Peripheral Edema in Advanced Cancer: Mechanisms and Management-A Scoping Review

Peripheral edema is a common but under-researched complication in advanced cancer, significantly impacting patients' quality of life. It can result from various causes beyond lymphatic dysfunction, necessitating a mechanism-based management approach.

This study aims to address knowledge gaps by characterizing the causes, treatments, and outcomes of peripheral edema in patients with advanced cancer.

A predefined protocol was registered on the Open Science Framework, using a five-step scoping review methodology. Eligible studies included adult patients with peripheral edema related to advanced cancer, its treatments, or comorbidities. Searches were conducted in MEDLINE, Embase, and the Cochrane Library from 2010 to June 30, 2023. Two independent reviewers screened titles, abstracts, and full texts; extracted data, and assessed the quality of observational studies using the Effective Public Health Practice Project's tool.

Of 426 publications, 31 studies met inclusion criteria: 10 observational studies (2,128 patients), 5 case series (79 patients), and 16 case reports (16 patients). Most studies involved patients with limited prognoses. The 10 observational studies had moderate (6/10) or weak (4/10) quality ratings. Among these studies, the reported causes included overhydration, malignant inferior vena cava obstruction, and multiple risk factors. Seven observational studies addressed treatments, often using mechanism-guided (and sometimes multimodal) strategies, encompassing stenting, parenteral fluid and medication management including diuretics, and decongestive physical therapy interventions.

Peripheral edema in patients with advanced cancer arises from diverse and often overlapping mechanisms, and the available limited evidence from this scoping review suggests that mechanism-based interventions can yield meaningful short-term improvements in symptom burden. Targeted management, such as hydration or medication management, decongestive therapy, or inferior vena cava stenting, produced measurable benefits. These findings underscore the need for standardized assessment and more prospective studies to strengthen the evidence base for individualized, mechanism-driven care for peripheral edema in the advanced cancer population.