Korean American Breast Cancer Survivors Research Articles

Health-Promoting Lifestyle Behaviors of Korean American Breast Cancer Survivors: Adherence to the American Cancer Society Guidelines.

Breast cancer incidence has been increasing in Korean American women. However, there are limited data on Korean American breast cancer survivors' health-promoting lifestyle behaviors. The American Cancer Society (ACS) publishes guidelines on weight, diet, physical activity, and alcohol for cancer survivors. Because of limited data on Korean American breast cancer survivors, their level of adherence to ACS guidelines is unknown. The aim of this study was to examine Korean American breast cancer survivors' level of adherence to ACS guidelines. Korean American breast cancer survivors (N = 50) participated in a cross-sectional study. Diet data including alcohol consumption were collected with 4-day diet records. Physical activity data were collected with the International Physical Activity Questionnaire. Total score of adherence to ACS guidelines was assessed with a systematic scoring system that ranged from 0 to 8. Participants' average body mass index was 23.7 (±2.7). Average daily serving of fruits and vegetables was 3.3 (±2.9), red meat was 0.8 (±1.5), and alcohol was 0. On average per week, participants had 51.8 (±85.2) minutes of moderate physical activity, 35 (±78.3) minutes of vigorous physical activity, and 69.1 (±73.7) minutes of walking. The average total adherence score to ACS guidelines was 5.3 (±1.3). Findings indicate modest adherence to ACS guidelines, with the alcohol guideline score contributing the most and diet guideline score the least. Findings from this study can be used to inform healthcare providers to educate Korean American breast cancer survivors on improving their diet and physical activity behaviors.

Attitudes toward Technology-Based Cancer Support Programs Among Korean American Breast Cancer Survivors.

Despite the increasing usages of technology-based programs, few technology-based support programs are currently available for racial/ethnic minority cancer survivors including Korean-American cancer survivors. The purpose of this study was to explore the attitudes toward technology-based cancer support programs among Korean-American cancer survivors from a feminist perspective. In-person focus group interviews were held with 17 Korean-American cancer survivors. All the interviews were recorded by writing memos. Then, the written memos were analyzed using a content analysis. Four major themes reflecting their attitudes toward technology-based cancer-support programs were identified: (a) "easy to access"; (b) "good for peer and family support," (c) "overcoming language barriers," and (d) "providing Korean-specific and personalized trustable information." Future technology-based cancer support groups for this specific population need to incorporate peer support, support for family members, Korean language, and Korea-specific information and intervention components.

Abstract PR02: Randomized controlled trial to increase quality of life and reduce perceived stress among Korean American breast cancer survivors

