Investigation of the current status of lymphedema management in 45 hospitals in China
Jiajia Qiu1,2#
, Xia Li3#, Jinhua Li4
Contributions: (I) Conception and design: J Qiu, X Li; (II) Administrative support: J Qiu, J Li; (III) Provision of study materials or patients: J Qiu, X Li; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: X Li, J Li; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.
#These authors contributed equally to this work.
Background: Cancer-related lymphedema (CRL) seriously affects patients’ quality of life. Many practice guidelines emphasize the importance of early prevention. However, a significant gap exists between these guidelines and clinical practice. This study aimed to understand the current status of lymphedema management in Chinese hospitals and to provide a basis for promoting standardized practices in lymphedema care.
Methods: A cross-sectional survey was conducted from September to November 2024 using a self-designed questionnaire on lymphedema management. A convenience sample of 45 hospitals nationwide was surveyed.
Results: The survey revealed that 60% of hospitals had established outpatient clinics for lymphedema, while 46.7% routinely implemented manual lymphatic drainage. Additionally, 68.9% of hospitals performed routine high-risk screening or preoperative assessments for lymphedema. Regarding treatment management, the application rate of complete decongestive therapy (CDT) was 88.9%, but 42.2% of hospitals lacked a standardized fee system. Concerning personnel training, 37.8% of hospitals had not conducted lymphedema training.
Conclusions: Challenges in lymphedema management in Chinese hospitals include the limited implementation of standardized care protocols, incomplete fee systems for treatments, and the low coverage of specialized training. Efforts should focus on enhancing medical staff training, establishing standardized care pathways, and improving technical fee structures to advance the standardized development of lymphedema care.
Keywords: Lymphedema; management; current status; cross-sectional study
Submitted Sep 22, 2025. Accepted for publication Dec 12, 2025. Published online Jan 27, 2026.
doi: 10.21037/gs-2025-433
Highlight box
Key findings
• A national survey across 45 Chinese hospitals revealed significant gaps in the standardization of cancer-related lymphedema (CRL) care.
• While 68.9% of hospitals perform routine high-risk screening and 88.9% apply complete decongestive therapy (CDT), standardized implementation lags. Only 60% have dedicated lymphedema clinics, and merely 46.7% routinely perform manual lymphatic drainage.
• Critical systemic barriers were identified: 42.2% of hospitals lack a standardized fee system for lymphedema treatments, and 37.8% have not conducted any specialized lymphedema training for staff.
What is known and what is new?
• Cancer-related lymphedema is a serious condition impacting quality of life. International and national practice guidelines strongly advocate for early prevention, risk assessment, and standardized treatment (like CDT) to mitigate its burden.
• This study provides the first structured, national-level snapshot of the real-world implementation of CRL care in Chinese clinical settings. It quantifies the specific disparities between guideline recommendations and actual practice, highlighting not just clinical inconsistencies but critical systemic obstacles such as the absence of fee structures and training programs that hinder standardized care delivery.
What is the implication, and what should change now?
• The observed gaps suggest that patients may not be receiving consistent, guideline-adherent care for lymphedema prevention and management, potentially leading to preventable complications and reduced quality of life. The lack of fee systems and training acts as a structural barrier to quality improvement.
• To advance standardized lymphedema care, concerted efforts are required to (I) develop and mandate standardized clinical pathways for screening, prevention, and treatment; (II) establish and promote specialized training programs to increase workforce competency; (III) create and implement a transparent, standardized technical fee structure for lymphedema management services to ensure sustainable and equitable service delivery.
