The effect of compression therapies and therapeutic modalities on lymphedema secondary to cancer: a rapid review and evidence map

Abstract

The identification of effective therapeutic modalities to manage lymphedema secondary to cancer is a high priority among patients and clinicians. Complex decongestive therapy (CDT) remains a fundamental intervention for individuals with lymphedema; however, interventions involving modalities such as low level laser therapy, specially designed compression systems, and compression pumps may be helpful to improve outcomes and reduce costs of care. We conducted a rapid review of the literature examining compression therapies and therapeutic modalities in the treatment of lymphedema secondary to cancer. A search of the electronic databases from June 2018 to October 2023 was performed including MEDLINE, EMBASE, and CINAHL. The electronic search yielded 438 potentially relevant citations with 40 randomized controlled trials included in the review, and 30 in the mapping process. Ninety-three percent (n = 37) of the trials included participants with a diagnosis of breast cancer. Across all categories and domains, all but two trials were rated as having 'some concerns' or a 'high risk of bias'. Intervention effects ranged from clinically insignificant to large effects on lymphedema volume. Evidence mapping suggests potential for benefit from (1) compression garments for the prevention of lymphedema, (2) interventions added to CDT in the intensive reduction phase, and (3) nighttime compression and compression pump treatments in the maintenance phase. A multi-centre collaborative research approach is needed to support the conduct of high-quality large-scale trials to inform the optimal type, timing, and combination of compression therapies and therapeutic modalities in the treatment of lymphedema secondary to cancer.

Keywords: Cancer; Compression pumps; Compression therapies; Extracorporeal shockwave therapy; Low-level laser therapy; Lymphedema; Mapping review.

Fig. 1

Summary of trial selection process for mapping

Fig. 2

Risk of bias of included trials (N = 40 trials; 41 comparisons)

Fig. 3

Map of preventative interventions (n = 9 RCTs)

Fig. 4

Map of alternative interventions to CDT (n = 9 RCTs with 10 comparisons)

Fig. 5

Map of adjunctive interventions to CDT (n = 7 RCTs)

Fig. 6

Map of stand-alone interventions (n = 2 RCTs)

Fig. 7

Map of maintenance interventions (n = 4 RCTs with 5 comparisons)