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Brunelle CL, Serig A. Is axillary web syndrome a risk factor for breast cancer-related lymphedema of the upper extremity? A systematic review and meta-analysis. Breast Cancer Res Treat 2024; 208:471-490. [PMID: 39414730 DOI: 10.1007/s10549-024-07518-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Accepted: 10/04/2024] [Indexed: 10/18/2024]
Abstract
PURPOSE To systematically review the available literature to determine if axillary web syndrome (AWS) is a risk factor for breast cancer-related lymphedema (BCRL) of the upper extremity. METHODS The study is Prospero-registered (ID CRD42024508169) and follows PRISMA guidelines. Ovid MEDLINE, PubMED, CINAHL, Embase, clinicaltrials.gov and the WHO International Clinical Trials Registry Platform were searched February 24, 2024. Original studies including a cohort of females > 18 years of age diagnosed with AWS after breast cancer surgery and assessing BCRL outcome were included. Scoping, mapping, systematic or qualitative reviews, dissertations without peer-review and conference abstracts were excluded. Methodological quality was assessed using the Modified Downs and Black Checklist and overall certainty in the body of evidence was assessed using Cochrane's GRADE criteria (Grading of Recommendations Assessment, Development and Evaluation). RESULTS Nine cohort studies representing 3218 participants were included. The median incidence of AWS and BCRL was 31.79% (IQR 8.90%) and 14.29% (IQR 19.01%), respectively, across all studies. Pooled analysis indicated an odds ratio of 1.19 (95% confidence interval 0.60,2.37), with substantial heterogeneity across studies (Chi2 p < 0.0001, I2 = 82%). Methodological quality of the included studies was poor to fair, and there was very low certainty evidence indicating no difference in AWS for BCRL risk. The strongest study included, found that AWS more than doubles BCRL risk in the upper extremity. CONCLUSION The available evidence base cannot definitively determine whether AWS imparts risk of BCRL. AWS should be considered a potential risk factor for BCRL, until definitive conclusions from future research are available.
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Affiliation(s)
- Cheryl L Brunelle
- Department of Physical and Occupational Therapy, Breast Cancer-Related Lymphedema Research Program, Massachusetts General Hospital, Boston, MA, USA.
| | - Angela Serig
- Department of Rehabilitation Services, Brigham and Women's Faulkner Hospital; Division of Breast Surgery, Brigham and Women's Hospital; Lymphedema Screening Program, Dana Farber Brigham Cancer Center, Boston, MA, USA
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Berretta M, Garozzo D, Foti C, Roselli M, Materazzo M, Vita G, Iellamo F, Scordari M, Di Mauro G, Spatari G, Ottaiano A, Noce A, Pellicciaro M, Bignucolo A, Vanni G, Buonomo OC. Implementing fencing as adapted physical activity in non-metastatic breast cancer patients: design and early rehabilitation strategy of the FENICE study protocol. Front Oncol 2024; 14:1407919. [PMID: 39184037 PMCID: PMC11341382 DOI: 10.3389/fonc.2024.1407919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 07/24/2024] [Indexed: 08/27/2024] Open
Abstract
Background Improving prognosis of BC patients has drawn the attention of health care professionals on disease related long-term side effects and on the multiple treatments BC patients must undergo. Despite advances in procedures, surgery still has multiple detrimental effects, including pain, edema, and limited mobility. For this reason, fostering adapted physical activity (APA) and healthy lifestyle (including a balanced diet and weight management) should become an everyday purpose of healthcare professionals. Fencing may be a well-suited activity to counteract fatigue, pain, and limited arm mobility. Method and analysis The FENICE study is a mono-center, randomized clinical trial targeting women with BC stages I-III within four weeks from BC surgery. Participants in the control arm will receive the usual recommendations based on the good clinical practice guidelines. In the study arm, participants will be treated with the usual clinical and therapeutic recommendations together with APA and correct lifestyle suggestions. Objective The primary objective of the study is to compare whether implementation of APA and healthy lifestyle in BC patient after surgery will result in an overall improvement of physical and mental status. Conclusion Fencing and its early application in postoperative period may represent a feasible strategy to be implemented in the rehabilitation journey of BC patients. Ethics and dissemination The study protocol FENICE has been approved by an Italian Ethics Committee on May 2023 (R.S 100.23 5th May 2023).
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Affiliation(s)
- Massimiliano Berretta
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Daniele Garozzo
- Department of Clinical Science and Translational Medicine and School of Sports Medicine, University Tor Vergata, Rome, Italy
| | - Calogero Foti
- Physical and Rehabilitation Medicine, Tor Vergata University, Rome, Italy
| | - Mario Roselli
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, PTV Policlinico Tor Vergata University, Rome, Italy
| | - Giulia Vita
- Physical and Rehabilitation Medicine, Tor Vergata University, Rome, Italy
| | - Ferdinando Iellamo
- Department of Clinical Science and Translational Medicine and School of Sports Medicine, University Tor Vergata, Rome, Italy
| | - Marco Scordari
- Physical and Rehabilitation Medicine, Tor Vergata University, Rome, Italy
| | - Giordana Di Mauro
- School of Specialization in Medical Oncology, University of Messina, Messina, Italy
| | - Giovanna Spatari
- Department of Biomedical and Dentistry Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Alessandro Ottaiano
- Istituto Nazionale Tumori di Napoli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) “G. Pascale”, Napoli, Italy
| | - Annalisa Noce
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- UOSD Nephrology and Dialysis, Policlinico Tor Vergata, Rome, Italy
| | - Marco Pellicciaro
- Breast Unit, Department of Surgical Science, PTV Policlinico Tor Vergata University, Rome, Italy
| | - Alessia Bignucolo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Gianluca Vanni
- Breast Unit, Department of Surgical Science, PTV Policlinico Tor Vergata University, Rome, Italy
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, PTV Policlinico Tor Vergata University, Rome, Italy
- Department of Health Science, University of Basilicata, Potenza, Italy
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González-Rubino JB, Vinolo-Gil MJ, Martín-Valero R. Effectiveness of physical therapy in axillary web syndrome after breast cancer: a systematic review and meta-analysis. Support Care Cancer 2023; 31:257. [PMID: 37043039 PMCID: PMC10097759 DOI: 10.1007/s00520-023-07666-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/02/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND The axillary web syndrome (AWS) is a surgical breast cancer sequel that limits the functionality of the patient and delays the protocol times of application of cancer treatments. This implies a long period of discomfort and limitations for the user. OBJECTIVE To investigate the different physiotherapy treatments for the AWS and how effective they are. METHODS A systematic review based on PRISMA protocol and registered in PROSPERO (CRD42021281354) was conducted. The research was performed using PubMed, Scopus, CINAHL, PEDro, and Web of Science databases during January 2022 and March 2022. All randomized controlled trials and controlled clinical trials were included in this review. RESULTS A total of 188 articles were identified, with 9 studies selected for the systematic review. These studies basically propose treatments based on exercises and stretching, manual therapy, and the combination of manual therapy and exercises. CONCLUSIONS Exercise and stretching are the most effective therapies within the field of physiotherapy for the rehabilitation of axillary web syndrome. They restore range of motion faster, reduce pain, improve quality of life, and reduce disabilities. Manual therapy, scar massage, and myofascial release could help improve outcomes but with worse results. The meta-analysis conclusion is that pain is the only outcome with a significant reduction after the application of physiotherapy treatments - 0.82 [- 1.67; 0.03]. This conclusion is drawn from the only three studies with small sample sizes.
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Affiliation(s)
| | - Maria Jesus Vinolo-Gil
- Department of Nursing and Physiotherapy, University of Cadiz, 11009, Cadiz, Spain.
- Rehabilitation Clinical Management Unit, Interlevels-Intercenters Hospital Puerta del Mar, Hospital Puerto Real, Cadiz Bay-La Janda Health District, 11006, Cadiz, Spain.
