Skip to main content

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

Journal of Cancer Survivorship volume 8, pages 94–107 (2014)Cite this article

Abstract

Introduction

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.

Methods

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.

Results

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.

Conclusions

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.

Implications for Cancer Survivors

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Siegel R, Naishadham D, Jemal A. Cancer statistics. CA Cancer J Clin. 2012;62:10–29.

    Article  PubMed  Google Scholar 

  2. Deapen D, Liu L, Perkins C, Bernstein L, Ross RK. Rapidly rising breast cancer incidence rates among Asian-American women. Int J Cancer. 2002;99:747–50.

    CAS  Article  PubMed  Google Scholar 

  3. Liu L, Zhang J, Wu AH, Pike MC, Deapen D. Invasive breast cancer incidence trends by detailed race/ethnicity and age. Int J Cancer. 2012;130:395–404.

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  4. Smith BD, Smith GL, Hurria A, Hortobagyi GN, Buchholz TA. Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol. 2009;27:2758–65.

    Article  PubMed  Google Scholar 

  5. Powe BD, Hamilton J, Hancock N, Johnson N, Finnie R, Ko J, et al. Quality of life of African American cancer survivors: a review of the literature. Cancer. 2007;109:435–45.

    Article  PubMed  Google Scholar 

  6. Montazeri A. Health-related quality of life in breast cancer patients: a bibliographic review of the literature from 1974 to 2007. J Exp Clin Cancer Res. 2008;27:32.

    PubMed Central  Article  PubMed  Google Scholar 

  7. Yu ES. Health of the Chinese elderly in America. Res Aging. 1986;8:84–109.

    CAS  Article  PubMed  Google Scholar 

  8. Nguyen TT, Somkin CP, Ma Y. Participation of Asian-American women in cancer chemoprevention research: physician perspectives. Cancer. 2005;104:3006–14.

    PubMed Central  Article  PubMed  Google Scholar 

  9. Tu SP, Chen H, Chen A, Lim J, May S, Drescher C. Clinical trials: understanding and perceptions of female Chinese-American cancer patients. Cancer. 2005;104:2999–3005.

    PubMed Central  Article  PubMed  Google Scholar 

  10. Reich M, Lesur A, Perdrizet-Chevallier C. Depression, quality of life and breast cancer: a review of the literature. Breast Cancer Res Treat. 2008;110:9–17.

    CAS  Article  PubMed  Google Scholar 

  11. Wong-Kim E, Sun A, DeMattos MC. Assessing cancer beliefs in a Chinese immigrant community. Cancer Control. 2003;10:22–8.

    PubMed  Google Scholar 

  12. Ma GX, Shive SE, Wang MQ, Tan Y. Cancer screening behaviors and barriers in Asian Americans. Am J Health Behav. 2009;33:650–60.

    Article  PubMed  Google Scholar 

  13. Ashing-Giwa KT. The contextual model of HRQoL: a paradigm for expanding the HRQoL framework. Qual Life Res. 2005;14:297–307.

    Article  PubMed  Google Scholar 

  14. Yanez B, Thompson EH, Stanton AL. Quality of life among Latina breast cancer patients: a systematic review of the literature. J Cancer Surviv. 2011;5:191–207.

    PubMed Central  Article  PubMed  Google Scholar 

  15. Kagawa-Singer M, Wellisch DK, Durvasula R. Impact of breast cancer on Asian American and Anglo American women. Cult Med Psychiatry. 1997;21:449–80.

    CAS  Article  PubMed  Google Scholar 

  16. Wellisch D, Kagawa-Singer M, Reid SL, Lin YJ, Nishikawa-Lee S, Wellisch M. An exploratory study of social support: a cross-cultural comparison of Chinese-, Japanese-, and Anglo-American breast cancer patients. Psychooncology. 1999;8:207–19.

    CAS  Article  PubMed  Google Scholar 

  17. Chiu L. Spiritual resources of Chinese immigrants with breast cancer in the USA. Int J Nurs Stud. 2001;38:175–84.

    CAS  Article  PubMed  Google Scholar 

  18. Gotay CC, Holup JL, Pagano I. Ethnic differences in quality of life among early breast and prostate cancer survivors. Psychooncology. 2002;11:103–13.

    Article  PubMed  Google Scholar 

  19. Ashing-Giwa KT, Padilla G, Tejero J, Kagawa-Singer M. Understanding the breast cancer experience of Asian American women. Psychooncology. 2003;12:38–58.

    Article  Google Scholar 

  20. Kagawa-Singer M, Wellisch DK. Breast cancer patients' perceptions of their husbands' support in a cross-cultural context. Psychooncology. 2003;12:24–37.

