Disparities in Breast Cancer-related Lymphedema: A Systematic Review of Inequities and Barriers in Care

Breast cancer-related lymphedema (BCRL) is a chronic condition secondary to multimodal cancer treatment. This systematic review summarized the evidence for disparities and barriers surrounding BCRL care, particularly in diagnosis, education, and accessibility to treatment.

A search of PubMed/MEDLINE, Embase, Scopus, and Web of Science following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted from January 1, 1990, through October 3, 2024. Mixed-methods, qualitative, cross-sectional, multiple-case, longitudinal, and randomized controlled trials that reported disparities and barriers surrounding BCRL care were included. Review articles, editorials, commentaries, abstracts, poster papers, translation or validation of patient-reported outcome measures, and non-English articles were excluded.

The search yielded 1059 articles, and 39 met inclusion criteria. Themes identified included the following: racial and ethnic disparities; increased risk associated with younger age, low education level, low income, rural geographic location, and presence of medical comorbidities; inadequate provider and patient knowledge; low patient education; burden and challenges with lifelong self-management; and barriers in receiving healthcare provider diagnosis or adequate BCRL management. Subthemes included cumulative cost burden, psychosocial barriers, and the role of patient self-efficacy.

Younger non-White women, residents of rural regions, and those with low income or education levels seemed to be at greatest risk for self-reported (rather than physician-diagnosed) BCRL. Patients of diverse racial and ethnic backgrounds and low socioeconomic status were at increased risk for inadequate self-care education and breast cancer survivorship support. Active prevention with multidisciplinary interventions is imperative to lower BCRL rates, empower breast cancer survivors, and strengthen self-efficacy.