Опубликован сводный анализ доказательств по полной декомпрессионной терапии лимфедемы у пациенток с раком молочной железы

Researchers categorized best-evidence items into 3 domains to support complete decongestive therapy (CDT) in women with breast cancer-related lymphedema (BCRL). These results of an evidence summary recently published in the Asia-Pacific Journal of Oncology Nursing. A research team set out to synthesize the best available evidence for CDT in patients with BCRL. They conducted a systematic literature search that initially yielded 558 records. After applying inclusion/exclusion criteria, quality assessment, and evidence synthesis and grading, they identified 31 evidence sources for evidence synthesis, of which 8 were evidence summaries, 8 were clinical decision support sources, 10 were systematic reviews, and 5 were expert consensus documents. Their evidence summary included 37 best-evidence items, which they categorized across 3 core domains: - Implementation principles encompass the requirements for CDT delivery, target population, core components of CDT, and risk assessment. - The intensive treatment phase covers the recommended treatment cycle and the implementation of the 4 core CDT components (manual lymphatic drainage, compression therapy, skin care, and therapeutic exercise). - The maintenance treatment phase addresses the optimal timing for transitioning to maintenance; the adapted application of the 4 core components; the role of adjunctive therapies, follow-up, and monitoring protocols; and patient education and self-management strategies. Among the 37 evidence items, 19 (51.4%) were classified as Level 1 evidence, and 25 (67.6%) received a Grade A recommendation. However, although some Grade A recommendations were based on lower-level evidence, they still largely reflected critical clinical importance and were consistently endorsed by experts. Effective CDT delivery requires a structured implementation system, which follows a phased approach and individualized treatment plans, explained the researchers. Careful attention must also be paid during the maintenance phase to bridging the gap during the transition from therapist-led care to self-managed care supported by clinicians. Implementation of the items in the evidence-informed framework for CDT delivery would likely face some practical challenges in the real-world clinical setting. The researchers outlined 4 key considerations that would be helpful for this purpose: - CDT implementation in low-resource or primary care settings, - Practical barriers to long-term adherence and follow-up, - The role of telehealth and other support tools, and - The specific role of specialist nurses in coordinating CDT care. “By focusing on CDT across the full care continuum, this evidence summary delineates the distinct therapeutic goals and implementation priorities for each phase, thereby providing synthesized evidence to support and standardize clinical practice,” the researchers wrote. “By explicitly operationalizing the intensive-to-maintenance phase transition and providing phase-specific recommendations, this evidence summary directly addresses the continuity gap identified in the existing literature,” they continued. However, these results show that the evidence supporting the core delivery of CDT and patient self-management approaches remains limited. Additionally, strategies such as tiered care models for low-resource settings, telehealth integration, and the development of specialist nurse roles are essential to addressing the gap between evidence and real-world clinical practice. Disclosures: This research was supported by the “Huhang” Program of the Nursing Research Fund of the Oncology Nursing Committee of Shanghai Anti-Cancer Association. The study authors declare they have no conflicts of interest. Please see the original reference for a full list of disclosures. References: Zhu C, Cai M, Li Y, Hou S, Zhang X, Qiu J. Complete decongestive therapy for breast cancer-related lymphedema: an evidence summary. Asia Pac J Oncol Nurs. 2026;13:101011. doi:10.1016/j.apjon.2026.101011