Abstract Background: Despite large increases in breast cancer incidence among Korean women, there have been remarkably few empirical studies to improve survivorship among Korean American breast cancer survivors (KBCS), many of whom experience linguistic and cultural barriers. According to limited research on Asian Americans, KBCS report low quality of life (QOL) and high perceived stress (henceforth referred to as “stress”). To address this gap, we tested the effectiveness of one of the first linguistically appropriate and culturally sensitive cognitive-behavioral stress management programs that was developed to improve QOL and reduce stress in KBCS. Methods: The TOGETHER (Together Overcome and Get Empowered Through Health Education and Relationships) program consists of seven 2-hour sessions and one follow-up seven weeks post-intervention. These findings are preliminary results based on cycles one to four of the program, consisting of 66 KBCS in the Washington, D.C. metropolitan area of which complete data was available for 61 participants (92.4%). The standard intervention (SI) group (n=28) received linguistically and culturally tailored health information related to breast cancer, while the enhanced intervention (EI) group (n=33) received this and additional information/practice on relaxation, stress reduction techniques, mindfulness, utilizing social support, anger management, and assertiveness training. Outcomes were measured at baseline, upon completion of the program, and at follow-up. QOL was assessed using the Functional Assessment of Cancer Therapy-Breast (FACT-B), which includes five subscales (physical well-being (PWB), social well-being (SWB), emotional well-being (EWB), functional well-being (FWB), and breast cancer subscale (BCS)), while stress was assessed using the Perceived Stress Scale (PSS). Generalized estimating equation (GEE) models were used to examine program effects on QOL and PSS separately. Moreover, the impact of program site (Maryland vs. Virginia), cycle (one to four), and age (less than 65 vs. 65 and over) on these relationships was assessed. Results: Randomization was effective in that SI and EI participants were similar in regards to sociodemographic, breast cancer-related, and acculturation variables. Program site and cycle did not impact program effects on QOL and PSS and were thus not included in subsequent models. For QOL, the SI group had better quality of life at baseline (mean FACT-B score: 103.3) compared to the EI group (mean FACT-B score: 100.7). Changes in mean FACT-B, SWB, and FWB scores significantly differed between the SI and EI group from baseline to the end of the program. Specifically, the EI group had a 7.0 unit greater increase in mean FACT-B scores, 2.6 unit greater increase in mean SWB scores, and 2.5 unit greater increase in mean FWB scores from baseline to the end of the program as compared to the SI group on average. For stress, the EI group had a higher level of stress (mean PSS score: 18.82) than the SI group (mean PSS score: 17.25) at baseline. Changes in mean PSS scores significantly differed across time between the SI and EI groups. Those in the EI group had a 2.7 unit greater decrease in mean PSS scores from baseline to the end of the program as compared to those in the SI group on average. For age, those who were less than 65 showed overall decreases in stress from baseline to follow-up, while those 65 and over showed initial decreases from baseline to the end of the program and then increases from the end of the program to follow-up beyond the baseline values. Conclusions: The TOGETHER program is effective in increasing QOL and reducing stress among KBCS and can potentially be adapted and implemented for other socially or linguistically isolated groups in the U.S. Citation Format: Sunmin Lee, Mary Y. Jung, Jamie H. Sim. Randomized controlled trial to increase quality of life and reduce perceived stress among Korean American breast cancer survivors. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr PR02.

Abstract B23: Examining the psychometric properties of the Functional Assessment of Cancer Therapy-Breast (FACT-B) among Korean American breast cancer survivors

Abstract Background: The 37-item Functional Assessment of Cancer Therapy-Breast (FACT-B) instrument has been validated and widely used in the literature to assess quality of life (QOL) among women with breast cancer. However, validation of the Korean version was conducted among breast cancer patients in Korea, and most studies in the United States have examined multiethnic samples with typically small numbers of Korean Americans (KA). This study examined the psychometric properties of FACT-B and its five subscales (physical well-being (PWB), social well-being (SWB), emotional well-being (EWB), functional well-being (FWB), and breast cancer subscale (BCS)) in a sample of KA breast cancer survivors. Methods: Data for this study are from a seven week randomized control trial aiming to increase QOL and reduce perceived stress among KA breast cancer survivors. Participants completed the FACT-B instrument at baseline, end of the program, and 7-weeks post intervention. In this study, baseline assessments of FACT-B were examined from 61 KA women in the Washington, D.C. metropolitan area with stages 0 to IV breast cancer. Participants' ages ranged from 30 to 83 (mean=56.7; SD=10.2). Principal component analysis (PCA) was conducted to examine FACT-B and its subscales. The factor correlation matrix was examined to determine the appropriate rotation method. Internal reliability was assessed using Cronbach's alpha. Results: Varimax rotation was employed given that factor correlations were mostly less than 0.32, which suggests that the variance between factors do not greatly overlap. The internal reliability of FACT-B in this sample was found to be good (α=.88). Moreover, the internal reliabilities were also good for PWB, SWB, and FWB (α=.85 to .89), but lower for EWB and BCS (α=.69 and α=.67 respectively). In general, these findings are consistent with the literature on White (α=.64-.91), African American (α=.77-.92), and Latina women (α=.72-.91) with breast cancer. Some variations were found between our study on KA women and other literature on breast cancer patients in China, Japan, and Korea. The internal reliability for EWB was lower in KA women (α=.69) as compared to Chinese women (α=.84), Japanese women (α=.74), and women in Korea (α=.79). However, our reliability is the same as that found in the initial FACT-B validation study by Brady et al. (1997) (α=.69). For other subscales, the internal reliabilities were similar or lower than in our sample. The initial PCA with varimax rotation retained 11 factors with eigenvalues above 1. However, 4 factors had only one or two items with factor loadings of at least |0.4|. Thus, 5 factors were specified based on the established number of subscales in the literature. The only item with a factor loading less than .4 was a question that asked how bothered participants were by hair loss. The low loading may be a result of few participants experiencing hair loss at the time of the survey. Interestingly, an item asking participants about how much they worry about dying had a negative loading even after reverse coding (ℓ=-.48), meaning those who worry more tend to have better QOL. One reason may be that concerns regarding death motivate some individuals to reassess priorities and better allocate their time on things that are more valued and enjoyable. Conclusions: Our findings were consistent with those from previous studies examining White, African American, and Latina women with breast cancer. In addition, FACT-B and its subscales had similar or higher internal reliabilities in our sample of KA women with breast cancer as compared to breast cancer patients in China, Japan, and Korea, with the exception of EWB. Overall, FACT-B was found to be reliable in our sample of KA breast cancer survivors providing additional support for its use in this population. Citation Format: Mary Y. Jung, Min Q. Wang, Sunmin Lee. Examining the psychometric properties of the Functional Assessment of Cancer Therapy-Breast (FACT-B) among Korean American breast cancer survivors. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B23.

The impact of comorbidity on the relationship between life stress and health-related quality of life for Chinese- and Korean-American breast cancer survivors

ABSTRACTObjective: The current study aimed to (1) identify the occurrence of comorbidities among Chinese- and Korean-American breast cancer survivors (BCS), (2) examine whether health-related quality of life (HRQOL) scores varied with the occurrence of specific comorbidities, and (3) investigate the mediating effect of comorbidities on the relationship between life stress and HRQOL.Design: Data were drawn from the parent study, a cross-sectional study investigating HRQOL in 86 Chinese- and 71 Korean-American BCS in Southern California. Two comorbidity-related variables, the occurrence of the specific comorbidity and the total number of comorbidities, were used to comprehensively reflect the characteristics of comorbidity.Results: Approximately 60% of participants had at least one comorbid disease, and osteoporosis was the most prevalent comorbidity. HRQOL differences based on the occurrence of a specific comorbidity were evident for arthritis, eye/vision problems, dental and gum problems, lymphedema, and psychological difficulties. Structural equation modeling demonstrated that the nature of the outcome variable, either physical or mental HRQOL, influenced the overall patterns of the findings. For example, life stress was significantly associated with the total number of comorbidities and in turn influenced physical HRQOL. In terms of mental HRQOL, arthritis, dental and gum problems, chronic pain, heart disease, lymphedema, and psychological difficulties mediated the relationship between life stress and mental HRQOL.Conclusion: The current study adds to the existing literature by examining the mediating effects of comorbidity on the relationship between life stress and HRQOL. The findings support the need for health care professionals to clearly assess physical and psychological comorbidities when providing survivorship care for cancer survivors.

Understanding the Stress Process of Chinese- and Korean-American Breast Cancer Survivors.

Guided by the stress process model (SPM), this study investigated the direct and indirect pathways of primary (negative self-image and life stress), secondary stressors (family communication strain) and family coping (external and internal) on mental health outcomes among Chinese- and Korean-American breast cancer survivors (BCS). A total of 156 Chinese- and Korean-American BCS were surveyed. Results showed primary and secondary stressors had a negative effect on better mental health outcomes. External coping was associated with better mental health. Family communication strain mediated the relationship between life stress and mental health outcomes. External coping mediated the relationship between family communication strain and mental health outcomes. Multi-group analysis revealed the stress process did not differ across ethnic groups. Findings suggest the SPM may be applicable to understand the stress process of Chinese- and Korean-American BCS and provide valuable insight into the role of family communication and external coping on mental health outcomes.

Coping with breast cancer: Reflections from Chinese American, Korean American, and Mexican American women.

