Non-pharmacological rehabilitation methods for upper limb breast cancer-related lymphedema: a systematic review

Background. Breast cancer-related lymphedema (BCRL) of the upper limb is one of the most frequent and disabling complications of treatment, having detrimental effects on the functional status, quality of life and social adaptation of such patients. Despite widespread use of non-pharmacological rehabilitation interventions, the issues of their comparative effectiveness, optimal combinations and long term outcomes continue to be debatable. An analysis of international guidelines in the context of Russian clinical experience is a relevant research task.

Objective: To carry out a systematic review of scientific publications on non-pharmacological rehabilitation methods for patients with BCRL of the upper limb.

Material and methods. The review was carried out according to the PRISMA 2020 guidelines. Literature search was conducted across the PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, PEDro and eLibrary databases and covered the period from 2000 to 2025. The analysis included clinical guidelines, systematic reviews and meta-analyses, randomized controlled trials and cohort clinical studies evaluating complete decongestive therapy (CDT), compression therapy, physical exercise, manual lymphatic drainage, kinesio taping, low level laser therapy (LLLT), intermittent pneumatic compression (IPC), instrumental physiotherapy and surgical methods. The risk of bias was assessed using Cochrane RoB 2, ROBINS I, and AMSTAR 2 tools.

Results. A total of 33 sources were included: clinical guidelines (n=3), systematic reviews and meta-analyses (n=10), randomized controlled trials (n=7), and cohort/prospective studies (n=3), as well as reviews, methodological and clinical works (n=10). CDT has the strongest evidence base and is considered the “gold standard” for BCRL management. Compression therapy is effective for both prevention and remedial treatment. Physical exercise is safe given proper compression and improves functional outcomes. Manual lymphatic drainage is considered effective as a component of CDT. LLLT, kinesio taping, and IPC have a moderate evidence base as adjunctive modalities. Russian studies highlight the potential of instrumental physiotherapy and surgical approaches, although requiring further validation in multicenter randomized controlled trials.

Conclusion. The effectiveness of a multicomponent rehabilitation strategy in BCRL of the upper limb has been confirmed. CDT remains the method of choice, while individualized programs incorporating physical exercise, instrumental techniques and surgical interventions extend treatment opportunities at different stages of the disease. Further multicenter studies are required to clarify optimal combinations, long term outcomes, and cost effectiveness of various approaches.

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