Introduction
Lymphedema is a chronic, progressive disease. It occurs when lymph nodes or lymphatic vessels are damaged, obstructing the return of lymph fluid and causing an abnormal accumulation of fluid in the tissue space, resulting in local tissue edema. It is broadly classified into two types: primary lymphedema, caused by congenital maldevelopment of the lymphatic vessels, and secondary lymphedema, which results from damage to a previously normal lymphatic system. With the increasing number and incidence of malignant tumors, cancer treatment has become the most common cause of secondary lymphedema (1). Female patients who have undergone surgery for malignant tumors are at high risk of secondary lymphedema, especially breast cancer-related lymphedema (BCRL), with an incidence ranging from 7.2% to 82.2% (2,3), and gynecological CRL, with an incidence of 1.2% to 47.1% (4,5). A cohort study involving 2,597 breast cancer patients in China found a 10.7% incidence of BCRL within five years after surgery (6). Another prospective study revealed that the incidence of BCRL within two years after breast cancer surgery increased over time, with rates of 4.4%, 10.1%, 15.2%, 28.6%, 30.2%, and 41.1% at 1, 3, 6, 12, 18, and 24 months postoperatively, respectively (7). In its early stages, lymphedema primarily manifests as progressive edema, which can develop into irreversible inflammation, tissue fibrosis, and fat deposition in later stages. Pathological changes, such as edema, can seriously affect a patients’ quality of life (8). Currently, there is no cure for lymphedema. Complete decongestive therapy (CDT) remains the gold standard for conservative treatment. Many practice guidelines emphasize the importance of early prevention (9,10). However, a significant gap exists between these guidelines and clinical practice; management standards are not unified, and the prevention and control of lymphedema are not effectively managed. Particularly in China, the awareness of lymphedema remains to be improved. There are still notable deficiencies in the establishment of systematic diagnosis and treatment frameworks, as well as in the development of management recommendations based on the latest research advances and evidence in this field. Currently, standardized guidelines to inform clinical practice are still lacking (11). To address this, the Breast Cancer Integrated Nursing Committee of the Chinese Anti-Cancer Association conducted a nationwide survey to better understand the current status of lymphedema management in China, provide a basis for building a standardized management system, and ultimately improve the quality of life for patients. We present this article in accordance with the STROBE reporting checklist (available at https://gs.amegroups.com/article/view/10.21037/gs-2025-433/rc).
Methods
Ethical approval
The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. This study was approved by the Scientific and Ethical Committee of the Shanghai Cancer Center, Fudan University (No. 2302270-17). All individuals discussed in this manuscript have given written informed consent to publish their details.
Study population
From September to November 2024, hospitals meeting the following inclusion criteria were invited to complete the electronic questionnaire through the platform of the Breast Cancer Integrated Care Professional Committee of the China Anti-Cancer Association. A total of 53 questionnaires were distributed, with responses received from 45 hospitals, yielding a response rate of 84.9%. The inclusion criteria were: (I) second-level or above general hospitals or specialized hospitals; and (II) willingness to participate in the study. Each questionnaire was completed by one healthcare professional who was required to be familiar with the diagnosis and treatment of lymphedema. Eligible respondents included certified therapists, specialized nurses, or clinical managers involved in lymphedema care. As the sampling frame was based on a national committee, the sample was representative of specialized oncology care settings in urban China but may not fully represent practices in community clinics or rural hospitals.
Study methods
This study used questionnaires to investigate the current status of lymphedema management in China.
Research tools
Based on a literature review (12,13), self-designed questionnaire was developed, including seven sections: basic hospital information, lymphedema management staffing, lymphedema prevention and management, lymphedema treatment and management, lymphedema outpatient management, lymphedema training, and recommendations for future development.
In this survey, staff roles were defined as follows: a “lymphedema therapist” referred to a healthcare professional (typically a physiotherapist or occupational therapist) certified to provide the hands-on technical components of CDT, such as manual lymph drainage and multilayer bandaging. A “lymphedema specialist nurse” referred to a registered nurse with advanced training in lymphedema care, whose responsibilities typically encompass patient assessment, education, care coordination, psychosocial support, and may include elements of self-management training.
Statistical analysis
SPSS 22.0 was used to collate and analyze the data in this study. Frequencies, percentages, and rates were used to describe the main findings.