- Research Unit, Department Biomedical Research and Innovation Institute of Cadiz (INiBICA), Puerta del Mar University Hospital, University of Cadiz, 11009, Cadiz, Spain.
| | - Rocío Martín-Valero
- Department of Physiotherapy, Faculty of Health Sciences, University of Malaga, CTS-1071 Research Group, Malaga, Spain
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Braudy R, Atoms B, Coghlan J, Staples M, Moga D, Tollefsrud R, Lawrence RL, Ludewig P, Koehler L. Shoulder Kinematics of Axillary Web Syndrome in Women Treated for Breast Cancer. Arch Phys Med Rehabil 2023; 104:403-409. [PMID: 36202228 DOI: 10.1016/j.apmr.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/29/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To better understand how the shoulder moves in breast cancer survivors with axillary web syndrome (AWS), we compared 3-dimensional (3D) shoulder kinematics during shoulder elevation among breast cancer survivors with and without AWS 5 years postoperatively. Although research consistently shows decreased shoulder range of motion with AWS, we do not understand the underlying biomechanics. DESIGN Nested case control study. SETTING University Academic Breast Center. PARTICIPANTS Twenty-five women who had surgery 5 years previously for unilateral breast cancer with the removal of at least 1 lymph node participated in this study (N=25). Twelve participants had AWS; 13 women did not have AWS. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Three-dimensional shoulder kinematic data during shoulder forward flexion, scapular plane abduction, and coronal plane abduction were collected using 3D electromagnetic motion tracking. Kinematic data were extracted at 30°, 60°, 90°, and 120° of arm elevation for scapular upward rotation, internal rotation, and posterior tilt as well as for glenohumeral external rotation. RESULTS Women with AWS demonstrated 15.2° less scapular upward rotation at 120° humerothoracic elevation (95% confidence interval [-25.2, -5.2], P=.005), regardless of plane. No significant between-group differences were found for any other angle of scapular upward rotation, nor for scapular internal rotation, scapular posterior tilt, or glenohumeral axial rotation at any angle. CONCLUSIONS Five years after surgery for breast cancer, women diagnosed with AWS have altered scapulohumeral kinematics that may place them at an increased risk of shoulder pain based on existing kinematic literature in healthy cohorts. This information can help guide rehabilitation programs for breast cancer survivors to facilitate pain-free upper extremity function after treatment.
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Affiliation(s)
- Renata Braudy
- Department of Rehabilitation Medicine, Division of Rehabilitation Science, University of Minnesota, Minneapolis, MN.
| | - Brittany Atoms
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, MN
| | - Jenna Coghlan
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, MN
| | - Meaghan Staples
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, MN
| | - David Moga
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, MN
| | - Ryan Tollefsrud
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, MN
| | - Rebekah L Lawrence
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO
| | - Paula Ludewig
- Department of Rehabilitation Medicine, Division of Rehabilitation Science, University of Minnesota, Minneapolis, MN; Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, MN
| | - Linda Koehler
- Department of Rehabilitation Medicine, Division of Rehabilitation Science, University of Minnesota, Minneapolis, MN; Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, MN
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Alharazy SM. Occurrence of axillary web syndrome without surgical intervention: a case report. J Int Med Res 2023; 51:3000605231152384. [PMID: 36694987 PMCID: PMC9893068 DOI: 10.1177/03000605231152384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Axillary web syndrome (AWS) is characterized by the formation of cords in the axilla. Classically, it develops after surgical biopsy or removal of axillary lymph nodes for breast cancer. It can cause a limited range of motion and may contribute to abnormal shoulder movements or patterns that can cause pain. In this report, an atypical case of AWS presented in a 38-year-old male after physical activity but with no surgical history or breast cancer. This case report highlights that AWS can appear in healthy individuals with no history of breast cancer and/or surgical intervention. It also emphasizes the need to consider AWS in clinical practice as a differential diagnosis of painful shoulder movement and restricted range of motion.
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Affiliation(s)
- Shatha Matoug Alharazy
- Department of Physiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia,King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia,Shatha Matoug Alharazy, Department of Physiology, Faculty of Medicine, King Abdulaziz University, 9 Al Ehtifalat Street, 22252 Jeddah, Kingdom of Saudi Arabia.
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González Rubino JB, Vinolo-Gil MJ, García Muñoz C, Martín-Valero R. Randomised clinical trial of a manual therapy programme to reduce the evolution time of axillary web syndrome in women affected by breast cancer: study protocol. BMJ Open 2022; 12:e063305. [PMID: 36130744 PMCID: PMC9494586 DOI: 10.1136/bmjopen-2022-063305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Breast cancer is the most common malignant tumour in women, with more than 2 million new cases annually worldwide. One of the most frequent and well-known surgical and post-actinic sequelae is post-mastectomy lymphoedema. The axillary web syndrome is another sequela that limits the functionality of the patient and delays the protocol time of administering cancer treatments; and in many cases, this sequela is misdiagnosed. This surgical sequela usually disappears spontaneously after the third month of appearance, but this implies a long period of discomfort and limitations for the patient, at the same time, it may delay the application of radiotherapy within the indicated protocol deadline (due to a need for body posture). METHODS AND ANALYSIS With the present quasi-experimental study, we intend to show the application of physiotherapy and stretching from the beginning of the appearance of the axillary cord, in a controlled and scheduled way by the physiotherapist. It is possible to reduce the time in which the lymphatic thrombus is present and, therefore, recover functionality and mobility, reduce pain and be able to apply treatments within the established deadline. We intend to apply this therapy into the intervention group and compare thrombus evolution time with the control group. ETHICS AND DISSEMINATION This trial has the approval of the Andalucía Ethics Committee (PEIBA code 1909-N1-21, reg. number 171.21). TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT05115799).
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Affiliation(s)
| | | | | | - Rocío Martín-Valero
- Department of Physiotherapy, Faculty of Health Sciences, University of Malaga, Malaga, Spain
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Koehler L, Day A, Hunter D, Blaes A, Haddad T, Shanley R. 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. Arch Phys Med Rehabil 2022; 103:1798-1806. [PMID: 35398047 PMCID: PMC9452471 DOI: 10.1016/j.apmr.2022.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/07/2022] [Accepted: 03/08/2022] [Indexed: 11/24/2022]
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.
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Affiliation(s)
- Linda Koehler
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota; Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota; Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.
| | - Amanda Day
- Division of Physical Medicine and Rehabilitation, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - David Hunter
- Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Anne Blaes
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota; Hematology/Oncology, University of Minnesota, Minneapolis, Minnesota
| | - Tufia Haddad
- Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | - Ryan Shanley
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota; Clinical and Translational Science Institute, Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis, Minnesota, United States
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Lippi L, de Sire A, Losco L, Mezian K, Folli A, Ivanova M, Zattoni L, Moalli S, Ammendolia A, Alfano C, Fusco N, Invernizzi M. Axillary Web Syndrome in Breast Cancer Women: What Is the Optimal Rehabilitation Strategy after Surgery? A Systematic Review. J Clin Med 2022; 11:jcm11133839. [PMID: 35807124 PMCID: PMC9267329 DOI: 10.3390/jcm11133839] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/15/2022] [Accepted: 06/29/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Axillary web syndrome (AWS) is one of the most prevalent and underrecognized disorders affecting breast cancer (BC) women. However, the optimal therapeutic strategy to manage AWS is far from being fully characterized. Therefore, this systematic review aims to provide a broad overview of the available rehabilitation treatments in this burdensome condition. Methods: On 13 January 2022, PubMed, Scopus, Web of Science, Cochrane, and PEDro were systematically searched for clinical studies assessing rehabilitation interventions in post-surgical BC women with AWS. The outcomes analyzed were pain, AWS clinical resolution, upper limb function, and health-related quality of life (HR-QoL). Results: The search identified 1115 records, of which 11 studies were included. A total of 174 patients were assessed (ages ranging from 37 and 66 years old). The interventions included manual lymphatic drainage, manual therapy, stretching, resistance training, mobilization techniques, and Kinesio tape. Positive improvements were reported in terms of pain relief (in 7 studies), AWS clinical resolution (in 9 studies), upper limb function (in 10 studies), and HR-QoL (in 2 studies). Conclusions: Our findings suggest that rehabilitation might be considered an effective therapeutic strategy in AWS patients. Further RCTs are needed to characterize the optimal rehabilitative interventions.
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Affiliation(s)
- Lorenzo Lippi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (A.F.); (S.M.); (M.I.)
- Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Translational Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Alessandro de Sire
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, Viale Europa, 88100 Catanzaro, Italy;
- Correspondence: ; Tel.: +39-061712819
| | - Luigi Losco
- Plastic Surgery Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende, 43, Baronissi, 84081 Salerno, Italy; (L.L.); (C.A.)
| | - Kamal Mezian
- Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University and General University Hospital, 11000 Prague, Czech Republic;
| | - Arianna Folli
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (A.F.); (S.M.); (M.I.)
| | - Mariia Ivanova
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141 Milan, Italy; (M.I.); (L.Z.); (N.F.)
| | - Lorenzo Zattoni
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141 Milan, Italy; (M.I.); (L.Z.); (N.F.)
| | - Stefano Moalli
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (A.F.); (S.M.); (M.I.)
| | - Antonio Ammendolia
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, Viale Europa, 88100 Catanzaro, Italy;
| | - Carmine Alfano
- Plastic Surgery Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende, 43, Baronissi, 84081 Salerno, Italy; (L.L.); (C.A.)
| | - Nicola Fusco
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141 Milan, Italy; (M.I.); (L.Z.); (N.F.)
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (A.F.); (S.M.); (M.I.)
- Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Translational Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
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Roman MM, Barbieux R, Eddy C, Karler C, Veys I, Zeltzer A, Adriaenssens N, Leduc O, Bourgeois P. Lymphoscintigraphic Investigations for Axillary Web Syndromes. Lymphat Res Biol 2021; 20:417-424. [PMID: 34813367 PMCID: PMC9422805 DOI: 10.1089/lrb.2021.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Axillary web syndrome (AWS) is a frequent complication after surgery for breast cancer, but its lymphatic involvement is not definitively established. Here we report the results of lymphoscintigraphic investigations in patients with AWS. Methods and Findings: We conducted a retrospective, single-center review of lymphoscintigraphic investigations performed in 46 patients with AWS that was either clinically obvious or suspected. Of this group, 23 patients had two investigations with a mean interval of 19 weeks between them (range, 6-98 weeks). Results of the lymphoscintigraphic investigations, which were performed according to a well-standardized protocol, were classified into four patterns: normal; functional lymphatic insufficiency only (no lymphatic vascular morphologic abnormality); lymphovascular blockade without collateralization; and vascular collateralization and/or dermal backflow. Of the 46 patients, on the first lymphoscintigraphic investigation, four (8.6%) had a normal pattern, seven (15.2%) had functional lymphatic insufficiency only, four (8.6%) had lymphovascular blockade without collateralization, and 31 (67.3%) had vascular collateralization and/or dermal backflow. Among patients who underwent two investigations, four of the five who had only functional lymphatic insufficiency at the first investigation had developed vascular collateralization and/or dermal backflow by the second. The three patients who had lymphovascular blockade without collateralization at the first examination had also progressed to collateralization and/or dermal backflow at the second. None of the 15 patients who initially had vascular collateralization and/or dermal backflow showed any reversal at the second examination. Conclusions: Our analysis confirms the lymphatic nature of AWS and shows the lymphoscintigraphic patterns and evolutions of the lymphatic lesions with potential therapeutic implications. The retrospective review of our database is approved by the institutional ethics committee under number 2048.
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Affiliation(s)
- Mirela Mariana Roman
- Department of Mammo-Pelvic Surgery, Institute Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.,Multi-disciplinary Clinic of Lymphology, Institute Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Romain Barbieux
- Departement of Physical Therapy, Université Libre de Bruxelles, Brussels, Belgium
| | - Christine Eddy
- Department of Mammo-Pelvic Surgery, Institute Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Clarence Karler
- Department of Anesthesia-Algologia, Hospital Moliere, Université Libre de Bruxells, Brussels, Belgium
| | - Isabelle Veys
- Department of Mammo-Pelvic Surgery, Institute Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Assaf Zeltzer
- European Center for Lymphedema Surgery, Department of Plastic and Reconstructive Surgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nele Adriaenssens
- Medical Oncology Department, Universitair Ziekenhuis Brussel, Brussels, Belgium & Rehabilitation Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Olivier Leduc
- Departement of Physical Therapy, Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre Bourgeois
- Multi-disciplinary Clinic of Lymphology, Institute Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.,Service of Dermatology, Hospital Erasme, and Services of Nuclear Medicine, Institut Jules Bordet and HIS-IZZ Hospitals, Université Libre de Bruxelles, Brussels, Belgium
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10
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Tay MRJ, Wong CJ, Aw HZ. Prevalence and associations of axillary web syndrome in Asian women after breast cancer surgery undergoing a community-based cancer rehabilitation program. BMC Cancer 2021; 21:1019. [PMID: 34521359 PMCID: PMC8439086 DOI: 10.1186/s12885-021-08762-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/28/2021] [Indexed: 12/02/2022] Open
Abstract
Background Patients 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. Methods This 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. Results There 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. Conclusions A 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.
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Affiliation(s)
- Matthew Rong Jie Tay
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore. .,Singapore Cancer Society Rehabilitation Center, Singapore Cancer Society, Singapore, Singapore.
| | - Chin Jung Wong
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.,Singapore Cancer Society Rehabilitation Center, Singapore Cancer Society, Singapore, Singapore
| | - Hui Zhen Aw
- Singapore Cancer Society Rehabilitation Center, Singapore Cancer Society, Singapore, Singapore
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11
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Basu A, Mondal J, Swetha B, Chakrabarty S, Ghosh D, Gangopadhyay S, Mandal B. Patient-Reported Shoulder Morbidity and Fatigue among Breast Cancer Survivors: An Insight from a Tertiary Care Cancer Hospital. Indian J Med Paediatr Oncol 2021. [DOI: 10.4103/ijmpo.ijmpo_257_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Context: Breast cancer is the most common cancer in Indian women with an annual mortality of around 87,000. Treatment for breast carcinoma may lead to swelling of the ipsilateral arm, shoulder stiffness, arm pain, and cancer-related fatigue. Very few centers in India have reported the arm and shoulder morbidity treated in their hospitals. Aims: The aim was to evaluate the predictive factors of arm and shoulder morbidity and fatigue among breast cancer survivors. Settings and Design: This was a retrospective analysis based on a prospectively maintained database. Materials and Methods: Early and locally advanced cases of breast cancer patients were screened for the study during 2015–2018. Eligible participants were invited to fill up the predetermined questionnaire, and their demographic and treatment-related information was accrued from a file archive. Follow-up period was estimated from the date of tissue diagnosis to last contact/time of interview. Results: Shoulder stiffness was the most common complaint followed by arm numbness. Obesity and diabetes played a crucial role in most of the morbidities and fatigue. The median fatigue score was 34, and the median time of appearance of lymphedema was 13 months. Modified radical mastectomy and radiotherapy to axilla were statistically significantly (P = 0.04 and 0.01, respectively) associated with greater shoulder stiffness and arm swelling. Conclusions: Obesity, diabetes, type of surgery, the extent of axillary dissection, and radiation plan are the major predictive factors of arm and shoulder morbidity. Further prospective validation is necessary for future breast cancer survivorship programs.
