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A mixed method exploration of survivorship among Chinese American and non-Hispanic White breast cancer survivors: the role of socioeconomic well-being

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Abstract

Purpose

Cancer-related stress is heavily influenced by culture. This study explored similarities and differences in survivorship care concerns among Chinese American and non-Hispanic White (NHW) breast cancer survivors.

Methods

A sequential, mixed-method design (inductive/qualitative research-phase I and deductive/quantitative research-phase II) was employed. Eligible women identified from the Greater Bay Area Cancer Registry were age ≥21, diagnosed with stage 0–IIa breast cancer between 2006 and 2011, and had no recurrence or other cancers. In phase I, we conducted 4 Chinese (n = 19) and 4 NHW (n = 22) focus groups, and 31 individual telephone interviews (18 Chinese immigrants, 7 Chinese US-born, and 6 NHW). Content analysis was conducted to examine qualitative data. In phase II, another 296 survivors (148 NHW age-matched to 148 Chinese cases) completed a cross-sectional survey. Descriptive statistics and linear regression analysis were conducted to examine quantitative data.

Results

Qualitative data revealed “socioeconomic well-being” (SWB) as a dominant survivorship concern, which was operationalized as a cancer survivor’s perceived economic and social resources available to access care. Quantitative data showed that low-acculturated Chinese immigrants reported the poorest SWB, controlling for covariates. Highly acculturated Chinese immigrants and the US-born Chinese/NHW group reported similar SWB. Women who had low-income levels or chemotherapy had poorer SWB.

Conclusions

SWB emerged as an important aspect of breast cancer survivorship. Immigration stress, cancer care costs, and cultural values all contributed to immigrants’ socioeconomic distress. Immigrant and US-born breast cancer survivors experienced different socioeconomic circumstances and well-being following treatment. Our findings warrant further investigation of socioeconomic distress and survivorship outcomes.

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References

  1. Glanz, K., & Schwartz, M. D. (2008). Stress, coping, and health behavior. In K. Glanz, B. K. Rimer, & K. Viswanath (Eds.), Health behavior and health education theory, research and practice (pp. 212–236). San Francisco: Jossey-Bass.

    Google Scholar 

  2. Rowland, J. H. (1990). Intrapersonal resources: Coping. In J. C. Holland & J. H. Rowland (Eds.), Handbook of psychooncology: psychological care of the patient with cancer (pp. 44–57). New York, NY: Oxford University Press.

    Google Scholar 

  3. Folkman, S., Lazarus, R. S., