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ONS Guidelines Article
Online Exclusive Article

Conservative Intervention Strategies for Adult Cancer-Related Lymphedema: A Systematic Review and Network Meta-Analysis

Lyubov Lytvyn
Dena Zeraatkar
Allison B. Anbari
Pamela K. Ginex
Michael J. Zoratti
Kacper Niburski
Behnam Sadeghirad
Madelin Siedler
Lehana Thabane
Rebecca L. Morgan
ONF 2020, 47(5), E171-E189 DOI: 10.1188/20.ONF.E171-E189

Problem Identification: The comparative effectiveness of available management options for cancer-related secondary lymphedema is unknown.

Literature Search: CINAHL®, Embase®, and MEDLINE® were searched for randomized trials comparing conservative treatment strategies.

Data Evaluation: A network meta-analysis was conducted for lymphedema volume, along with pairwise meta-analyses for remaining outcomes. Evidence certainty was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach.

Synthesis: Overall, 36 studies with a total of 1,651 participants were included. Compared to standard care, conservative treatments did not significantly reduce lymphedema volume. There was low to very low certainty evidence of benefit for several treatments on secondary outcomes.

Implications for Practice: There is insufficient evidence to suggest important differences between standard care and conservative treatment strategies for reducing lymphedema volume and improving lymphedema-related symptoms.

Supplemental material can be found at https://onf.ons.org/supplementary-material-conservative-intervention-strategies-adult-cancer-related-lymphedema

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