Five-Year Cumulative Incidence of Axillary Web Syndrome and Comparison in Upper Extremity Movement, Function, Pain, and Lymphedema in Survivors of Breast Cancer With and Without Axillary Web Syndrome

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: Breast neoplasms; Incidence; Lymphedema; Rehabilitation.

Figure 1:

Axillary web syndrome of the left axilla 5-years after surgery indicated by arrow.

Figure 2:

The 5-year temporal change of pain (a) and DASH scores (b) in the axillary web syndrome (AWS) group, Non-AWS group, and the total mean of both groups combined. DASH=Disability of the Arm, Shoulder, and Hand; VAS=Visual Analog Scale, wk=week, Error bars=95% confidence interval

Figure 3:

The 5-year temporal change of shoulder range of motion in the axillary web syndrome (AWS) group and Non-AWS group and the total mean of both groups combined. a) abduction PROM, b) abduction AROM, c) flexion PROM, and d) flexion AROM PROM=passive range of motion; AROM=active range of motion; Error bars=95% confidence interval, wk=week *Groups were significantly different at the 2- and 4-week visits (p<0.05)