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Prophylactic complex physiotherapy in gynecologic cancer survivors: patient-reported outcomes based on a lymphedema questionnaire
  1. Mine Daggez1,
  2. Esra Gizem Koyuncu2,
  3. Rukiye Kocabaş2 and
  4. Cem Yener3
  1. 1 Department of Gynecologic Oncology, Tekirdag Dr Ismail Fehmi Cumalioglu City Hospital, Tekirdag, Turkey
  2. 2 Department of Physical Medicine and Rehabilitation, Tekirdag Dr Ismail Fehmi Cumalioglu City Hospital, Tekirdag, Turkey
  3. 3 Obstetrics and Gynecology, Istanbul Bagcilar Training and Research Hospital, Istanbul, Turkey
  1. Correspondence to Dr Mine Daggez, Department of Gynecologic Oncology, Tekirdag Dr Ismail Fehmi Cumalioglu City Hospital, Tekirdag 59030, Turkey; minedaggez{at}


Objective Lower extremity lymphedema secondary to cancer treatment impacts quality of life for gynecological cancer survivors. Complex decongestive physiotherapy is applied when lymphedema is diagnosed, but prophylactic physiotherapy is not yet a standard of care. The aim of this study is to evaluate prophylactic complex physiotherapy in patients with gynecological cancer and its effects on patient-reported symptoms based on the Gynecologic Cancer Lymphedema Questionnaire.

Methods The data of patients diagnosed with gynecological cancers who underwent lymphadenectomy from July 2021 to June 2022 was evaluated. All patients were referred to the physiotherapy unit before adjuvant treatment. Patients who accepted prophylactic physiotherapy were informed and massage and exercise training were implemented, whereas patients who declined were solely informed. Bilateral lower extremity circumferences were measured at 1, 3, 6, and 12 months at the levels of 10 cm, 30 cm, and 50 cm above the heels. A translated form of the Gynecologic Cancer Lymphedema Questionnaire was administered to all patients at the last visit.

Results A total of 100 patients were included in the study. Patients were diagnosed with endometrial (50%), ovarian (32%), cervical (16%), and vulvar (2%) cancer. Overall, 70% underwent systematic pelvic±para-aortic lymphadenectomy whereas sentinel lymph node mapping was performed in 30%. Lymphedema was seen in 5% (n=3) of the prophylactic physiotherapy positive group and in 60% (n=24) of the physiotherapy negative group. The median score was 3 (range 1–5) in the physiotherapy positive group and 16 (range 9–20) in the physiotherapy negative group. In patients diagnosed with lymphedema in the physiotherapy negative group, systematic lymphadenectomy was performed in 91.7% (n=22) and a higher number of lymph nodes was extracted (median 45.5; p=0.002).

Conclusion Prophylactic complex physiotherapy is associated with lower rates of lymphedema and better patient-reported symptom scores according to the Gynecologic Cancer Lymphedema Questionnaire.

  • Postoperative complications
  • SLN and Lympadenectomy
  • Lymphatic System
  • Uterine Cancer
  • Ovarian Cancer

Data availability statement

Data are available upon reasonable request.

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  • Contributors MD is responsible for the overall content as the guarantor. Concept and design of the study, manuscript preparation, editing, and review: MD, CY, and EGK. Data acquisition: MD and RK. Data analysis and interpretation and statistical analysis: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.