Asian American Breast Cancer Research Articles

Internet Recruitment of Asian American Breast Cancer Survivors.

The purpose of this article is to identify practical issues in Internet recruitment of racial/ethnic minorities by analyzing an Internet intervention study conducted with Asian American breast cancer survivors, and to propose directions for recruitment of racial/ethnic minorities for future Internet research. Six practical issues were identified: (a) a relatively fewer number of Internet communities/groups; (b) hindrances in establishing authenticity;

Internet Recruitment of Asian American Breast Cancer Survivors

Internet Recruitment of Asian American Breast Cancer Survivors

Practical issues in multi-lingual research

BackgroundWith an increasing number of ethnic minority populations, the use of multiple languages in one research study has increased in recent years. The use of multiple languages helps increase comprehensiveness of educational materials and/or survey questionnaires, and promote ethnic minorities’ participation in research. However, little has been clearly known about practical issues in using multiple languages in one research study. ObjectivesThe purpose of this paper is to explore practical issues in using multiple languages in a study among diverse sub-ethnic groups of Asian American breast cancer survivors in order to propose future directions for the use of multiple languages in research projects. MethodsThroughout the research process, research team made written records of practical issues and possible reasons for the issues as they arose. Weekly group discussions among research team members were administered, and the written records of these discussions were reviewed and analyzed using the content analysis. The unit of analysis was individual words. The words in the data (memos and written records) were classified into idea categories that emerged from the coding process. ResultsThe idea categories included issues in: (a) collaborators from various sub-ethnic groups; (b) IRB protocol submissions; (c) consistencies in translation process, (d) conceptual equivalence; (e) cultural differences; (f) existing translated versions; and (g) authorship issues. Based on the issues, we made the following suggestions for multi-lingual research: (a) networking and setting multiple communication channels with potential collaborators; (b) checking the institution's IRB policies related to the use of multiple languages; (c) setting the rules and procedures for translation process; (d) checking existing different language versions of instruments; and (e) setting the rules for authorship in advance. ConclusionsThe suggestions made in this study would help the researchers be prepared in advance to deal with the challenges.

Breast cancer experience and survivorship among Asian Americans: a systematic review

Breast cancer is the most common cancer in Asian American women, and the number of Asian American breast cancer survivors is rapidly increasing. Although Asian Americans are one of the fastest growing and most heterogeneous ethnic groups in the United States, limited data exist in regard to their breast cancer experience and survivorship. A systematic review of the breast cancer experience literature was conducted and included studies of Asian Americans or their subgroups as a major category of study participants. Of the 125 studies reviewed, 10 qualitative studies, 10 quantitative studies, 5 studies that used a mixed-method approach, and 1 intervention study met the criteria for inclusion. Qualitatively, Asian Americans reported unmet physical and emotional needs and challenges during survivorship. Quantitative studies consistently found that socioeconomic status, cultural health beliefs, immigration stress, acculturation level, English proficiency, social support, and spirituality associated with Asian American breast cancer patients' health behaviors and health-related quality of life (HRQOL). Studies also revealed significant variation in breast cancer reaction and HRQOL within Asian American subgroups. Although research on Asian American breast cancer experience and survivorship is sparse, we concluded that Asian Americans experience disrupted HRQOL following breast cancer diagnosis and treatment, interwoven with their cultural and socio-ecological system, and that programs focused on improving cancer survivorship outcomes among this ethnic minority group are limited. Most studies have concentrated on the West coast population, and there is significant underrepresentation of longitudinal and intervention studies. Implications for study design, measurement, and future research areas are also included. The results highlight a need to understand ethnic differences and to take into account social, cultural, and linguistic factors in breast cancer survivorship experiences among Asian American subgroups as a means to develop culturally relevant and linguistically appropriate interventions designed to improve HRQOL.

