Hot off the Press October 2026

Article to ponder

Around 1 in 4 older adults living in the community may have chronic lower-limb oedema. Oedema commonly occurs alongside multimorbidity, particularly diabetes, heart disease and obesity. Oedema commonly occurs alongside multimorbidity, particularly diabetes, heart disease and obesity. Evidence from aged-care homes remains limited, and current prevalence estimates may underestimate the extent of the problem in this high-risk population.

Prevalence, characteristics and risk factors for chronic lower-limb oedema in the older population living in the community or in an aged-care home: a systematic review

Maree O’Connor, Suzanne Kuys, Michael Steele, Peter Franks, Helen Badge, Age and Ageing, Volume 55, Issue 9, September 2026, afag277,

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Key Takeaway: Chronic lower-limb oedema is a common but under-recognised condition in older adults that is frequently associated with obesity, diabetes, heart disease, cellulitis and wounds.

We have collated some great articles and material published over the last month. Click on the links below to read the  abstract or download the full paper.

Prevalence and Risk Factors

Impact of climatic variations on lymphoedema: an international comparison.

Witt, S., Oberlin, M., Gordon, S., Campbell, N., & Piller, N. (2026). British Journal of Community Nursing, 31(Sup10), S39-S45.

Background

Lymphoedema is a chronic condition that requires ongoing, daily management. It can have a significant impact on an individual’s quality of life and comes with a high personal and health service cost. Lymphoedema is a highly dynamic disease requiring constant adaptation of management techniques to prevent worsening of the symptoms.
Aims

To understand differences in lymphoedema management across the changing seasons in Germany and Australia.
Methods

Focus groups were conducted in Germany with people living with lymphoedema by following a phenomenological approach. Outcomes were compared to those from focus groups previously conducted with people in Australia.
Findings

There were high similarities between countries, with most participants reporting that heat and humidity caused increased challenges in managing lymphoedema, namely that the affected limb felt heavier, more swollen and caused increased lethargy. European participants tended to do more self-bandaging and more regular therapy appointments than their Australian counterparts.
Conclusions

All participants reported needing to consider the weather in planning their daily activities, with a large range of strategies implemented to keep their swelling in check and prevent further decline.
Implications for practice

Further research in this area will subsequently contribute to treatment recommendations and may benefit production of new materials that can, in the light of predicted climate change, prepare for the future.

Assessment

Health-Related Quality of Life and Associated Factors in Long-Term Breast Cancer Survivors With and Without Lymphedema: A Cross-Sectional Study

Huihong He, Danli Wang, Haiyan Zhu, Jiamin Xu, Manfei Qian. J Vis Exp. 2026 Sep 3.

Breast cancer-related lymphedema is a common long-term complication of breast cancer treatment that may continue to affect survivors well beyond active treatment. This study compared health-related quality of life between long-term breast cancer survivors with and without lymphedema and examined factors associated with poorer quality of life in a hospital-based cross-sectional study. Women who had undergone definitive breast cancer surgery at least 5 years earlier were recruited from outpatient and follow-up services at Shaoxing People’s Hospital. Lymphedema status was determined using predefined criteria based on symptom duration and objective upper-limb measurements. Health-related quality of life was assessed using the Functional Assessment of Cancer Therapy-Breast (FACT-B), the EQ-5D-5L, and the EQ visual analogue scale (EQ-VAS). Clinical, treatment-related, and symptom-related variables were collected for adjusted analyses. Among 268 long-term breast cancer survivors, 69 were classified as having lymphedema and 199 as not having lymphedema. Participants with lymphedema had lower breast cancer-specific and generic health-related quality-of-life scores than those without lymphedema. In adjusted analyses, lymphedema status and pain remained independently associated with lower FACT-B total scores. These findings indicate that lymphedema remains associated with poorer health-related quality of life in long-term breast cancer survivors and support continued symptom-oriented surveillance during survivorship.:10.3791/72086

Based on the health belief model: a qualitative exploration of factors influencing early screening behavior for breast cancer-related lymphedema

Jinting Sun, Yuanfei Chen, Juan Xu, Ying Jiang, Juan Ji. Support Care Cancer. 2026 Sep 15.

