- Professional overview
Dr. Mei R. Fu (PhD, RN, FAAN) is an internationally and nationally well-known nurse scientist and outstanding researcher and educator. She is a Tenured Associate Professor of Nursing at NYU Rory Meyers College of Nursing, New York University. Dr. Fu is also a Fellow of American Academy of Nursing, the highest professional honor recognizing outstanding contributions, achievements, and leadership in the nursing field; a Fellow of Geriatrics at the Hartford Institute of Geriatrics, the highest honor for Dr. Fu’s expert knowledge contributed to the field of geriatrics; and a Fellow of New York Academy of Medicine, recognition of the highest levels of achievement and leadership in the fields of urban health, science, social work, nursing, education, law, medicine and research. Dr. Fu’s scientific focus has been on cancer-related symptoms and management of chronic illnesses. Her research incorporates qualitative and quantitative methods, genomic and biomarker approaches, cutting edge measurement technology, innovative behavioral interventions and mHealth. The significance of her research has been recognized with highly competitive funding from National Institute of Health (NIH), the Oncology Nursing Society (ONS), the Hartford Institute of Geriatric Nursing, the Avon Foundation, the Vital Fund, Judges and Lawyers for Breast Cancer Alert, Pfizer Independent Learning and Change grant. She has over 100 high quality publications in peer-reviewed journals, book chapters, and professional publications. She has over 200 invited or peer-reviewed keynote and podium presentations at international, national, regional, and local conferences. Her creative research has been recognized with prestigious research awards from Oncology Nursing Society and International Lymphology Association, in addition she was awarded the best article award by Oncology Nursing Society, outstanding journal article by Journal of Nursing Diagnosis, and Eminent Scientist of the Year 2003 by International Research Promotion Council. Dr. Fu is the recipient of 2015 Chinese American Nurses Association Outstanding Professional Achievement Award to honor her accomplishments in nursing profession, education, and research. This award is given to a Chinese American Nurse who has demonstrated outstanding contribution and leadership in nursing profession, education, and research.
PhD, 2003, University of Missouri-ColumbiaMS, 2002, University of Missouri-ColumbiaBSN, 1997, University of Missouri-Columbia
Non-communicable diseasePolicyWomen's healthGlobal
- Professional membership
American Academy of NursingOncology Nursing SocietyNew York Academy of MedicineChinese American Nurses AssociationInternational Society of LymphologyLymphology Association of North AmericanNational Lymphedema NetworkInternational Lymphedema Framework: American Lymphedema Framework ProjectAmerican Nurses AssociationSigma Theta Tau International, Honor Society of NursingEastern Nursing Research Society
A Web- and Mobile-Based Intervention for Women Treated for Breast Cancer to Manage Chronic Pain and Symptoms Related to Lymphedema: Randomized Clinical Trial Rationale and Protocol.Fu, M. R., Axelrod, D., Guth, A., Scagliola, J., Rampertaap, K., El-Shammaa, N., … D'Eramo Melkus, G. (2016). JMIR research protocols, 5, e7, 10.2196/resprot.5104
Despite current advances in cancer treatment, many breast cancer survivors still face long-term post-operative challenges as a result of suffering from daily pain and other distressing symptoms related to lymphedema, ie, abnormal accumulation of lymph fluid in the ipsilateral upper limb or body. Grounded in research-driven behavioral strategies, The-Optimal-Lymph-Flow is a unique Web- and mobile-based system focusing on self-care strategies to empower, rather than inhibit, how breast cancer survivors manage daily pain and symptoms. It features a set of safe, feasible, and easily-integrated-into-daily-routine exercises to promote lymph flow and drainage, as well as guidance to maintain an optimal body mass index (BMI).
Cancer-related lymphedema: an overview of current evidence-based treatmentDeng, J., Beck, M., Poage, E., Burns, B., Lockwood, S., Ostby, P., Armer, J.M. (2016). ADVANCE for Nurses, 27-29,
mHealth self-care interventions: managing symptoms following breast cancer treatment.Fu, M. R., Axelrod, D., Guth, A. A., Rampertaap, K., El-Shammaa, N., Hiotis, K., … Wang, Y. (2016). mHealth, 2, 10.21037/mhealth.2016.07.03
Many women suffer from daily distressing symptoms related to lymphedema following breast cancer treatment. Lymphedema, an abnormal accumulation of lymph fluid in the ipsilateral body area or upper limb, remains an ongoing major health problem affecting more than 40% of 3.1 million breast cancer survivors in the United States. Patient-centered care related to lymphedema symptom management is often inadequately addressed in clinical research and practice. mHealth plays a significant role in improving self-care, patient-clinician communication, and access to health information. The-Optimal-Lymph-Flow health IT system (TOLF) is a patient-centered, web-and-mobile-based educational and behavioral mHealth interventions focusing on safe, innovative, and pragmatic electronic assessment and self-care strategies for lymphedema symptom management. The purpose of this paper is to describe the development and test of TOLF system.
Precision assessment of heterogeneity of lymphedema phenotype, genotypes and risk prediction.Fu, M. R., Conley, Y. P., Axelrod, D., Guth, A. A., Yu, G., Fletcher, J., & Zagzag, D. (2016). Breast (Edinburgh, Scotland), 29, 231-40, 10.1016/j.breast.2016.06.023
Lymphedema following breast cancer surgery is considered to be mainly due to the mechanical injury from surgery. Recent research identified that inflammation-infection and obesity may be the important predictors for lymphedema. The purpose of this exploratory research was to prospectively examine phenotype of arm lymphedema defined by limb volume and lymphedema symptoms in relation to inflammatory genes in women treated for breast cancer. A prospective, descriptive and repeated-measure design using candidate gene association method was used to enroll 140 women at pre-surgery and followed at 4-8 weeks and 12 months post-surgery. Arm lymphedema was determined by a perometer measurement of ≥5% limb volume increase from baseline of pre-surgery. Lymphedema symptom phenotype was evaluated using a reliable and valid instrument. Saliva samples were collected for DNA extraction. Genes known for inflammation were evaluated, including lymphatic specific growth factors (VEGF-C & VEGF-D), cytokines (IL1-a, IL-4, IL6, IL8, IL10, & IL13), and tumor necrosis factor-a (TNF-a). No significant associations were found between arm lymphedema phenotype and any inflammatory genetic variations. IL1-a rs17561 was marginally associated with symptom count phenotype of ≥8 symptoms. IL-4 rs2070874 was significantly associated with phenotype of impaired limb mobility and fluid accumulation. Phenotype of fluid accumulation was significantly associated with IL6 rs1800795, IL4 rs2243250 and IL4 rs2070874. Phenotype of discomfort was significantly associated with VEGF-C rs3775203 and IL13 rs1800925. Precision assessment of heterogeneity of lymphedema phenotype and understanding the biological mechanism of each phenotype through the exploration of inherited genetic susceptibility is essential for finding a cure. Further exploration of investigative intervention in the context of genotype and gene expressions would advance our understanding of heterogeneity of lymphedema phenotype.
Precision health and precision phenotype assessment of breast cancer-related lymphedemaDeng, J., Armer, J.M., Lockwood, S., Beck, M., Ostby, P., Burns, B., Poage, E. (2016). ADVANCE for Nurses,
Psychometric properties of the Breast Cancer and Lymphedema Symptom Experience Index: The Chinese version.Shi, S., Lu, Q., Fu, M. R., Ouyang, Q., Liu, C., Lv, J., & Wang, Y. (2016). European journal of oncology nursing : the official journal of European Oncology Nursing Society, 20, 10-6, 10.1016/j.ejon.2015.05.002
To translate the Breast Cancer and Lymphedema Symptom Experience Index (BCLE-SEI) into Chinese language and evaluate its psychometric properties among breast cancer survivors with and without lymphedema in China.
Symptom reporting as a useful tool to detect lymphedema for breast cancer survivors and health care providersQiu, J.M., Rampertaap, K., El-Shammaa, N. (2016). Canadian Lymphedema Magazine: Lymphedema Pathways, 5-8,
The relationship of lymphedema status and lymphedema symptoms in breast cancer survivorsLiu, F., Lu, Q., Ouyang, Q., Liu, C., Lu, J., Wang, Y. (2016). Chinese Journal of Nursing [中华护理杂志], 5, 518-522,
Translation and evaluation of Chinese version of the symptom experience index.Li, K., Fu, M. R., Zhao, Q., & Chen, L. (2016). International journal of nursing practice, 10.1111/ijn.12464
Symptom assessment is crucial for patient care through the entire disease trajectory. Patients often experience multiple symptoms concurrently. The symptom experience index is reliable and valid as an instrument developed in the USA for assessing multiple symptoms and distress. The aim of the study was to translate and evaluate the Chinese version of the instrument in healthy adults and oncology patients. This is a psychometric study with a cross-sectional design. To ensure the semantic equivalence and content validity, an integrative translation method was employed to translate the English version into Chinese language. The participants were recruited during 2014 from a large university, two university-affiliated hospitals and a community in Changchun, China. The Chinese version demonstrated high internal consistency, test-retest reliability and content validity. Construct validity was supported by factor analysis and significant differences of symptom experience scores between healthy and oncology groups. Participants' acceptance of the Chinese version and its ability to collect adequate data among Chinese population provided evidence for using this version among Chinese population. This study provided initial evidence to support the psychometric properties of the Chinese version. The Chinese version demonstrated adequate reliability and validity to assess multiple symptom experience by Chinese populations.
Usability and feasibility of health IT interventions to enhance Self-Care for Lymphedema Symptom Management in breast cancer survivorsFu, M.R., Axelrod, D., Guth, A.A., Wang, Y., Scagliola, J., Hiotis, K., … El-Shammaa, N. (2016). Internet Interventions, 5, 56-64, 10.1016/j.invent.2016.08.001
Accuracy of body weight perception and obesity among Chinese Americans.Liu, S., Fu, M. R., Hu, S. H., Wang, V. Y., Crupi, R., Qiu, J. M., … D'Eramo Melkus, G. (2015). Obesity research & clinical practice, 10.1016/j.orcp.2015.04.004
Accuracy of body weight perception is an individual's perception of their body weight in comparison with actual body weight and is associated with weight-related behaviors. Chinese Americans have increased risk for obesity but no studies have examined accuracy of body weight perception.
Breast cancer-related lymphedema and sexual experiences: a mixed-method comparison study.Radina, M. E., Fu, M. R., Horstman, L., & Kang, Y. (2015). Psycho-oncology, 24, 1655-62, 10.1002/pon.3778
Up to 40% of breast cancer survivors develop lymphedema, a chronic and sometimes disabling condition that manifests as abnormal swelling of the effected arm or hand or upper chest areas. Although the effects of lymphedema on quality of life have been well established, less well documented are the sexual experiences of breast cancer survivors with lymphedema. This study is the first to compare the sexual experiences of women with (n = 243) and without breast cancer-related lymphedema (n = 109).
Comorbidities and Quality of Life among Breast Cancer Survivors: A Prospective Study.Fu, M. R., Axelrod, D., Guth, A. A., Cleland, C. M., Ryan, C. E., Weaver, K. R., … Melkus, G. D. (2015). Journal of personalized medicine, 5, 229-42, 10.3390/jpm5030229
Many breast cancer survivors have coexistent chronic diseases or comorbidities at the time of their cancer diagnosis. The purpose of the study was to evaluate the association of comorbidities on breast cancer survivors' quality of life. A prospective design was used to recruit 140 women before cancer surgery, 134 women completed the study. Comorbidities were assessed using self-report and verified by medical record review and the Charlson Comorbidity Index (CCI) before and 12-month after cancer surgery. Quality of life was evaluated using Short-Form Health Survey (SF-36 v2). Descriptive statistics, chi-square tests, t-tests, Fisher's exact test, and correlations were performed for data analysis. A total of 28 comorbidities were identified. Among the 134 patients, 73.8% had at least one of the comorbidities, 54.7% had 2-4, and only 7.4% had 5-8. Comorbidities did not change at 12 months after surgery. Numbers of comorbidities by patients' self-report and weighted categorization of comorbidities by CCI had a similar negative correlation with overall quality of life scores as well as domains of general health, physical functioning, bodily pain, and vitality. Comorbidities, specifically hypertension, arthritis, and diabetes, were associated with poorer quality of life in multiple domains among breast cancer survivors. Future research should consider the combined influence of comorbidity and cancer on patients' quality of life.
Lived experiences of reducing environmental risks in an environmental justice communityDory, G., Qiu, Z., Qiu, C., Ryan C.E. (2015). Proceedings of the International Academy of Ecology and Environmental Sciences, 128-141,
Lymphedema managementFu, M.R. & Lasinski, B. (2015). 279-298,
Maintaining pre-surgery weight in the first year of breast cancer treatment: A prospective studyQiu, J.M., Axelrod, D., Guth, A., Fletcher, J., Scagliola, J., Kleinman, R., E. Pego, K., Jaravata, A.J., Ryan, C. E., Nicholas, C., Melkus, G., Haber, J. (2015). Lymphlink,
Obesity Indicators and Chronic Illness among Chinese Americans: A Pilot StudyMei R Fu, S.L. (2015). J Obes Weight Loss Ther, 05, 10.4172/2165-7904.1000270
Patterns of Obesity and Lymph Fluid Level during the First Year of Breast Cancer Treatment: A Prospective Study.Fu, M. R., Axelrod, D., Guth, A. A., Fletcher, J., Qiu, J. M., Scagliola, J., … Haber, J. (2015). Journal of personalized medicine, 5, 326-40, 10.3390/jpm5030326
Obesity is one of the risk factors for developing lymphedema following breast cancer treatment. We prospectively enrolled 140 women and followed the participants for 12 months after surgery to investigate patterns of obesity and lymph fluid level in the first year of cancer treatment. Electrical bioimpedance devices were used to measure weight, BMI, and percent of body fat as well as lymph fluid level. General instructions were given to the participants on maintaining pre-surgery weight. Among the 140 participants, 136 completed the study with 2.9% attrition. More than 60% of the participants were obese (30.8%) or overweight (32.4%), while only two participants were underweight and about 35% had normal weight. This pattern of obesity and overweight was consistent at 4-8 weeks and 12 months post-surgery. At 12 months post-surgery, the majority of the women (72.1%) maintained pre-surgery weight and 15.4% had >5% weight loss; 12.5% of the women increase >5% of their weight. Significantly more patients in the obesity group had lymphedema defined by L-Dex ratio >7.1 than those in the normal/underweight and overweight group at pre-surgery and 4-8 weeks post-surgery. There was a trend of more patients in the obesity group had L-Dex ratio >7.1 at 12 months post-surgery. Obesity and overweight remain among women at the time of cancer diagnosis and the patterns of obesity and overweight continue during the first year of treatment. General instructions on having nutrition-balanced and portion-appropriate diet and physical activities daily or weekly can be effective to maintain pre-surgery weight.
Predictors of Practice Patterns for Lymphedema Care Among Oncology Advanced Practice NursesRyan, J.C., RN, Cleland, C.M., PhD, & Fu, M.R., PhD (2015). Journal of the Advanced Practitioner in Oncology, 3, 10.6004/jadpro.2012.3.5.4
Self-care status, symptom burden, and reported infections in individuals with lower-extremity primary lymphedema.Deng, J., Radina, E., Fu, M. R., Armer, J. M., Cormier, J. N., Thiadens, S. R., … Ridner, S. H. (2015). Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing / Sigma Theta Tau, 47, 126-34, 10.1111/jnu.12117
The purposes of this study were (a) to evaluate self-care, symptom burden, and reported infections among individuals with lower-extremity primary lymphedema; (b) to examine the differences in self-care, symptom burden, and reported infections between individuals with unilateral and those with bilateral lower-extremity primary lymphedema; and (c) to examine the associations among self-care status, symptom burden, and reported infections in individuals with lower-extremity primary lymphedema.
Symptom report in detecting breast cancer-related lymphedema.Fu, M. R., Axelrod, D., Cleland, C. M., Qiu, Z., Guth, A. A., Kleinman, R., … Haber, J. (2015). Breast cancer (Dove Medical Press), 7, 345-52, 10.2147/BCTT.S87854
Breast cancer-related lymphedema is a syndrome of abnormal swelling coupled with multiple symptoms resulting from obstruction or disruption of the lymphatic system associated with cancer treatment. Research has demonstrated that with increased number of symptoms reported, breast cancer survivors' limb volume increased. Lymphedema symptoms in the affected limb may indicate a latent stage of lymphedema in which changes cannot be detected by objective measures. The latent stage of lymphedema may exist months or years before overt swelling occurs. Symptom report may play an important role in detecting lymphedema in clinical practice. The purposes of this study were to: 1) examine the validity, sensitivity, and specificity of symptoms for detecting breast cancer-related lymphedema and 2) determine the best clinical cutoff point for the count of symptoms that maximized the sum of sensitivity and specificity. Data were collected from 250 women, including healthy female adults, breast cancer survivors with lymphedema, and those at risk for lymphedema. Lymphedema symptoms were assessed using a reliable and valid instrument. Validity, sensitivity, and specificity were evaluated using logistic regression, analysis of variance, and areas under receiver operating characteristic curves. Count of lymphedema symptoms was able to differentiate healthy adults from breast cancer survivors with lymphedema and those at risk for lymphedema. A diagnostic cutoff of three symptoms discriminated breast cancer survivors with lymphedema from healthy women with a sensitivity of 94% and a specificity of 97% (area under the curve =0.98). A diagnostic cutoff of nine symptoms discriminated at-risk survivors from survivors with lymphedema with a sensitivity of 64% and a specificity of 80% (area under the curve =0.72). In the absence of objective measurements capable of detecting latent stages of lymphedema, count of symptoms may be a cost-effective initial screening tool for detecting lymphedema.