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Affiliation(s)
- Abhishek Basu
- Department of Radiotherapy, Medical College and Hospital, Kolkata, West Bengal, India
| | - Janmenjoy Mondal
- Department of Radiotherapy, Medical College and Hospital, Kolkata, West Bengal, India
| | - Bhukya Swetha
- Department of Radiotherapy, Medical College and Hospital, Kolkata, West Bengal, India
| | - Shinjini Chakrabarty
- Department of Radiotherapy, Medical College and Hospital, Kolkata, West Bengal, India
| | - Debjit Ghosh
- Department of Radiotherapy, Medical College and Hospital, Kolkata, West Bengal, India
| | - Subhendu Gangopadhyay
- Department of Radiotherapy, Medical College and Hospital, Kolkata, West Bengal, India
| | - Bidyut Mandal
- Department of Radiotherapy, Medical College and Hospital, Kolkata, West Bengal, India
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12
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Lang AE, Kim SY, Dickerson CR, Milosavljevic S. Measurement of objective shoulder function following breast cancer surgery: a scoping review. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1851439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Angelica E. Lang
- School of Rehabilitation Sciences, University of Saskatchewan, Saskatoon, Canada
| | - Soo Y. Kim
- School of Rehabilitation Sciences, University of Saskatchewan, Saskatoon, Canada
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13
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Brunelle CL, Roberts SA, Shui AM, Gillespie TC, Daniell KM, Naoum GE, Taghian AG. Reply to: Bergmann et al comment to "Patients who report cording after breast cancer surgery are at higher risk of lymphedema: Results from a large prospective screening cohort". J Surg Oncol 2020; 122:999-1002. [PMID: 32700315 DOI: 10.1002/jso.26132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Cheryl L Brunelle
- Department of Physical and Occupational Therapy, Massachusetts General Hospital, Boston, Massachusetts
| | - Sacha A Roberts
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Amy M Shui
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Tessa C Gillespie
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Kayla M Daniell
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - George E Naoum
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Alphonse G Taghian
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
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14
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Bergmann A, Baiocchi JMT, de Andrade MFC, Thuler LCS. Comment to "Patients who report cording after breast cancer surgery are at higher risk of lymphedema: Results from a large prospective screening cohort". J Surg Oncol 2020; 122:997-998. [PMID: 32700318 DOI: 10.1002/jso.26094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Anke Bergmann
- Program of Clinical Epidemiology, National Cancer Institute, Rio de Janeiro, Brazil
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15
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Vidt ME, Potochny J, Dodge D, Green M, Sturgeon K, Kass R, Schmitz KH. The influence of mastectomy and reconstruction on residual upper limb function in breast cancer survivors. Breast Cancer Res Treat 2020; 182:531-541. [PMID: 32506338 DOI: 10.1007/s10549-020-05717-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/01/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE Breast cancer survivorship is common (90% of women survive 5 or more years), but many women are not able to return to full function and well-being after treatment due to functional limitations, persistent pain, and inability to perform daily activities. Since each surgical reconstructive option (e.g., autologous tissue flaps versus implants) can impact shoulder and arm function differently, it is important to understand how shoulder and upper limb strength, mobility, and function are influenced by the type of surgical intervention. Efforts can then focus on prehabiliation strategies to prevent the onset of limitations and on developing rehabilitation protocols that directly target shortcomings. METHODS The current paper presents a review summarizing how shoulder and upper limb function may be affected by surgical mastectomy and breast reconstruction. RESULTS Mastectomy and breast reconstruction with implants or autologous tissues present different functional outcomes for patients. Each surgical procedure is associated with unique sequelae derived from the tissues and procedures associated with each surgery. Characterizing the specific functional outcomes associated with each surgical approach will promote the development of targeted rehabilitation strategies that can be implemented into a multidisciplinary treatment planning pathway for breast cancer patients. CONCLUSIONS Surgical treatments for breast cancer, including mastectomy and breast reconstruction, can have negative effects. Focused efforts are needed to better understand treatment-specific effects so that targeted rehabilitation can be developed to improve patient function, QoL, and ability to return to work and life activities post-breast cancer.
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Affiliation(s)
- Meghan E Vidt
- Department of Biomedical Engineering, Pennsylvania State University, 331 Chemical and Biomedical Engineering Building, University Park, PA, 16802, USA. .,Department of Physical Medicine and Rehabilitation, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA.
| | - John Potochny
- Department of Plastic Surgery, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA
| | - Daleela Dodge
- Department of Surgery, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA.,Department of Humanities, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA
| | - Michael Green
- Department of Humanities, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA.,Department of Medicine, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA
| | - Kathleen Sturgeon
- Department of Public Health Sciences, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA
| | - Rena Kass
- Department of Surgery, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA.,Department of Medicine, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA
| | - Kathryn H Schmitz
- Department of Physical Medicine and Rehabilitation, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA.,Department of Public Health Sciences, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA
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16
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Brunelle CL, Roberts SA, Shui AM, Gillespie TC, Daniell KM, Naoum GE, Taghian A. Patients who report cording after breast cancer surgery are at higher risk of lymphedema: Results from a large prospective screening cohort. J Surg Oncol 2020; 122:155-163. [PMID: 32497273 DOI: 10.1002/jso.25944] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/05/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To identify the association between cording and breast cancer-related lymphedema (BCRL); describe time course, location, symptoms and functional impairments. METHODS A total of 1181 patients were prospectively screened for BCRL after breast cancer (BC) surgery, including patient-reported outcome measures (4193) and perometric arm volume measurements (BCRL defined as relative or weight-adjusted volume change [RVC or WAC] ≥10% ≥3 months postoperatively). RESULTS A total of 374/1181 patients (31.7%) reported cording first a median of 4.5 months postoperatively, and were more likely to: have body mass index less than 30 kg/m2 ; be less than 55 years of age; have had mastectomy, axillary lymph node dissection, regional lymph node radiation, neoadjuvant chemotherapy (all P < .001), or RVC/WAC ≥10% (P = .002). Patients who reported cording had 2.4 times the odds of developing BCRL compared to those who did not (odds ratio = 2.40; 95% confidence interval = 1.40-4.11; P = .002), and most frequently reported these symptoms: tenderness (61.2%), aching (60.7%), and firmness/tightness (59.8%). On multivariable analysis, cording was significantly correlated with functional difficulty for 17 actions. CONCLUSIONS Patients frequently present with cording, potentially months after BC surgery. Risk factors for and symptoms of cording are identified, and treatment is recommended. Patients reporting cording are at higher risk of BCRL, therefore, cording should be incorporated into BCRL risk stratification.
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Affiliation(s)
- Cheryl L Brunelle
- Department of Physical and Occupational Therapy, Massachusetts General Hospital, Boston, Massachusetts
| | - Sacha A Roberts
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Amy M Shui
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Tessa C Gillespie
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Kayla M Daniell
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - George E Naoum
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Alphonse Taghian
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
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17
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Koehler LA, Mayrovitz HN. Tissue Dielectric Constant Measures in Women With and Without Clinical Trunk Lymphedema Following Breast Cancer Surgery: A 78-Week Longitudinal Study. Phys Ther 2020; 100:1384-1392. [PMID: 32379872 PMCID: PMC7439223 DOI: 10.1093/ptj/pzaa080] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 01/11/2019] [Accepted: 02/11/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Following breast cancer surgery with lymph node removal, women are at risk of developing lymphedema in the upper extremity or trunk. Currently, trunk lymphedema diagnosis relies on a clinical assessment because no quantifiable standard method exists. Tissue dielectric constant (TDC) values are quantifiable measures of localized skin tissue water and may be able to detect trunk lymphedema. The goal of this study was to (1) compare parameters derived from TDC measurements with those derived from clinically accepted criteria for trunk lymphedema in women following breast cancer surgery and (2) explore the potential utility of TDC to detect trunk lymphedema early in its progression. METHODS This prospective longitudinal study, a secondary analysis from a larger study, observed women with and without clinically determined truncal lymphedema following breast cancer surgery. TDC was measured on the lateral trunk wall at post-surgery weeks 2, 4, 12, and 78 in women who had surgical breast cancer treatment with lymph node removal. Clinical assessment for trunk lymphedema was determined at 78 weeks by a lymphedema expert. Comparison of TDC measurements in women with and without clinical trunk lymphedema was analyzed. RESULTS Clinical assessment identified trunk lymphedema in 15 out of 32 women at 78 weeks. These women had TDC ratios statistically higher than women without truncal lymphedema. CONCLUSION The overall findings indicate that TDC has the ability to quantify trunk lymphedema and might be valuable in early detection. IMPACT TDC may be a beneficial tool in the early detection of breast cancer-related trunk lymphedema, which could trigger intervention. LAY SUMMARY A new device may help recognize trunk lymphedema in patients with breast cancer so they could receive appropriate treatment.
