Conservative Intervention Strategies for Adult Cancer-Related Lymphedema: A Systematic Review and Network Meta-Analysis.

ABSTRACT

PROBLEM IDENTIFICATION The comparative effectiveness of available management options for cancer-related secondary lymphedema is unknown. LITERATURE SEARCH CINAHL®, Embase®, and MEDLINE® were searched for randomized trials comparing conservative treatment strategies. DATA EVALUATION A network meta-analysis was conducted for lymphedema volume, along with pairwise meta-analyses for remaining outcomes. Evidence certainty was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. SYNTHESIS: Overall, 36 studies with a total of 1,651 participants were included. Compared to standard care, conservative treatments did not significantly reduce lymphedema volume. There was low to very low certainty evidence of benefit for several treatments on secondary outcomes. IMPLICATIONS FOR PRACTICE There is insufficient evidence to suggest important differences between standard care and conservative treatment strategies for reducing lymphedema volume and improving lymphedema-related symptoms. SUPPLEMENTAL MATERIAL CAN BE FOUND AT HTTPS //onf.ons.org/supplementary-material-conservative-intervention-strategies-adult-cancer-related-lymphedema.