The present study identified and compared the coping strategies of Chinese American, Korean American, and Mexican American breast cancer survivors (BCS). Six focus groups were conducted with Chinese American (n = 21), Korean American (n = 11), and Mexican American (n = 9) BCS. Interviews were audio-recorded, transcribed, and translated for thematic content analysis of coping experiences and strategies. Women reported the use of 8 coping strategies (religious/spiritual, benefit finding, fatalism, optimism, fighting spirit, information seeking, denial, and self-distraction). Among Chinese American BCS, benefit finding was the most referenced coping strategy, whereas religious/spiritual coping was most frequently reported among Korean American and Mexican American BCS. Denial and self-distraction were the least cited strategies. Survivors draw upon new found inner strength to successfully integrate their cancer experience into their lives. Coping models must consider the diversity of cancer survivors and the variability in coping strategies among cultural ethnic minority BCS.

Recruiting Chinese- and Korean-Americans in Cancer Survivorship Research: Challenges and Lessons Learned.

This paper describes Asian-American recruitment experiences using data from the cancer survivorship study involving Chinese- and Korean-American breast cancer survivors specifically. The article discusses challenges to the successful recruitment of Asian-American populations for cancer survivorship research and provides recommendations for future recruitment efforts. The study investigated the role of family communication in coping and quality of life for survivors from Chinese- and Korean-American groups diagnosed with breast cancer. Participants were primarily recruited through cancer registries and community outreach. A total of 157 breast cancer survivors (86 Chinese-Americans and 71 Korean-Americans) completed the final survey, yielding a final response rate of 62.8 % of the accessible samples. Chinese-Americans were more likely to agree to participate but less frequently completed the survey, and Korean-Americans were more likely to refuse to participate. Common reasons for refusal were "too busy or too painful to recall," followed by "not interested," "too old," "distrust of the research," or "health issue." Participants were more likely to be young and Korean-American compared to non-participants. Cultural and linguistic barriers, distrust, and lack of awareness about cancer research should be considered to recruit more Asian-American cancer survivors. Community participatory research is required to ensure participation by sufficient numbers of ethnic minorities in cancer survivorship research.

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.

The relationship between communication and health-related quality of life in survivorship care for Chinese-American and Korean-American breast cancer survivors

The purpose of this study was (1) to compare family communication, decision support (i.e., supporting the patient in making decisions), self-efficacy in patient-physician communication (i.e., patients' confidence level in communicating with physicians), and health-related quality of life (HRQOL) between Chinese-American and Korean-American breast cancer survivors (BCS) and (2) to investigate how family communication, decision support, and self-efficacy in patient-physician communication influence HRQOL for Chinese-American and Korean-American BCS. A cross-sectional design was used. A total of 157 Chinese-American (n = 86) and Korean-American (n = 71) BCS were recruited from the California Cancer Surveillance Program and area hospitals in Los Angeles County. The chronic care model was utilized. Chinese-Americans and Korean-Americans showed a significant difference in the decision support only. Self-efficacy in patient-physician communication was directly associated with HRQOL for Chinese-Americans, whereas for Korean-Americans, family communication was related to HRQOL. The mediating effects of decision support and self-efficacy in physician-patient communication in the relationship between family communication and HRQOL were observed for Chinese-Americans only. Multiple group analysis demonstrated that the structural paths varied between Chinese-American and Korean-American BCS. Our results provide insight into the survivorship care of Chinese-American and Korean-American BCS, allowing a better understanding of communication among survivors, family, and healthcare providers. Communication skills to manage conflict and attain consensus among them under the cultural contexts are essential to improve HRQOL for BCS.

Is family functioning and communication associated with health-related quality of life for Chinese- and Korean-American breast cancer survivors?