Results
Basic information and personnel allocation of medical institutions for lymphedema
This survey covered 45 hospitals from 23 provinces in China, with Grade III Class A hospitals accounting for 95.6% of the total. Lymphedema therapists were present in 86.6% of hospitals, but only 5.2% had more than 10 therapists. Of the therapists in these hospitals, 53.3% were certified through the Casley-Smith International Lymphedema Therapist Training Program, while 31.1% were certified by Hunan Cancer Hospital. Lymphedema nurse specialists were present in 66.6% of hospitals, but 73.3% had fewer than five (see Table 1).
Table 1
| Item | Number of cases | Percentage |
|---|---|---|
| Area | ||
| North China | 6 | 13.3 |
| Central China | 8 | 17.8 |
| East China | 12 | 26.7 |
| South China | 3 | 6.6 |
| Northeast China | 7 | 15.7 |
| Southwest China | 6 | 13.3 |
| Northwest China | 3 | 6.6 |
| Hospital grade | ||
| Grade III Class A | 43 | 95.6 |
| Grade III Class B | 1 | 2.2 |
| Grade II Class A | 1 | 2.2 |
| Does the hospital have a lymphedema therapist? | ||
| Yes | 39 | 86.6 |
| No | 6 | 13.4 |
| Number of lymphedema therapists | ||
| ≤5 | 35 | 76.9 |
| 6–10 | 8 | 17.9 |
| >10 | 2 | 5.2 |
| Initial specialization of lymphedema therapist | ||
| Clinical | 3 | 6.7 |
| Nursing | 39 | 86.6 |
| Rehabilitation | 3 | 6.7 |
| Lymphedema therapist qualification certification agency | ||
| Casley-Smith International Lymphedema Therapist Training | 24 | 53.3 |
| Hunan Cancer Hospital | 14 | 31.1 |
| Other | 7 | 15.6 |
| Does the hospital have a lymphedema specialist nurse? | ||
| Yes | 30 | 66.6 |
| No | 15 | 33.4 |
| Number of lymphedema specialist nurses | ||
| ≤5 people | 33 | 73.4 |
| 6–10 people | 6 | 13.3 |
| >10 people | 6 | 13.3 |
| Lymphedema specialist nurse training institution | ||
| Their own hospital | 5 | 11.1 |
| Other hospitals in the same province | 10 | 22.2 |
| Other hospitals in other provinces | 30 | 66.7 |
| Responsibilities of the lymphedema specialist nurse | ||
| Lymphedema assessment | 30 | 66.7 |
| Lymphedema screening | 30 | 66.7 |
| Complete decongestive therapy | 29 | 64.4 |
| Lymphedema health education | 30 | 66.7 |
| Lymphedema follow-up | 29 | 64.4 |
| Lymphedema consultation | 26 | 57.8 |
| Quality supervision of management | 18 | 40.0 |
| In-hospital lymphedema nursing training | 25 | 55.6 |
| Lymphedema nursing research | 19 | 42.2 |
Current status of lymphedema prevention management in hospitals in China
A total of 68.9% of the hospitals conducted high-risk lymphedema screening, while 31.3% did not perform high-risk screening. Among those that did perform screening, 80% used subjective scales, and only 24.4% combined these with bioelectrical impedance testing. Pre-treatment lymphedema assessment was routinely performed in 68.9% of hospitals, and 46.7% incorporated manual lymphatic drainage into routine perioperative care. Bioelectrical impedance assessment was lacking in 84.4% of hospitals, while baseline arm circumference was measured preoperatively in 82.2% (see Table 2).