Abstract B21: Associations of physical activity with physical functioning and emotional distress among non-Hispanic white and Chinese-American breast cancer survivors

Abstract Breast cancer is the most commonly diagnosed cancer and one of the leading causes of cancer deaths for Asian-American women. Asian-American breast cancer survivors often report higher rates of poor quality of life than Non-Hispanic White (NHW) survivors. While physical activities were found to improve breast cancer survivors' health related quality of life (HRQOL), knowledge regarding their quality of life and physical activity behaviors among Asian women is limited. This study examined the association of self-reported physical activity levels with HRQOL outcomes (i.e., physical function and emotional distress) among a sample of Non-Hispanic White (NHW) and Chinese-American breast cancer survivors. We also examined whether the association was modified by high-acculturated Chinese-American (HCA) versus low-acculturated Chinese-American (LCA). We obtained breast cancer cases from California Cancer Registries and recruited women who were over age 21, diagnosed with breast cancer at stage 0-III, and had completed primary treatment within 1-5 years with no recurrence. Acculturation was defined by Chinese-American women's English ability (high vs. low) and years of US residency (median=25 years). Cross-sectional survey data were collected from 381 breast cancer survivors (184 NHW, 68 HCA, and 129 LCA) via telephone. Physical activity was measured using the International Physical Activity Questionnaire (IPAQ) and physical functioning and emotional distress were measured using Patient Reported Outcomes Measurement Information System (PROMIS) items. GLM and multivariate logistic regression analysis was used to model relationships between physical activity levels and patient reported outcomes, controlling for covariates (e.g., body mass index and comorbidity). Results showed that NHW and acculturated Chinese survivors had higher physical functioning than low-acculturated Chinese survivors, although the three groups had no difference in emotional distress. For reported physical activity levels, 42% of NHWs reported high physical activity levels (>150 minutes/week of moderate intensity) compared to the two Chinese-American groups (25% HCA and 13% LCA). Regardless of race, those who reported high physical activity levels were more likely to have higher physical functioning (OR: 3.07, CI: 1.53, 6.17) and lower depression (OR: 0.48, CI: 0.25, 0.91) and anxiety (OR: 0.47, CI: 0.25, 0.90). Specifically, higher levels of physical activity were strongly associated with higher levels physical functioning among NHW and HCA survivors, but this association was less evident for LCA survivors. Moreover, Chinese breast cancer survivors, regardless of acculturation level, those who reported higher levels of physical activities were less likely to report emotional stress compared to NHW women. Overall, results extend upon the importance of promoting physical activity to improve HRQOL outcomes in breast cancer survivors. Differences by race and acculturation status also warrants further investigation in future studies designed to improve HRQOL outcomes in breast cancer survivors, especially in immigrant populations with different acculturation status. Citation Format: Bang Hyun Kim, Chiranjeev Dash, Scarlett Lin Gomez, Vanessa B. Sheppard, Laura Allen, Yiru Wang, Judy Huei-yu Wang. Associations of physical activity with physical functioning and emotional distress among non-Hispanic white and Chinese-American breast cancer survivors. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr B21.

Challenges and Needs of Chinese and Korean American Breast Cancer Survivors: In-Depth Interviews.

Breast cancer incidence and the number of breast cancer survivors have been rapidly increasing among Chinese and Korean women in the United States. However, few data are available regarding quality of life in Asian American breast cancer survivors. This qualitative study aims to describe Asian American women's perceptions of quality of life and their breast cancer experiences. In-depth interviews with four Chinese and five Korean American breast cancer survivors and three oncologists were conducted in Chinese, Korean, or English. Interviews were recorded and transcripts were translated into English. Qualitative analyses were performed by two independent coders and then discussed and agreed upon by the research team. The respondents reported that the breast cancer experience had affected various domains of quality of life, but women reported having limited resources with which to cope effectively. Depression, anxiety, and stress were commonly reported, but women rarely discussed these issues with family and friends or sought professional help. As immigrants, women's loneliness and a lack of social support and culturally relevant resources seemed to be major barriers to maintaining good quality of life. Women also expressed interest in learning more about alternative therapies and relaxation skills. These findings can be used to help inform the development of a culturally appropriate intervention for Asian American breast cancer survivors. Future programs may provide information in women's native languages to teach skills to cope with stress and anxiety, increase women's self-efficacy within the context of their cultural background, and enhance social support among women from the same ethnic group.

