Comparative Effectiveness of Adjunct Therapies and Exercise Versus Exercise Alone in Managing Axillary Web Syndrome following Breast Cancer Surgery: A Systematic Review

Chojnacka, Julia Janina, Omileye, Adebayo, Tadesse, Gebrye, Fatoye, Francis ORCID: https://orcid.org/0000-0002-3502-3953 and Mbada, Chidozie ORCID: https://orcid.org/0000-0003-3666-7432 (2024) Comparative Effectiveness of Adjunct Therapies and Exercise Versus Exercise Alone in Managing Axillary Web Syndrome following Breast Cancer Surgery: A Systematic Review. Annals of Cancer Research and Therapy, 32 (2). pp. 45-55. ISSN 1344-6835

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Abstract

Introduction: Axillary web syndrome (AWS) continues to be a misunderstood and poorly researched sequela of Breast Cancer (BC) care. Attempts have been made to encapsulate the optimal rehabilitative approach. This systematic review (SR) examines the effectiveness of adjunct therapies combined with Exercise-Based Interventions (EBIs) versus EBIs alone in managing AWS following BC surgery. Methods: Following the PRISMA guidelines for SRs, PubMed, Scopus, EBSCO CINAHL, EBSCO Medline, and Cochrane CENTRAL were systematically searched for eligible studies on the effectiveness of EBIs or any adjunctive intervention for AWS in terms of pain, health-related Quality of life (HRQoL) and resolution of AWS. The JBI critical appraisal guide for SR was used to assess the quality of eligible studies. Results: The search yielded 1302 records. Six studies were included in this review. The EBIs consisted of active, passive, and active-assisted stretching, mobility exercises, proprioceptive neuromuscular facilitation, and progressive functional activities. Other therapies included soft tissue mobilisations (STM), manual lymphatic drainage (MLD), myofascial release, and vacuum-sealing drainage. EBIs were significantly beneficial in resolving AWS (in two studies), preventing AWS (in one study), reducing AWS-related pain (in four studies), and improving HRQoL (in three studies). Exercise was often prescribed with STM in the axilla of the operated side. Significantly greater effects were observed in all three outcomes when EBIs were recommended with MLD. Conclusion: EBIs are effective in treating AWS and its associated symptoms. However, the prescription of exercise therapies with MLD appears to be superior in treating symptoms, resolving AWS quicker, and preventing its development.