Article type
Abstract
Background: Breast cancer-related lymphedema poses a significant concern for patients undergoing breast cancer treatment, prompting the exploration of diverse interventions aimed at symptom reduction. This network meta-analysis aims to assess the efficacy of various interventions in mitigating lymphedema symptoms.
Patients and Methods: Adhering to the Cochrane Handbook and PRISMA guidelines, this study, registered under PROSPERO (registration number: CRD42021249308), systematically searched databases including PubMed, Embase, Cochrane Library, and ClinicalTrials.gov for randomized controlled trials comparing interventions for breast cancer-related lymphedema. The primary outcome measure was arm volume. The network meta-analysis was conducted using R software, with outcome assessment utilizing Confidence in Network Meta-Analysis (CINeMA) criteria.
Results: A total of 81 randomized controlled trials encompassing 39 interventions were identified. Pooled estimates revealed that combined complex decongestive therapy (CDT) with intermittent pneumatic compression (IPC), or IPC alone, exhibited the highest efficacy in reducing excessive arm volume when compared to usual care (standardized mean difference [SMD]=5.33; 95% confidence interval [CI]: 2.22 to 8.43; SMD=4.94; 95% CI: 1.62 to 8.26, respectively). However, CDT plus IPC did not yield significant pain relief compared to usual care (SMD=0.2; 95% CI: -0.92 to 1.33). Manual lymphatic drainage (MLD) combined with compression emerged as the most effective intervention for enhancing quality of life in comparison to usual care (SMD=1.93; 95% CI: 1.21 to 2.65). IPC did not significantly improve quality of life (SMD=-2.72; 95% CI: -4.14 to -1.3). No evidence of publication bias or significant inconsistency was detected across most findings.
Discussion: Comprehensive interventions comprising non-pharmacological modalities are imperative for breast cancer-related lymphedema patients.
IPC-based therapy significantly reduced excess arm volume, but its impact on pain relief and quality of life improvement was relatively modest. Optimal treatment options should consider arm volume, subjective perception, and intervention accessibility.
Patients and Methods: Adhering to the Cochrane Handbook and PRISMA guidelines, this study, registered under PROSPERO (registration number: CRD42021249308), systematically searched databases including PubMed, Embase, Cochrane Library, and ClinicalTrials.gov for randomized controlled trials comparing interventions for breast cancer-related lymphedema. The primary outcome measure was arm volume. The network meta-analysis was conducted using R software, with outcome assessment utilizing Confidence in Network Meta-Analysis (CINeMA) criteria.
Results: A total of 81 randomized controlled trials encompassing 39 interventions were identified. Pooled estimates revealed that combined complex decongestive therapy (CDT) with intermittent pneumatic compression (IPC), or IPC alone, exhibited the highest efficacy in reducing excessive arm volume when compared to usual care (standardized mean difference [SMD]=5.33; 95% confidence interval [CI]: 2.22 to 8.43; SMD=4.94; 95% CI: 1.62 to 8.26, respectively). However, CDT plus IPC did not yield significant pain relief compared to usual care (SMD=0.2; 95% CI: -0.92 to 1.33). Manual lymphatic drainage (MLD) combined with compression emerged as the most effective intervention for enhancing quality of life in comparison to usual care (SMD=1.93; 95% CI: 1.21 to 2.65). IPC did not significantly improve quality of life (SMD=-2.72; 95% CI: -4.14 to -1.3). No evidence of publication bias or significant inconsistency was detected across most findings.
Discussion: Comprehensive interventions comprising non-pharmacological modalities are imperative for breast cancer-related lymphedema patients.
IPC-based therapy significantly reduced excess arm volume, but its impact on pain relief and quality of life improvement was relatively modest. Optimal treatment options should consider arm volume, subjective perception, and intervention accessibility.