OBJECTIVE: This study explored postoperative breast cancer patients’ experiences, perceptions, and barriers associated with breast cancer-related lymphedema (BCRL) screening.
METHODS: A qualitative descriptive design was employed. Semi-structured interviews were conducted with 20 postoperative breast cancer patients recruited from a tertiary hospital in Suzhou, China, using purposive sampling with maximum variation. Data were analyzed using thematic analysis following the six-phase procedure outlined by Braun and Clarke. Reporting followed the COREQ guidelines.
RESULTS: Four themes were identified: (1) limited understanding and misinterpretation of BCRL risk; (2) motivations and barriers to screening behavior; (3) social and systemic constraints on screening; and (4) self-efficacy and health responsibility. Participants commonly lacked knowledge of BCRL, underestimated their risk, and had limited awareness of its long-term consequences. Screening participation was shaped by perceived benefits, logistical barriers, skepticism regarding effectiveness, and broader social and healthcare system constraints. Self-efficacy and an internalized sense of health responsibility promoted screening despite existing barriers.
CONCLUSION: BCRL screening behavior reflects an interaction between cognitive appraisal, contextual constraints, and health system factors. Interventions should focus on strengthening survivorship follow-up, clinician communication, and access to screening services.:10.1007

From Surveillance to Intervention in Breast Cancer-Related Lymphedema: Clinical Thresholds, Longitudinal Monitoring, and Actionable Care Pathways

Eun Joo Yang, Seung Hyun Chung, Jang-Hyuk Cho, Mi Ri Suh, Ha Ra Jeon, Han Gyu Cha, Ji Young Lee, Joon Young Choi. Clin Breast Cancer. 2026 Sep 2.

Breast cancer-related lymphedema (BCRL) is a common and potentially progressive complication of breast cancer treatment. Although lymphatic dysfunction may precede clinically apparent swelling, uncertainty remains regarding how surveillance findings should be translated into confirmation, intervention, and follow-up. This review synthesized evidence on early detection and prospective surveillance for BCRL, focusing on the transition from measurement to clinical action. A systematic search of PubMed/MEDLINE, Embase, the Cochrane Library, KoreaMed, and KMbase from inception through March 2026 included 57 unique studies addressing diagnostic modalities, intervention thresholds and early management, patient-centered monitoring and self-management, and prospective surveillance strategies. Serial bioimpedance spectroscopy and limb-volume assessment referenced to individual baseline measurements were the most extensively evaluated approaches for identifying clinically meaningful changes before overt BCRL. A lymphedema index increase of at least 6.5 units and a relative limb-volume increase of 5% to 10% were most appropriately interpreted as triggers for confirmatory assessment and consideration of early conservative intervention rather than as stand-alone diagnostic criteria. Ultrasonography and indocyanine green lymphography provided complementary tissue and anatomical information but were better suited to selected clinical assessment than routine surveillance. Evidence supporting patient self-monitoring and health-system implementation remained limited. The clinical value of prospective surveillance depends on linking baseline-based longitudinal monitoring to confirmation of meaningful change, timely intervention, response reassessment, and escalation when necessary. An actionable care pathway integrating objective measurements, symptoms, clinical context, and patient participation may support earlier and more consistent BCRL management throughout breast cancer survivorship.:10.1016/j.clbc.2026.08.024

Evaluation of upper extremity performance in women with and without breast cancer-related lymphedema

Gülbin Ergin, Hüseyin Mahiroğlu, Ümit Akay, Ali İbrahim Sevinç, Didem Karadibak. J Hand Ther. 2026 Sep 2.

