Are post-operative preventative measures effective in breast cancer-related lymphedema? A systematic review

Vivekanandan, Preksha, Hashmi-Greenwood, Molly, Omileye, Adebayo, Gebrye, Tadesse ORCID: https://orcid.org/0000-0001-7976-2013, Fatoye, Francis ORCID: https://orcid.org/0000-0002-3502-3953 and Mbada, Chidozie Emmanuel ORCID: https://orcid.org/0000-0003-3666-7432 (2024) Are post-operative preventative measures effective in breast cancer-related lymphedema? A systematic review. Palliative Medicine in Practice. ISSN 2545-0425

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Abstract

Breast cancer-related lymphedema (BCRL) is one of the most debilitating complications of breast cancer therapy. Many of the current approaches to preventing BRCL are based solely on anecdotes and insufficient evidence. This systematic review aimed to determine the effectiveness of post-operative BCRL preventive measures. The preferred reporting items for systematic reviews and meta-analysis guidelines were used in this review. Four databases (EBSCO CINAHL, EBSCO MEDLINE, EBSCO AMED, and Cochrane) were searched from 2012 to 2021. Studies were screened following preset inclusion and exclusion criteria. Joanna Briggs Institute (JBI) checklist and the Oxford Centre for Evidence-Based Medicine Hierarchy of Evidence (OCEBM) were used to critically appraise and evaluate the level of evidence of eligible studies. Out of the 470 articles screened, 29 were eligible for review. The articles were classified into six categories based on risk behaviors. Venipuncture, blood pressure measurements, and air travel had no strong evidence to be correlated with remission or exacerbation of BCRL (p > 0.05). There was a strong correlation between obesity and exacerbation or onset of lymphedema (p < 0.05). Physical activity and resistance training had high-quality evidence in preventing BCRL. Most studies were of moderate evidence level. There is limited evidence for post-operative precautions — like venipuncture, air travel, blood pressure measurements, and lifting heavy loads as risk factors for BCRL in patients with breast cancer. Empirical information regarding post-operative suggestions given to patients with BCRL will help to limit potentially harmful practices and enhance psychosocial health.