Table 2
| Item | Number of cases | Percentage |
|---|---|---|
| Admission of patients | ||
| Breast cancer-related lymphedema | 39 | 86.7 |
| Gynecologic cancer-related lymphedema | 27 | 60.0 |
| Head and neck tumor lymphedema | 13 | 28.9 |
| Urinary system tumor lymphedema | 14 | 31.1 |
| Primary lymphedema | 1 | 2.2 |
| Methods of lymphedema assessment and diagnosis implemented in hospitals | ||
| Subjective scale assessment | 36 | 80.0 |
| Arm circumference measurement | 41 | 91.1 |
| Volume measurement | 12 | 26.7 |
| Bioelectrical impedance testing | 11 | 24.4 |
| Ultrasound examination | 25 | 55.6 |
| Indocyanine green testing | 6 | 13.3 |
| Does the hospital conduct high-risk screening for lymphedema? | ||
| Yes | 31 | 68.9 |
| No | 14 | 31.1 |
| Lymphedema high-risk screening method | ||
| Intelligent prediction model | 4 | 8.9 |
| Subjective scale assessment | 30 | 66.7 |
| Bioelectrical impedance | 5 | 11.1 |
| Ultrasound examination | 12 | 26.7 |
| Early preventive measures | ||
| Recognizing early symptoms | 43 | 95.6 |
| Protection of the affected limb | 45 | 100.0 |
| Skin care | 45 | 100.0 |
| Exercise | 45 | 100.0 |
| Wear elastic sleeves/socks as a preventive measure | 37 | 82.2 |
| Manual lymphatic drainage | 37 | 82.2 |
| Maintaining a healthy weight | 42 | 93.3 |
| Invite family members to participate in management | 34 | 75.6 |
| Traditional Chinese medicine preventive management | 8 | 17.8 |
| Is manual lymphatic drainage a routine perioperative nursing procedure? | ||
| Yes | 21 | 46.7 |
| No | 24 | 53.3 |
| Is lymphedema assessment a routine pre-treatment assessment for patients? | ||
| Yes | 31 | 68.9 |
| No | 14 | 31.1 |
| Do you routinely measure bilateral arm circumference? | ||
| Yes | 37 | 82.2 |
| No | 8 | 17.8 |
| Is bioelectrical impedance testing routinely performed? | ||
| Yes | 7 | 15.6 |
| No | 38 | 84.4 |
| Is there a fee for lymphedema screening assessment? | ||
| Yes | 4 | 8.9 |
| No | 41 | 91.1 |
| Are there corresponding nursing records for lymphedema assessment? | ||
| Yes | 30 | 66.7 |
| No | 15 | 33.3 |
Current status of lymphedema treatment management in hospitals in China
Whole-course management for lymphedema was implemented in 57.8% of hospitals. The utilization of internet platforms (58.9%), artificial intelligence (AI)-powered follow-up (2.9%), and case manager follow-up (2.9%) was relatively low. Currently, hospitals have applied conservative treatments. Among these, manual lymphatic drainage, CDT, and low-elastic bandaging had the highest application rates, at 91.1%, 88.9%, and 86.7%, respectively. However, 57.8% of hospitals charged for CDT, and only 22.2% of manual lymphatic drainage and 6.7% of Kinesio taping were included in the billing process (see Table 3).