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Affiliation(s)
- Linda A Koehler
- Department of Rehabilitation Medicine, Division of Physical Therapy, Division of Rehabilitation Science, University of Minnesota, Mayo Mail Code 388, 420 Delaware St, SE, Minneapolis, MN 55455 (USA); and Masonic Cancer Center, University of Minnesota,Address all correspondence to Dr Koehler at:
| | - Harvey N Mayrovitz
- College of Medical Sciences, Nova Southeastern University, Ft Lauderdale, Florida
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18
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Ryans K, Davies CC, Gaw G, Lambe C, Henninge M, VanHoose L. Incidence and predictors of axillary web syndrome and its association with lymphedema in women following breast cancer treatment: a retrospective study. Support Care Cancer 2020; 28:5881-5888. [PMID: 32270312 DOI: 10.1007/s00520-020-05424-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 03/17/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Axillary web syndrome (AWS) presents as a common postsurgical complication in individuals with breast cancer. Breast cancer-related lymphedema (BCRL) contributes to the shoulder and arm morbidity common in breast cancer survivors and often associated to cancer treatment. A paucity of literature exists evaluating the risk factors for developing AWS and the association between AWS and BCRL. The purposes of this study were (1) to identify risk factors for AWS in individuals with breast cancer, (2) to examine the association between BCRL and AWS, and (3) to determine if AWS increases the risk for developing BCRL. METHODS A retrospective study of 354 women who underwent breast cancer treatment and received physical therapy was included. RESULTS Axillary web syndrome developed in a third of women and predominately occurred in the first 8 postoperative weeks. The odds of AWS development were 73% greater for participants over the age of 60 (OR = 1.73, CI 95% 1.05-2.84). Women with AWS had 44% greater risk to develop lymphedema during the first postoperative year (RR = 1.44, CI 95% 1.12-1.84, p = 0.002). If AWS developed within the first postoperative month, women were almost 3 times more likely to develop lymphedema within the first 3 postoperative months compared with other women with AWS (RR = 2.75, CI 95% 1.199-6.310, p = 0.007). CONCLUSIONS Our findings suggest that 30% of breast cancer survivors will have AWS during the first year of survivorship. As institutions prioritize screening efforts, early postoperative prospective surveillance is needed for women over 60 due to high risk for AWS development and any women with AWS for increased risk of lymphedema development based on our findings.
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Affiliation(s)
- Kathryn Ryans
- Department of Physical Therapy, Mercy College, Dobbs Ferry, NY, USA. .,Department of Oncology Rehabilitation & Lymphedema Management, Atlantic Health System, Morristown, NJ, USA.
| | - Claire C Davies
- Nursing and Allied Health Research Office, Baptist Health Lexington, Lexington, KY, USA
| | - Gizela Gaw
- Department of Oncology Rehabilitation & Lymphedema Management, Atlantic Health System, Morristown, NJ, USA
| | - Caroline Lambe
- Department of Oncology Rehabilitation, Regional Cancer Center at Lee Health , Cape Coral, FL, USA
| | - Morgan Henninge
- Physical Therapy and Rehabilitation, United Health Services, Vestal, NY, USA
| | - Lisa VanHoose
- Department of Physical Therapy, University of Louisiana Monroe, Monroe, LA, USA
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19
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Ramírez-Parada K, Garay-Acevedo D, Mella-Abarca W, Petric-Guajardo M, Sánchez-Rojel C, McNeely ML, Leao-Ribeiro I, Fernández-Verdejo R. Axillary web syndrome among Chilean women with breast cancer: incidence and possible predisposing factors. Support Care Cancer 2019; 28:2941-2947. [PMID: 31768730 DOI: 10.1007/s00520-019-05190-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/12/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE Breast cancer (BC) is the most common cancer in women worldwide. The main treatment for BC is surgery, which involves an axillary procedure that associates with the development of axillary web syndrome (AWS). The incidence of AWS among Chilean women with BC and its possible predisposing factors are currently unknown. Thus, we aimed to (1) determine the incidence of AWS among Chilean women with BC after surgery and (2) identify possible predisposing factors. METHODS Within 90 days post-surgery, patients were assessed for AWS, i.e., palpable or visible axillary cords in the axillary region extending down from the mid-axilla to the ipsilateral arm. We then computed the odds ratio with 95% confidence interval (OR [95% CI]) for having AWS considering the following predisposing factors: age, body mass index (BMI), number of lymph nodes removed, axillary procedure, days from surgery to the physical therapy assessment, hospital for the surgery, type of breast surgery, and neoadyuvant chemotherapy. RESULTS AWS was present in 49 out of 107 patients (45.8%). Younger age and lower BMI appeared as the sole predisposing factors for AWS (age, 0.95 [0.91-0.99]; BMI, normal weight 1.00, overweight 0.35 [0.11-1.12], obesity 0.28 [0.08-0.97]). CONCLUSION The incidence of AWS among Chilean women with BC was 45.8%. Our study also confirms data from previous reports showing that younger age and low BMI are associated with the development of AWS.
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Affiliation(s)
- Karol Ramírez-Parada
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Diana Garay-Acevedo
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Williams Mella-Abarca
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - César Sánchez-Rojel
- Departamento de Hemato-Oncología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Margaret L McNeely
- Department of Physical Therapy and Oncology, University of Alberta and Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Ivana Leao-Ribeiro
- Departamento de Kinesiología Facultad de Ciencias de la Salud, Universidad Católica del Maule, Talca, Chile
| | - Rodrigo Fernández-Verdejo
- Carrera de Nutrición y Dietética, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
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20
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Outcomes of Lymphedema Microsurgery for Breast Cancer-related Lymphedema With or Without Microvascular Breast Reconstruction. Ann Surg 2019; 268:1076-1083. [PMID: 28594742 DOI: 10.1097/sla.0000000000002322] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE This study investigated the outcome of lymphedema microsurgery with or without microsurgical breast reconstruction for breast cancer-related lymphedema (BCRL). BACKGROUND Complete decongestive therapy, lymphovenous anastomosis, and vascularized lymph node flap transfer are the 3 major treatment modalities for BCRL. Releasing axillary contracture and transferring a free flap may potentially improve the BCRL. METHODS Between 2004 and 2015, 124 patients with BCRL who underwent 3 treatment modalities without or with microsurgical breast reconstruction were included in this study as groups I and II, respectively. Patients were offered the lymphedema microsurgery depending on the availability of patent lymphatic ducts on indocyanine green lymphography if they failed to complete decongestive therapy. The circumferential difference, reduction rate, and episodes of cellulitis were used to evaluate the outcome of treatments. RESULTS Improvements in the circumferential difference (12.8 ± 4.2% vs 11.5 ± 5.3%), the reduction rate (20.4 ± 5.1% vs 14.7 ± 6%), and episodes of cellulitis (1.7 ± 1.1 vs 2.1 ± 2.4 times/yr) did not significantly differ between groups I and II (P = 0.06, 0.07, and 0.06, respectively). In both groups, vascularized lymph node flap transfer was significantly superior to lymphovenous anastomosis or complete decongestive therapy in terms of improvements in the circumferential difference, reduction rate and episodes of cellulitis (P = 0.04, 0.04, and 0.06, respectively). CONCLUSIONS Microsurgical breast reconstruction did not improve the outcome of BCRL. Improvements in BCRL were better for lymphatic microsurgery than complete decongestive therapy. Moreover, vascularized lymph node flap transfer provided greater improvements in the BCRL than lymphovenous anastomosis.
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21
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Chrischilles EA, Riley D, Letuchy E, Koehler L, Neuner J, Jernigan C, Gryzlak B, Segal N, McDowell B, Smith B, Sugg SL, Armer JM, Lizarraga IM. Upper extremity disability and quality of life after breast cancer treatment in the Greater Plains Collaborative clinical research network. Breast Cancer Res Treat 2019; 175:675-689. [PMID: 30852760 PMCID: PMC6534523 DOI: 10.1007/s10549-019-05184-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 02/20/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE Chronic upper extremity disability (UED) is common after breast cancer treatment but under-identified and under-treated. Although UED has been linked to quality of life (QoL), the role of UED as mediator between contemporary treatment practices and QoL has not been quantified. This investigation describes UED in a contemporary sample of breast cancer patients and examines its relationship with personal and treatment factors and QoL. METHODS Eight hundred and thirty-three women diagnosed at eight medical institutions during 2013-2014 with microscopically confirmed ductal carcinoma in situ or invasive stage I-III breast cancer were surveyed an average of 22 months after diagnosis. UED was measured with a modified QuickDASH and QoL with the FACT-B. The questionnaire also collected treatments, sociodemographic information, comorbidity, body mass index, and a 3-item health literacy screener. RESULTS Women who received post-mastectomy radiation and chemotherapy experienced significantly worse UED and QoL. Women who had lower income, lower health literacy and prior diabetes, arthritis or shoulder diagnoses had worse UED. Patients with worse UED reported significantly worse QoL. Income and health literacy were independently associated with QoL after adjustment for UED but treatment and prior conditions were not, indicating mediation by UED. UED mediated 52-79% of the effect of mastectomy-based treatments on QoL as compared with unilateral mastectomy without radiation. UED and QoL did not differ by type of axillary surgery or post-mastectomy reconstruction. CONCLUSIONS A large portion of treatment effect on QoL is mediated by UED. Rehabilitation practices that prevent and alleviate UED are likely to improve QoL for breast cancer survivors.
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Affiliation(s)
- Elizabeth A Chrischilles
- University of Iowa College of Public Health, Iowa City, IA, USA.
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA.
- College of Public Health, University of Iowa, S424 CPHB, 145 N. Riverside Dr., Iowa City, IA, 52242-2007, USA.
| | - Danielle Riley
- University of Iowa College of Public Health, Iowa City, IA, USA
| | - Elena Letuchy
- University of Iowa College of Public Health, Iowa City, IA, USA
| | | | - Joan Neuner
- Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Brian Gryzlak
- University of Iowa College of Public Health, Iowa City, IA, USA
| | - Neil Segal
- University of Iowa College of Public Health, Iowa City, IA, USA
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Bradley McDowell
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA
| | - Brian Smith
- University of Iowa College of Public Health, Iowa City, IA, USA
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA
| | - Sonia L Sugg
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Jane M Armer
- University of Missouri Sinclair School of Nursing, Columbia, MO, USA
| | - Ingrid M Lizarraga
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
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22
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Mullen LA, Harvey SC. Review of axillary web syndrome: What the radiologist should know. Eur J Radiol 2019; 113:66-73. [PMID: 30927961 DOI: 10.1016/j.ejrad.2019.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 11/19/2022]
Abstract
Axillary web syndrome is common after axillary surgery, frequently affecting breast cancer patients. In this condition, patients develop one or more linear bands of firm tissue, also known as "cords", in the axilla and arm, associated with pain and limited range of motion of the shoulder and arm. Radiologists may encounter this syndrome in patients referred for axillary or upper extremity ultrasound, and should be aware of the physical examination and ultrasound findings for accurate diagnosis. However, there are currently limited articles about this syndrome published in radiology journals, suggesting that radiologists may be unaware of this entity. In this work, axillary web syndrome will be discussed, including background knowledge, incidence, clinical presentation, possible etiology, and ultrasound appearance.
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Affiliation(s)
- Lisa A Mullen
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine, 601 N. Caroline St., Suite 4120, Baltimore, MD, 21287, USA.
| | - Susan C Harvey
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine, 601 N. Caroline St., Suite 4120, Baltimore, MD, 21287, USA.
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Koehler LA, Haddad TC, Hunter DW, Tuttle TM. Axillary web syndrome following breast cancer surgery: symptoms, complications, and management strategies. BREAST CANCER (DOVE MEDICAL PRESS) 2018; 11:13-19. [PMID: 30588087 PMCID: PMC6304256 DOI: 10.2147/bctt.s146635] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Axillary web syndrome (AWS) is a common condition occurring in up to 86% of patients following breast cancer surgery with ipsilateral lymphadenectomy of one or more nodes. AWS presents as a single cord or multiple thin cords in the subcutaneous tissues of the ipsilateral axilla. The cords may extend variable distances "down" the ipsilateral arm and/or chest wall. The cords frequently result in painful shoulder abduction and limited shoulder range of motion. AWS most frequently becomes symptomatic between 2 and 8 weeks postoperatively but can also develop and recur months to years after surgery. Education about and increased awareness of AWS should be promoted for patients and caregivers. Assessments for AWS should be performed on a regular basis following breast cancer surgery especially if there has been associated lymphadenectomy. Physical therapy, which consists of manual therapy, exercise, education, and other rehabilitation modalities to improve range of motion and decrease pain, is recommended in the treatment of AWS.
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Affiliation(s)
- L A Koehler
- Division of Physical Therapy,
- Division of Rehabilitation Medicine, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, USA,
- University of Minnesota, Masonic Cancer Center, Minneapolis, MN, USA,
| | - T C Haddad
- Mayo Clinic, Division of Medical Oncology, Department of Oncology, Rochester, MN, USA
| | - D W Hunter
- Department of Radiology, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - T M Tuttle
- University of Minnesota, Masonic Cancer Center, Minneapolis, MN, USA,
- Department of Surgery, Medical School, University of Minnesota, Minneapolis, MN, USA
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Prevalence of shoulder morbidity after treatment for breast Cancer in South Africa. Support Care Cancer 2018; 27:2591-2598. [PMID: 30456720 DOI: 10.1007/s00520-018-4540-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 11/04/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Breast cancer is the most frequently diagnosed cancer and leading cause of cancer death among women, representing a considerable public health burden in South Africa and other low-middle income countries. Short- and long-term complications of these treatments include shoulder morbidities such as pain, decreased range of motion, tightness, weakness, pain, numbness and lymphoedema and may be present for up to 6 years post-treatment. An understanding of baseline demographic and clinical risk factors can guide rehabilitation and management strategies for high-risk patients. The aims of this study were to quantify the burden of shoulder pain and disability in a tertiary academic hospital in Cape Town, South Africa, and identify potential risk factors for the development of shoulder morbidity. METHODS This study was a cross-sectional analysis of the prevalence of shoulder pain and dysfunction in women attending their post-treatment annual follow-up visit for unilateral breast carcinoma. RESULTS Three in four patients reported a presence of any pain or disability while only 9% experienced severe pain and disability. Multivariable ordinal logistic regression analysis identified race, side, axillary surgery, chemotherapy and age as significant predictors of pain and chemotherapy a significant predictor of disability. CONCLUSION The substantial burden of shoulder morbidity in this population represents a significant public health burden. The use of identified clinical and demographic characteristics may guide in the development of survivorship programmes incorporating surveillance and management of these high-risk patients.
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25
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Koehler LA, Mayrovitz HN. Spatial and Temporal Variability of Upper Extremity Edema Measures After Breast Cancer Surgery. Lymphat Res Biol 2018; 17:308-315. [PMID: 30427746 DOI: 10.1089/lrb.2018.0022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Tissue dielectric constant (TDC), as an index of local tissue water, and girth measurements are quantitative methods to measure and characterize lymphedema. Objective: To describe the spatial and temporal variability in arm girth and TDC values in women surgically treated for breast cancer and to describe the relationship between these measures. Methods and Results: This was a prospective longitudinal study that observed 36 women for 78 weeks after breast cancer surgery with lymph node removal. Arm circumferences and TDC values, as indices of local tissue water, were measured on both arms at multiple sites at postsurgery weeks 2, 4, 12, and 78 in women undergoing surgical breast cancer treatment with one or more axillary lymph nodes removed. TDC and girth values remained relatively uniform from visit-to-visit for both at-risk and contralateral control arms with no overall statistically significant difference in values (p > 0.05). There was a strong inverse correlation between arm girth and the TDC value in both the at-risk and control arms (p < 0.001). Overall, there was no statistically significant difference in TDC interarm ratios among visits or anatomical sites. TDC values for at-risk and control arms tended to significantly decrease with increasing distance from the wrist (p < 0.001). Conclusion: TDC arm values and girth measures remained relatively uniform in women after breast cancer surgery. The fact that TDC values are higher distally than proximally provides new information from which TDC measurements may be interpreted and also provides a better understanding of arm spatial variability in relation to girth measures.
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Affiliation(s)
- Linda A Koehler
- 1 Divisions of Physical Therapy and Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota Medical School, University of Minnesota, Minneapolis, Minnesota.,2 Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Harvey N Mayrovitz
- 3 College of Medical Sciences, Nova Southeastern University, Ft. Lauderdale, Florida.,4 Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Ft. Lauderdale, Florida
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26
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Koehler LA, Hunter DW, Blaes AH, Haddad TC. Function, Shoulder Motion, Pain, and Lymphedema in Breast Cancer With and Without Axillary Web Syndrome: An 18-Month Follow-Up. Phys Ther 2018; 98:518-527. [PMID: 29361075 PMCID: PMC6692645 DOI: 10.1093/ptj/pzy010] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 01/17/2018] [Indexed: 11/14/2022]
Abstract
BACKGROUND Axillary web syndrome (AWS) can develop following breast cancer surgery and presents as a tight band of tissue in the axilla with shoulder abduction. OBJECTIVE The objectives were to determine the prevalence and natural history of AWS and the association between AWS and function, range of motion, pain, lymphedema, and body mass index (BMI). DESIGN This study was a longitudinal prospective cohort study utilizing a repeated measures design. METHODS Axillary web syndrome, function, shoulder range of motion, pain, and lymphedema (using circumference, bioimpedance spectroscopy, tissue dielectric constant) were assessed in women at 2, 4, and 12 weeks and 18 months following breast cancer surgery. Prevalence of AWS and the association with the measured outcomes were analyzed. RESULTS Thirty-six women agreed to participate in the study. The cumulative prevalence of AWS was 50% (18/36) at 18 months following breast cancer surgery. AWS was identified as a risk factor for reduced function. Women with AWS had statistically reduced range of motion, lower BMI, and higher number of lymph nodes removed compared to the non-AWS group. Forty-one percent (13/32) of women had AWS at 18 months. AWS reoccurred in 6 women following resolution, and a new case developed beyond the early postoperative period. The overall prevalence of physical impairments ranged from 66% to 97% within the first 18 months following surgery regardless of AWS. LIMITATIONS Limitations include a small sample size and potential treatment effect. CONCLUSION AWS occurs in approximately 50% of women following breast cancer surgery. It can persist for 18 months and potentially longer, develop beyond the early postoperative time period, and reoccur after resolution. Clinicians need to be aware of the chronicity of AWS and its association with reduced range of motion and function.
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Affiliation(s)
- Linda A Koehler
- Divisions of Physical Therapy and Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota Medical School, Mayo Mail Code 388, 420 Delaware St. SE, Minneapolis, MN 55455; and Masonic Cancer Center, University of Minnesota,Address all correspondence to Dr. Koehler at:
| | | | - Anne H Blaes
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota; and Masonic Cancer Center, University of Minnesota
| | - Tufia C Haddad
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota
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27
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Harris SR. Axillary Web Syndrome in Breast Cancer: A Prevalent But Under-Recognized Postoperative Complication. Breast Care (Basel) 2018; 13:132-135. [PMID: 29887791 PMCID: PMC5981636 DOI: 10.1159/000485023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The purpose of this review is to define axillary web syndrome (AWS) and describe its diagnosis and management. The following databases were searched through July 2017: PubMed, EMBASE (OvidSP), Cumulative Index for Nursing and Allied Health Literature, Physiotherapy Evidence Database, and Cochrane Database of Systematic Reviews. Search terms included 'axillary web syndrome', 'axillary cording', and 'lymphatic cording'. 49 articles were identified; 8 did not relate to breast cancer, and 3 were not in English. Of the remaining articles, the majority were case reports, case series, or descriptive reviews. 2 systematic reviews were located as well as 1 randomized trial, 6 prospective cohort studies, and 2 retrospective cohort studies. Although a common sequela after axillary surgery for breast cancer staging, AWS has been poorly described in the medical literature as to the underlying pathophysiology, diagnosis, and management. Interventions range from patient education and simple reassurance that the syndrome will resolve spontaneously to active physical or manual therapies to maintain upper extremity range-of-motion, especially adequate motion for undergoing radiation therapy. Oncologists, breast surgeons, family physicians, and oncology nurse practitioners that work with patients with breast cancer should educate them about this prevalent complication and inform them preoperatively about what to anticipate.
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Affiliation(s)
- Susan R. Harris
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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28
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Baggi F, Nevola Teixeira LF, Gandini S, Simoncini MC, Bonacossa E, Sandrin F, Sciotto Marotta M, Lanni G, Dadda P, Colpani D, Luini A. Axillary web syndrome assessment using a self-assessment questionnaire: a prospective cohort study. Support Care Cancer 2018; 26:2801-2807. [PMID: 29508139 DOI: 10.1007/s00520-018-4123-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 02/20/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Surgical procedure for breast cancer is not without its side effects and one such side effect is axillary web syndrome (AWS), characterized by palpable fibrotic-like cords in the operated arm. As physical evaluation is the only gold standard method used, our study aims to assess the incidence and early detection of AWS with a self-assessment questionnaire. METHODS From July 2013 to July 2014, 370 breast cancer patients were enrolled. AWS incidence was 51.1%, with 94.1% onset in the first 4 weeks after surgery; 43.5% of the patients did not recover in the first 8 weeks. Univariate analysis showed that BMI (P < 0.001), age (P < 0.001), educational level (P = 0.01), and exercise frequency in the eighth week of follow-up (P < 0.001) were significantly associated with the AWS detection, and multivariate analyses confirmed that younger patients (age < 50) have significantly higher AWS detection (OR = 2.38 (95%CI 1.53, 3.71) and that BMI is associated with AWS, with normal weight patients (BMI ≤ 25) having a significantly greater AWS detection with an odds ratio of 2.11 (95%CI 1.33, 3.36). CONCLUSION Our findings indicated that the incidence of AWS is high in breast cancer patients, particularly in the first month after surgery. Not all patients achieved recovery during our 8 week follow-up, suggesting that evaluation and treatment should be longer. Double AWS detection was found for patients who were younger (age < 50) and with normal weight.
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Affiliation(s)
- F Baggi
- Physiotherapy Department, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | | | - S Gandini
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - M C Simoncini
- Physiotherapy Department, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - E Bonacossa
- Physiotherapy Department, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - F Sandrin
- Physiotherapy Department, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - M Sciotto Marotta
- Physiotherapy Department, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - G Lanni
- Physiotherapy Department, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - P Dadda
- Physiotherapy Department, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - D Colpani
- Physiotherapy Department, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - A Luini
- Breast Surgery Unit, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
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29
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Luz CMD, Deitos J, Siqueira TC, Palú M, Heck APF. Management of Axillary Web Syndrome after Breast Cancer: Evidence-Based Practice. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2017; 39:632-639. [PMID: 28701024 PMCID: PMC10309465 DOI: 10.1055/s-0037-1604181] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 05/05/2017] [Indexed: 10/19/2022] Open
Abstract
Axillary web syndrome is characterized as a physical-functional complication that impacts the quality of life of women who have undergone treatment for breast cancer. The present study aims to verify the physiotherapy treatment available for axillary web syndrome after surgery for breast cancer in the context of evidence-based practice. The selection criteria included papers discussing treatment protocols used for axillary web syndrome after treatment for breast cancer. The search was performed in the MEDLINE, Scopus, PEDro and LILACS databases using the terms axillary web syndrome, lymphadenectomy and breast cancer, focusing on women with a previous diagnosis of breast cancer who underwent surgery with lymphadenectomy as part of their treatment. From the 262 studies found, 4 articles that used physiotherapy treatment were selected. The physiotherapy treatment was based on lymphatic drainage, tissue mobilization, stretching and strengthening. The four selected articles had the same outcome: improvement in arm pain and shoulder function and/or dissipation of the axillary cord. Although axillary web syndrome seems to be as frequent and detrimental as other morbidities after cancer treatment, there are few studies on this subject. The publications are even scarcer when considering studies with an interventional approach. Randomized controlled trials are necessary to support the rehabilitation resources for axillary web syndrome.
