EFFECTIVENESS OF PHYSICAL THERAPY ON AXILLARY WEB SYNDROME AFTER BREAST CANCER SURGERY: A RANDOMIZED, SINGLE-BLIND, CONTROLLED TRIAL

M. Torres-Lacomba¹, V. Prieto-Gómez¹, B. Arranz-Martín¹, M.J. Yuste-Sánchez¹, B. Navarro-Brazález¹, H. Romay-Barrero²

Background: Axillary web syndrome (AWS) is a common and self-limiting complication in women with breast cancer occurring mainly during the early post-operative period after breast cancer axillary surgery. The aim of this study was to determine the effectiveness of physiotherapy tailored to the pathophysiology of AWS on pain, shoulder active range of motion (AROM), shoulder disability, health-related quality of life (HRQoL), and arm volume.

Purpose: The aim of the study was to determine the effectiveness of PT tailored to the AWS pathophysiology in the reduction of pain and associated improvement in range of motion, perceived shoulder disability, health-related quality of life (HRQoL) and arm volume.

Methods: A prospective, single-center, assessor-blinded, and randomized controlled trial was carried out to determine the effectiveness of physical therapy tailored to the pathophysiology of axillary web syndrome (AWS) on pain, shoulder active range of motion (AROM), shoulder disability, health-related quality of life (HRQoL), and arm volume. Ninety-six women with AWS were assigned to the physical therapy (n = 48) or control (n = 48) group, with both groups receiving treatment three times a week for three weeks. The primary outcome was self-reported pain relief measured on a visual analog scale; secondary outcomes included shoulder active range of motion, shoulder disability; HRQoL; and arm volume. Outcomes were assessed at baseline, after intervention, and three- and six-month follow-ups.

Results: In comparison with control group, physical therapy subjects reported significant and clinically relevant effects on subjective pain intensity in short- (P < 0.001) and at medium-term (P < 0.001). Significant and clinically relevant differences were also found between groups in the short- and medium-term in secondary outcomes (except clinically relevant difference for shoulder range of motion at medium-term) and HRQoL regarding physical and functional aspects assessed by the breast cancer subscale plus the arm subscale and the trial outcome index (all P < 0.001). No long-term follow-up differences were found in either primary (P = 0.064) or secondary outcomes (P > 0.05), except for arm volume (P < 0.001).

Conclusion(s): A physiotherapy program—tailored to the pathophysiology of AWS and composed of manual lymph-drainage in the arm and on the taut cords in conjunction with progressive active and action-assisted arm exercises focused on stretching taut cords—significantly reduced pain and arm volume, enhanced shoulder function and disability, and improved specific functional and physical aspects of HRQoL in women with AWS after breast cancer surgery both in the short- and medium-term.

Implications:  Tis study emphasizes the role of physiotherapy in the awareness, early diagnosis, and treatment of AWS. AWS is an early complication of axillary surgery for breast cancer, which is more common than infection, seroma, or lymphedem, in addition to being a source of nociceptive pain, which can have an important impact on the HRQoL of breast cancer patients. As this condition can also appear in the medium- and long-term after surgery and be recurrent, close collaboration of surgeons, radiation oncologists, medical oncologists, primary care providers, and physiotherapists is essential for the prevention and management of AWS.

Funding, acknowledgements: Supported by PI17/01449 Instituto de Salud Carlos III, Madrid, Spain and by the European Regional Development Fund (FONDOS FEDER).

Keywords: axillary web syndrome, breast cancer, pain

Topic: Oncology, HIV & palliative care

Did this work require ethics approval? Yes

Institution: Principe de Asturias Hospital

Committee: Clinical Research Committee of the Principe de Asturias Hospital

Ethics number: OE32/2014