphedema related to breast cancer: a systematic review and evidence summary. Support Care Cancer 12, 421–431 (2004). https://doi.org/10.1007/s00520-004-0627-0

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  • DOI: https://doi.org/10.1007/s00520-004-0627-0

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