Hot of the Press November 2025

Article to ponder

This systematic review and meta-analysis found that among physical therapy interventions for breast cancer-related lymphedema, yoga and multimodal exercise programs showed the greatest short-term benefits for improving quality of life and shoulder mobility, though overall evidence quality was low and no clear advantage was seen for limb volume or pain reduction.

Which Physical Therapy Intervention Is Most Effective in Reducing Secondary Lymphedema Associated with Breast Cancer? A Systematic Review and Network Meta-Analysis

Raúl Alberto Aguilera-Eguía, Pamela Serón, Ruvistay Gutiérrez-Arias, Brenda Herrera-Serna, Víctor Pérez-Galdavini, Gloria Inostroza-Reyes, Cristian Yáñez-Baeza, Héctor Fuentes-Barría, Hellen Belmar Arriagada, Jaqueline Inostroza-Quiroz, Mariana Melo-Lonconao, Miguel Alarcón-Rivera, Mario Muñoz-Bustos, Mónica Pinzón-Bernal, Patricia López-Soto, Ángel Roco-Videla, Lisse Angarita-Dávila, Xavier Bonfill, Carlos Zaror. J Clin Med. 2025 Sep 24

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Key Takeaway: Yoga and multimodal exercise may best improve quality of life and shoulder movement in breast cancer-related lymphedema.

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.

Anatomy / Physiology /Pathophysiology

Changes in the Diameter of Lymphatic Vessels and Veins Due to Body Position, Evaluated by Ultrasound

Hisako Hara, Makoto Mihara. Lymphat Res Biol. 2025 Sep 24.

Background: The purpose of this study was to clarify how lymphatic vessels and veins change when body position is changed in lower limbs affected by lymphedema.
Methods: We performed a retrospective study of 18 consecutive patients (33 limbs) who underwent lymphaticovenous anastomosis (LVA) for lower limb lymphedema. We performed ultrasound to detect the suitable lymphatic vessels and veins preoperatively, applying the index of D-CUPS (Doppler, Crossing, Uncollapsible, Parallel, and Superficial fascia) to identify lymphatic vessels. We measured the vertical diameter of the lymphatic vessels and veins in each incision site for LVA using ultrasound with the patients lying, sitting, and standing, and a Student’s t test was performed.
Results: The mean age of the participants was 61.8 years old, and the mean body mass index was 21.7 (range: 18.3-28.1). Thirty-eight sites on the 30 thighs and 21 sites on the 18 calves were evaluated. The diameter of veins increased significantly when changing from a lying to a sitting or a standing position (thigh: p < 0.01, calf: p = 0.016 and 0.015, respectively), but lymphatic vessels did not (thigh: p = 0.65, calf: p = 0.60 and 0.36, respectively). A weak correlation was found between dilatation rates of veins and lymphatic vessels in the calf (r = 0.39, p = 0.030).
Conclusion: The veins dilated significantly when the body changed from the supine to standing position, but the lymphatic vessels did not. Similar studies with a larger number of cases are desirable in the future.:10.1177/15578585251382108

Clinical Features, Microbial Epidemiology, and Recurrence Risk of Cellulitis in Breast Cancer-Related Lymphedema.

Wagner, B.D., Rubin, J., Lin, IH. et al. Ann Surg Oncol (2025).

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Prevalence and Risk Factors

Analysis of Risk Factors of Lymphedema After Surgical Treatment in Cervical Cancer: A Case-Control Retrospective Study

Xiufen Gu, Yu Luo, Cuiwei Lai, Yun Liu. Int J Gen Med. 2025 Sep 30.-5938.

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Effect of body mass index on postoperative lymphedema after breast cancer: a systematic review and meta-analysis

Weiwei Zhang, Zhilin Liu, Jinming Li, Hengheng Zhang, Meijie Wu, Ping Yang, Tao Wu, Guoshuang Shen, Fuxing Zhao, Zhen Liu. Discov Oncol. 2025 Sep 29.

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Characterizing Trends of Lymphedema After Axillary Lymph Node Dissection with and Without Immediate Lymphatic Reconstruction

Kella L. Vangsness, Andre-Philippe Sam, Jeff Chang, Yash A. Mehta, Michael W. Chu, Mouchammed Agko, Antoine L. Carré. Cancers (Basel). 2025 Sep 10.