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Affiliation(s)
- Clarissa Medeiros da Luz
- Physiotherapy Postgraduate Program, Center of Health and Sport Sciences, Universidade do Estado de Santa Catarina (Udesc), Florianópolis, SC, Brazil
| | - Julia Deitos
- Physiotherapy Postgraduate Program, Center of Health and Sport Sciences, Universidade do Estado de Santa Catarina (Udesc), Florianópolis, SC, Brazil
| | - Thais Cristina Siqueira
- Physiotherapy Postgraduate Program, Center of Health and Sport Sciences, Universidade do Estado de Santa Catarina (Udesc), Florianópolis, SC, Brazil
| | - Marina Palú
- Physiotherapy Postgraduate Program, Center of Health and Sport Sciences, Universidade do Estado de Santa Catarina (Udesc), Florianópolis, SC, Brazil
| | - Ailime Perito Feiber Heck
- Physiotherapy Postgraduate Program, Center of Health and Sport Sciences, Universidade do Estado de Santa Catarina (Udesc), Florianópolis, SC, Brazil
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30
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Furlan C, Matheus CN, Jales RM, Derchain S, Sarian LO. Vascular Alterations in Axillary and Brachial Vessels in Patients with Axillary Web Syndrome After Breast Cancer Surgery. Lymphat Res Biol 2017; 16:287-293. [PMID: 28961070 DOI: 10.1089/lrb.2017.0037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Surgical manipulations of the axilla may cause a condition known as Axillary Web Syndrome (AWS). The systems compromised and the sequence of events leading to this syndrome remains unknown. This study evaluated clinical, surgical, and vascular factors associated with onset and duration of AWS after breast cancer surgery. METHODS AND RESULTS In this prospective study, 155 women were included. They were submitted to a physical examination that consisted of ultrasound Doppler of axillary and brachial vessels and the evaluation of AWS in 1, 3, and 6 months after breast cancer surgery. Women with advanced disease had a significantly higher incidence of AWS than those with early stage breast cancer (p = 0.02). In addition, women who underwent mastectomy or axillary lymph node dissection (ALND) had a significantly higher incidence of AWS in the 1-month (p < 0.01; p < 0.01) and 3-months (p < 0.01; p = 0.02) assessment rounds, respectively. The cross-sectional area of brachial artery was significantly smaller (p = 0.04) in women with AWS at the 3-months postoperative visit. The peak systolic velocity and the blood flow of the axillary artery was significantly higher in women with AWS 6 months after surgery (p < 0.03 and p = 0.02 respectively). CONCLUSION Our study confirm the combined changes of lymphatic and vascular systems in woman with AWS, since AWS was associated with more extensive dissection of axillary lymph nodes, compromised lymph nodes, and with abnormalities of the vascular parameters.
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Affiliation(s)
- Cintia Furlan
- 1 Department of Obstetrics and Gynecology, State University of Campinas (Unicamp) , Campinas, São Paulo, Brazil .,2 Division of Gynecologic and Breast Oncology, Women's Hospital (CAISM) , Unicamp, Campinas, São Paulo, Brazil
| | - Carolina Nascimben Matheus
- 1 Department of Obstetrics and Gynecology, State University of Campinas (Unicamp) , Campinas, São Paulo, Brazil .,2 Division of Gynecologic and Breast Oncology, Women's Hospital (CAISM) , Unicamp, Campinas, São Paulo, Brazil
| | - Rodrigo Menezes Jales
- 1 Department of Obstetrics and Gynecology, State University of Campinas (Unicamp) , Campinas, São Paulo, Brazil .,3 Radiology Sector, Women's Hospital (CAISM) , Unicamp, Campinas, São Paulo, Brazil
| | - Sophie Derchain
- 1 Department of Obstetrics and Gynecology, State University of Campinas (Unicamp) , Campinas, São Paulo, Brazil .,2 Division of Gynecologic and Breast Oncology, Women's Hospital (CAISM) , Unicamp, Campinas, São Paulo, Brazil
| | - Luís Otávio Sarian
- 1 Department of Obstetrics and Gynecology, State University of Campinas (Unicamp) , Campinas, São Paulo, Brazil .,2 Division of Gynecologic and Breast Oncology, Women's Hospital (CAISM) , Unicamp, Campinas, São Paulo, Brazil
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31
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Thompson Buum HA, Koehler L, Tuttle TM. Venturing Out on a Limb: Axillary Web Syndrome. Am J Med 2017; 130:e209-e210. [PMID: 28249666 DOI: 10.1016/j.amjmed.2016.12.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 12/12/2016] [Accepted: 12/12/2016] [Indexed: 11/20/2022]
Affiliation(s)
| | - Linda Koehler
- Physical Therapy Program and Masonic Cancer Center, University of Minnesota, Minneapolis
| | - Todd M Tuttle
- Surgical Oncology, University of Minnesota, Minneapolis
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Welsh P, Gryfe D. Atypical presentation of axillary web syndrome (AWS) in a male squash player: a case report. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2016; 60:294-298. [PMID: 28065989 PMCID: PMC5178020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Axillary Web Syndrome (AWS), also known as lymphatic cording, refers to a condition in which a rope-like soft-tissue density develops in the axilla. It usually appears in the 5 to 8 week period following breast cancer surgery and can lead to shoulder pain and restricted motion. We present a case of AWS in a male squash player with no history of breast cancer or surgery following a period of intense exercise. This case highlights the rare presentation of AWS in a male patient and raises awareness for the health care practitioner who may not suspect this condition in this population.
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Affiliation(s)
- Patrick Welsh
- Sports Sciences Resident, Division of Graduate Studies, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario
| | - David Gryfe
- Humber Family Chiropractic, Rehabilitation & Wellness, Etobicoke, Ontario
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Na HS, Oh AY, Koo BW, Lim DJ, Ryu JH, Han JW. Preventive Analgesic Efficacy of Nefopam in Acute and Chronic Pain After Breast Cancer Surgery: A Prospective, Double-Blind, and Randomized Trial. Medicine (Baltimore) 2016; 95:e3705. [PMID: 27196485 PMCID: PMC4902427 DOI: 10.1097/md.0000000000003705] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Breast cancer surgery is known to cause severe acute postoperative pain, which can persist for a long time. We administered nefopam preventively to patients undergoing lumpectomy with axillary lymph node dissection or sentinel lymph node biopsy, and evaluated its efficacy on acute and chronic postoperative pain.Enrolled patients were assigned to the nefopam (n = 41) or the control (n = 42) group. Before initiating the operation, 20 mg of nefopam was given to the patients of the nefopam group, and normal saline was used in the control group. Ketorolac was given at the end of surgery, and meloxicam was prescribed in the postoperative period to all patients in both groups. Pain was assessed using a numerical rating scale (NRS), and the rescue analgesic drug was given when the NRS was >5. Implementation of postoperative chemotherapy, radiotherapy (RT), or hormone therapy was evaluated.The NRS of postoperative pain was significantly lower in the nefopam than in the control group in the postanesthetic care unit (4.5 ± 2.2 vs 5.7 ± 1.5, respectively; P = 0.01), at postoperative 6 h (3.0 ± 1.6 vs 4.5 ± 1.3, respectively; P < 0.001), and at postoperative 24 h (3.1 ± 1.1 vs 3.8 ± 1.5, respectively; P = 0.01) with reduced use of rescue analgesic drugs. Significantly fewer patients suffered from chronic postoperative pain in the nefopam than in the control group at postoperative 3 months (36.6% vs 59.5%, P = 0.04). Considering only the cohort without postoperative adjuvant RT, the difference in the proportion of patients reporting chronic pain increased (23.5% in the nefopam group vs 61.5% in the control group, P = 0.04).Preventive nefopam was helpful in reducing the acute postoperative pain, with reduced use of rescue analgesic drugs, and it contributed to reduced occurrence of chronic pain at postoperative 3 months after breast cancer surgery.
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Affiliation(s)
- Hyo-Seok Na
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam (H-SN, A-YO, B-WK, J-HR, J-WH); Department of Anesthesiology and Pain Medicine, Yonsei Barun Orthopedic Clinic, Yongin (D-JL), Gyeonggi; and Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul (A-YO, J-HR), Republic of Korea
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Effects of a physical therapy program combined with manual lymphatic drainage on shoulder function, quality of life, lymphedema incidence, and pain in breast cancer patients with axillary web syndrome following axillary dissection. Support Care Cancer 2015; 24:2047-2057. [DOI: 10.1007/s00520-015-3005-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 10/27/2015] [Indexed: 12/13/2022]
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