Interventions to improve the psychosocial outcomes of individuals with lymphedema: a systematic review

Clinical Snapshot

Key Findings

• P Value: Not reported at the review level; individual study-level statistics not summarised in the abstract

• Effect Size: No pooled effect size reported; narrative synthesis only. Hybrid (combined in-clinic and remote) delivery demonstrated qualitatively stronger evidence for improving mental health outcomes compared to either setting alone

• Primary Outcome: Psychosocial outcomes (mental health and quality of life) in individuals with lymphedema following psychosocial interventions across three modality categories: mind-body (n=3), education and support (n=3), and physical activity (n=4)

• Nnt Or Sensitivity: Not calculable from available data; no NNT, sensitivity/specificity, or hazard ratio reported. MQRS scores ranged from 5 to 13 out of 14, indicating a wide range of methodological quality across the 10 included studies

• Confidence Interval: Not reported; meta-analysis was not conducted due to study heterogeneity

Clinical Application

Hybrid delivery models (combining in-clinic and remote components) appear feasible and may offer logistical advantages for patients with lymphedema who face mobility limitations, geographic barriers, or treatment fatigue. Physical activity and mind-body interventions are generally low-cost and low-risk. Education and support interventions may be integrated into existing survivorship care frameworks. Standardisation of psychosocial outcome measures is needed before routine implementation can be recommended In Australia, lymphedema is recognised as a significant survivorship issue, with approximately 20% of breast cancer survivors developing upper limb lymphedema following axillary lymph node dissection. The RACGP and Cancer Australia have highlighted the importance of survivorship care planning, including psychosocial support. Lymphedema management is partially supported through Medicare (MBS item numbers for lymphoedema treatment by accredited practitioners) and the National Lymphoedema Practitioners Register (NLPR). Psychosocial interventions for lymphedema are not currently PBS-listed as standalone items, but may be accessed through Mental Health Treatment Plans (MBS Better Access initiative) or cancer-specific survivorship programs. Telehealth expansion post-COVID-19 in Australia supports the feasibility of hybrid delivery models identified in this review. The TGA does not regulate the psychosocial interventions described. Integration of psychosocial care into existing Australian lymphedema management pathways — including those recommended by the Australasian Lymphology Association (ALA) — would align with this review's conclusions. RACGP guidelines on cancer survivorship care support routine psychosocial screening and referral, providing a framework for implementing findings from this evidence base as it matures. Adults with cancer-related lymphedema (predominantly) across survivorship phases, particularly those who have completed decongestive therapy. Applicability to patients in active decongestive therapy phases or with primary (non-oncological) lymphedema is less well-supported by the current evidence base

Abstract

PURPOSE: Lymphedema is a common and enduring consequence of cancer treatment with substantial physical and psychosocial morbidity, yet research predominantly focuses on physical outcomes. This systematic review examines psychosocial interventions for individuals with lymphedema, describing the intervention characteristics, methodological quality, and strength of the evidence. METHODS: A systematic literature search was conducted of studies published through November 2025. Empirical interventions with psychosocial components and outcomes for individuals with lymphedema were eligible. Methodological quality was assessed. Strength of the evidence was determined by combining quality with intervention effectiveness. RESULTS: Ten studies met inclusion criteria, including mind-body (n = 3), education and support (n = 3), and physical activity (n = 4) intervention models, and most delivered following completion of decongestive therapy. Psychosocial outcomes included mental health (n = 8) and quality of life (n = 6). Methodological rigor was mixed, with MQRS scores ranging from 5-13 (of 14). Interventions delivered in combined in-clinic and remote settings demonstrated stronger evidence for improving mental health outcomes than either setting alone. CONCLUSION: Few empirical evaluations exist targeting the psychosocial needs of individuals with lymphedema, particularly during intensive phases of decongestive therapy. Heterogeneity in intervention models, outcome measures, and treatment timing limits cross-study comparisons; however, hybrid delivery approaches show promise for improving psychosocial outcomes. Greater integration of psychosocial care across the lymphatic care continuum, supported by standardized outcome measures, may strengthen supportive care for individuals living with lymphedema.

References

1. 1.Stolker, S., Yin, S., & Auslander, W. (2026). Interventions to improve the psychosocial outcomes of individuals with lymphedema: a systematic review. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer. https://doi.org/10.2196/30162