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Assessment

Pain and lymphoedema: a challenging combination

Susan Witt, Jesús Baltasar González-Rubino, Gabriele Erbacher, Rocío Martín-Valero, María Jesús Vinolo-Gil, Michael Oberlin. Br J Community Nurs. 2025 Oct 1.Sup10)

This article is a case study of a 26-year-old woman with stage III lymphoedema, secondary to complex regional pain syndrome. Progressive limb swelling, pain, limited mobility and skin breakdown, including open wounds, led to consideration of amputation. However, following an intensive period of conservative, interdisciplinary, multimodal treatment, including compression wraps, limb volume was significantly reduced, pain was better managed, and amputation was avoided. This case demonstrates that with coordinated care, even severe complex regional pain syndrome-associated lymphoedema can be effectively managed.:10.12968.0066

The Relationship Between Sleep Quality, Fatigue, and Quality of Life in Women with Lipedema

Ayla Cagliyan Turk, Dilek Eker Buyuksireci, Ender Erden, Ebru Erden, Pinar Borman. Lymphat Res Biol. 2025 Oct 7..1177/1557 858 52.

Background: We aimed to assess the sleep quality and the relationship between sleep and fatigue and quality of life in female lipedema patients.
Methods and Results: A total of 52 patients with lipedema (Group 1) and 40 healthy control subjects (Group 2) were enrolled. The type and stage of lipedema were recorded for Group 1. The quality of sleep was assessed by using the Pittsburgh Sleep Quality Index (PSQI). The Fatigue Severity Scale (FSS) was used for assessing fatigue. Quality of life was assessed with the World Health Organization Quality of Life. The mean age of the patient group was 45.26 ± 9.81, whereas it was 42.10 ± 6.36 years in the control group (p > 0.05). The mean body mass index was 30.23 ± 4.70 in Group 1 and 28.55 ± 4.14 in Group 2 (p > 0.05). The total PSQI score was 10 (range: 7-12.75) in Group 1 and 8 (range: 5-10) in Group 2 (p < 0.05). There was no difference between the groups in terms of FSS. In the assessment of quality of life, only the physical function domain was significantly poorer in Group 1 than in Group 2 (p < 0.05). Physical function was correlated with subjective sleep quality, sleep disorder, and daytime dysfunction; fatigue was correlated with sleep disorder, daytime dysfunction, and use of sleep medications (p < 0.05). There was a correlation between the total PSQI score and physical functioning and fatigue (p < 0.05).
Conclusion: Female patients with lipedema have poor sleep quality and decreased quality of life. Sleep disturbance is associated with both physical function and fatigue. Quality of sleep should be questioned in every assessment of patients with lipedema.:10.1177/15578585251387100

Modeling of Lymphedema Distribution and Complex Decongestive Therapy Effectiveness

Giovanni Farina, Ilaria Santaniello, Manuela Galli, Antonella LoMauro. Lymphat Res Biol. 2025 Oct 7..1177/1557 858 52.

Background: Lymphedema is a potential chronic degenerative secondary condition of oncologic treatments. Complex decongestive therapy (CDT) is the only treatment. Quantitative dimensional characterization of lymphedema is a topic of great clinical interest that has not been sufficiently analyzed yet. We aimed to develop statistical models that evaluate lymphedema’s local spatial distribution and the effectiveness of CDT.
Methods and Results: Retrospective observational analysis of 74 individuals (220 medical records) with unilateral upper or lower limb lymphedema who completed at least one cycle of the first phase of CDT. Statistical mixed-effects models were used to quantify the local distribution of lymphedema through the circumference of eight detection points and the efficacy of CDT according to the entity and the etiology of lymphedema. The coefficients of the models considered both fixed (i.e., the effect at the population level) and random (i.e., subject) effects. All points significantly reduced between pre- and posttreatment. Lymph stagnation occurred in the forearm and below the knee. The dimensions and effective treatment were similar between primary and secondary lymphedema and between mild and moderate lymphedema. The median global volume reduction of the upper limb was 55.1%, while it was 55%, 44.8%, and 41.7% in mild, moderate, and severe lymphedema; 50.6% and 49.4% in primary and secondary lymphedema. The median global volume reduction of the lower limb was 49.5%, while it was 64%, 49.4%, and 48.2% in mild, moderate, and severe lymphedema.
Conclusion: A modeling of lymphedema distribution was provided, finding a dysmorphic pattern driven by the gravitation effect, with lymphedema accumulating on the lower part of the limbs, which is also the part that mostly responded to CDT. The response to CDT was assessed locally and not in terms of global volume change. A new segmental proportional technique was proposed that allows making comparisons between and within subjects.:10.1177/15578585251387049

