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

Linda Koehler; Amanda Day; David Hunter; Anne Blaes; Tufia Haddad; Ryan Shanley

doi:10.1016/j.apmr.2022.03.007

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

Linda Koehler, Amanda Day, David Hunter, Anne Blaes, Tufia Haddad, Ryan Shanley

Research output: Contribution to journal › Article › peer-review

9 Scopus citations

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.

Original language	English (US)
Pages (from-to)	1798-1806
Number of pages	9
Journal	Archives of Physical Medicine and Rehabilitation
Volume	103
Issue number	9
DOIs	https://doi.org/10.1016/j.apmr.2022.03.007
State	Published - Sep 2022

Bibliographical note

Funding Information:
Supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award No. K12HD055887, the Powell Center Fund for Women's Health Advancement endowment at the University of Minnesota, administered by the University of Minnesota Women's Health Research Program, and in part by shared resources via NIH P30 CA77598, using Masonic Cancer Center's shared resources, and NCATS CTSA UL1TR002494, University of Minnesota, and the National Institutes of Health's National Center for Advancing Translational Sciences, grant UL1TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding sources.

Publisher Copyright:
© 2022 American Congress of Rehabilitation Medicine

Keywords

Breast neoplasms
Incidence
Lymphedema
Rehabilitation

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.apmr.2022.03.007

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Koehler, L., Day, A., Hunter, D., Blaes, A., Haddad, T., & Shanley, R. (2022). 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. Archives of Physical Medicine and Rehabilitation, 103(9), 1798-1806. https://doi.org/10.1016/j.apmr.2022.03.007

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. / Koehler, Linda; Day, Amanda; Hunter, David et al.
In: Archives of Physical Medicine and Rehabilitation, Vol. 103, No. 9, 09.2022, p. 1798-1806.

Research output: Contribution to journal › Article › peer-review

Koehler, L, Day, A, Hunter, D, Blaes, A, Haddad, T & Shanley, R 2022, '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', Archives of Physical Medicine and Rehabilitation, vol. 103, no. 9, pp. 1798-1806. https://doi.org/10.1016/j.apmr.2022.03.007

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

abstract = "Objective: To determine the cumulative incidence and natural history of axillary web syndrome (AWS) and its related postoperative risk for physical impairments in a cohort of women followed for 5 years post breast cancer surgery. Design: Prospective, longitudinal study. Setting: Academic health center. Participants: Women (N=36) with and without AWS after breast cancer surgery with sentinel node biopsy or axillary lymph node dissection. Interventions: Not applicable. Main Outcome Measures: Participants were assessed for AWS, shoulder goniometric flexion and abduction range of motion, function (Disability of the Arm, Shoulder, and Hand), lymphedema (bioimpedance spectroscopy, girth measures, tissue dielectric constant), and pain (visual analog scale) at 2, 4, 12, and 78 weeks and 5 years after breast cancer surgery. Analysis of variance compared range of motion, function, lymphedema, and pain in women identified with AWS with those without AWS across visits. Univariate logistic regression assessed if AWS was a risk factor for physical impairment at 5 years. Results: The cumulative incidence of AWS was 57%. Fifty percent (14/28) of the women who completed all study visits had signs of AWS at 5 years. Abduction active range of motion was significantly lower in women with AWS at 2 and 4 weeks post surgery. AWS was identified as a risk factor for reduced shoulder motion at 5 years. Regardless of AWS, 75% of the women experienced 1 or more upper extremity physical impairments at 5 years, which is an increase from 66% at 78 weeks in the same cohort. Conclusions: AWS is associated with reduced shoulder range of motion in the early postoperative time period, can persist for 5 years after breast cancer surgery, and increases the risk of long-term reduced shoulder range of motion. Long-term physical issues are apparent after breast cancer surgery regardless of AWS.",

keywords = "Breast neoplasms, Incidence, Lymphedema, Rehabilitation",

author = "Linda Koehler and Amanda Day and David Hunter and Anne Blaes and Tufia Haddad and Ryan Shanley",

note = "Funding Information: Supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award No. K12HD055887, the Powell Center Fund for Women's Health Advancement endowment at the University of Minnesota, administered by the University of Minnesota Women's Health Research Program, and in part by shared resources via NIH P30 CA77598, using Masonic Cancer Center's shared resources, and NCATS CTSA UL1TR002494, University of Minnesota, and the National Institutes of Health's National Center for Advancing Translational Sciences, grant UL1TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding sources. Publisher Copyright: {\textcopyright} 2022 American Congress of Rehabilitation Medicine",

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language = "English (US)",

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AU - Koehler, Linda

AU - Day, Amanda

AU - Hunter, David

AU - Blaes, Anne

AU - Haddad, Tufia

AU - Shanley, Ryan

N1 - Funding Information: Supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award No. K12HD055887, the Powell Center Fund for Women's Health Advancement endowment at the University of Minnesota, administered by the University of Minnesota Women's Health Research Program, and in part by shared resources via NIH P30 CA77598, using Masonic Cancer Center's shared resources, and NCATS CTSA UL1TR002494, University of Minnesota, and the National Institutes of Health's National Center for Advancing Translational Sciences, grant UL1TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding sources. Publisher Copyright: © 2022 American Congress of Rehabilitation Medicine

PY - 2022/9

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N2 - 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.

AB - 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.

KW - Breast neoplasms

KW - Incidence

KW - Lymphedema

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

Abstract

Bibliographical note

Keywords

UN SDGs

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