Examining the efficacy of treatments for arm lymphedema in breast cancer survivors: an overview of systematic reviews with meta-analysesResearch in context
Summary: Background: Lymphedema affects one in six breast cancer survivors making it a global healthcare challenge. There is considerable debate about the efficacy of different treatments for lymphedema. We aimed to summarize the current evidence for treatments for lymphedema in breast cancer survi...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-01-01
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| Series: | EClinicalMedicine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537023005746 |
| _version_ | 1797347059701907456 |
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| author | Bolette Skjødt Rafn Anne Bodilsen Annika von Heymann Maja Johannsen Lindberg Sofia Byllov Tine Ginnerup Andreasen Christoffer Johansen Peer Christiansen Robert Zachariae |
| author_facet | Bolette Skjødt Rafn Anne Bodilsen Annika von Heymann Maja Johannsen Lindberg Sofia Byllov Tine Ginnerup Andreasen Christoffer Johansen Peer Christiansen Robert Zachariae |
| author_sort | Bolette Skjødt Rafn |
| collection | DOAJ |
| description | Summary: Background: Lymphedema affects one in six breast cancer survivors making it a global healthcare challenge. There is considerable debate about the efficacy of different treatments for lymphedema. We aimed to summarize the current evidence for treatments for lymphedema in breast cancer survivors. Methods: In this overview of systematic reviews with meta-analyses (SRMAs), five databases were searched for SRMAs of randomised controlled trials (RCTs) reporting effects of medications, surgery, exercise, laser therapy, acupuncture, kinesio taping, or complex decongestive physiotherapy (CDP) for breast cancer-related lymphedema published from database inception up to March 7, 2023. Data extraction was performed for the SRMAs and RCTs, and SRMAs were appraised with AMSTAR2. Random effects meta-analyses of the RCTs provided estimates of the pooled effects sizes (Hedges’ g) for each treatment modality. This study is registered with PROSPERO, CRD42020184813. Findings: 1569 studies were identified by the search and eighteen SRMAs with 51 RCTs were included, investigating manual lymphatic drainage (MLD), compression pump, exercise, kinesio taping, laser, and acupuncture. Overall, the methodological quality of the SRMAs was low. SRMAs reached different conclusions for all treatment modalities, except for kinesio taping where the two SRMAs found no effect. The analysis of 40 RCTs with 1970 participants revealed a small effect across all interventions compared to any control (g = 0.20, p = 0.047, I2 = 0.79), corresponding to volume reductions of 119.7 ml (95% CI 135–104) and 88.0 ml (95% CI 99–77) in the intervention and control groups, respectively, and a small effect of exercise (g = 0.26, p = 0.022, I2 = 0.44). The between-group differences in volume reduction were small and did not reach statistical significance for any one treatment modality. Interpretation: Based on the available data, there is no evidence of superiority of any one treatment on volume reduction nor any solid research refuting these treatments. Thus, definitive conclusions to inform clinical practice about the efficacy of these treatments cannot be drawn. Due to poor-quality evidence, more research is needed to untangle the efficacy of each treatment component for different stages of lymphedema. Funding: Danish Cancer Society. |
| first_indexed | 2024-03-08T11:42:08Z |
| format | Article |
| id | doaj.art-20be3510973346979cc07cefb258d507 |
| institution | Directory Open Access Journal |
| issn | 2589-5370 |
| language | English |
| last_indexed | 2024-03-08T11:42:08Z |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj.art-20be3510973346979cc07cefb258d5072024-01-25T05:23:36ZengElsevierEClinicalMedicine2589-53702024-01-0167102397Examining the efficacy of treatments for arm lymphedema in breast cancer survivors: an overview of systematic reviews with meta-analysesResearch in contextBolette Skjødt Rafn0Anne Bodilsen1Annika von Heymann2Maja Johannsen Lindberg3Sofia Byllov4Tine Ginnerup Andreasen5Christoffer Johansen6Peer Christiansen7Robert Zachariae8Cancer Survivorship and Treatment Late Effects (CASTLE) - Danish Cancer Society National Research Center, Department of Oncology, Copenhagen University Hospital Rigshospitalet, Denmark; Corresponding author. Blegdamsvej 58, Copenhagen 2100, Denmark.Department of Surgery, Aarhus University, DenmarkCancer Survivorship and Treatment Late Effects (CASTLE) - Danish Cancer Society National Research Center, Department of Oncology, Copenhagen University Hospital Rigshospitalet, DenmarkDepartment of Psychiatry, Aarhus University Hospital, Gødstrup, DenmarkDanish Breast Cancer Group Center and Clinic for Late Effects (DCCL), Aarhus University Hospital, Aarhus, Denmark; Department of Plastic and Breast Surgery, Aarhus University Hospital, DenmarkDanish Breast Cancer Group Center and Clinic for Late Effects (DCCL), Aarhus University Hospital, Aarhus, Denmark; Department of Plastic and Breast Surgery, Aarhus University Hospital, DenmarkCancer Survivorship and Treatment Late Effects (CASTLE) - Danish Cancer Society National Research Center, Department of Oncology, Copenhagen University Hospital Rigshospitalet, DenmarkDanish Breast Cancer Group Center and Clinic for Late Effects (DCCL), Aarhus University Hospital, Aarhus, Denmark; Department of Plastic and Breast Surgery, Aarhus University Hospital, DenmarkDanish Breast Cancer Group Center and Clinic for Late Effects (DCCL), Aarhus University Hospital, Aarhus, Denmark; Unit for Psycho-oncology and Health Psychology, Department of Oncology, Aarhus University Hospital, and Department of Psychology and Behavioural Sciences, Aarhus University, DenmarkSummary: Background: Lymphedema affects one in six breast cancer survivors making it a global healthcare challenge. There is considerable debate about the efficacy of different treatments for lymphedema. We aimed to summarize the current evidence for treatments for lymphedema in breast cancer survivors. Methods: In this overview of systematic reviews with meta-analyses (SRMAs), five databases were searched for SRMAs of randomised controlled trials (RCTs) reporting effects of medications, surgery, exercise, laser therapy, acupuncture, kinesio taping, or complex decongestive physiotherapy (CDP) for breast cancer-related lymphedema published from database inception up to March 7, 2023. Data extraction was performed for the SRMAs and RCTs, and SRMAs were appraised with AMSTAR2. Random effects meta-analyses of the RCTs provided estimates of the pooled effects sizes (Hedges’ g) for each treatment modality. This study is registered with PROSPERO, CRD42020184813. Findings: 1569 studies were identified by the search and eighteen SRMAs with 51 RCTs were included, investigating manual lymphatic drainage (MLD), compression pump, exercise, kinesio taping, laser, and acupuncture. Overall, the methodological quality of the SRMAs was low. SRMAs reached different conclusions for all treatment modalities, except for kinesio taping where the two SRMAs found no effect. The analysis of 40 RCTs with 1970 participants revealed a small effect across all interventions compared to any control (g = 0.20, p = 0.047, I2 = 0.79), corresponding to volume reductions of 119.7 ml (95% CI 135–104) and 88.0 ml (95% CI 99–77) in the intervention and control groups, respectively, and a small effect of exercise (g = 0.26, p = 0.022, I2 = 0.44). The between-group differences in volume reduction were small and did not reach statistical significance for any one treatment modality. Interpretation: Based on the available data, there is no evidence of superiority of any one treatment on volume reduction nor any solid research refuting these treatments. Thus, definitive conclusions to inform clinical practice about the efficacy of these treatments cannot be drawn. Due to poor-quality evidence, more research is needed to untangle the efficacy of each treatment component for different stages of lymphedema. Funding: Danish Cancer Society.http://www.sciencedirect.com/science/article/pii/S2589537023005746Complex decongestive physiotherapyExerciseLaser therapyKinesio tapingAcupuncture |
| spellingShingle | Bolette Skjødt Rafn Anne Bodilsen Annika von Heymann Maja Johannsen Lindberg Sofia Byllov Tine Ginnerup Andreasen Christoffer Johansen Peer Christiansen Robert Zachariae Examining the efficacy of treatments for arm lymphedema in breast cancer survivors: an overview of systematic reviews with meta-analysesResearch in context EClinicalMedicine Complex decongestive physiotherapy Exercise Laser therapy Kinesio taping Acupuncture |
| title | Examining the efficacy of treatments for arm lymphedema in breast cancer survivors: an overview of systematic reviews with meta-analysesResearch in context |
| title_full | Examining the efficacy of treatments for arm lymphedema in breast cancer survivors: an overview of systematic reviews with meta-analysesResearch in context |
| title_fullStr | Examining the efficacy of treatments for arm lymphedema in breast cancer survivors: an overview of systematic reviews with meta-analysesResearch in context |
| title_full_unstemmed | Examining the efficacy of treatments for arm lymphedema in breast cancer survivors: an overview of systematic reviews with meta-analysesResearch in context |
| title_short | Examining the efficacy of treatments for arm lymphedema in breast cancer survivors: an overview of systematic reviews with meta-analysesResearch in context |
| title_sort | examining the efficacy of treatments for arm lymphedema in breast cancer survivors an overview of systematic reviews with meta analysesresearch in context |
| topic | Complex decongestive physiotherapy Exercise Laser therapy Kinesio taping Acupuncture |
| url | http://www.sciencedirect.com/science/article/pii/S2589537023005746 |
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