Reference Values for Interstitial Tissue Water in the Head and Neck Area: Non-lymphedema Participants

Coralie R. Arends, Caitlyn An Haack, Lisette van der Molen, Michiel W. M. van den Brekel, Martijn M. Stuiver. Lymphat Res Biol. 2025 Oct 8..1177/1557 858 52.

Background: To determine reference values for interstitial percentage water content (PWC) in the head and neck area, in a large and heterogeneous sample of non-lymphedema participants; to determine left-right interchangeability of measurement locations, and to explore to what extent PWC values vary with age, sex, skin type, and body mass index (BMI) at the determined measuring locations.
Methods and Results: In this cross-sectional study, a heterogeneous group of adult non-lymphedema participants was included. PWC was measured according to an earlier developed protocol by seven trained health professionals. Limits of agreement, error correlations, and bias, as determined by Bland and Altman analysis, were used to assess the left-right interchangeability. Mixed effects models were used to explore variables that explain the variety in PWC values. Stratified descriptive reference values were calculated for relevant subgroups. A total of 412 participants were included in the study. The unstratified PWC values ranged from 38.9% to 45.5%. Sex and BMI were statistically significantly correlated with PWC values, while sex is also clinically relevant.
Conclusion: This study resulted in sex-stratified reliable reference PWC values in the head and neck area for healthy adults. A difference of 10 percentage point between the same measurement point on the left and right side of the head or neck can be considered normal. The established reference values for PWC can be used to assist diagnosis and follow-up in patients with lymphedema in the head and neck area.:10.1177/15578585251385299

Breast Swelling and Chest Wall Swelling as a Symptom Cluster Associated With Emotional Distress in Women with Breast Cancer-Related Lymphedema

Amy Swartz. Nurs Womens Health. 2025 Oct 1.

OBJECTIVE: To explore the emotional health of women with breast cancer-related lymphedema, focusing on the symptom cluster of breast swelling and chest wall swelling.
DESIGN: A descriptive correlational design was used for this secondary analysis.
SETTING: Patients were recruited from a breast cancer center in New York City.
PARTICIPANTS: Women aged 21 years and older were recruited after initial breast cancer treatment. A sample size of 568 participants participated in the original study. The secondary analysis included 57 participants with breast swelling and chest wall swelling.
METHODS: The Breast Cancer and Lymphedema Symptom Experience Index plus demographic information were collected. Four groups were created including the symptom cluster group of breast swelling and chest wall swelling for comparison. Parametric and nonparametric tests, such as descriptive statistics, chi-square, and Kruskal-Wallis H tests, were used to assess the data.
RESULTS: Results revealed a 10% prevalence of the symptom cluster among participants. The median score on the emotional distress subscale was 9 out of 48. The emotional health of those with the symptom cluster showed a significant difference compared to those without the cluster.
CONCLUSION: These findings underscore the emotional distress burden associated with this symptom cluster, offering insights for the future development of targeted interventions and supportive care for affected individuals.:10.1016/j.nwh.2025.07.004

Body Image, Coping Styles, and Self-Care Capacity Among Breast Cancer Patients With Lymphedema: A Moderating Model Analysis.

Jiang W, Li Y. Western Journal of Nursing Research. 2025;0(0).

