Current Evidence on Patient Precautions for Reducing Lymphedema Manifestation and Progression Risks

Objective(s): The purpose of this study was to review if current evidence supports or refutes patient precautions to prevent the manifestation and/or progression of breast cancer-related lymphedema (BCRL), review if behavioral changes result in the prevention or reduction of BCRL, and identify related gaps of knowledge for future research.

Data Sources: Medline, CINAHL, and Cochrane databases were searched between January 2008 and March 2023. Hand searches of systematic review references were completed.

Study Selection: Studies were eligible for inclusion if: they were intervention, prospective, retrospective, or case study designs; included adult breast cancer survivors with or without BCRL; studied patient-specific risk exposures associated with BCRL in the upper quadrant ipsilateral to breast cancer or interventions focused on risk reduction; and 4) included objective measurements of lymphedema. Abstract and full-text screening was completed with the use of two independent reviewers and a third reviewer available to resolve conflicts.

Data Extraction: Studies were synthesized according to risk reduction intervention or the patient-specific risk exposure categories of trauma, blood pressure, temperature, and air travel. Data quality was assessed using levels of evidence outlined in the APTA Clinical Practice Guideline Process Manual and estimates of confidence outlined by Kondo et al. (2017).

Data Synthesis: Blood draws, medical skin punctures, and blood pressure measurements in the ipsilateral upper extremity were not generally associated with increased risk for BCRL in prospective studies. Evidence for surgery in the ipsilateral upper quadrant as a risk factor for BCRL was mixed. Temperature was not associated with increased risk for BCRL. Air travel did not appear to be a risk factor for BCRL. Seroma was retained as a risk factor because it was related to an increased risk for BCRL. Wound infection was also retained as a risk for BCRL. Evidence for lymphedema prevention through behavioral change is mixed. Nine of the thirteen included studies in this review evidenced that behavioral change reduced the risk of BCRL progression.

Conclusions: Evidence is sufficient to refute many of the previously claimed risk factors for the manifestation of BCRL. However, there was scant evidence about risks for lymphedema progression. There is evidence that suggests that behavioral change influences BCRL progression. Patient education about precautionary risks needs to be concordant with what is currently evidenced in the literature. Future studies should continue to focus on prospective cohort designs with robust outcome measures.

Author(s) Disclosures: Authors have no financial or non-financial interests to disclose. Authors contributed to the entirety of the study. Authors have approved the manuscript.