Table 3
| Item | Number of cases | Percentage |
|---|---|---|
| Used lymphedema treatments | ||
| Manual lymphatic drainage | 41 | 91.1 |
| Low-elastic bandage | 39 | 86.7 |
| Complete decongestive therapy | 40 | 88.9 |
| Surgical treatment | 17 | 37.8 |
| Air wave pressure therapy | 37 | 82.2 |
| Spa | 1 | 2.2 |
| Microwave therapy | 9 | 20.0 |
| Kinesio taping | 20 | 44.4 |
| Charges for complete decongestive therapy in the ward | ||
| No | 19 | 42.2 |
| <100 RMB | 1 | 2.2 |
| 100–200 RMB | 19 | 42.2 |
| 201–300 RMB | 6 | 13.4 |
| Charges for manual lymphatic drainage in the ward | ||
| No | 35 | 77.8 |
| <100 RMB | 2 | 4.4 |
| 100–200 RMB | 8 | 17.8 |
| Charges for kinesio taping technology in the ward | ||
| No | 42 | 93.3 |
| <100 RMB | 3 | 6.7 |
| Does the hospital provide nursing specialist consultation for patients’ lymphedema? | ||
| Yes | 25 | 55.6 |
| No | 20 | 44.4 |
| Follow-up service for lymphedema | ||
| No | 11 | 24.4 |
| Follow-up by phone/text message | 34 | 75.6 |
| WeChat follow-up | 28 | 62.2 |
| Internet platform follow-up | 20 | 44.4 |
| Artificial intelligence follow-up | 1 | 2.2 |
| Follow-up visit with case manager | 1 | 2.2 |
| Does the hospital provide whole-course management for lymphedema? | ||
| Yes | 26 | 57.8 |
| No | 19 | 42.2 |
Current status of outpatient clinic management for lymphedema in hospitals in China
Lymphedema outpatient clinics have been established in 60% of hospitals, but the rate of joint medical and nursing clinics was relatively low. Among the services provided by these clinics, follow-up and consultation services accounted for a relatively low proportion, at 81.5% and 85.2%, respectively (see Table 4).
Table 4
| Item | Number of cases | Percentage |
|---|---|---|
| Outpatient clinic visit format | ||
| None | 18 | 40.0 |
| Lymphedema medical and nursing joint clinic | 9 | 20.0 |
| Lymphedema nursing clinic | 18 | 40.0 |
| Services for outpatient clinic | ||
| Lymphedema assessment | 27 | 60.0 |
| Lymphedema screening | 26 | 57.8 |
| Complete decongestive therapy | 26 | 57.8 |
| Lymphedema health education | 27 | 60.0 |
| Lymphedema follow-up | 22 | 48.9 |
| Lymphedema consultation | 23 | 51.1 |
Current status of lymphedema training in hospitals in China
Lymphedema-related training was conducted in 62.2% of hospitals. Among the hospitals that did provide training, 85.7% focused on specialized training, with a lack of continuing education programs. Specialist nurse training bases accounted for only 15.5%, and only 28.9% of hospitals had held specialist nurse training courses (Table 5).
Table 5
| Item | Number of cases | Percentage |
|---|---|---|
| Does the hospital provide lymphedema training? | ||
| No | 17 | 37.8 |
| Pre-job training for new nurses | 9 | 20.0 |
| Nurse-level training | 17 | 37.8 |
| Specialized training for specialized fields | 24 | 53.3 |
| Joint training for medical staff | 9 | 20.0 |
| Does the hospital hold a training course for lymphedema specialist nurses? | ||
| Yes | 13 | 28.9 |
| No | 32 | 71.1 |
| Is the hospital a training and practice base for lymphedema specialist nurses? | ||
| Yes | 7 | 15.5 |
| No | 38 | 84.5 |
| Does the hospital select nurses to participate in lymphedema specialist nurse training? | ||
| Yes | 39 | 86.7 |
| No | 6 | 13.3 |
Discussion
Inadequate management of lymphedema prevention and treatment in hospitals
Currently, there is a lack of radical treatment methods in the field of lymphedema treatment. Therefore, early identification of high-risk factors and the implementation of precise intervention strategies are key measures for preventing lymphedema (1). A study has shown that the use of bioelectrical impedance assessment and subjective scales for high-risk screening before surgery can significantly improve the early identification rate of lymphedema (14). International guidelines strongly recommend baseline lymphedema assessment and regular screening for cancer patients (15,16). However, the prevention, screening and early intervention measures for lymphedema in China have not been effectively implemented. In our study, 68.9% of the hospitals performed high-risk screening, yet nearly one-third did not carry it out routinely. This may be because medical staff and patients lack awareness regarding lymphedema prevention. The survey showed that the patients with lymphedema admitted to hospitals in China are mainly breast cancer-related and gynecological tumor-related lymphedema patients. As the internationally recognized gold standard for conservative treatment, CDT should be widely adopted (17). However, the application rate of CDT in the hospitals surveyed was 88.9% and manual lymphatic drainage, CDT, and low-elastic bandages were frequently used, indicating that there is room for improvement in the standardization of lymphedema treatment. On the other hand, objective assessment tools such as bioelectrical impedance analysis are internationally recommended for early detection, yet their utilization remains very low in China (in this study, only 15.6% of hospitals routinely performed bioelectrical impedance testing). This further highlights the gap in the modernization of assessment techniques. Therefore, it is recommended that hospitals strengthen the standardization of lymphedema management processes and incorporate high-risk screening, bioelectrical impedance assessment, and CDT into routine operations to improve prevention and treatment effectiveness.