Cultural Health Beliefs and Health Behaviors in Asian American Breast Cancer Survivors: A Mixed-Methods Approach

To explore the relationships between cultural health beliefs, acculturation, treatment-related decisions, the doctor-patient relationship, and health behaviors among Asian American breast cancer survivors (AABCS), and the contextual meaning of those relationships among Korean American breast cancer survivors (KABCS) and AABCS. A mixed-methods triangulation design. Community- and hospital-based support groups and hospital cancer registries in California. 206 AABCS were included in the quantitative phase, and two focus groups were conducted with KABCS (N = 11) during the qualitative phase. The quantitative phase used secondary data for AABCS. Standardized (i.e., cultural health beliefs, doctor-patient relationship, and acculturation) and newly developed instruments (i.e., health behaviors and treatment-related decisions) were used in the quantitative phase. An exploratory, descriptive, qualitative study of KABCS then was undertaken. Cultural health beliefs, acculturation, treatment-related decisions, the doctor-patient relationship, and health behaviors. Inter-intrapersonal health beliefs, doctor-patient relationship, and shared decision making were positively associated with adopting healthy lifestyle practices. Findings from the quantitative phase were explained further by the diverse themes that emerged in the KABCS focus groups. This study provides new knowledge about cultural health beliefs and health behaviors among KABCS using a mixed-methods approach. The results highlight the need for greater attention to the cultural contexts of AABCS to promote healthy behaviors and recognition of the significant relationship between health professionals and breast cancer survivors.

What is lacking in patient-physician communication: Perspectives from Asian American breast cancer patients and oncologists

Interactions between breast cancer patients and their oncologists are important as effective patient-physician communication can facilitate the delivery of quality cancer care. However, little is known about patient-physician communication processes among Asian American breast cancer patients, who may have unique communication needs and challenges. Thus, we interviewed Asian American patients and several oncologists to explore patient-physician communication processes in breast cancer care. We conducted in-depth interviews with nine Chinese- or Korean American breast cancer patients and three Asian American oncologists who routinely provided care for Asian American patients in the Washington DC metropolitan area in 2010. We conducted patient interviews in Chinese or Korean and then translated into English. We conducted physicians' interviews in English. We performed qualitative analyses to identify themes. For women with limited English proficiency, language was the greatest barrier to understanding information and making treatment-related decisions. Both patients and oncologists believed that interpretation provided by patients' family members may not be accurate, and patients may neglect to ask questions because of their worry of burdening others. We observed cultural differences regarding expectations of the doctor's role and views of cancer recovery. As expressed by the patients and observed by oncologists, Asian American women are less likely to be assertive and are mostly reliant on physicians to make treatment decisions. However, many patients expressed a desire to be actively involved in the decision-making process. Findings provide preliminary insight into patient-physician communication and identify several aspects of patient-physician communication that need to be improved for Asian American breast cancer patients. Proper patient education with linguistically and culturally appropriate information and tools may help improve communication and decision-making processes for Asian American women with breast cancer.

A pilot study of expressive writing intervention among Chinese-speaking breast cancer survivors.

Little attention has been focused on Asian American breast cancer survivor's psychological needs. No outcome-based psychosocial interventions have been reported to target at this population. Expressive writing interventions have been previously shown to improve health outcomes among non-Hispanic White breast cancer populations. This pilot study aimed to test the cultural sensitivity, feasibility, and potential health benefits of an expressive writing intervention among Chinese-speaking breast cancer survivors. Participants (N = 19) were asked to write about their deepest thoughts and feelings, their coping efforts, and positive thoughts and feelings regarding their experience with breast cancer each week for 3 weeks. Health outcomes were assessed at baseline, 3, and 6 months after the intervention. A Community-Based Participatory Research Approach (CBPR) is used. Expressive writing was associated with medium and large effect sizes (η(p)² = 0.066∼0.208) in improving multiple health outcomes (quality of life, fatigue, posttraumatic stress, intrusive thoughts, and positive affect) at follow-ups. Participants perceived the study to be valuable. The study yielded high compliance and completion rates. Expressive writing is associated with long-term improvement of health outcomes among Chinese breast cancer survivors and has the potential to be utilized as a support strategy for minority cancer survivors. In addition, CBPR is valuable in improving feasibility and cultural sensitivity of the intervention in understudied populations. Future studies employing randomized, controlled trial designs are warranted.

