Review of research evidence

The following is a brief summary of the literature review available in full here. The bold headings outline the objectives of the literature review.

• Describe the prevalence, incidence and nature of secondary lymphoedema following treatment for cancer
  
  The incidence of secondary lymphoedema following treatment for cancer in Australia is unknown and it is likely that its prevalence is underestimated. Taken together, conservative estimates suggest that 20% of cancer survivors will experience secondary lymphoedema. This equates to more than 8000 new cases per year in Australia, highlighting the potential public health burden of cancer-related secondary lymphoedema.
   
• Identify risk factors associated with the development of secondary lymphoedema following treatment for cancer
  
  The aetiology of secondary lymphoedema seems to be multifactorial. The relationship between patient risk factors, behavioural risk factors and subsequent development of lymphoedema are currently unclear. Minimally aggressive and invasive surgical and radiation treatment are recommended to reduce risk of subsequent lymphoedema.
   
• Provide an overview of the evidence pertaining to strategies for prevention of secondary lymphoedema
  
  At this time the evidence base for prevention recommendations is limited. Current prevention guidelines are frequently derived from theoretical speculation or anecdotal experience. There is a clear need for well-designed, population-based prospective studies to investigate the causal relationship between suggested risk factors and subsequent development of secondary lymphoedema. In the meantime, it is reasonable for health professionals to discuss preventive strategies with patients to encourage healthy lifestyle behaviours.
   
• Describe the evidence surrounding treatment strategies for secondary lymphoedema
  
  Available treatment options are varied and often based on little or no evidence of benefit. However, conservative lymphoedema treatment, including complex physical therapy, manual lymph drainage, compression, bandaging, elevation and massage, is associated with volume reductions and improvements in quality of life. The role of exercise in lymphoedema remains uncertain, but to date there have been no reports of secondary lymphoedema being initiated or worsened as a consequence of exercise. Surgical treatment for lymphoedema should only be considered for a small subset of patients who have failed to obtain relief from less invasive measures. Current evidence does not support the use of any specific pharmacological intervention. There are not adequate studies investigating any one specific complementary or alternative treatment to comment on the effectiveness of such treatments.

Adverse effects, such as a burden on a patient’s finances, time or lifestyle, have also been associated with treatment for secondary lymphoedema. Therefore, consideration of the acceptability of treatment strategies to patients may be as important as monitoring compliance or treatment success.

Future research must focus on building the evidence upon which to base effective prevention and treatment activities, taking into account potential adverse and psychosocial sequelae.