Lymphedema outpatient services and charging standards need optimization
Systematic and standardized outpatient clinics can effectively help patients manage lymphedema (18), and also provide a practical platform for the development of specialist nurses. The results of this study indicate that outpatient clinics are mainly conducted in the form of nursing clinics, and a single clinic format may not meet the complex diagnosis and treatment needs of patients. Multidisciplinary clinics are an important form of multidisciplinary collaboration. Lymphedema clinics can provide patients with assessment, screening, treatment, health education, and other services, but follow-up and consultation services require further development. Post-treatment follow-up is an important step in consolidating therapeutic effects. Currently, follow-up is mainly conducted through traditional methods such as telephone/WeChat. Globally, specialist nurse-led clinics are already very common, whereas in China, their establishment is still in its early stages, and relevant targeted strategies need to be further improved (19). The prominence of cost as a barrier in our findings must be understood within the context of China’s healthcare financing. While basic medical insurance provides broad coverage, specialized rehabilitative therapies and durable medical goods for chronic conditions like lymphedema are often not fully reimbursable. Essential items such as compression garments and prolonged therapist-led sessions (e.g., manual lymphatic drainage) typically require substantial out-of-pocket payment. This financing gap places significant economic burden on patients and influences both the availability of services in hospitals and long-term adherence to treatment regimens. Therefore, developing supportive reimbursement policies is crucial for improving the accessibility and quality of lymphedema care in China. It is recommended to promote joint medical and nursing outpatient clinics, establish a full-course disease management system, formulate standardized diagnosis and treatment pathways, include CDT, manual lymphatic drainage, and other technologies in medical insurance coverage, and establish unified charging standards.
Insufficient training and qualification certification for lymphedema professionals
A shortage of lymphedema professionals is a prominent problem in the current management of lymphedema. In this study, although 86.6% of hospitals had lymphedema therapists, only 5.2% had more than 10 therapists, and the international certification rate was not high. International consensus emphasizes that lymphedema therapists should undergo specialized training and certification (15,16). However, such a national-level qualification certification system has not yet been established in China. This study shows that the training of lymphedema therapists in China mainly relies on a few institutions or within the hospitals themselves, which lacks systematicity and standardization. While this model differs from the international academic certification pathway, it can be seen as a pragmatic response in the context of a shortage of specialized professionals. However, the challenge lies in the potential variability of training quality. Lymphedema training has not been carried out in 37.8% of hospitals, and there is a lack of continuing education and training. Liu et al. (20) pointed out that specialist nurses need to have lymphedema assessment, health education, and scientific research capabilities, and they recommended the establishment of a unified certification system and the implementation of tiered training based on regional medical centers. The training of professional talent is key to improving the level of lymphedema management (21). It is recommended that a qualification certification system for lymphedema therapists and specialist nurses be introduced as soon as possible to improve the technical level and qualification certification rate of professionals (22), ensure the quality of professional training, and meet the quality needs of lymphedema patients.