Abstract B28: Catering to the needs of young and older Asian American breast cancer survivors: In-depth interviews

Abstract Objective: Breast cancer has been rapidly increasing in Asian American women in the United States. Breast cancer may have different physical and psychosocial impact on young and older women's quality of life (QOL), but little is known about QOL among Asian American breast cancer survivors of different age groups. The purpose of this study was to identify the differences in the needs and challenges among young and older Asian American breast cancer survivors. Methods: In-depth interviews with four young (under age 55) and five older (≥ 55 years old) breast cancer survivors were conducted in Chinese or Korean. Brief interviews were conducted with three caregivers of older survivors. Interviews were recorded and transcripts were translated into English. Using qualitative data analysis software Max QDA, transcripts were analyzed by two independent coders to identify common and unique themes across interviews. Any discrepancies between coders were discussed among the investigators and resolved. Results: Both young and older women experienced serious emotional or psychosocial distress due to breast cancer and most of them had limited coping methods. Young women reported greater stress and in many cases cancer stress was mixed with stress from work or other life stress such as being a single mother. Family was the major source of support for both young and older women, and adult children were the main caregivers for some older women. Young women who did not have a spouse had a weaker supporting system and mostly relied on themselves to deal with cancer. Concerns such as burdening family members were common among all participants and most of them hid feelings to their family. This was confirmed by the interviews with caregivers who admitted that they did not talk much about emotions with the patients and did not have good coping strategies. Language was a common barrier for young and older breast cancer survivors, but it was more difficult for older women who had limited English proficiency. Some older women solely relied on their family members or interpreters to communicate with the doctors. On the other hand, young women were more active in communicating with physicians and reported effective strategies such as preparing written notes and bringing a native speaker with them to the visits. Doctors played a leading role in treatment decision making for most participants, but family influence was more evident among older women. While young women experienced “sad,” “angry” or “disappointed” about their body changes, older women didn't seem to have been affected by the body change as it had on younger women. Both young and older women expressed the need for more culturally relevant resources. Almost none of the participants had attended support groups and most of them agreed that they would join one if there was one for Asian. Conclusion: Young and older Asian American breast cancer survivors shared some common challenges in coping with cancer, but they also had distinct needs in many aspects of QOL. A linguistically and culturally appropriate intervention should provide information, teach skills to cope with problems and manage stress, increase self-efficacy in the context of cultural background and build a support group for women of same ethnicity. It is desirable to have separate interventions for young and older women to cater to their unique needs. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B28.

Projecting Individualized Absolute Invasive Breast Cancer Risk in Asian and Pacific Islander American Women

The Breast Cancer Risk Assessment Tool (BCRAT) of the National Cancer Institute is widely used for estimating absolute risk of invasive breast cancer. However, the absolute risk estimates for Asian and Pacific Islander American (APA) women are based on data from white women. We developed a model for projecting absolute invasive breast cancer risk in APA women and compared its projections to those from BCRAT. Data from 589 women with breast cancer (case patients) and 952 women without breast cancer (control subjects) in the Asian American Breast Cancer Study were used to compute relative and attributable risks based on the age at menarche, number of affected mothers, sisters, and daughters, and number of previous benign biopsies. Absolute risks were obtained by combining this information with ethnicity-specific data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program and with US ethnicity-specific mortality data to create the Asian American Breast Cancer Study model (AABCS model). Independent data from APA women in the Women's Health Initiative (WHI) were used to check the calibration and discriminatory accuracy of the AABCS model. The AABCS model estimated absolute risk separately for Chinese, Japanese, Filipino, Hawaiian, Other Pacific Islander, and Other Asian women. Relative and attributable risks for APA women were comparable to those in BCRAT, but the AABCS model usually estimated lower-risk projections than BCRAT in Chinese and Filipino, but not in Hawaiian women, and not in every age and ethnic subgroup. The AABCS model underestimated absolute risk by 17% (95% confidence interval = 1% to 38%) in independent data from WHI, but APA women in the WHI had incidence rates approximately 18% higher than those estimated from the SEER program. The AABCS model was calibrated to ethnicity-specific incidence rates from the SEER program for projecting absolute invasive breast cancer risk and is preferable to BCRAT for counseling APA women.

