Beck, M., Wanchai, A., Stewart, B.R., Cormier, J.N., & Armer, J.M. (2012). Palliative care for cancer-related lymphedema: A systematic review. Journal of Palliative Medicine, 15(7), 821–827.

To a conduct a systematic review of the published literature related to the effectiveness of cancer-related lymphedema management in palliative care

Databases searched were PubMed, MEDLINE, CINAHL, Cochrane Library databases, PapersFirst, Proceedings First, Worldcat, PEDro, National Guidelines Clearing House, ACP Journal Club, and Dare.

Search keywords were lymphedema (lymphoedema, lymphodema, elephantiasis, swelling, edema, and oedema) and palliative care (advanced disease and metastatic cancer).

Studies were included in the reivew if they related to lymphedema management in the setting of palliative care, including randomized controlled trials, cohort studies, case-control studies, meta-analyses, and systematic reviews.

Studies were excluded if they

• Had no available English translation
• Did not evaluate an intervention
• Did not address lymphedema in the palliative care period
• Were abstracts only, letters to the editor, cross-sectional studies, qualitative studies, or general lymphedema overviews.

• Using the search terms, 31 references were retrieved.
• The research was evaluated using the PEP categories of levels of evidence.

• Eleven studies were included.
• Samples sizes ranged from 1–90 across studies.
• Samples included patients with various types of advanced or metastatic cancer and lymphedema.

Patients were undergoing end-of-life and palliative care.

The study identified four categories of lymphedema in the palliative care settings.

• Five case studies addressed closed-controlled subcutaneous drainage.
• One retrospective study dealt with manual lymphatic drainage (MLD).
• Two case studies looked at compression therapy.
• Three case studies addressed complete decongestive therapy (CDT).

Only a few studies (4 out of 11) included objective measures of outcomes. All studies were in the category of \"Effectiveness Not Established\" assessed by the Oncology Nursing Society Putting Evidence Into Practice classification.

A lack of rigorously designed clinical research studies have been conducted pertaining to the treatment of lymphedema in patients with advanced or metastatic cancer.

• Articles published prior to January 2004 were not included in this systematic review. The authors did not provide an explanation for this.
• Articles with no available English translation were excluded. This exclusion criterion indicates that articles from non-English countries (e.g., Germany, China, and India) were not reviewed; however, the authors did not state the possible number of these non-English articles.

This systematic review indicated that the identified procedures (closed-controlled subcutaneous drainage, MLD, compression therapy, and CDT) are relatively safe. Nurses may consider recommending these procedures to individuals with lymphedema and advanced or metastatic cancer. Nurse scientists need to conduct more rigorously designed studies to test the effectiveness of management of cancer-related lymphedema in palliative care.