Patient-Reported Outcome Measures in Lymphedema: A Systematic Review and COSMIN Analysis

Ann Surg Oncol. 2021 Mar;28(3):1656-1668. doi: 10.1245/s10434-020-09346-0. Epub 2020 Nov 28.


Background: Lymphedema is a chronic and debilitating condition that affects many cancer survivors. Patient-reported outcome measures (PROMs) can give valuable insight into the impact of lymphedema on a patient's quality of life and can play an essential role in treatment decisions. This study aims to (1) identify PROMs used to assess health-related quality of life (HRQoL) in patients with lymphedema; and (2) assess the quality of the lymphedema-specific PROMs.

Methods: We performed a systematic search to identify articles on lymphedema, quality of life, and PROMs. An overview was created of all PROMs used to assess HRQoL in patients with lymphedema. The methodological quality of the lymphedema-specific PROMs was assessed using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) criteria.

Results: A total of 235 articles met the inclusion criteria, of which 200 described studies using one or more PROMs as an outcome measure in patients with lymphedema. The other 35 studies described the development and/or validation of a lymphedema-specific PROM. The COSMIN assessment demonstrated that none of these PROMs met all quality standards for development.

Conclusion: The use of PROMs in lymphedema is increasing; however, based on our findings, we cannot fully support the use of any of the existing instruments. A well-developed lymphedema-specific PROM, based on patient input, is needed to gain better insight into the impact of this condition, and can be used to measure the effect of possible medical and surgical treatments.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Consensus
  • Humans
  • Lymphedema* / etiology
  • Lymphedema* / therapy
  • Outcome Assessment, Health Care
  • Patient Reported Outcome Measures
  • Quality of Life*