Poage, E.G., Rodrick, J.R., Wanchai, A., Stewart, B.R., Cormier, J.N., & Armer, J.M. (2014). Exploring the usefulness of botanicals as an adjunctive treatment for lymphedema: A systematic search and review. PM&R, 7, 296–310.

DOI Link

Purpose

STUDY PURPOSE: To review and critique the evidence of published studies that investigated the use of botanicals in the treatment of lymphedema
 
TYPE OF STUDY: Systematic review

Search Strategy

DATABASES USED: PubMed, CINAHL, the Cochrane Database of Systematic Reviews, the Cochrane Controlled Trials Register, PapersFirst, ProceedignsFirst, WorldCat, PEDro, National Guidelines Clearing House, ACP Journal Club, DARE, and articles sent to authors
 
KEYWORDS: Terms used by the International Lymphoedema Framework in 2006 for the Best Practice for the Management of Lymphoedema
 
INCLUSION CRITERIA: Not clearly stated; English language, evidence-based, lymphedema, complimentary and alternative therapies, 2004–2012
 
EXCLUSION CRITERIA: Not clearly stated; inadequate sample (not defined), insufficient level of evidence due to study design (not defined), not a complimentary and alternative medicine study

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 5,927
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Articles were categorized according to the Oncology Nursing Society's Putting Evidence Into Practice levels of evidence guidelines. A limited number of randomized, controlled trials were found; sample sizes were small, and studies had design flaws.

Sample Characteristics

FINAL NUMBER STUDIES INCLUDED = 11 
 
TOTAL PATIENTS INCLUDED IN REVIEW = Not stated
 
SAMPLE RANGE ACROSS STUDIES: Not stated
 
KEY SAMPLE CHARACTERISTICS: Patients with lymphedema

Phase of Care and Clinical Applications

PHASE OF CARE: Late effects and survivorship

Results

  • No botanicals reviewed were recommended for practice. 
  • The benefits of alpha benzopyrones are balanced with harms.
  • The effectiveness of gamma benzopyrones is not established
  • The effectiveness of saponin is not established.
  • The effectiveness of horse chestnut seed extract in combination therapies is not established
  • The effectiveness of pine bark extract versus gama benzopyrone is not established.
  • The effectiveness of selenium is not established.

Conclusions

One botanical intervention, alpha benzopyrones, had benefits that were balanced with harms, but the effectiveness of all other botanical interventions was not established. At this time, botanical supplements cannot be recommended as part of a therapeutic protocol to manage lymphedema in patients with cancer.

Limitations

At this time, there is limited high-quality evidence investigating the potential use of botanicals in the treatment of cancer-related lymphedema. The number of studies using botanical interventions is small, and most possess significant design flaws. This review did not clearly state the inclusion and exclusion criteria used to select literature, and patient demographics were not described.

Nursing Implications

At this time, botanical supplements should not be considered as part of routine care in the treatment of cancer-related lymphedema. Nurses must be knowledgeable about the various botanical supplements patients may be using, and they must always assess patients for the use of any botanical supplements. Nurses should council patients who are taking or who ask about botanical supplements on the current state of the research.

Legacy ID

4907