The impact of patients' awareness of disease status on treatment preferences and quality of life among patients with metastatic cancer: a systematic review from 1997-2014.Finlayson, C. S., Chen, Y. T., & Fu, M. R. (2015). Journal of palliative medicine, 18, 176-86, 10.1089/jpm.2014.0222
Advances in cancer treatment present challenges to patients with metastatic cancer who have to make treatment decisions in the face of newer and more effective treatments. Patients' awareness of disease status has been an important factor in making treatment choices. We conducted a systematic review of the published literature from 1997-2014 to evaluate the evidence of the impact of patients' awareness of disease status on treatment preferences and quality of life among patients with metastatic cancer.
A synopsis: understanding genetic predisposition to lymphedema following breast cancer treatmentPatel, T., Qiu, J.M. (2014). LymphLink, 6-9,
Breast cancer-related lymphedema in genomic eraQiu, J.M., Petel, T. (2014). LymphLink, 1-3,
Breast cancer-related lymphedema: Symptoms, diagnosis, risk reduction, and management.Fu, M. R. (2014). World journal of clinical oncology, 5, 241-7, 10.5306/wjco.v5.i3.241
The global burden of breast cancer continues to increase largely because of the aging and growth of the world population. More than 1.38 million women worldwide were estimated to be diagnosed with breast cancer in 2008, accounting for 23% of all diagnosed cancers in women. Given that the 5-year survival rate for breast cancer is now 90%, experiencing breast cancer is ultimately about quality of life. Women treated for breast cancer are facing a life-time risk of developing lymphedema, a chronic condition that occurs in up to 40% of this population and negatively affects breast cancer survivors' quality of life. This review offers an insightful understanding of the condition by providing clinically relevant and evidence based knowledge regarding lymphedema symptoms, diagnosis, risk reduction, and management with the intent to inform health care professionals so that they might be better equipped to care for patients.
Is bioelectrical impedance analysis reliable and sensitive for detecting breast cancer-related lymphedemaQiu, J.M. (2014). LymphLink, 8, 30,
Lower limb lymphedema after gynecological cancer surgery: An overviewLi, K., Qiu, M.J. (2014). Canadian Lymphedema Magazine: Lymphedema Pathways, 10-11,
Lymphedema Self-ManagementRidner, S.H., Qiu, C.M., Kayal, M., Kang, Y. (2014). LymphLink, 29-30,
Nursing care of patients with cancerFu, M.R. & Yee, R. (2014). 333-373,
Proactive approach to lymphedema risk reduction: a prospective study.Fu, M. R., Axelrod, D., Guth, A. A., Cartwright, F., Qiu, Z., Goldberg, J. D., … Haber, J. (2014). Annals of surgical oncology, 21, 3481-9, 10.1245/s10434-014-3761-z
Advances in cancer treatments continue to reduce the incidence of lymphedema. Yet, many breast cancer survivors still face long-term postoperative challenges as a result of developing lymphedema. The purpose of this study was to preliminarily evaluate The Optimal Lymph Flow program, a patient-centered education and behavioral program focusing on self-care strategies to enhance lymphedema risk reduction by promoting lymph flow and optimize body mass index (BMI).
Psychosocial Impact of LymphedemaRidner, S.H., Kayal, M., Kang, Y., & Qiu, C.M. (2014). LymphLink, 26, 31-33,
Putting evidence into practice: cancer-related lymphedema.Fu, M. R., Deng, J., & Armer, J. M. (2014). Clinical journal of oncology nursing, 18 Suppl, 68-79, 10.1188/14.CJON.S3.68-79
Cancer-related lymphedema is a progressive and chronic syndrome of abnormal swelling and multiple symptoms resulting from cancer treatment. Even with modern medical advances, lymphedema remains a major health problem affecting thousands of cancer survivors. To provide healthcare professionals with evidence-based clinical practice guidelines for lymphedema treatment and management, a systematic review was conducted to evaluate 75 selected articles from 2009-2014 by the Oncology Nursing Society Putting Evidence Into Practice lymphedema team. Findings of the systematic review support complete decongestive therapy, compression bandages, and compression garments with highest evidence for best clinical practice. Weight management, full-body exercise, information provision, prevention, and early intervention protocols are likely to be effective for clinical practice. Historic recommendations for activity restriction and avoidance of aerobic and resistive exercises that limit cancer survivors' daily lives have been challenged with more evidence. Cancer survivors may not need to restrict activities such as resistive or aerobic exercises and weightlifting with gradual exercise progression. Future research should focus on providing high-level evidence using randomized clinical trials with larger samples and studying lymphedema beyond breast cancer.
Breast cancer related lymphedema: risk factors, assessment and managementLu, Q., Liu, Y., Lin, F. (2013). hinese Journal of Surgery [中华外科杂志], 51, 458-460,
L-Dex Ratio in Detecting Breast Cancer-Related Lymphedema: Reliability, Sensitivity, and SpecificityCleland, C.M., Guth, A.A., Kayal, M., Haber, J., Cartwright- Alcarese, F., Kleinman, R., Kang, Y., Scagliola, J., & Axelrod, D. (2013). Lymphology, 36, 85-96,
Psychosocial impact of living with cancer-related lymphedema.Fu, M. R., & Kang, Y. (2013). Seminars in oncology nursing, 29, 50-60, 10.1016/j.soncn.2012.11.007
To summarize the evidence of and identify factors influencing the psychosocial impact of lymphedema, as well as to discuss nursing strategies.
Psychosocial impact of lymphedema: a systematic review of literature from 2004 to 2011.Fu, M. R., Ridner, S. H., Hu, S. H., Stewart, B. R., Cormier, J. N., & Armer, J. M. (2013). Psycho-oncology, 22, 1466-84, 10.1002/pon.3201
This systematic review aimed to evaluate the level of evidence of contemporary peer-reviewed literature published from 2004 to 2011 on the psychosocial impact of lymphedema.
