Evidence-based practice in the management of lower limb lymphedema after gynecological cancer

ABSTRACT

Purpose: Lower limb lymphedema (LLL) is characterized as a physical-functional chronic complication that impacts the quality of life of women who have gone through treatment for gynecological cancer. The present study aims to check the conservative treatments available for lymphedema after gynecological cancer in the context of evidence-based practice. Methods: The selection criteria included papers from May 1993 discussing treatment protocols used in LLL after treatment for gynecological cancer. The search was performed until October 2014 in MEDLINE, SciVerse, and PEDro using “rehabilitation,” “treatment outcome,” “therapeutics,” “clinical protocol,” “gynecologic surgery,” “lower extremity,” “lower limb,” and “lymphedema” as keywords, focused on women with a previous diagnosis of gynecological cancer who received radiation and/or chemotherapy and/or surgery and/or lymphadenectomy as part of their treatment. Results: From 110 studies found, 3 articles that used the complex decongestive therapy (CDT) as a treatment protocol were selected. There were no randomized clinical trials associated with the conservative treatment of LLL post-treatment of gynecological cancer. The three selected articles are retrospective, and had the same outcome – decreased volume of the affected limb lymphedema. Conclusions: Although LLL is more or as frequent and detrimental as upper limb lymphedema post-cancer treatment, there are only a few studies about this subject. Publications are even scarcer when considering studies with interventional approach. Randomized controlled trials are necessary to support rehabilitation resources on lymphedema post-gynecological cancer treatment.

KEYWORDS:

• Hysterectomy
• lymph node excision
• physical therapy modalities
• radiation oncology
• rehabilitation
• women’s health

Declaration of interest

All authors had an effective participation in the making of this paper, such as study design, collection, analysis, and interpretation of data, writing, and reviewing the report. There is no financial support or financial agreement, bonds, or any other conflict of interest involving the authors and companies, which may have an interest in the publication of this paper.