F. Baggi, Luiz Felipe Nevola Teixeira, S. Gandini, M. C. Simoncini, E. Bonacossa, F. Sandrin, M. Sciotto Marotta, G. Lanni, P. Dadda1 & D. Colpani, A. Luini. Supportive Care in Cancer 2018

Main findings

• This study has a primary aim to assess the incidence and early detection of AWS by using a self-assessment questionnaire which includes external validation of the tool. Secondary aims are to evaluate the time of onset of axillary web syndrome and to identify possible risk factors for this disease.
• Patients who underwent axillary dissection received the standard physiotherapy treatment during recovery, they performed six exercises and received educational information on how to continue the exercises at home, care for the arm, prevent lymphedema, and AWS. Moreover, they received the questionnaire for self-assessment of AWS. The assessment of the presence or absence of AWS was made by a telephone follow-up, conducted at three time points: 2 weeks after surgery, 4 weeks after surgery, and 8 weeks after surgery. Physiotherapists telephoned those patients who had filled in the questionnaire, so that patients could report whether they had cord characteristic of AWS, and provide physiotherapists with valuable information on the timing of onset.
• A total of 370 patients met the inclusion criteria and agreed to participate; the syndrome was present in 186 patients with an incidence of 51.1%.
• The timing of onset, 93 patients (25.5%) developed the syndrome within the first 2 weeks after surgery, 79 patients (21.7%) between the third and fourth week, and 11 patients (3.0%) between the fifth and eight week. Compliance with carrying out the physiotherapy exercises was recorded during onset time.
• Regarding timing of resolution of the syndrome, 17 patients (9.1%) had definitive resolution within 4weeks after surgery, 5 patients (2.7%) had resolution within 4 weeks but then had a recurrence of the disease, 82 patients (44.1%) had a definitive resolution between 5 and 8 weeks, and 76 (40.9%) patients did not have resolution during the 8 weeks of follow-up.
• Exercise frequency (P <0.001) is significantly associated with AWS in the eight week of follow-up.
• Multivariate analyses confirmed that younger patients (age <50) have significantly greater incidence of AWS and that BMI is associated with AWS, normal weight patients (BMI ≤25) having a significantly greater detection of AWS.
• The validated questionnaire offers the opportunity to have a self-diagnosis of the syndrome, made by the patient also living far from the hospital.
• It provides the possibility to make a diagnosis of AWS even if the therapist is not able to recognize it through palpation, since not all physiotherapists have expertise concerning this side effect.
• It is less likely that people with a higher BMI will have AWS, probably because the cords are less visible and palpable, lying under adipose tissue in armpit, making it difficult for patients and healthcare professionals to detect.
• Younger women may be more physically active and thus easily aware of any difficulty in arm movement during daily activities, which may prove to be the initial signs of AWS.
• Patients with a higher educational level are better at detecting the syndrome, and with a greater frequency.
• Limitations of the study included not including those that underwent SNB and the follow up time could have been longer than 8 weeks.
• Further research should consider information regarding treatment, resolution, exercise influence, and recurrence (especially after adjuvant treatment).