Self-reported information sources and perceived knowledge in individuals with lymphedemaDeng, J., Armer, J., Cormier, J., Radina, E., Thiadens, S., Dietrich, M., Weiss, J., Tuppo, C., Ridner, S.H. (2013). Lymphology, 173-183,
The Korean version of the Symptom Experience Index: a psychometric study.Ryu, E., Kim, K., Choi, S. Y., Cleland, C. M., & Fu, M. R. (2013). International journal of nursing studies, 50, 1098-107, 10.1016/j.ijnurstu.2012.12.008
Symptom assessment and management are vital aspects of patient care through the entire illness trajectory. Patients often experience two or more symptoms concurrently. Building global assessment capacity on symptoms holds significant promise for advancing the science of nursing. The Symptom Experience Index is a reliable and valid patient-centered health outcome measure developed in the United States to assess multiple symptoms and distress. No Korean version is available for Korean healthcare professionals and patients to promote an accurate assessment of multiple symptoms.
Autologous lymph node transfer: update on a clinical trialChen, C.M. (2012). LymphLink, 24, 7-9,
Barriers to self-management of cancer-related lymphedemaKang, Y. (2012). LymphLink, 24, 6-7, 34,
Clinicians’ training and interests in lymphedema research: SynopsisArmer, J.M., Thiadens, S.R.J., Feldman, J.L., Ridner S.H., Weiss, J., Tuppo, C.M., & Cormier, J.N. (2012). LymphLink, 24, 8, 35,
Lymphedema knowledge and practice patterns among oncology nurse navigatorsRyan, J.C., & Cleland, C.M. (2012). Journal of Oncology Navigation & Survivorship, 3, 9-15,
Preparing for and Coping with breast cancer-related lymphedemaRadina, E.M. & Fu, M.R. (2012). Lymphedema, 53-88,
Seroma: A predictor for breast cancer-related lymphedemaKang, Y. (2012). LymphLink, 24, 10,
Symptom burden and infection occurrence among individuals with extremity lymphedema.Ridner, S. H., Deng, J., Fu, M. R., Radina, E., Thiadens, S. R., Weiss, J., … Armer, J. M. (2012). Lymphology, 45, 113-23,
Currently, there is a lack of data related to differences in symptoms and infection across different types and anatomical sites of lymphedema. The objective of this study was to examine differences in symptoms and infection status among individuals with lymphedema of the upper or lower extremities. The National Lymphedema Network initiated an online survey of self-report lymphedema data from March 2006 through January 2010. Descriptive statistics, Mann-Whitney tests, and Chi-square tests were used to analyze data. 723 individuals with upper extremity lymphedema and 1114 individuals with lower extremity lymphedema completed the survey. Individuals with extremity lymphedema experienced high symptom burden and infectious complications. Compared with individuals with upper extremity lymphedema, individuals with lower extremity lymphedema experienced more frequent and more severe symptoms (p<.001), infection episodes (p<.001), and infection-related hospitalizations (p<.001). No statistically significant differences of symptom burden and infection status were identified between individuals with lower extremity primary and secondary lymphedema. Individuals with extremity lymphedema experience substantial symptom burden and infectious complications; however, those with lower extremity lymphedema have more severe symptoms and more infections than those with upper extremity lymphedema.
The Effects of providing lymphedema information on patients’ cognitive, behavioral, and symptom outcomesKang, Y., & Meringer, P. (2012). LymphLink, 24, 29-30,
Clinicians’ training and interests in lymphedema researchFu, M., Armer, J., Thiadens, S., Hurless, V., Feldman, J., Ridner S., Weiss, J., Meringer, P., Tuppo, C., Meringer, J., & Cormier, J. (2011). Journal of Lymphoedema, 24-29,
Background: It is essential to understand clinicians’ research training to advance the field of lymphoedema through continuous research and implementation of evidence-based practice. Aims: To investigate clinicians’ training, interests, and opinions regarding lymphoedema research. Methods: A survey was conducted by the National Lymphedema Network (NLN) Research Committee from 2007–2009. A sample of NLN professional members was recruited. Descriptive and comparative data analyses were performed. Results: Among 317 clinicians who completed the survey, 52.4% had received some formal research training. The clinicians rated the most important obstacles for research were lack of funds, followed by lack of time and lack of knowledge. Clinicians rated that the most beneficial education programme should focus on performing clinical research in a busy clinic setting with limited resources. Over 80% of the clinicians expressed interests in research training on critical evaluation of current lymphoedema research, development of research ideas and clinical protocols, and writing fundable grants. Conclusions: This survey identified clinicians’ research training needs and obstacles. Professional organisations may use this information to strategically plan educational opportunities and venues. Declaration of interest: None.
Inflammation-infection: A complication or trigger of lymphedemaRidner, S. (2011). LymphLink, 22, 8-11,
The Effects of symptomatic seroma on lymphedema symptoms following breast cancer treatmentGuth, A.A., Cleland, C.M., Lima, E.D.R.P., Kayal, M., Haber, J., Gallup, L., & Axelrod, D. (2011). Lymphology, 44, 134-143,
Cancer Survivors’ views of lymphoedema managementFu, M.R. (2010). Journal of Lymphoedema, 5, 39-48,
Confronting the unexpected: temporal, situational, and attributive dimensions of distressing symptom experience for breast cancer survivors.Rosedale, M., & Fu, M. R. (2010). Oncology nursing forum, 37, E28-33, 10.1188/10.ONF.E28-E33
To describe women's unexpected and distressing symptom experiences after breast cancer treatment.
