Stuiver, M.M., Ten Tusscher, M.R., Agasi-Idenburg, C.S., Lucas, C., Aaronson, N.K., & Bossuyt, P.M. (2015). Conservative interventions for preventing clinically detectable upper-limb lymphoedema in patients who are at risk of developing lymphoedema after breast cancer therapy. Cochrane Database of Systematic Reviews, 2, CD009765. 

DOI Link

Purpose

STUDY PURPOSE: To assess the effects of conservative (nonsurgical and nonpharmacologic) interventions on lymphedema after breast cancer treatment

TYPE OF STUDY: Systematic review

Search Strategy

DATABASES USED: Cochrane Breast Cancer Group’s (CBCG) Specialized Register, CENTRAL, MEDLINE, EMBASE, CINAHL, PEDro, PsycINFO, and the World Health Organization International Clinical Trials Registry Platform in May 2013 (reference lists of included trials and other systematic reviews were searched)

KEYWORDS: Lymphedema
 
INCLUSION CRITERIA: Randomized controlled trials, women at risk of lymphedema with breast cancer
 
EXCLUSION CRITERIA: Not listed specifically

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 10 
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Cochrane method

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 10
  • TOTAL PATIENTS INCLUDED IN REVIEW = 1,122
  • SAMPLE RANGE ACROSS STUDIES: 48–205 patients
  • KEY SAMPLE CHARACTERISTICS: All had breast cancer

Phase of Care and Clinical Applications

PHASE OF CARE: Late effects and survivorship

Results

Ten studies were included. Four studies used manual lymphatic drainage with usual care or combined with exercise or compression versus usual care or education alone (395 participants). Three studies examined early- versus late-start postoperative shoulder exercises (378 participants). Two studies used either progressive resistance exercise or restricted activity (358 participants), and one study investigated a physiotherapy care plan versus no physiotherapy (65 participants).
 
No firm conclusion could be drawn about the effect of manual lymphatic drainage in addition to exercise and education on preventing the incidence of lymphedema. Arm mobility (i.e., reaching up over the head) was better after manual lymphatic drainage than without it, but this improvement lasted only for the first few weeks after breast cancer surgery.
 
The effects of early or late shoulder exercises remain inconclusive regarding the likelihood of developing lymphedema. Starting shoulder exercises immediately after surgery may improve shoulder mobility in the first month compared to starting after the first week, but no firm conclusions could be drawn and mobility was comparable later on. Progressive resistance training did not increase the risk of developing lymphedema compared to restricted activity.

Conclusions

The evidence from this review was insufficient to draw firm conclusions.

Limitations

All included studies were deemed to be of low or very low quality.

Nursing Implications

The quality of the evidence regarding interventions for reducing the risk of lymphedema remains low. More research is needed.

Legacy ID

5488