Prevalence and incidence of cancer related lymphedema in low and middle-income countries: A systematic review and meta-analysis

Abstract

<jats:title>Abstract</jats:title> <jats:p>Background Little is known about the prevalence and incidence in low and middle-income countries (LMICs) of secondary lymphedema due to cancer. This study aims to estimate the prevalence and incidence in LMICs of secondary lymphedema related to cancer and/or its treatment(s) and identify risk factors. Method A systematic review and meta-analysis was conducted. Medline, EMBASE and CINAHL were searched in June 2019 for peer-reviewed articles that assessed prevalence and/or incidence of cancer-related lymphedema in LMICs. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies. Estimates of pooled prevalence and incidence estimates were calculated with 95% confidence intervals (CI), with sub-group analyses grouping studies according to: country of origin, study design, risk of bias, setting, treatment, and lymphedema site and measurement. Heterogeneity was measured using X ² and I 2 , with interpretation guided by the Cochrane Handbook for Systematic Reviews. Results Of 8766 articles, 36 were included. Most reported on arm lymphedema secondary to breast cancer treatment (n=31), with the remainder reporting on leg lymphedema following gynecological cancer treatment (n=5). Arm lymphedema was mostly measured by arm circumference (n=16/31 studies), and leg lymphedema through self-report (n=3/5 studies). Eight studies used more than one lymphedema measurement. Only two studies that measured prevalence of leg lymphedema could be included in a meta-analysis (pooled prevalence =10.0%, 95%CI 7.0 – 13.0, I 2 =0%). The pooled prevalence of arm lymphedema was 27%, with considerable heterogeneity (95%CI 20.0 – 34.0, I 2 =94.69%, n =13 studies). The pooled incidence for arm lymphedema was 21%, also with considerable heterogeneity (95%CI 15.0 – 26.0, I 2 =95.29%, n =11 studies). There was evidence that higher BMI (&gt;25) was associated with increased risk of arm lymphedema (OR: 1.98, 95%CI 1.45 – 2.70, I 2 =84.0%, P&lt; 0.0001, n =4 studies). Conclusion Better understanding the factors that contribute to variability in cancer-related arm lymphedema in LMICs is an important first step to developing targeted interventions to improve quality of life. Standardising measurement of lymphedema globally and better reporting would enable comparison within the context of information about cancer treatments and lymphedema care.</jats:p>

Limb Volume Measurements: A Comparison of Circumferential Techniques and Optoelectronic Systems against Water Displacement

“…Second, the proposed segmental technique paralleled the points taken for the elasticcompression garment. This would better quantify and optimize the effect of complex decongestive therapy (i.e., the first intensive phase) and the maintenance phase (i.e., the daily compression by a low-stretch elastic stocking or sleeve) of the treatment by localizing the points that would need more drainage and/or compressive bandaging [10][11][12][13].…”

“…The aim of Complex Physical Therapy is firstly to reduce the volume of lymphoedema through the compression bandage and then to maintain such reduction over time [8]. The efficacy of Complex Physical Therapy is usually evaluated by the volumetric measurement of the limbs, which can be direct and indirect [10][11][12][13].…”

Effect of Supervised Resistance Training on Arm Volume, Quality of Life and Physical Perfomance Among Women at High Risk for Breast Cancer-Related Lymphedema: A Study Protocol for a Randomized Controlled Trial (STRONG-B)

“…Among the adverse effects, lymphedema deserves attention because of its chronic nature (15). One-third of breast cancer survivors develop breast cancer-related arm lymphedema (BCRL), 80% of them closely after treatments (16)(17)(18). BCRL is an excess accumulation of protein-rich fluid that would otherwise drain via the lymphatic system, leading to regional swelling in one or both arms after breast cancer (19,20).…”