Abstract
Objective
To determine the cumulative incidence and natural history of axillary web syndrome
(AWS) and its related postoperative risk for physical impairments in a cohort of women
followed for 5 years post breast cancer surgery.
Design
Prospective, longitudinal study.
Setting
Academic health center.
Participants
Women (N=36) with and without AWS after breast cancer surgery with sentinel node biopsy
or axillary lymph node dissection.
Interventions
Not applicable.
Main Outcome Measures
Participants were assessed for AWS, shoulder goniometric flexion and abduction range
of motion, function (Disability of the Arm, Shoulder, and Hand), lymphedema (bioimpedance
spectroscopy, girth measures, tissue dielectric constant), and pain (visual analog
scale) at 2, 4, 12, and 78 weeks and 5 years after breast cancer surgery. Analysis
of variance compared range of motion, function, lymphedema, and pain in women identified
with AWS with those without AWS across visits. Univariate logistic regression assessed
if AWS was a risk factor for physical impairment at 5 years.
Results
The cumulative incidence of AWS was 57%. Fifty percent (14/28) of the women who completed
all study visits had signs of AWS at 5 years. Abduction active range of motion was
significantly lower in women with AWS at 2 and 4 weeks post surgery. AWS was identified
as a risk factor for reduced shoulder motion at 5 years. Regardless of AWS, 75% of
the women experienced 1 or more upper extremity physical impairments at 5 years, which
is an increase from 66% at 78 weeks in the same cohort.
Conclusions
AWS is associated with reduced shoulder range of motion in the early postoperative
time period, can persist for 5 years after breast cancer surgery, and increases the
risk of long-term reduced shoulder range of motion. Long-term physical issues are
apparent after breast cancer surgery regardless of AWS.
Keywords
List of abbreviations:
AROM (active range of motion), AWS (axillary web syndrome), DASH (Disabilities of Arm, Shoulder, and Hand), MCID (minimal clinically important difference), PI (primary investigator), PROM (passive range of motion), VAS (visual analog scale), TDC (tissue dielectric constant)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 05, 2022
Accepted:
March 8,
2022
Received in revised form:
February 7,
2022
Received:
September 27,
2021
Footnotes
Presented to the American Physical Therapy Association, February 14, 2020, Denver, CO; the Association of Academic Physiatrists, February 21, 2019, San Juan, PR; and the Building Interdisciplinary Research Careers in Women's Health, December 14, 2020, virtual.
Supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award No. K12HD055887, the Powell Center Fund for Women's Health Advancement endowment at the University of Minnesota, administered by the University of Minnesota Women's Health Research Program, and in part by shared resources via NIH P30 CA77598, using Masonic Cancer Center's shared resources, and NCATS CTSA UL1TR002494, University of Minnesota, and the National Institutes of Health's National Center for Advancing Translational Sciences, grant UL1TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding sources.
Disclosures: none.
Identification
Copyright
© 2022 by the American Congress of Rehabilitation Medicine.