Lymphedema managementFu, M.R. & Smith, J. (2010). 341-358,
Lymphedema-related symptom distress among breast cancer survivorsFu, M.R. (2010). Vasomed, 22, 243-244,
Nursing care of patients with cancerFu, M.R. (2010). 341-282,
Perceived Burdens to Others: A Perspective from breast cancer survivors with lymphedemaFu, M.R. (2010). LymphLink, 22, 11-12,
Preventing skin breakdown in lymphoedemaFu, M.R. (2010). Wounds International, 1, 17-19,
The effect of providing information about lymphedema on the cognitive and symptom outcomes of breast cancer survivors.Fu, M. R., Chen, C. M., Haber, J., Guth, A. A., & Axelrod, D. (2010). Annals of surgical oncology, 17, 1847-53, 10.1245/s10434-010-0941-3
Despite recent advances in breast cancer treatment, breast cancer related lymphedema (BCRL) continues to be a significant problem for many survivors. Some BCRL risk factors may be largely unavoidable, such as mastectomy, axillary lymph node dissection (ALND), or radiation therapy. Potentially avoidable risk factors unrelated to breast cancer treatment include minor upper extremity infections, injury or trauma to the arm, overuse of the limb, and air travel. This study investigates how providing information about BCRL affects the cognitive and symptomatic outcome of breast cancer survivors.
Updating the best practice document (Part I): The charge of the American Lymphedema Framework Project (ALFP)Cormier, J.N., Feldman, J.L., Askew, R.L., Beck, M.S., Bernas, M., Francis, K., Fu, M.R., Lasinski, B.B., Rodrick, J.R., Stewart, B.R., Stewart, P., Stout, N.L., Thrift, K., Tuppo, C.M., Weiss, B., Moffatt, C.J., Armer, J.M. (2010). Journal of Lymphoedema, 5, 69-71,
Breast cancer survivors' experiences of lymphedema-related symptoms.Fu, M. R., & Rosedale, M. (2009). Journal of pain and symptom management, 38, 849-59, 10.1016/j.jpainsymman.2009.04.030
As a serious chronic condition from breast cancer treatment, lymphedema or a syndrome of persistent swelling and symptoms is caused by chronic accumulation of lymph fluid in the interstitial spaces of the affected limb or surrounding areas. Although significant prevalence of ongoing multiple symptoms has been reported, little is known about how survivors with lymphedema perceive and respond to lymphedema-related symptoms in their daily lives.
Pathophysiology of post-breast cancer lymphedemaFu, M.R., Ridner, S.H., & Armer, J.M. (2009). American Journal of Nursing, 109,
Post-breast cancer lymphedema: part 2.Fu, M. R., Ridner, S. H., & Armer, J. (2009). The American journal of nursing, 109, 34-41; quiz 42, 10.1097/01.NAJ.0000358492.91678.78
As breast cancer survivors often say, lymphedema is more than just a swollen arm. A result of surgical or radiologic breast cancer treatment, it's an abnormal accumulation of lymph in the arm, shoulder, breast, or thoracic area that usually develops within three years of a breast cancer diagnosis but can occur much later. In Part 1 (July) the authors described the pathophysiology and diagnosis of lymphedema. In Part 2 they discuss current approaches to risk reduction, treatment and management of the condition, and implications for nurses.
Post-breast cancer. Lymphedema: part 1.Fu, M. R., Ridner, S. H., & Armer, J. (2009). The American journal of nursing, 109, 48-54; quiz 55, 10.1097/01.NAJ.0000357172.94131.58
Lymphedema, which can be a debilitating sequela to breast cancer treatment, is characterized by an abnormal accumulation of lymph in the arm, shoulder, breast, or thoracic area. It may appear gradually or suddenly, and although it usually develops within three years of a breast cancer diagnosis, it can arise much later; survivors remain at lifetime risk. The condition can cause physical discomfort and pain, impaired function, and emotional distress. It's imperative that survivors' risk of lymphedema be reduced and that those who develop it receive help to manage it. Part 1 of this two-part article describes post-breast cancer lymphedema and discusses its diagnosis and measurement. Part 2 (next month) will discuss risk reduction, treatment, and implications for nurses.
Question Corner: Risk reduction practice. National Lymphedema NetworkFu, M.R. (2009). LymphLink, 21, 28-29,
The American Lymphedema Framework Project (ALFP) – Identifying issues in the field of lymphedema in the United States: Report of the stakeholder’s meetingArmer, J.M., Feldman, J.L, Fu, M.R., Stout, N.L., Lasinski, B.B., Tuppo, C.M., Beck, M.S., Rodrick, J.R., Shook, R.P., Brooks, C.W., Gonon, P., Moffatt, C.J., Stewart, B.R., Cormier, J.N. (2009). Journal of Lymphedema, 4, 85-91,
'Making the best of it': Chinese women's experiences of adjusting to breast cancer diagnosis and treatment.Fu, M. R., Xu, B., Liu, Y., & Haber, J. (2008). Journal of advanced nursing, 63, 155-65, 10.1111/j.1365-2648.2008.04647.x
This paper is a report of a study to describe Chinese women's experiences of adjusting to breast cancer diagnosis and treatment.
Breast-cancer-related lymphedema: information, symptoms, and risk-reduction behaviors.Fu, M. R., Axelrod, D., & Haber, J. (2008). Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing / Sigma Theta Tau, 40, 341-8, 10.1111/j.1547-5069.2008.00248.x
To explore the effect of providing lymphedema information on breast cancer survivors' symptoms and practice of risk-reduction behaviors.
Lymphedema education among breast cancer survivors undergoing radiotherapyFu, M.R., Haber, J., Guth, A., Axelrod, D. (2008). LymphLink, 20, 8-9,
Women at work with breast cancer-related lympheodemaFu, M.R. (2008). Lymphedema, 3, 30-36,
Measuring symptom occurrence and symptom distress: development of the symptom experience index.Fu, M. R., McDaniel, R. W., & Rhodes, V. A. (2007). Journal of advanced nursing, 59, 623-34, 10.1111/j.1365-2648.2007.04335.x
This paper is a report of a study to assess reliability and construct validity of revised and refined version of the Adapted Symptom Distress Scale: the Symptom Experience Index (SEI).
