Oremus, M., Dayes, I., Walker, K., & Raina, P. (2012). Systematic review: Conservative treatments for secondary lymphedema. BMC Cancer, 12, 6.

STUDY PURPOSE: To examine the effectiveness of conservative treatments for lymphedema

TYPE OF STUDY: Systematic review

DATABASES USED: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, AMED, and CINAHL 1990–January 2010

KEYWORDS: Search terms provided in online file

INCLUSION CRITERIA: RCT or observational study with comparison group, pediatric and adult patients with secondary lymphedema for any reason except filariasis infection

EXCLUSION CRITERIA: Pharmacologic or surgical treatment for lymphedema

TOTAL REFERENCES RETRIEVED: 6,814 articles were evaluated.

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Jadad scale used for RCTs; Newcastle-Ottawa Scale used  for observational studies

• FINAL NUMBER STUDIES INCLUDED = 44 (32 with cancer)
• SAMPLE RANGE ACROSS STUDIES: 21–150
• KEY SAMPLE CHARACTERISTICS: Cancer evidence was in patients with breast cancer.

PHASE OF CARE: Not provided

Six RCTs involving intermittent pneumatic compression (IPC) were used. Two showed IPC had benefit over CDT or self-massage, and three did not show IPC to be any better than massage, skin care, or elastic sleeve; one compared different IPC devices. Six RCTs using massage-based treatments were used, and five showed no benefit. Four studies of low-level laser were used. Three showed low-level laser was superior to exercise, sham laser, or usual care, and one shows that low-level laser was better than sham laser at some time points in the study. Dieting yielded conflicting findings. Equivocal results were seen for ultrasound, modified manual lymph drainage, and compression stockings.

This review provides limited evidence of effects of conservative treatments for lymphedema, and no conclusions about the most effective conservative approach are possible from this review.

Most studies had “fair” quality. Follow-up time frames in studies varied considerably. The majority of studies were among breast cancer patients only. It is surprising that this review did not include any studies involving CDT.

Findings from this review showed that most interventions reduced limb volume and were not associated with any significant patient harms. Dieting alone does not appear to be particularly effective for limb volume reduction. Patients may benefit from a variety of conservative approaches to manage lymphedema. Ongoing research is needed to determine comparative effects of various approaches.