Background:

With adequate self-care capacity, patients with breast cancer-related lymphedema (BCRL) can reduce the frequency of outpatient and hospitalization treatments and execute decongestive procedures at home at a substantially reduced economic outlay.
Objective:

To test whether coping styles moderate the relationship between body image and self-care capacity among patients with BCRL and to identify the simple slope change trajectories and threshold value.
Methods:

From May 2022 to December 2023, the Body Image Scale, Medical Coping Modes Questionnaire, and the Appraisal of Self-Care Agency Scale-Revised were used to investigate 358 patients with BCRL. Pearson correlation analysis was used for the correlation relationship. Hierarchical multiple regression analysis of Model 1 in Process v3.5 was applied to identify the moderating effect. Johnson-Neyman technology was used to explore the detection of simple slope trajectories.
Results:

The moderating effect was found for coping styles (confrontation, avoidance, yielding) (ΔR2 = 0.012, 0.009, 0.010, P < .05), with critical thresholds of 29.87, 15.09, and 9.04, respectively. The trend and strength of body image’s influence on self-care capacity differed at high/low coping style (simple slope = −0.365/−0.936/−0.880, simple slope = −0.753/−0.654/−0.548, P < .001).
Conclusions:

Coping styles partially moderate between body image and self-care capacity, and body image exhibits a less negative impact on the self-care capacity of those with highly positive coping styles, while negative coping exacerbates this relationship. Pathway-role interactions and moderating effects of coping styles may facilitate nursing practitioners in formulating targeted interventions to effectively enhance self-care capacity.

Behavioural trajectories of delay in seeking medical care in participants with breast cancer-related lymphoedema: a qualitative study

Min Li, Linying Wang, Yuting Zhang, Yongxia Ding, Pingzhi Wang. BMJ Open. 2025 Sep 26.

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Treatment-related adverse events as a source of financial hardship in young adults with breast cancer: a qualitative study

Sara P. Myers, Ramona G. Olvera, Sandy Lee, Karen Shiu, Tessa Blevins, Willi L. Tarver, William E. Carson, Electra D. Paskett, Samilia Obeng-Gyasi, Ann Scheck McAlearney. Support Care Cancer. 2025 Sep 26

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Decision-Making for Lymphedema Diagnostic and Surveillance Measures: A Case-Based Approach.

Vargo, M., Aldrich, M., Iker, E. et al.. Curr Phys Med Rehabil Rep 13, 38 (2025). https://doi.org/10.1007/s40141-025-00507-4

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Breast cancer related lymphedema and shoulder mobility following radiotherapy.

Jarm, T., Besic, N., Arnez, R.C. et al. Strahlenther Onkol (2025).

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Novel quantitative parameters of lymphatic contrast-enhanced ultrasound for breast cancer-related lymphoedema: Correlating with clinical staging

Z.J. Liu, Z.S. Zeng, P Fu, J.L. Wang, J Zhu, Z.R. Liu, L.L. Zhang. Radiography (Lond). 2025 Oct 24

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Management Strategies

Effectiveness of Biker Shorts-Style Compression Garments for the Treatment of Secondary Lower Limb Lymphedema

Kazuyo Kamiyama, Akira Shinaoka, Yoshihiro Kimata. Lymphat Res Biol. 2025 Sep 25.

Background: Gradient compression garments are a standard treatment for lower limb lymphedema. However, few reports exist on the indications, effectiveness, and limitations of a biker shorts-style compression garment providing only proximal local compression of the thigh and lower abdomen for lymphedema treatment. This pilot study aimed to investigate the therapeutic effects of using biker shorts-style compression garments for lower limb lymphedema treatment.
Methods and Results: We retrospectively analyzed 40 limbs that received treatment using biker shorts-style compression garments. The primary endpoint was the volume change in the thigh (compression region) and the lower leg (non-compression region) after 6 months of using biker shorts-style compression garments. The control was the volume change in the same patients during an equivalent time period when gradient compression garments were worn. Changes in lymphedema-related symptoms and patients’ subjective comments were secondary endpoints. Of the 40 limbs analyzed, 33 limbs were early-stage cases classified as stage 1 or lower by the International Society of Lymphology. Twenty-one limbs had pain and heaviness associated with lymphedema in the thigh or groin. After 6 months of using biker shorts-style compression garments, there was a significant reduction in thigh volume compared to that after using gradient compression garments during the same period. Lymph-related pain improved in all limbs. Significantly poorer thigh volume improvement was observed in patients with a missing posterolateral pathway on lymphangiography and a history of radiation therapy.
Conclusion: Compared to gradient compression garments, biker shorts-style compression garments may improve thigh volume and symptoms in lower limb secondary lymphedema.:10.1177/15578585251378442

Home self-management experience of gynaecological tumour patients with lower limb lymphoedema: a qualitative study

Gaoming Liu, Yuanyuan Liu, Jin Hu, Shijia Deng, Jielin Fan. Prim Health Care Res Dev. 2025 Oct 13.