BACKGROUND: Breast cancer-related lymphedema may negatively affect upper extremity function; however, objective evidence regarding task-oriented upper extremity performance and hand reaction time in this population remains limited.
PURPOSE: To compare upper extremity performance and hand reaction time in women with and without breast cancer-related lymphedema after breast cancer treatment.
STUDY DESIGN: Cross-sectional study.
METHODS: Fifty women after breast cancer treatment were included: 25 with breast cancer-related lymphedema and 25 without lymphedema. Limb volume was calculated using the frustum formula from circumferential measurements taken at 5-cm intervals. Upper extremity performance was assessed using the Timed Functional Arm and Shoulder Test (TFAST), and hand reaction time was assessed using the Nelson Hand Reaction Test (NHRT).
RESULTS: Age, body mass index (BMI), pain intensity, and time since surgery were comparable between groups. Affected-side arm volume was higher in the breast cancer-related lymphedema group than in the non-lymphedema group (2095.5 ± 425.7 cm³ vs 1695.9 ± 365.5 cm³; mean difference: 399.6 cm³; p < 0.001). TFAST scores were lower in women with breast cancer-related lymphedema on the affected/dominant side (median: 41 vs 53; r = 0.69; p < 0.001) and on the unaffected/non-dominant side (median: 39 vs 57; r = 0.67; p < 0.001). NHRT reaction time in the affected hand was longer in the breast cancer-related lymphedema group (median: 0.259 seconds vs 0.234 seconds; r = 0.66; p < 0.001). Limb volume was negatively correlated with affected-side TFAST scores in women with breast cancer-related lymphedema (r = -0.58, p = 0.002), but not with NHRT scores (r = 0.15, p = 0.227).
CONCLUSIONS: Breast cancer-related lymphedema is associated with clinically meaningful impairments in task-oriented upper extremity performance and longer affected-hand reaction time. Performance-based assessment may help identify functional impairments associated with breast cancer-related lymphedema and guide individualized hand and upper extremity rehabilitation for women after breast cancer treatment.:10.1016/j.jht.2026.06.024

SkinFibroMeter in lower extremity lymphedema assessment: Reliability, correlation with ultrasound, and the determination of minimal detectable change

Elif Duygu-Yildiz, Samet Genez, Serkan Sevim, Beyza Özcan, Gozde Tekin, Nuriye Özengin. Phlebology. 2026 Sep 19.

Objectives: This study aimed to determine the inter- and intra-rater reliabilities of the SkinFibroMeter in individuals with lower extremity lymphedema. The secondary aim was to examine its correlation with skin/subcutaneous tissue thickness and establish minimal detectable change (MDC95) values.
Methods: Thirty lower extremities with physician-diagnosed lymphedema were included in this cross-sectional study. Tissue stiffness was assessed at standardized anatomical sites using the SkinFibroMeter® by four raters with varying clinical experience. Skin and subcutaneous tissue thickness were measured at the same points via ultrasound (US). Inter- and intra-rater reliabilities were evaluated using intraclass correlation coefficients (ICC), and the standard error of measurement and MDC95 were calculated.
Results: Participants had a mean age of 68 ± 11.9 years, a mean BMI of 34.0 ± 6.0 kg/m2, and a mean limb volume of 10,020 ± 3,148 mL. Intra-rater reliability ranged from moderate to excellent (ICC = 0.600-0.976), while inter-rater reliability varied by site (ICC = 0.647-0.941), with the highest agreement at 20 cm above the patella and the lowest at the foot dorsum. Bland-Altman analysis confirmed acceptable absolute agreement across rater pairs with negligible systematic bias. Low-to-moderate positive correlations were observed between the indentation values of the SkinFibroMeter and skin thickness (r = 0.377-0.556, p < .05), whereas negative correlations were found with subcutaneous thickness at several points (r = -0.508 to -0.421, p < .05). No statistically significant correlation was found between localized stiffness and total limb volume (r = -0.023, p = .907). MDC95 values ranged from 0.013 to 0.158.
Conclusion: The SkinFibroMeter demonstrates acceptable clinical reliability, with values representing a complex interplay of dermal thickness, interstitial hydration, and tissue compliance rather than global limb size or pure fibrosis. This is the first study to establish MDC95 thresholds, providing clinicians with reference baselines for treatment-related changes. Future studies should incorporate larger, stage-homogeneous cohorts using 3D scanning and shear-wave elastography for comprehensive tissue characterization.:10.1177/02683555261491461