Limitations of the study
There are certain limitations in this study. First, the sampling method, while efficient for reaching hospitals, limits the generalizability of the findings. Our sample was derived from members of a national committee and thus overrepresents large, urban, tertiary-care institutions that are at the forefront of oncology care. Practices in community health centers and rural medical facilities, where resources and awareness may differ substantially, are not captured in this survey. Future nationwide surveys should employ stratified sampling to include a wider spectrum of healthcare institutions. Second, while we reported the absolute number of lymphedema care staff in participating hospitals, we were unable to contextualize these figures within metrics of hospital scale or service volume, such as the number of hospital beds, annual caseload of cancer patients, or size of the catchment population. Consequently, our data cannot speak to the adequacy or relative density of specialist human resources (e.g., therapists per 100 beds), which is critical for inter-hospital comparison and health workforce planning. Future studies should integrate these operational metrics to facilitate a more meaningful assessment of resource allocation and need. Third, this survey mainly focused on the conservative management of lymphedema. It did not capture data on emerging surgical interventions, such as immediate lymphatic reconstruction (ILR) or other lymphatic microsurgeries, as these procedures are not yet standard practice in most Chinese hospitals. Future studies should monitor the adoption and outcomes of these advanced techniques as the field evolves. Fourth, this study was a cross-sectional investigation. In the future, we could perform in-depth interviews with health professionals to learn more about their understanding of lymphedema management in detail. Additionally, we can design experimental trials regarding the prevention and treatment of lymphedema in our future research.
Conclusions
This study, through a cross-sectional survey of 45 hospitals in China, revealed multiple challenges faced in lymphedema management in terms of prevention, treatment, outpatient services, and talent development. The results showed that lymphedema management in China is still in its developmental stages. Key challenges include the lack of widespread adoption of standardized preventive measures, the inadequate integration of bioelectrical impedance assessment and high-risk screening into routine procedures, a single outpatient service model, and a lack of multidisciplinary collaboration and comprehensive disease management. The professional talent training system is imperfect and lacks unified certification standards. Future research needs to further explore the management differences between different regions and different levels of hospitals to promote the standardization and systematization of lymphedema management.
Acknowledgments
We would like to express our gratitude to the Breast Cancer Integrated Nursing Committee of the China Anti-Cancer Association for providing a nationwide platform, as well as to the 45 hospitals from across the country that participated in the survey.
Footnote
Reporting Checklist: The authors have completed the STROBE reporting checklist. Available at https://gs.amegroups.com/article/view/10.21037/gs-2025-433/rc
Data Sharing Statement: Available at https://gs.amegroups.com/article/view/10.21037/gs-2025-433/dss
Peer Review File: Available at https://gs.amegroups.com/article/view/10.21037/gs-2025-433/prf
Funding: This work was supported by
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://gs.amegroups.com/article/view/10.21037/gs-2025-433/coif). The authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the Scientific and Ethical Committee of the Shanghai Cancer Center, Fudan University (No. 2302270-17). All individuals discussed in this manuscript have given written informed consent to publish their details.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
References
- Zhang L, Luo QH, Zhang HZ, et al. Lymphedema Group of the Chinese Society of Plastic Surgery. Chinese expert consensus on the diagnosis and treatment of peripheral lymphedema. Chinese Journal of Plastic Surgery 2020;36:355-0.
- Hasenoehrl T, Palma S, Ramazanova D, et al. Resistance exercise and breast cancer-related lymphedema-a systematic review update and meta-analysis. Support Care Cancer 2020;28:3593-3603. [Crossref] [PubMed]
- Executive Committee of the International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2020 Consensus Document of the International Society of Lymphology. Lymphology 2020;53:3-19.
- Dessources K, Aviki E, Leitao MM Jr. Lower extremity lymphedema in patients with gynecologic malignancies. Int J Gynecol Cancer 2020;30:252-260. [Crossref] [PubMed]
- Gynecological Oncology Prevention and Treatment Committee of China Maternal and Child Health Association. Expert consensus on lower limb lymphedema after treatment of gynecological tumors. Chinese Journal of Clinicians 2021;49:149-5.