This study aims to investigate direct and indirect pathways of family flexibility, social support, and family communication on health-related quality of life (HRQOL) for Chinese- and Korean-American breast cancer survivors (BCS). A total of 157 Chinese (n = 86)- and Korean-American (n = 71) BCS were recruited from the California Cancer Surveillance Program and area hospitals in Los Angeles County. The present study was guided by the Resiliency Model of Family Stress, Adjustment, and Adaptation. Structural equation modeling demonstrated that (1) family communication was directly associated with HRQOL for both groups; (2) family flexibility was indirectly associated with HRQOL through family communication for Korean-Americans only; (3) social support mediated the relationship between family flexibility and family communication for Chinese-Americans only; and (4) acculturation was directly related to social support for both groups. Multigroup analysis demonstrated that the structural paths were equivalent between Chinese- and Korean-American BCS, although statistical differences in baseline parameters were noted. Our findings suggest that family communication impacts HRQOL among Asian-American BCS. Our results show that while there are commonalities in family characteristics among Asian-Americans, specific ethnic variations also exist. Therefore, specific cultural and familial contexts should be assessed to better inform interventions to enhance family communication strategies and improve HRQOL.

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.

Cross-Ethnicity Measurement Equivalence of Family Coping for Breast Cancer Survivors

Objective: The current study examines the equivalence of a measure of family coping, the Family Crisis Oriented Personal Evaluation scales (F-COPES), in Chinese American and Korean American breast cancer survivors (BCS). Methods: Factor structure and cross-ethnicity equivalence of the F-COPES were tested using structural equation modeling with 157 Chinese American and Korean American BCS in California. Results: Of the original F-COPES subscales, acquiring social support, reframing, and passive appraisal did not adequately fit the data. Thus, a modified five-factor structure of the F-COPES was created. The modified F-COPES was validated with respect to quality of life, psychological distress, and family communication. Conclusions: The findings illustrate the importance of cross-ethnicity measurement testing and provide a rationale for developing culturally tailored measurements for ethnic minority populations.

The Effects of Religiosity, Spirituality, and Social Support on Quality of Life: A Comparison Between Korean American and Korean Breast and Gynecologic Cancer Survivors

To examine the differences in religiosity, spirituality, and quality of life (QOL) between Korean American and Korean breast and gynecologic cancer survivors and investigate the effect of religiosity, spirituality, and social support on QOL. Cross-sectional design. Participants were recruited from hospitals and community-based support groups in the areas of Southern California and Seoul, Korea. 161 women diagnosed with breast and gynecologic cancer (110 Koreans and 51 Korean Americans). Participants completed a mailed questionnaire. To identify the QOL outcomes, religiosity, spirituality, and social support, four standardized measures were used. QOL outcomes, religiosity, spirituality, religious involvement, and social support. Religiosity and spirituality were related to some QOL outcomes in different patterns in Korean American and Korean breast and gynecologic cancer survivors. The effect on QOL, however, was not strong after controlling for covariates. Social support partially mediated the effect of spirituality on QOL but only among the Korean American cancer survivors. The findings provide evidence that the effect of religiosity and spirituality on QOL varied between Korean American and Korean survivors. The mediating effect of social support between spirituality and QOL for Korean Americans also was demonstrated. The results present nursing practice and research implications that religiosity, spirituality, and social support need to be considered in developing services for enhancing QOL of immigrant cancer survivors.

Different pathways in social support and quality of life between Korean American and Korean breast and gynecological cancer survivors

The purpose of this study was to investigate: (1) how social support influences quality of life (QOL) and (2) whether or not the pathways for predicting QOL outcomes differ between Korean American and Korean survivors of breast and gynecological cancer. To identify multiple dimensions of health status and psychosocial outcomes, two standardized QOL and psychological distress measures were administered to 51 Korean Americans and 110 Koreans. Social support was measured by items assessing functional social support and social network structures. Hierarchical multiple regression and path analyses were employed to investigate the effects of social support on outcomes and to compare between Korean Americans and Koreans. The findings indicate that functional social support directly influences QOL and psychological distress, and social network structures are directly and/or indirectly associated with outcomes. Moreover, the two groups showed different pathways from social support to outcomes. This study provides practical research information by illuminating the relationships between social support components influencing QOL for Korean American and Korean survivors. This study may increase the utility and efficacy of the research and interventions to enhance cancer survivors' social participation and to diminish barriers to follow-up care, considering the different living conditions between the United States and Korea.