Quantitative ultrasound skin thickness measurement for assessment of lower-limb lymphedema

Paloma Malagón, Xinyu Lou, Longbiao Yu, Jingjing Wen, Zhegang Zhou. J Plast Reconstr Aesthet Surg. 2026 Sep 4.

INTRODUCTION: A previous study demonstrated that ultrahigh frequency ultrasound can be used to assess upper-limb lymphedema by measuring skin thickness. The aim of this study was to establish skin thickness cut-off values using conventional high-frequency ultrasound (HFUS) for lower limb lymphedema.
METHODS: Skin thickness was measured at 10 points in the lower limbs of 20 healthy volunteers and 20 patients with lower limb lymphedema using HFUS (15 MHz). Measurements were statistically compared between the groups and with the indocyanine-green lymphography findings. A multivariable linear model and ROC curve analysis were also performed to establish cut-off values.
RESULTS: Skin thickness was significantly greater in lymphedematous limbs than in controls (p < 0.001). Mean examination time was 5 min per patient. Cut-off values at each point were established to identify lymphedema with a specificity of 100% and sensitivity of 70-95%. The medial ankle was the most informative site, with a cut-off value of 2 mm (sensitivity 95% and specificity 100%). Based on the results, a practical algorithm was proposed: values <1.95 mm at all points were not suggestive of lymphedema; any value ≥2.3 mm was highly suggestive of lymphedema; intermediate values (1.95-2.3 mm) required point-specific interpretation or confirmatory imaging. Using this approach, ultrasound was used to identify subclinical contralateral lymphedema in 4 patients (20%), ultrasound + ICG-L in 3 additional patients (15%), and only 6 limbs (7.5%) required confirmatory imaging.
CONCLUSIONS: Point-based skin-thickness measurement using HFUS is useful in detecting and assessing lymphedema, including early or subclinical stages. The proposed cut-off values should be considered preliminary and require validation in larger multicenter studies involving different populations and ultrasound systems. Nevertheless, this approach may represent a practical tool for screening at-risk patients, guiding additional imaging studies, and identifying the most affected regions.:10.1016/j.bjps.2026.08.044

Do not mistake symptomatic improvement for disease modification: therapeutic endpoints in secondary lower-extremity lymphedema require inflammation-fibrosis anchoring

Jia-Wen Wang, Li-Na Jian. Front Immunol. 2026 Aug 13

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Multimodal Assessment of Breast Cancer-Related Lymphedema Using Bioimpedance Analysis, Ultrasound Tissue Thickness, and Shear Wave Elastography

Mi-Hyeon Bang, Ha-Lim Song, Geunyeol Jo, Hwan-Kwon Do. Diagnostics (Basel). 2026 Aug 16

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Objective Severity, Pain and Range-of-Motion Limitation in Breast Cancer-Related Upper-Limb Lymphedema: Associations with Patient-Reported Burden

Emine Çetin Duru, Mehmet Adam, Pınar Doruk Analan. J Clin Med. 2026 Aug 17

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A qualitative study exploring the experiences of individuals living with lipoedema and the impacts it has on their quality of life

Rhiannon Stellmaker, Belinda Thompson, Vincent Singh Paramanandam, Kerry A. Sherman, Helen Mackie, Louise Koelmeyer. Int J Qual Stud Health Well-being. 2026 Sep 18. 

