title: The management of secondary lower limb lymphoedema in cancer patients: a systematic review.
abstract: BACKGROUND
  Lower limb lymphoedema is a recognised complication of cancer commonly encountered in palliative care, associated with reduced mobility and poor quality of life.
  
  
  OBJECTIVE
  To evaluate the available evidence for the treatment of secondary lower limb lymphoedema in patients with malignancies.
  
  
  METHODS
  A systematic review of the literature.
  
  
  METHODS
  The MEDLINE, Embase, LILACS, Science Citation Index, Cochrane Databases and conference proceedings for published data from date of inception to July 2014 were searched. Relevant unpublished studies via relevant databases, Internet searches and hand-searches of the bibliographies of relevant papers were performed.
  
  
  RESULTS
  From 1617 citations, 32 papers were selected for full-text assessment. Two randomised trials and five observational studies were identified. The two randomised controlled trials evaluated graded compression stockings and Coumarin capsules, respectively. The five observational studies evaluated lymphovenous microsurgical shunts, pneumatic compression devices, compression bandages alone, manual lymphatic drainage with compression and a herbal remedy combining Coumarin, Ginkgo and Melitoto (with or without manual lymphatic drainage), respectively. The extracted studies showed substantial heterogeneity. Hence, a meta-analysis was inappropriate and not performed.
  
  
  CONCLUSIONS
  Few studies have evaluated the clinical effectiveness and potential side effects of treatments for lower limb lymphoedema. Moreover, symptoms and quality-of-life assessments were inconsistently reported. All included studies report lower limb volume reduction after treatment, which includes complex decongestion therapy, graded compression stockings and lymphovenous microsurgical shunts. Adequately powered randomised controlled trials of these interventions are recommended. Effort should be made to establish standardised outcomes, to minimise bias and to improve reporting quality in future trials of treatment for lower limb lymphoedema.
authors.affiliation: Women's Health Research Unit, Centre of Public Health and Primary Care, Queen Mary University of London, London, UK elaine.leung@qmul.ac.uk.
authors.forename: Elaine Y L
authors.initials: EY
authors.lastname: Leung
authors.affiliation: Women's Health Research Unit, Centre of Public Health and Primary Care, Queen Mary University of London, London, UK.
authors.forename: Seema A
authors.initials: SA
authors.lastname: Tirlapur
authors.affiliation: Health Economics Research Group, Brunel University, London, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Meads
mesh_terms: D003374:Coumarins / Q000627:therapeutic use; D019468:Disease Management; D006801:Humans; D035002:Lower Extremity / Q000473:pathology; D008209:Lymphedema / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy*; D009369:Neoplasms / Q000150:complications*; D065126:Palliative Medicine / Q000379:methods; D011788:Quality of Life; D053828:Stockings, Compression / Q000706:statistics & numerical data
chemical_list: D003374:Coumarins; C030123:coumarin
keywords: Lower extremities; lymphoedema; neoplasm; systematic review