Abstract
BackgroundPatients who have breast cancer surgery are at risk of axillary web syndrome (AWS), an under-recognized postsurgical complication which can result in shoulder morbidity and functional impairment. Emerging studies have indicated that AWS may persist beyond the first few months after surgery, although few studies have assessed the prevalence and association of AWS beyond a year after diagnosis. Therefore, the aim of this study was to investigate the prevalence and associations for AWS in post-operative breast cancer patients up to 3 years after surgery.MethodsThis cross sectional observational study was conducted at a community-based cancer rehabilitation center. Patients were evaluated for the presence of AWS via physical examination. Disease-related data was obtained from clinical review and medical records. Descriptive statistics were utilized to illustrate patient demographics and clinical characteristics. Logistic regression analyses were used to determine associations of AWS.ResultsThere were 111 Asian women who were recruited, who had undergone breast surgery and were referred to a national outpatient rehabilitation center. The prevalence of AWS in this population was 28.9%. In the multivariate regression model, significant factors were age < 50 years (OR = 3.51; 95% CI = 1.12–11.0; p = 0.031) and ALND (OR = 6.54; 95% CI = 1.36–31.3; p = 0.019). There was reduced shoulder flexion ROM (p < 0.001) in patients with AWS compared to patients without AWS.ConclusionsA high prevalence of AWS was reported in breast cancer survivors even at 3 years after breast surgery. Our findings highlight the need to identify breast cancer survivors with AWS even in the survivorship phase, and develop strategies to raise awareness and minimize functional impairment in these patients.
Highlights
Patients who have breast cancer surgery are at risk of axillary web syndrome (AWS), an underrecognized postsurgical complication which can result in shoulder morbidity and functional impairment
Breast cancer surgery is the main treatment of breast cancer which is often combined with either sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) for prognostication and therapeutic decision making
AWS is believed to be associated with a lymphatic origin [8,9,10,11], and evaluation should exclude Mondor’s disease, a condition which is caused by superficial thrombophlebitis, and may present with palpable cord-like induration over the mid-upper arm [12,13,14,15,16]
Summary
Patients who have breast cancer surgery are at risk of axillary web syndrome (AWS), an underrecognized postsurgical complication which can result in shoulder morbidity and functional impairment. Breast cancer surgery is the main treatment of breast cancer which is often combined with either sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) for prognostication and therapeutic decision making Such axillary approaches may result in postoperative morbidity, such as pain, lymphedema, shoulder dysfunction and postoperative infection [1]. The diagnosis is clinical, and is characterized by the presence of cording, where one or more visible or palpable cords are present in the axilla, which can extend down to the medial ipsilateral arm, frequently to the antecubital space and occasionally to the base of the thumb [2] This can result in pain, limited shoulder range of motion, postural impairment, numbness, functional impairment of the shoulder joint, psychological problems and impaired quality of life [3, 4]. AWS is believed to be associated with a lymphatic origin [8,9,10,11], and evaluation should exclude Mondor’s disease, a condition which is caused by superficial thrombophlebitis, and may present with palpable cord-like induration over the mid-upper arm [12,13,14,15,16]
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