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Management Strategies

The Role of Technology in the Care of Breast-Cancer Related Lymphedema: A Scoping Review

Che-Chung Justin Lin, Ewa Zuzanna Krzyż. Clin Breast Cancer. 2026 Aug 1.

Digital technologies are increasingly being incorporated into breast cancer-related lymphedema (BCRL) care, yet their role across the continuum of care has not been comprehensively synthesized. This scoping review mapped current applications of technology-assisted care for BCRL and identified key implementation considerations relevant to clinical practice. A scoping review was conducted following the Arksey and O’Malley framework and reported according to the Preferred Reporting Items of Systematic Reviews and Meta-analyses extension for Scoping Reviews guidelines. PubMed, Scopus, EMBASE, Web of Science, and MEDLINE were searched from inception to June 2026. Nineteen studies met the inclusion criteria. Digital technologies supported prevention, surveillance and monitoring, self-management, rehabilitation, and long-term follow-up. Frequently reported technologies included bioimpedance spectroscopy, three-dimensional imaging, mobile applications, telehealth, virtual reality, and remote monitoring tools. Most studies evaluated clinical outcomes, including limb volume, symptom severity, physical function, and quality of life, whereas implementation outcomes were less frequently assessed. Reported facilitators included improved accessibility, reduced travel burden, professional support, and enhanced patient engagement. Common barriers comprised technical challenges, limited digital literacy, unequal access to technology, and patient preference for face-to-face care. This review provides the first comprehensive overview of technology-assisted care across the BCRL continuum and highlights important gaps in implementation research. The findings support integrating digital technologies into patient-centered survivorship care while emphasizing the need for equitable, sustainable, and clinically integrated implementation strategies.:10.1016/j.clbc.2026.07.034

One contract, one Wales: standardising lymphoedema garment provision through a national procurement model

Karen Morgan, Garry Cooper, Cheryl E. Pike, Melanie J. Thomas, Gavin Hughes, James Evans, Louise Barry. Br J Community Nurs. 2026 Sep 2.

Before 2014, lymphoedema compression garment provision in Wales was fragmented, with wide variation in access, prescribing routes, product quality and cost, resulting in inequity for patients and inefficiency. Given the chronic nature of lymphoedema and the central role of compression therapy, a more consistent national approach was required. This commentary describes the rationale, development and impact of implementing a single national procurement contract and standardised garment formulary for lymphoedema care in Wales. Between 2014 and 20., a clinically led, collaborative procurement process was undertaken involving national clinical leadership, procurement services, clinicians, patients and independent laboratory testing to inform garment selection. The resulting contract improved equity of access, strengthened quality assurance, standardised prescribing practice and enabled all-Wales audit and exception monitoring. This model demonstrates how national procurement, grounded in clinical evidence and stakeholder engagement, can reduce unwarranted variation, optimise value-based healthcare and support consistent, person-centred care across community and specialist settings.:10.12968.0018

Manual Lymph Drainage in Lower Extremity Lymphedema Management: An Essential Component or An Optional Extra? A Single-Blind, Randomized Non-Inferiority Trial

Elif Duygu-Yildiz, Samet Genez, Mustafa Fatih Yaşar, Nuriye Özengin. Arch Phys Med Rehabil. 2026 Sep.