NauseaFu, M.R, McDaniel, R.W., & Rhodes, V.A. (2007). 701-717,
Nursing care of clients with cancerFu, M.R. (2007). 368-418,
Caring for clients with cancerFu. M.R. (2006). 252-283,
FatigueFu, M.R, McDaniel, R.W., & Rhodes, V.A. (2005). 741-760,
Lymphedema following breast cancer treatment, including sentinel lymph node biopsy.Armer, J., Fu, M. R., Wainstock, J. M., Zagar, E., & Jacobs, L. K. (2004). Lymphology, 37, 73-91,
To compare the occurrence, signs, and symptoms of lymphedema (LE) the arms of women after axillary lymph node dissection (ALND), sentinel lymph node biopsy (SLNB), combined SLNB and ALND (Both), or neither as part of breast cancer diagnosis and treatment, a concurrent descriptive-comparative cross-sectional four-group design with retrospective chart review was carried out. In a convenience sample of 102 women treated for breast cancer and receiving follow-up care at a midwestern United States cancer center, sequential circumferential measurements at five selected anatomical sites along both arms and hands were used to determine the presence of LE (> or = 2 cm differences between sites). Participants self-reported LE-related signs and symptoms by interview and completion of the Lymphedema and Breast Cancer Questionnaire (LBCQ). Retrospective chart review was carried out to verify lymph node-related diagnostic and treatment procedures. Based on node group, LE occurred as follows: 43.3% (29 of 67) of women who underwent ALND alone; 22.2% (2 of 9) of those who underwent SLNB alone; 25.0% (3 of 12) of those with combined SLNB and ALND; and 22.2% (2 of 9) with neither SLNB nor ALND. LE-related symptoms were reported by women who underwent ALND alone, SLND alone, combined SLNB and ALND, and neither. Among the node groups, three symptoms were more common: larger arm size, firmness/tightness in past year, and numbness in past year. We conclude that circumferential measurements of the upper arm and forearm may be critical for distinguishing LE from no LE. Overall, the proportion of women who experienced LE-related signs and symptoms was higher among women who underwent ALND versus SLNB. However, numbness and tenderness frequently were reported by those undergoing ALND, SLNB or both; and by women without LE. It is possible that some frequently occurring symptoms, such as numbness and tenderness, may be related to breast cancer surgery and not LE. Findings from this study can assist health professionals in educating women with breast cancer about LE risk factors, as well as early detection and management of LE by using the LBCQ and sequential circumferential arm measurements to evaluate limb changes subjectively and objectively concurrent with each breast cancer survivor's follow-up care.
Post-breast cancer lymphedema and managementFu, M.R. (2004). Recent Advances: Research Updates, 5, 125-138,
Therapeutic effects of exercise on fatiguePorock, D. & Fu, M.R. (2004). 291-301,
Patients' perceptions of fatigue in response to biochemotherapy for metastatic melanoma: a preliminary study.Fu, M. R., Anderson, C. M., McDaniel, R., & Armer, J. (2002). Oncology nursing forum, 29, 961-6, 10.1188/02.ONF.961-966
To explore patients' perceptions of fatigue in response to biochemotherapy treatment for metastatic melanoma.
The Chinese translation of the Index of Nausea, Vomiting, and Retching.Fu, M. R., Rhodes, V., & Xu, B. (2002). Cancer nursing, 25, 134-40,
The purpose of this study was to determine reliability and validity of the Chinese version of the Index of Nausea, Vomiting, and Retching (INVR) and the Index of Nausea and Vomiting Form 2 (INV-2) to provide a reliable and valid measure of nausea, vomiting, and retching for Chinese nurses and other healthcare providers. An integrative translation method was used in the study. The reliability and validity of the Chinese versions of the INVR and the INV-2 was evaluated using test-retest, parallel forms, and crossover design. A convenience sample of 177 Chinese-speaking participants was accrued from a large teaching cancer institute and a teaching obstetric hospital in Beijing, Peoples Republic of China. The integrative translation method was proven to be an effective method for translating instruments from the source to the target language. The Chinese versions of both the INV-2 and INVR were found to have high Cronbach's alpha scores and high agreement rates. The responses to the Chinese version of INVR were more frequently consistent than the responses to the INV-2. The majority of the patients voiced preference for the INVR. The findings suggest the significance of the Chinese versions of INVR and INV-2 in terms of nursing practice. The findings also support the cross-cultural method for future study at international level.
A multivariate validation of the defining characteristics of fatigueFu, M., LeMone, P., McDaniel, R., Bausler, C. (2001). Nursing Diagnosis: International Journal of Nursing Language and Classification, 12, 15-27,
Riding as a joy (and aid) to handicapped children.Collins, L. (1972). The Australian nurses' journal. Royal Australian Nursing Federation, 1, 27 passim,
Advanced nursing practice and research contributions to precision medicine.Williams, J. K., Katapodi, M. C., Starkweather, A., Badzek, L., Cashion, A. K., Coleman, B., … Hickey, K. T. Nursing outlook, 64, 117-23, 10.1016/j.outlook.2015.11.009
Genomic discoveries in the era of precision medicine hold the promise for tailoring healthcare, symptom management, and research efforts including targeting rare and common diseases through the identification and implementation of genomic-based risk assessment, treatment, and management. However, the translation of these discoveries into tangible benefits for the health of individuals, families, and the public is evolving.
