Complete decongestive therapy for breast cancer-related lymphedema: An evidence summary

Objective: To identify, appraise, and synthesize the best available evidence on complete decongestive therapy (CDT) for people with breast cancer-related lymphedema (BCRL). Methods: Using an evidence-based health care pyramid approach, we searched bibliographic databases, guideline and professional organization websites, and clinical decision support sources from inception to October 1, 2025. Eligibility was defined using the PIPOST framework. Methodological quality was independently appraised by three reviewers for guidelines and by two reviewers for other evidence types using evidence-type-specific appraisal tools. Two reviewers extracted and synthesized the evidence. Evidence levels were assigned using the JBI 2014 system, and recommendation grades were determined through expert-panel assessment of feasibility, appropriateness, meaningfulness, and effectiveness. Results: Thirty-one evidence sources were included, comprising clinical decision support sources, guidelines, evidence summaries, systematic reviews, and expert consensus documents. Thirty-seven evidence statements were synthesized across three domains: implementation principles, the intensive treatment phase, and the maintenance treatment phase. Nineteen statements (51.4%) were supported by Level 1 evidence, and 25 (67.6%) received Grade A recommendations. Conclusions: This evidence summary provides an evidence-informed framework for CDT across the intensive and maintenance phases, with explicit attention to transition planning and self-management. The evidence is stronger for several core interventions than for implementation strategies and long-term self-management. Further high-quality primary and implementation research is needed.