October 04, 2010 By Robert Graham Reporting -- From NIH Washington DC /Businesswire/
Mei R. Fu: A Pioneering Approach to Lymphedema
When Mei R. Fu, RN, PhD, began studying lymphedema, patients received little information on how to treat this common after-effect of breast-cancer treatment or reduce the risk of its occurrence. In fact, Dr. Fu says, it was practically taboo to talk about the condition with patients or to suggest that they had any control over developing it.
Now, Dr. Fu’s groundbreaking research has been credited with starting to change the way the health care system educates patients about controlling this debilitating and feared syndrome. Lymphedema, caused by abnormal accumulation of lymph fluid in the affected areas and arms, leads to persistent and painful swelling, as well as multiple distressing symptoms. It can occur at any time after breast cancer treatment, eventually affecting up to 65 percent of survivors in the United States.
“People used to think that lymphedema was the result of poor surgical techniques and that there was little they could do about it—both of which are untrue,” Dr. Fu says.
In the past 5 to 10 years, there has been growing awareness that lymphedema is a chronic problem that can be controlled and managed. In the past 2 years alone, technology and the availability of information online have significantly changed the attitudes of healthcare providers (including surgeons, oncologists, nurses, physical therapists) and patients.
Dr. Fu’s research, funded by the Avon Foundation, was the first to show that patient education has positive effects on patients’ cognitive-behavioroutcome in lymphedema risk reduction and patients’ symptom outcome, offering patients a major benefit. An abstract, “Lymphedema Education and Risk Reduction in Breast Cancer Survivors,” presented by Dr. Fu with Dr. Judith Haber, Dr. Amber Guth, and Dr. Deborah Axelrod at the Oncology Nursing Society 2008 Annual Congress, was chosen as one of the top 10 highest scoring abstracts among 500 entries, and their manuscript went on to win the Oncology Nursing Society Excellence in Cancer Nursing Research Award in 2009. This study was published in Annals of Surgical Oncology, a prestigious peer-reviewed journal in surgical oncology field and Journal of Nursing Scholarship, a prestigious nursing journal . Dr. Fu has also won the Young Investigator Award from International Lymphology Society for her three qualitative research studies on lymphedema and received the Excellent Service Award from the American Cancer Society for her long committed service and quality speech for cancer patients.]
Based on the findings, Dr. Fu and her research team have developed an intervention called The Optimal You to help patients reduce the risk of lymphedema or improve their symptom experience if they already experience it. With additional funding from Avon, she is testing the intervention with two groups of 120 patients each at the NYU Clinical Cancer Center. The intervention focuses on teaching patients to prevent inflammation and fluid accumulation—the major risk factors—through daily fluid drainage and other symptom-management strategies. The first group is receiving the risk-reduction intervention prior to cancer surgery and is being followed at three intervals after surgery to test its efficacy.
A second group of patients, who already demonstrate lymphedema symptoms, is receiving an intervention to help control their symptoms. This study is the first to focus on fluid drainage and other strategies to manage symptoms. It is also the first to make use of a new, state-of-the-science technology, the perometer, which calculates and tracks very small limb-volume changes, thereby identifying fluid build-up in the arm. The device located at NYU Clinical Cancer Center is one of only several in the country.
“The beauty of this study is that it focuses on risk reduction for people before surgery, so that we can take steps immediately to prevent the onset,” Dr. Fu says.
Is lymphedema still taboo? The culture is changing, according to Dr. Fu, and NYU’s Clinical Cancer Center is leading the way by talking about this difficult syndrome.
The next phase of Dr. Fu’s research involves looking at genetic variations that may put some patients at greater risk for developing lymphedema. She is the principal investigator on a pilot study with colleagues at the University of Pittsburgh, funded by the Pless Center for Nursing Research at the College of Nursing, aiming to explore the effect of r inflammatory genes and those genes related to the lymphatic system.
“We believe that some patients are more prone to inflammation and accumulation of fluid,” Dr. Fu says. “That’s why it’s very important to explore genetic variations, to see who is at greater risk.” Dr. Fu reports that nearly 100% of those patients who have been asked have willingly contributed genetic samples. “This information will give us a clearer idea of how to implement personalized care for those patients who are at greater risk,” she says.
For those patients who have developed lymphedema, Dr. Fu is collaborating with physical therapists at NYU Rusk Rehabilitaiton Center Physical Therapy Department to offer an innovative approach to treat this chronic condition by testing the effectiveness of low level laser therapy through a double-blind, randomized, placebo-controlled study.
Dr. Fu’s collaborators include nationally well-known breast surgeons at NYU Cancer Center, Dr. Deborah Axelrod and Dr. Amber A. Guth; Nurse Scientist, Dr. Francis Cartwright; nationally well-known geneticist, Dr. Yvette Conley at University of Pittsburgh; Physical therapists, Teresa V. Denham PT, MA and Ting Ting Kuo PT,DPT,WCS,CLT at NYU Rusk Rehabilitaiton Center Physical Therapy.
Dr. Fu also serves on the Board of Directors for the Lymphology of North American Association, the Medical Advisory Committee of the National Lymphedema Network, where she has co-chaired the research committee. She serves on the Steering Committee for the American Lymphedema Framework Project, a national partnership with the International Lymphedema Framework (ILF), where she has co-chaired the research and dissemination committee. She also serves as the Editorial Director and the Research Director for Stepup-speakout Organization, a patient advocacy organization to promote lymphedema research, education, and practice. She is on Education Advisory Panel and the Editor for Lymphedema Management Special Interest group for Oncology Nursing Society. In addition, she is also on the editorial board for several peer-reviewed journals, including Advances in Nursing Science, Austral-Asian Journal of Cancer: The International Cancer Journal of Australia and Asia, and Journal of Lymphedema.
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