ONS Guidelines™ for Cancer Treatment-Related Lymphedema.

PURPOSE: Lymphedema is a chronic condition that may result from cancer-related surgery. The incidence of lymphedema varies greatly; however, patients remain at risk for life and may experience decreased quality of life and functional capacity. Providing recommendations for an evidence-based guideline for care of cancer treatment-related lymphedema will help to improve outcomes for patients with this chronic condition. METHODOLOGIC APPROACH: A panel of healthcare professionals with patient representation convened to develop a national clinical practice guideline on prospective surveillance, risk reduction, and conservative treatment of lymphedema. Systematic reviews of the literature were conducted and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology approach was used to assess the evidence. FINDINGS: The panel made multiple recommendations for patients who are at risk for or experiencing lymphedema. IMPLICATIONS FOR NURSING: Early diagnosis and treatment of lymphedema may mitigate symptoms. This evidence-based guideline supports patients, clinicians, and other healthcare professionals in clinical decision making. SUPPLEMENTARY MATERIAL CAN BE FOUND AT HTTPS: //onf.ons.org/supplementary-material-ons-guidelines-cancer-treatment-related-lymphedema.

Recent progress in the treatment and prevention of cancer-related lymphedema.

This article provides an overview of the recent developments in the diagnosis, treatment, and prevention of cancer-related lymphedema. Lymphedema incidence by tumor site is evaluated. Measurement techniques and trends in patient education and treatment are also summarized to include current trends in therapeutic and surgical treatment options as well as longer-term management. Finally, an overview of the policies related to insurance coverage and reimbursement will give the clinician an overview of important trends in the diagnosis, treatment, and management of cancer-related lymphedema.

Complete decongestive therapy for treatment of lymphedema.

OBJECTIVES: To summarize current evidence on the management of lymphedema and to provide management recommendations. DATA SOURCES: Eleven databases, including PubMed and CINAHL from 2004-2011. CONCLUSION: Complete decongestive therapy (CDT) is effective in reducing lymphedema, although the contribution of each individual complete decongestive therapy component has not been determined. In general, levels of evidence for complete decongestive therapy are mid-level. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses and health care providers play key roles in assessing needs and prescribing interventions to support patients with lymphedema from admission to discharge. Reviewing risk-reduction strategies and supporting the patient with lymphedema to continue self-care when undergoing medical treatment empowers patients to be proactive in health maintenance. Identifying potential problems and making appropriate referral to a lymphedema specialist avoids triggering or worsening lymphedema.

A systematic review of the evidence for complete decongestive therapy in the treatment of lymphedema from 2004 to 2011.

OBJECTIVE: To critically analyze the contemporary published research that pertains to the individual components of complete decongestive therapy (CDT), as well as CDT as a bundled intervention in the treatment of lymphedema. DATA SOURCES: Publications were retrieved from 11 major medical indices for articles published from 2004-2010 by using search terms for lymphedema and management approaches. Literature archives of the authors and reference lists were examined through 2011. STUDY SELECTION: A research librarian assisted with initial literature searches by using search terms used in the Best Practice for the Management of Lymphoedema, plus expanded terms, for literature related to lymphedema. Authors sorted relevant literature for inclusion and exclusion; included articles were sorted into topical areas for data extraction and assessment of level of evidence by using a published grading system and consensus process. The authors reviewed 99 articles, of which 26 met inclusion criteria for individual studies and 1 case study did not meet strict inclusion criteria. In addition, 14 review articles and 2 consensus articles were reviewed. DATA EXTRACTION: Information on study design and/or objectives, participants, outcomes, intervention, results, and study strengths and weaknesses was extracted from each article. Study evidence was categorized according to the Oncology Nursing Society Putting Evidence into Practice level of evidence guidelines after achieving consensus among authors. DATA SYNTHESIS: Levels of evidence were only moderately strong, because there were few randomized controlled trials with control groups, well-controlled interventions, and precise measurements of volume, mobility and/or function, and quality of life. Treatment interventions were often bundled, which makes it difficult to determine the contribution of each individual component of treatment to the outcomes achieved. CONCLUSIONS: CDT is seen to be effective in reducing lymphedema. This review focuses on original research about CDT as a bundled intervention and 2 individual components, manual lymph drainage and compression bandages. Additional studies are needed to determine the value and efficacy of the other individual components of CDT.