OBJECTIVE: To determine whether compression bandaging (CB) alone is non-inferior to CB combined with manual lymphatic drainage (MLD) in terms of reducing limb volume, tissue stiffness, and skin/subcutaneous thickness during the intensive phase of Stage 2-3 lower extremity lymphedema (LEL) treatment. DESIGN: A single-blind, randomized non-inferiority trial.
SETTING: xxx University, Department of Physiotherapy and Rehabilitation, xxx Physical Therapy and Rehabilitation Training and Research Hospital.
PARTICIPANTS: A total of 32 extremities with Stage 2-3 LEL were randomly assigned to either the CB group (n = 16) or the CB+MLD group (n = 16). Thirty-one extremities completed the study (CB: n = 16; CB+MLD: n = 15).
INTERVENTIONS: Interventions were administered 5 days a week for 4 weeks. The CB group received CB alone, while the CB+MLD group received a combination of compression bandaging and MLD.
MAIN OUTCOME MEASURES: The primary outcome was percentage volume reduction (PVR), with a pre-specified non-inferiority margin (Δ) of -5%. Secondary outcomes included tissue stiffness measured via SkinFibroMeter, and skin and subcutaneous thickness evaluated using ultrasound at 17 standardized points across the lower extremity.
RESULTS: Both groups achieved significant reductions in limb volume (p<0.001, Cohen's d: 1.35 for CB, 1.49 for CB+MLD). No significant difference in PVR was observed between the CB (19.67±8.47%) and CB+MLD (22.23±8.74%) groups (p=0.466). The 95% confidence interval for the mean difference in PVR was [-4.57,9.68], which remained within the field non-inferiority margin. Both groups also demonstrated significant improvements in distal tissue stiffness (p<0.001, d: 1.27 for CB, 1.32 for CB+MLD) and subcutaneous thickness (p<0.001, d: 1.06-1.24), with no significant inter-group differences (p>0.05).
CONCLUSIONS: CB alone is non-inferior to CB+MLD for reducing edema and tissue stiffness in Stage 2-3 LEL. Consequently, prioritizing appropriate compression may allow for more cost-effective and less time-consuming treatment strategies without compromising therapeutic efficacy.:10.1016/j.apmr.2026.09.001

Exercise interventions for lower limb lymphedema: A scoping review of intervention characteristics and outcomes

Cansu Sahbaz Pirincci, Aysegul Dulger, Esma Demir, Serap Cinar, Serife Aydin, Tugba Ozcan, Emine Cihan. Phlebology. 2026 Sep 16.

This scoping review aimed to summarize the existing evidence regarding exercise interventions in individuals with lower limb lymphedema (LLL), focusing on intervention characteristics, outcome measures, and reported effects.
Methods: A scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). This study was conducted using a scoping review design to examine the existing literature on the effects of exercise interventions in LLL between January 1, 2016, and March 1, 2026. Studies investigating any type of exercise intervention in adults with primary or secondary LLL were included. Data on study characteristics, participant demographics, exercise protocols, outcome measures, and key findings were extracted and synthesized descriptively.
Results: Eighteen studies investigating exercise interventions for lower limb lymphedema were included. Most participants were women with secondary lymphedema following gynecological cancer treatment. Exercise, frequently combined with compression or complex decongestive therapy, was associated with reductions in limb volume and edema, as well as improvements in pain, functional capacity, walking performance, and quality of life. Preventive exercise programs also reduced the incidence or delayed the onset of lymphedema in several studies. Across all included studies, exercise was well tolerated, with no evidence of lymphedema exacerbation or serious adverse events. However, substantial heterogeneity was observed in exercise protocols, intervention duration, and outcome measures.
Conclusion: The studies reviewed in this review demonstrate that exercise is a safe, feasible, and effective approach to managing lower-extremity lymphedema. Active exercise combined with compression therapy significantly reduces edema volume.:10.1177/02683555261487774

Core components of physical activity interventions in the prevention and management of breast cancer-related lymphoedema (BCRL): A scoping review

Laura Henry, Julie S. Wilson, Jason J. Wilson, Esther R. Beck. PLoS One. 2026 Sep 2

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Factors Associated with Self-Management Behavior in Patients with Breast Cancer-Related Lymphedema

Yuanjin Jiang, Qi Lan, Junzhen Jiang, Xueping Mao. Patient Prefer Adherence. 2026 Sep 9.

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Determinants of self-care practices in patients with breast cancer-related upper limb lymphedema: a cross-sectional analysis

Zhongru Cao, Hongbo Huo. Front Public Health. 2026 Sep 1. 

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