    Article  PubMed  Google Scholar 

  21. Ashing-Giwa KT, Padilla G, Tejero J, Kraemer J, Wright K, Coscarelli A, et al. Understanding the breast cancer experience of women: a qualitative study of African American, Asian American, Latina and Caucasian cancer survivors. Psychooncology. 2004;13:408–28.

    PubMed Central  Article  PubMed  Google Scholar 

  22. Wong-Kim E, Sun A, Merighi JR, Chow EA. Understanding quality-of-life issues in Chinese women with breast cancer: a qualitative investigation. Cancer Control. 2005;12 Suppl 2:6–12.

    PubMed  Google Scholar 

  23. Kim J, Ashing-Giwa KT, Kagawa Singer M, Tejero JS. Breast cancer among Asian Americans: is acculturation related to health-related quality of life? Oncol Nurs Forum. 2006;33:E90–9.

    Article  PubMed  Google Scholar 

  24. Levine EG, Yoo G, Aviv C, Ewing C, Au A. Ethnicity and spirituality in breast cancer survivors. J Cancer Surviv. 2007;1:212–25.

    Article  PubMed  Google Scholar 

  25. Lim JW, Gonzalez P, Wang-Letzkus MF, Ashing-Giwa KT. Understanding the cultural health belief model influencing health behaviors and health-related quality of life between Latina and Asian-American breast cancer survivors. Support Care Cancer. 2009;17:1137–47.

    Article  PubMed  Google Scholar 

  26. Levine EG, Aviv C, Yoo G, Ewing C, Au A. The benefits of prayer on mood and well-being of breast cancer survivors. Support Care Cancer. 2009;17:295–306.

    PubMed Central  Article  PubMed  Google Scholar 

  27. Ashing-Giwa KT, Lim JW. Predicting physical quality of life among a multiethnic sample of breast cancer survivors. Qual Life Res. 2010;19:789–802.

    Article  PubMed  Google Scholar 

  28. Ashing-Giwa KT, Lim JW. Exploring the association between functional strain and emotional well-being among a population-based sample of breast cancer survivors. Psychooncology. 2010;19:150–9.

    Article  PubMed  Google Scholar 

  29. Yi JK, Swartz MD, Reyes-Gibby CC. English proficiency, symptoms, and quality of life in Vietnamese- and Chinese-American breast cancer survivors. J Pain Symptom Manage. 2011;42:83–92.

    Article  PubMed  Google Scholar 

  30. Tsai TI, Morisky DE, Kagawa-Singer M, Ashing-Giwa KT. Acculturation in the adaptation of Chinese-American women to breast cancer: a mixed-method approach. J Clin Nurs. 2011;20:3383–93.

    Article  PubMed  Google Scholar 

  31. Ashing-Giwa KT, Lim JW. Examining emotional outcomes among a multiethnic cohort of breast cancer survivors. Oncol Nurs Forum. 2011;38:279–88.

    Article  PubMed  Google Scholar 

  32. Lu Q, Zheng D, Young L, Kagawa-Singer M, Loh A. A pilot study of expressive writing intervention among Chinese-speaking breast cancer survivors. Health Psychol. 2012;31:548–51.

    PubMed Central  Article  PubMed  Google Scholar 

  33. Quach T, Nuru-Jeter A, Morris P, Allen L, Shema SJ, Winters JK, et al. Experiences and perceptions of medical discrimination among a multiethnic sample of breast cancer patients in the Greater San Francisco Bay Area, California. Am J Public Health. 2012;102:1027–34.

    PubMed Central  Article  PubMed  Google Scholar 

  34. Lee S, Chen L, Ma GX, Fang CY. What is lacking in patient-physician communication: Perspectives from Asian American breast cancer patients and oncologists. J Behav Health. 2012;1:102–9.

    Article  Google Scholar 

  35. Wang JH, Adams I, Huang E, Ashing-Giwa K, Gomez SL, Allen L. Physical distress and cancer care experiences among Chinese-American and non-Hispanic White breast cancer survivors. Gynecol Oncol. 2012;124:383–8.

    PubMed Central  Article  PubMed  Google Scholar 

  36. Paxton RJ, Phillips KL, Jones LA, Chang S, Taylor WC, Courneya KS, et al. Associations among physical activity, body mass index, and health-related quality of life by race/ethnicity in a diverse sample of breast cancer survivors. Cancer. 2012;118:4024–31.

    PubMed Central  Article  PubMed  Google Scholar 

  37. Lim JW, Baik OM, Ashing-Giwa KT. Cultural health beliefs and health behaviors in Asian American breast cancer survivors: a mixed-methods approach. Oncol Nurs Forum. 2012;39:388–97.

