Carmeli, E., & Bartoletti, R. (2011). Retrospective trial of complete decongestive physical therapy for lower extremity secondary lymphedema in melanoma patients. Supportive Care in Cancer, 19(1), 141–147.

To evaluate long-term effects of completed decongestive therapy (CDT) on lower-extremity lymphedema 

Patients who had been treated for lower-extremity lymphedema secondary to melanoma treatment from January 2006 to July 2009 were invited to participate in reevaluation. Patients participated in a interview and measurement of limb circumference. Treatment that had been provided included initial phase 1 treatment (five consecutive days of manual lymph drainage [MLD], compression bandaging, and exercises with bandages) and phase 2 maintenance treatment (skin care, supporting garments, low-stretch bandages, and a set of 10-minute exercises to be done at home). During active phases, patients completed comprehensive assessment via chart items developed by the Italian Lymphedema Association, including demographic and disease data and quality-of-life items rated by patients on a visual analog scale.

• The sample (N = 12) was 25% male and 75% female.
• All patients had melanoma that had been previously treated in the past one to four years, at least one lymph node removed from the groin area, and unilateral secondary lymphedema diagnosed by lymphoscintigraphy.
• Participants were excluded if they had complete decongestive therapy within the previous six months.

The study was conducted at a single-site, outpatient setting in Italy.

• Patients were in the long-term follow-up phase of care.
• This study has clinical applicability for late effects and survivorship.

A retrospective analysis and follow-up design was used.

• Limb circumference measurements were taken.
• In-depth interview (IDI) questionnaire history (IDI not defined) and quality-of-life information were obtained.

Findings showed that from baseline to the end of initial active treatment with CDT, the percent change in limb volume was –34%, and from baseline to the reevaluation for was –17% (p = 0.05). Patients with higher body mass index (BMI) reported significantly lower quality-of-life results (p < 0.05). Sixty percent of patients reported good compliance with the use of garments, bandages, and exercises.

The study provided limited information about longer-term outcomes of patients with lymphedema secondary to melanoma.

• The small sample (N < 30) and other study method questions limit utility of findings.
• The study had no comparison or controls.
• Procedures stated that all interviews and measurements were done by the same therapist, who was blinded to all prior measures; however, the authors did not explain how this was accomplished.
• Time from initial treatment was highly variable at one to four years.
• How the percent change at the reevaluation was significantly lower than baseline, when prior change that was greater was not significant, is unclear.

Study findings provided minimal information about the longer-term results from CDT for lower-limb lymphedema in patients who had melanoma. Information about management of lower-extremity lymphedema and long-range outcomes related to lymphedema and management approaches is limited. Further research in these areas is needed.