- Zhang X, Tang B, Zou D, et al. Discussion of relationships among changes of pathological indicators, postoperative lymphedema of the upper limb, and prognosis of patients with breast cancer. Biosci Rep 2019;39:BSR20190231. [Crossref] [PubMed]
- Zou L, Liu FH, Shen PP, et al. The incidence and risk factors of related lymphedema for breast cancer survivors post-operation: a 2-year follow-up prospective cohort study. Breast Cancer 2018;25:309-314. [Crossref] [PubMed]
- Li JQ, Qiang WM, Wei TT, et al. Evidence summary of non-drug interventions for breast cancer-related lymphedema. Chinese Journal of Nursing 2023;58:349-6.
- Davies C, Levenhagen K, Ryans K, et al. Interventions for Breast Cancer-Related Lymphedema: Clinical Practice Guideline From the Academy of Oncologic Physical Therapy of APTA. Phys Ther 2020;100:1163-1179. [Crossref] [PubMed]
- Chinese Nursing Association Oncology Nursing Committee. Prevention and care of lymphedema after breast cancer surgery. 2021-03-13. Available online: http://www.zhhlxh.org.cn/cnaWebcn/article/3243-
- Liu Y, Long X. Clinical Practice Guidelines for Tumor-related Lymphedema: Chinese Expert Consensus Based on the Delphi Method (2025 Version). Medical Journal of Peking Union Medical College Hospital 2025;16:1449-9.
- Jia YY, Cao SM, Bai SP, et al. Investigation on the management status of breast cancer-related lymphedema prevention and treatment. Chinese Journal of Practical Nursing 2021;37:538-5.
- Wu PP, Qiang WM, Wang Y, et al. Investigation and study on the current status of lymphedema nursing clinics in 60 hospitals in China. Chinese Journal of Practical Nursing 2022;38:1331-6.
- Torgbenu E, Luckett T, Buhagiar MA, et al. Guidelines Relevant to Diagnosis, Assessment, and Management of Lymphedema: A Systematic Review. Adv Wound Care (New Rochelle) 2023;12:15-27. [Crossref] [PubMed]
- Brunelle CL, Jackson K, Shallwani SM, et al. Evidence-based recommendations regarding risk reduction practices for people at risk of or with breast cancer-related lymphedema: consensus from an expert panel. Med Oncol 2024;41:298. [Crossref] [PubMed]
- Wong HCY, Wallen MP, Chan AW, et al. Multinational Association of Supportive Care in Cancer (MASCC) clinical practice guidance for the prevention of breast cancer-related arm lymphoedema (BCRAL): international Delphi consensus-based recommendations. EClinicalMedicine 2024;68:102441. [Crossref] [PubMed]
- Armer JM, Ostby PL, Ginex PK, et al. ONS Guidelines™ for Cancer Treatment-Related Lymphedema. Oncol Nurs Forum 2020;47:518-538. [Crossref] [PubMed]
- Liu ZZ, Li QH, Li WY, et al. Chinese expert consensus on the diagnosis and treatment of lymphedema after breast cancer surgery using integrated traditional Chinese and Western medicine. Traumatology and Critical Care Medicine 2023;11:1-8.
- Liu T, Yu W. Research progress on the practice model of specialized nursing clinics in China. Chinese Evidence-Based Nursing 2022;8:2202-5.
- Liu GM, Liu YY, Wang JL, et al. Qualitative study on the core competencies of lymphedema specialist nurses in cancer hospitals. General Nursing 2018;16:2369-1.
- Li Y, Hou SQ, Chen YQ, et al. Management and exploration of advanced nursing practice for lymphedema based on Brown's advanced nursing practice model. Military Nursing 2024;41:78-1.
- Liu GM, Li XY, Chen YL, et al. Operation practice of lymphedema rehabilitation nursing center in cancer hospital. Journal of Nursing 2020;35:51-4.
