Randomised clinical trial of a manual therapy programme to reduce the evolution time of axillary web syndrome in women affected by breast cancer: study protocol

Abstract

IntroductionBreast cancer is the most common malignant tumour in women, with more than 2 million new cases annually worldwide. One of the most frequent and well-known surgical and post-actinic sequelae is post-mastectomy lymphoedema. The axillary web syndrome is another sequela that limits the functionality of the patient and delays the protocol time of administering cancer treatments; and in many cases, this sequela is misdiagnosed. This surgical sequela usually disappears spontaneously after the third month of appearance, but this implies a long period of discomfort and limitations for the patient, at the same time, it may delay the application of radiotherapy within the indicated protocol deadline (due to a need for body posture).Methods and analysisWith the present quasi-experimental study, we intend to show the application of physiotherapy and stretching from the beginning of the appearance of the axillary cord, in a controlled and scheduled way by the physiotherapist. It is possible to reduce the time in which the lymphatic thrombus is present and, therefore, recover functionality and mobility, reduce pain and be able to apply treatments within the established deadline. We intend to apply this therapy into the intervention group and compare thrombus evolution time with the control group.Ethics and disseminationThis trial has the approval of the Andalucía Ethics Committee (PEIBA code 1909-N1-21, reg. number 171.21).Trial registration numberClinicalTrials.gov Registry (NCT05115799).

Postmastectomy Functional Impairments

“…AWS typically occurs 2–8 weeks after breast cancer surgery and resolves spontaneously within 3 months, although some cases can persist for years. Recent studies indicate that AWS can develop as well as recur within months to years after surgery [ 5 , 8 , 39 ]. The reported incidence of AWS varies widely, from 6 to 86%, partly due to misdiagnosis and confusion with scar tissue [ 8 , 39 , 40 ].…”

“…Recent studies indicate that AWS can develop as well as recur within months to years after surgery [ 5 , 8 , 39 ]. The reported incidence of AWS varies widely, from 6 to 86%, partly due to misdiagnosis and confusion with scar tissue [ 8 , 39 , 40 ].…”

“…Other factors associated with a higher incidence include lower BMI, younger age, higher education, frequent exercise, increased number of lymph nodes removed, extensive surgery, and adjunctive chemotherapy or radiation therapy [ 39 , 41 ]. AWS may also be associated with an increased risk of postmastectomy lymphedema, with patients experiencing AWS having a 44% higher likelihood of developing this breast cancer-related lymphedema [ 8 ].…”

“…Lymphovascular impairments are associated with the lymphatic system and blood vessels. Lymphedema is a common consequence of lymph node removal during mastectomy and is characterized by swelling due to fluid buildup [ 3 , 5 , 7 ••, 8 ]. Another common lymphovascular condition is axillary web syndrome (AWS), also known as cording, where visible or palpable fibrous cords develop in the axilla, causing pain and limited movement [ 3 , 5 , 8 ].…”

“…Lymphedema is a common consequence of lymph node removal during mastectomy and is characterized by swelling due to fluid buildup [ 3 , 5 , 7 ••, 8 ]. Another common lymphovascular condition is axillary web syndrome (AWS), also known as cording, where visible or palpable fibrous cords develop in the axilla, causing pain and limited movement [ 3 , 5 , 8 ]. Figure 1 provides an anatomical representation of functional impairments discussed in this review.…”