title: Systematic review of quality of life and patient reported outcomes in patients with oncologic related lower extremity lymphedema.
abstract: BACKGROUND
  Lower limb lymphedema (LLL) is a common complication of cancer treatment. The disease is chronic and progressive with no cure. Although a common and significant source of morbidity, the impact of this condition on health-related quality of life (HRQOL) has only recently been addressed. In effort to identify valid treatment strategies for LLL, we performed a systematic review, identifying studies describing HRQOL outcomes in patients with LLL secondary to cancer.
  
  
  RESULTS
  Seven medical databases were searched to identify reports using validated Patient Reported Outcome (PRO) instruments on patients with cancer-related LLL. Studies were classified by levels of evidence set by the Agency for Healthcare Research and Quality (AHRQ) and evaluated using the Efficace criteria. 25 studies were identified, 6 met inclusion criteria. Levels of evidence included: no level I studies, level II (n=3), level III (n=1), and level 4 (n=2). 50% of studies were compliant with the Efficace criteria. 5 PRO HRQOL instruments were used, but only 1 was specific to cancer-related lymphedema. Treatment strategies assessed included complete decongestive physiotherapy (CDP), exercise, and compression bandaging. CDP yielded significant enhancements in HRQOL.
  
  
  CONCLUSIONS
  There is a deficit in high quality studies for HRQOL in patients with LLL secondary to cancer. Furthermore, of the studies present, most did not conform to guidelines set for assessment of HRQOL, nor did they use lymphedema condition specific PRO instruments. New measures specific to assessing LLL are necessary to gain more accurate evaluation of how this debilitating disorder affects HRQOL.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
authors.forename: Yeliz
authors.initials: Y
authors.lastname: Cemal
authors.forename: Sarah
authors.initials: S
authors.lastname: Jewell
authors.forename: Claudia R
authors.initials: CR
authors.lastname: Albornoz
authors.forename: Andrea
authors.initials: A
authors.lastname: Pusic
authors.forename: Babak J
authors.initials: BJ
authors.lastname: Mehrara
mesh_terms: D058128:Compression Bandages; D015444:Exercise / Q000502:physiology; D006801:Humans; D035002:Lower Extremity / Q000473:pathology*; D008209:Lymphedema / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D009369:Neoplasms / Q000150:complications*; D017063:Outcome Assessment, Health Care; D026741:Physical Therapy Modalities; D011788:Quality of Life