    Article  PubMed  Google Scholar 

  38. Lim JW, Paek MS. The relationship between communication and health-related quality of life in survivorship care for Chinese-American and Korean-American breast cancer survivors. Support Care Cancer. 2013;21:1157–66.

    PubMed Central  Article  PubMed  Google Scholar 

  39. Lee S, Chen L, Ma GX, Fang CY, Oh Y, Scully L. Challenges and needs of Chinese and Korean American breast cancer survivors: in-depth interviews. N Am J Med Sci (Boston). 2013;6:1–8.

    Google Scholar 

  40. Lim JW, Yi J, Zebrack B. Acculturation, social support, and quality of life for Korean immigrant breast and gynecological cancer survivors. Ethn Health. 2008;13:243–60.

    Article  PubMed  Google Scholar 

  41. Hewitt ME, Ganz P, Institute of Medicine (US), American Society of Clinical Oncology, American Society of Clinical Oncology, Institute of Medicine Symposium on Cancer Survivorship. From cancer patient to cancer survivor: lost in transition. Washington, DC: National Academies Press; 2006.

    Google Scholar 

  42. Barg FK, Gullatte MM. Cancer support groups: meeting the needs of African Americans with cancer. Semin Oncol Nurs. 2001;17:171–8.

    CAS  Article  PubMed  Google Scholar 

  43. Nápoles-Springer AM, Ortíz C, O'Brien H, Díaz-Méndez M. Developing a culturally competent peer support intervention for Spanish-speaking Latinas with breast cancer. J Immigr Minor Health. 2009;11:268–80.

    Article  PubMed  Google Scholar 

  44. Kwok C, Ho M. Development and evaluation of a culturally sensitive support group programme for Chinese-Australian women with breast cancer: a pilot study. Eur J Cancer Care (Engl). 2011;20:795–802.

    CAS  Article  Google Scholar 

  45. US Department of Commerce. (2010) Facts for features: Asian/Pacific American Heritage Month: May 2010. Available from: http://www.census.gov/newsroom/releases/archives/facts_for_features_special_editions/cb10-ff07.html. Accessed 22 Oct 2013.

  46. Kagawa-Singer M. Improving the validity and generalizability of studies with underserved U.S. populations expanding the research paradigm. Ann Epidemiol. 2000;10(8 Suppl):S92–103.

    CAS  Article  PubMed  Google Scholar 

  47. Hahn EA, Cella D. Health outcomes assessment in vulnerable populations: measurement challenges and recommendations. Arch Phys Med Rehabil. 2003;84(4 Suppl 2):S35–42.

    Article  PubMed  Google Scholar 

  48. Mols F, Vingerhoets AJ, Coebergh JW, van de Poll-Franse LV. Quality of life among long-term breast cancer survivors: a systematic review. Eur J Cancer. 2005;41:2613–9.

    Article  PubMed  Google Scholar 

  49. America's new mobile majority: a look at smartphone owners in the U.S. Reported by Nielsen. 2012, http://www.nielsen.com/us/en/newswire/2012/who-owns-smartphones-in-the-us.html. Accessed on May/13/2013.

  50. Antoni MH, Lechner SC, Kazi A, Wimberly SR, Sifre T, Urcuyo KR, et al. How stress management improves quality of life after treatment for breast cancer. J Consult Clin Psychol. 2006;74:1143–52.

    Article  PubMed  Google Scholar 

  51. Fors EA, Bertheussen GF, Thune I, Juvet LK, Elvsaas IK, Oldervoll L, et al. Psychosocial interventions as part of breast cancer rehabilitation programs? Results from a systematic review. Psychooncology. 2011;20:909–18.

    PubMed  Google Scholar 

Download references

Acknowledgments

Kuang-Yi Wen is currently funded by AHRQ grant 1K01HS019001. This work was supported in part by the NIH-NCI's Community Network Program Center, ACCHDC (U54CA153513, PI: Dr. Grace Ma) and NIH P30 CA06927. We are indebted to Alison Petok and Kathy Ireton for their technical and administrative assistance.

Author information

Affiliations

  1. Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Avenue, Robert C. Young Pavilion, Philadelphia, PA, 19111, USA

    Kuang-Yi Wen & Carolyn Y. Fang

  2. Department of Public Health, Center for Asian Health, Temple University, Philadelphia, PA, 19122, USA

    Grace X. Ma

Authors
  1. Kuang-Yi Wen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carolyn Y. Fang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Grace X. Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kuang-Yi Wen.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Wen, KY., Fang, C.Y. & Ma, G.X. Breast cancer experience and survivorship among Asian Americans: a systematic review. J Cancer Surviv 8, 94–107 (2014). https://doi.org/10.1007/s11764-013-0320-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11764-013-0320-8

Keywords

  • Survivorship
  • Breast cancer
  • Asian Americans
  • Literature review