Management of Axillary Web Syndrome after Breast Cancer: Evidence-Based Practice

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. ResumoA síndrome da rede axilar (ou cordão axilar) é uma complicação físico-funcional que interfere na qualidade de vida de mulheres que foram submetidas a tratamento para o câncer de mama. O objetivo do presente estudo foi verificar os tratamentos fisioterapêuticos disponíveis para a síndrome da rede axilar após o tratamento cirúrgico do câncer de mama no contexto da prática clínica baseada em evidências. Utilizou-se como critério de inclusão artigos que discutissem protocolos de tratamento para a síndrome da rede axilar após o tratamento para o câncer de mama. A pesquisa foi

Axillary Web Syndrome in Breast Cancer: A Prevalent But Under-Recognized Postoperative Complication

“…Based on the limited treatment research published to date, it appears that PT (stretching and strengthening exercises and soft tissue mobilization) might improve shoulder function and quality of life and decrease pain in patients with AWS [26]. Future randomized trials should include, however, untreated control groups to definitively support this suggestion.…”

“…The authors concluded correctly, however, that additional randomized controlled trials are needed to examine the effects of PT [26].…”

“…Although a 2017 systematic review concluded that PT was effective in improving shoulder range-of-motion, resolving pain, and reducing the appearance of cording in patients with AWS [26], that review was based on only 4 studies, 2 of which were individual case reports. The authors concluded correctly, however, that additional randomized controlled trials are needed to examine the effects of PT [26].…”

Postoperative Upper Extremity Function in Implant and Autologous Breast Reconstruction

“…This can be useful information when counseling patients who are concerned about the appearance of the arms and underarms after reconstruction, since occurrences like axillary web syndrome can have a significant impact on postoperative quality of life. 36 PT can be an important tool for diagnosing and treating postoperative complications in breast reconstruction patients. 4,[37][38][39] The findings of this study can be used to help predict postoperative complications and guide PT strategies for flap and implant patients.…”

Cinesioterapia para melhora da qualidade de vida após cirurgia para câncer de mama

“…Entende-se que fatores externos e a forma com que o paciente lida com a doença refletem no caminho para o tratamento. Muitas mulheres após o tratamento cirúrgico para câncer de mama apresentam prejuízos físicos-funcionais como: lesões musculoesqueléticas e/ou nervosas, complicações cicatriciais, fibrose axilo-peitoral, alterações posturais, algias, comprometimento da amplitude de movimento, síndrome de rede axilar, diminuição da força muscular, alteração na percepção da imagem corporal, linfedema do membro homolateral, prejuízo da capacidade funcional para realização das atividades de vida diária e comprometimento da qualidade de vida (QV) [3][4][5][6][7][8][9][10][11].…”