Understanding the cultural health belief model influencing health behaviors and health-related quality of life between Latina and Asian-American breast cancer survivors

The purpose of this study was to (1) describe health behaviors and health-related quality of life (HRQOL) of Latina and Asian-American breast cancer survivors (BCS), (2) estimate possible culturally driven predictors of health behaviors and HRQOL, and (3) compare pathways for predicting health behaviors and HRQOL between the two groups. Secondary data were used to investigate health behaviors and HRQOL among 183 Latina and 206 Asian Americans diagnosed with breast cancer. The study methodology was guided by the health belief model and the contextual model of HRQOL. Structural equation modeling was used to test cultural predictors on health behaviors of BCS. Asian Americans reported higher emotional and physical well-being scores than Latina-Americans. Confirmatory factor analyses demonstrated the adequacy of the two-factor model ("powerful others" and "sociocultural factors") in the cultural health belief construct for Latina and Asian-American BCS. In the structural model, Latinas and Asian Americans showed different pathways in the predicted relationships among the variables. For Latina-Americans, doctor-patient relationship was positively related to exercise, and in turn, influenced physical and emotional well-being. For Asian Americans, treatment decisions and the "sociocultural factor" were significantly related to stress management. This study adds to the existing literature in that no study has focused on cultural health beliefs and health behaviors between Latina and Asian-American BCS. Evidence that Latinas and Asian Americans varied in the patterns of cultural factors influencing health behaviors and HRQOL might lead to the development of culturally sensitive breast cancer interventions for promoting positive health behavior and ultimately increasing HRQOL.

Comment on ‘Impact of CYP2D6*10 on recurrence‐free survival in breast cancer patients receiving adjuvant tamoxifen therapy’

(Cancer Sci 2008; 99: 1706–1707)

Breast Cancer Among Asian Americans: Is Acculturation Related to Health-Related Quality of Life?

To examine the association of acculturation with health-related quality of life (HRQOL) among Asian American breast cancer survivors. Cross-sectional. Analysis of an Asian American subsample of breast cancer survivors from a larger multiethnic study. 206 Asian Americans, including Chinese, Filipinos, Koreans, and Japanese. Most were diagnosed with early-stage breast cancer (stage 0-II) and were an average of 54 years old. Participants completed a mailed questionnaire or answered a telephone survey in English, Mandarin, or Korean. HRQOL was measured using the Functional Assessment of Cancer Therapy Breast Version 4. Acculturation was measured using an eight-item scale adapted from Marin's Short Acculturation Scale. HRQOL, acculturation, health insurance, life stress, and social support. Acculturation was significantly associated with HRQOL when demographic, medical, socioecologic, and healthcare access factors were controlled. However, the significant association between acculturation and HRQOL disappeared when Asian subgroup membership was considered. Subgroup differences in HRQOL remained after controlling for covariates, with Korean Americans reporting lower HRQOL than the other Asian American subgroups. The absence of a significant association between acculturation and HRQOL in the final model is likely a result of the strong association between acculturation and Asian American subgroup membership. The results suggest that the correlation between acculturation and HRQOL is not an effect of having health insurance, life stress, and social support. Closer attention is needed regarding acculturation level; Asian American subgroup differences, including language capacity; and socioecologic characteristics in nursing practice and research.

Understanding the breast cancer experience of Asian American women.

Breast cancer is the most common form of cancer in women and affects women across all ethnic groups. Although the psychosocial impact of breast cancer is being studied, there is little information on ethnic minorities. To better understand the breast cancer experience of Asian American women, we conducted key informant and focus group interviews. Six professionals participated in the key informant interviews. A total of 34 Asian American breast cancer survivors participated in focus group interviews, including Korean (n=10), Chinese (n=11), and a mixed Asian group (n=13). The common themes identified in this series of qualitative studies included: lack of knowledge about breast cancer; medical care issues such as cost and amount of time spent with physician; cultural factors related to beliefs about illness, gender role and family obligations (e.g. self-sacrifice) and language barriers; the importance of spirituality; and psychosocial concerns related to worry about children, burdening the family, body image and sexual health concerns. A primary source of support and coping for Asian American women with breast cancer was their spiritual beliefs. The results from this qualitative study have been used to prepare a survey instrument to examine these issues in a larger sample of Asian American women.