Age differences in post-breast cancer lymphedema signs and symptoms.Armer, J., & Fu, M. R. Cancer nursing, 28, 200-7; quiz 208-9,
This secondary data analysis was designed to explore the age differences in lymphedema (LE) occurrence and self-reported symptoms in post-breast cancer LE. A descriptive-exploratory cross-sectional design was used with a convenience sample composed of 102 women treated and followed for breast cancer at a midwestern cancer center. Sequential circumferential arm measurement was used to estimate limb volume differences. Self-reported symptoms were assessed by the Lymphedema and Breast Cancer Questionnaire (LBCQ) designed and tested by the research team. Lymphedema occurrence was relatively higher (41.2%) in breast cancer survivors younger than 60 than in those older than 60 (30.6%). Six subjectively reported symptoms were found to occur more often (P </= .05) in the younger women with LE: numbness now and in the past year, tenderness in the past year, aching now and in the past year, increased temperature in arm now. Numbness, tenderness, and aching were the most prevalent symptoms among women in both age groups regardless of LE presence. Our findings suggest that younger breast cancer survivors may have increased LE risk and report LE-related symptoms more often. Future research should focus on age differences in LE risk, occurrence, and perceptions of LE-related symptoms in women treated for breast cancer.
An integrated approach to an analysis of symptom management in patients with cancer.Fu, M. R., LeMone, P., & McDaniel, R. W. Oncology nursing forum, 31, 65-70, 10.1188/04.ONF.65-70
To provide a definition, describe uses, and identify essential attributes of symptom management by emphasizing the philosophical base for the concept.
Breast cancer survivors' intentions of managing lymphedema.Fu, M. R. Cancer nursing, 28, 446-57; quiz 458-9,
The purpose of this study was to describe the experience of managing lymphedema in breast cancer survivors. A descriptive phenomenological method was used as a guide for developing a bracket, gathering data, and analyzing data. A cross-sectional design with a purposive sampling technique was employed. During the 3 private, semi-structured, audio-recorded interviews with each woman, 12 breast cancer survivors described how they managed lymphedema in their daily lives. A taxonomy of 3 levels was created to describe the essential structures of the experience from general, to mediating, to specific: revelatory intention, cluster intention, and unit intention. The study revealed that the women's major intentions of managing lymphedema were to keep in mind the consequences, prevent lymphedema from getting worse, get ready to live with lymphedema, and integrate the care of lymphedema into daily life. Findings of the study provided an insightful alternative to the compliance approach to lymphedema management. Instead of merely evaluating breast cancer survivors' degree of compliance with treatment, it is suggested that researchers and practitioners should also assess the impact of the presence or absence of the women's intentions on lymphedema management.
Factors Associated with Reported Infection and Lymphedema Symptoms among Individuals with Extremity Lymphedema.Deng, J., Fu, M. R., Armer, J. M., Cormier, J. N., Radina, M. E., Thiadens, S. R., … Ridner, S. H. Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses, 40, 310-9, 10.1002/rnj.171
This study aimed to examine factors associated with reported infection and symptoms among individuals with extremity lymphedema.
Post lymphadenectomy complications and quality of life among breast cancer patients in Brazil.Paim, C. R., de Paula Lima, E. D., Fu, M. R., de Paula Lima, A., & Cassali, G. D. Cancer nursing, 31, 302-9; quiz 310-1, 10.1097/01.NCC.0000305747.49205.b1
This descriptive, cross-sectional, correlational study with a convenience sample of 96 women treated for breast cancer at an outpatient service in Brazil was designed to investigate post-lymphadenectomy complications after axillary lymph node dissection (ALND) and sentinel lymph node biopsy and explore the associative relationships between the complications and quality of life. Clinical evaluations using perimetry, goniometry, and muscle strength test were used to evaluate the complications. Pain and quality of life were assessed by the Short-Form McGill Pain Questionnaire and the Functional Assessment of Cancer Therapy-Breast. All participants had at least one complication. Incidence was higher for pain (57%), impaired shoulder strength (57%), and fibrosis (54%), followed by impaired shoulder range of motion (46%) and lymphedema (17%). The incidence of impaired shoulder flexion (P = .01) and lymphedema (P = .002) was higher in ALND group. Winged scapula (8.4%) only occurred in the ALND group. Quality of life was significantly correlated with pain (r = -0.53, P = .000) and impaired shoulder strength in flexion (r = 0.4; P = .000) and abduction (r = -0.5, P = .000). Future studies are needed to prospectively investigate the onset of the complications and identify appropriate interventions to promote quality of life in women treated for breast cancer.
Self-management of lymphedema: a systematic review of the literature from 2004 to 2011.Ridner, S. H., Fu, M. R., Wanchai, A., Stewart, B. R., Armer, J. M., & Cormier, J. N. Nursing research, 61, 291-9, 10.1097/NNR.0b013e31824f82b2
Little is known about the effectiveness of activities used to self-manage lymphedema.
Symptom clusters and quality of life in Korean patients with hepatocellular carcinoma.Ryu, E., Kim, K., Cho, M. S., Kwon, I. G., Kim, H. S., & Fu, M. R. Cancer nursing, 33, 3-10, 10.1097/NCC.0b013e3181b4367e
Hepatocellular carcinoma (HCC) is the fifth most common malignancy worldwide, causing about 1 million deaths annually. Patients with HCC usually reported multiple concurrent symptoms. The purpose of this multivariate study was to explore whether multiple concurrent symptoms are clustered into groups of symptoms and to explore the effect of symptom clusters on the quality of life (QOL) in patients with HCC. A sample of 180 patients with HCC at a medical center in Korea was recruited. Patients completed a demographic questionnaire, a Symptom Checklist, the Hospital Anxiety and Depression Scale, and the Functional Assessment of Cancer Therapy-Hepatobiliary. Factor analysis was used to identify symptom clusters based on the severity of patients' symptom experiences. Four symptom clusters were identified: pain-appetite, fatigue related, gastrointestinal, and itching-constipation. Two patient subgroups were identified through cluster analysis: high- and low-symptom group. Patients in the high-symptom group had significantly poorer functional status and poorer QOL in all the domains, with the exception of social well-being. The differences between the 2 patient subgroups were not only statistically but also clinically significant. Patients in the high-symptom group were also statistically and clinically anxious and depressed. Further research is needed to explore whether compositions of symptom cluster phenotypes vary over time and whether the associations of symptom clusters with QOL and mood are changing along the disease and treatment trajectory as well as symptom status.