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Self-perceived burden mediates the relationship between self-stigma and quality of life among Chinese American breast cancer survivors

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Abstract

Purpose

Cancer-related self-stigma (the internalized sense of shame about having cancer) has been found to associate with poorer quality of life (QoL) among cancer survivors. However, culturally salient illness beliefs (e.g., cancer is contagious; cancer is a result of karma; and cancer brings shame to the family) may make Chinese cancer survivors vulnerable to self-stigmatization. This study examined the association between self-stigma and QoL among Chinese American breast cancer survivors (BCS). To understand the potential mechanism, the mediating role of self-perceived burden to caregivers between self-stigma and QoL was also examined.

Methods

Chinese American BCS (n = 136) were recruited through community-based cancer associations. Participants’ self-stigma, self-perceived burden, and QoL were measured in a questionnaire package.

Results

Structural equation modeling results supported the proposed mediation model in predicting physical QoL (χ2(100) = 123.041, CFI = 0.982, TLI = 0.975, RMSEA = 0.041) and emotional QoL (χ2(84) = 137.277, CFI = 0.958, TLI = 0.940, RMSEA = 0.069), with satisfactory model fit indices. Both the indirect effects from self-stigma to QoL via self-perceived burden (physical: β = − 0.13; 95% CI = − 0.22, − 0.07 and emotional: β = − 0.11; 95% CI = − 0.22, − 0.04) and the direct effects from self-stigma to poorer QoL were significant (physical: β = − 0.22; 95% CI = −0.34, −0.10 and emotional: β = − 0.39; 95% CI = − 0.54, − 0.23), suggesting a partial mediation effect of self-perceived burden between self-stigma and QoL.

Conclusions

Self-stigma could reduce physical and emotional QoL through increasing self-perceived burden. Interventions aiming to reduce Chinese American BCS’ self-stigma and perceptions of burdensomeness may facilitate improvement in QoL, which in turn promotes better cancer survivorship.

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Funding

This study was supported by the American Cancer Society MRSGT-10-011-01-CPPB (PI: Qian Lu) and National Cancer Institute R01CA180896-01A1 (PI: Qian Lu).

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Authors and Affiliations

  1. Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 508, Postgraduate Education Centre, Prince of Wales Hospital, School of Medicine, Shatin, Hong Kong

    Nelson C. Y. Yeung

  2. Health Disparities Research Department – UNIT 1440, UT MD Anderson Cancer Center, P.O. Box 301402, Houston, TX, 77230–1402, USA

    Qian Lu

  3. Department of Psychology, The Chinese University of Hong Kong, Rm 354, Sino Building, Shatin, Hong Kong

    Winnie W. S. Mak

Authors
  1. Nelson C. Y. Yeung
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  2. Qian Lu
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  3. Winnie W. S. Mak
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Corresponding authors

Correspondence to Nelson C. Y. Yeung or Qian Lu.

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This study protocol was approved by the Institutional Review Board at the University of Houston.

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The authors declare that they have no conflicts of interest.

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Yeung, N.C.Y., Lu, Q. & Mak, W.W.S. Self-perceived burden mediates the relationship between self-stigma and quality of life among Chinese American breast cancer survivors. Support Care Cancer 27, 3337–3345 (2019). https://doi.org/10.1007/s00520-018-4630-2

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  • DOI: https://doi.org/10.1007/s00520-018-4630-2

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