AIM: This study aimed to investigate self-management experiences at home among gynaecological cancer patients with lower limb lymphoedema.
BACKGROUND: Lower limb lymphoedema is a common complication following gynaecological tumour treatment, causing physical and psychological distress and significantly impacting patients’ quality of life. Clinical observations reveal that many patients with lower limb lymphoedema following gynaecological tumour treatment exhibit poor compliance with family self-management, leading to complications such as worsening oedema, cellulitis, or erysipelas. This study seeks to gain insight into patients’ actual self-management experiences within their families, offering insights for tailored intervention plans and improved patient self-management compliance in clinical practice.
METHODS: Employing a phenomenological approach in qualitative research, one-on-one semi-structured interviews were conducted to gather face-to-face data from participants. A total of 16 gynaecological cancer patients with lower extremity lymphoedema were selected via purposive sampling from a tertiary cancer hospital. Semi-structured in-depth interviews took place between February and July 2021, with data analysed via the Colaizzi 7-step analysis method.
FINDINGS: Five key themes emerged: inadequate and uneven availability of medical resources for patients with lymphoedema, limited support for patients, deficient home self-management skills, considerable psychological stress during home management, and variations in self-management behaviours.
CONCLUSION: Based on the study findings, increased investment in lymphoedema-related medical care is recommended. Additionally, healthcare professionals can consider promoting family and social support, enhancing patient health education, offering remote psychological counselling, encouraging positive coping behaviours among gynaecological cancer patients with lower limb lymphoedema, and ultimately enhancing their self-management at home.:10.1017/S1463423625100406

Managing Lymphedema and Fibrosis in Head and Neck Cancer Survivors: A Data Analysis on Self-Care Behaviors

Jessica Abene, Liming Huang, Barbara A. Murphy, Jie Deng. Semin Oncol Nurs. 2025 Sep 23.

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Complex decongestive therapy combined with needle electrode stimulation facilitates postoperative rehabilitation of lymphedema

Qiong Wu, Longxin An, Li Xu, Wen Zhou, Xiaojing Li, Longfei Liu, Qi Tan, Xuecheng Sun, Naibo Feng. J Vasc Surg Venous Lymphat Disord. 2025 Oct 1:102337.

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Understandability and Actionability of Artificial Intelligence-Assisted Lymphedema Education Material in Patients Undergoing Breast Cancer Surgery: Expert Evaluation

Gülseren Maraş Baydoğan, Yeliz Sürme, Handan Topan. J Clin Nurs. 2025 Oct 13

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Preliminary Efficacy/Feasibility Study of a Breast Cancer-Related Lymphedema Prospective Screening and Early Intervention Program at the Dana-Farber Brigham Cancer Center

Sara P. Myers, Jacob M. Jasper, Tessa Higgins, Angela Serig, Amanda C. Faust, Lila J. Tappan, Faina Nakhlis, Erin M. Taylor, Shailesh Agarwal, Elizabeth A. Mittendorf, Tari A. King. J Clin Med. 2025 Oct 6

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Mapping the Research Landscape of Exercise and Breast Cancer: A Bibliometric Analysis From 2020 to 2024.

Li J, Qiang L, Jiao M, Zhang B, Zhang P. Int J Genomics. 2025 Oct 23;2025:2972077.

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Comprehensive Approach to Management of Lipedema.

Athavale, A., Fukaya, E. & Aday, A.W. Curr Treat Options Cardio Med 27, 66 (2025)

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Impact of Leg Compression on Arterial and Skin Blood Flow: A Scoping Review

Quintin Norris, Christopher Ephron, Jeremy Shore, Peter Akel, Deven Khanna, Harvey N. Mayrovitz. Cureus. 2025 Sep 22

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