A systematic review of axillary web syndrome (AWS)

Yeung, W.M., McPhail, S.M., & Kuys, S.S. (2015) A systematic review of axillary web syndrome (AWS). Journal of Cancer Survivorship, 9(4), pp. 576-598.

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Abstract

Introduction

Axillary web syndrome (AWS) can result in early post-operative and long-term difficulties following lymphadenectomy for cancer and should be recognised by clinicians. This systematic review was conducted to synthesise information on AWS clinical presentation and diagnosis, frequency, natural progression, grading, pathoaetiology, risk factors, symptoms, interventions and outcomes.

Methods

Electronic searches were conducted using Cochrane, Pubmed, MEDLINE, CINAHL, EMBASE, AMED, PEDro and Google Scholar until June 2013. The methodological quality of included studies was determined using the Downs and Black checklist. Narrative synthesis of results was undertaken.

Results

Thirty-seven studies with methodological quality scores ranging from 11 to 26 on a 28-point scale were included. AWS diagnosis relies on inspection and palpation; grading has not been validated. AWS frequency was reported in up to 85.4 % of patients. Biopsies identified venous and lymphatic pathoaetiology with five studies suggesting lymphatic involvement. Twenty-one studies reported AWS occurrence within eight post-operative weeks, but late occurrence of greater than 3 months is possible. Pain was commonly reported with shoulder abduction more restricted than flexion. AWS symptoms usually resolve within 3 months but may persist. Risk factors may include extensiveness of surgery, younger age, lower body mass index, ethnicity and healing complications. Low-quality studies suggest that conservative approaches including analgesics, non-steroidal anti-inflammatory drugs and/or physiotherapy may be safe and effective for early symptom reduction.

Conclusions

AWS appears common. Current evidence for the treatment of AWS is insufficient to provide clear guidance for clinical practice.

Implications for Cancer Survivors

Cancer survivors should be informed about AWS. Further investigation is needed into pathoaetiology, long-term outcomes and to determine effective treatment using standardised outcomes.

Impact and interest:

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6 citations in Web of Science®

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ID Code: 87841
Item Type: Journal Article
Refereed: Yes
Keywords: Axillary web syndrome, Axillary lymphadenectomy, Breast cancer, Melanoma, Post-operative morbidity, Pain
DOI: 10.1007/s11764-015-0435-1
ISSN: 1932-2267
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Public Health & Social Work
Deposited On: 28 Sep 2015 23:59
Last Modified: 17 May 2016 03:22

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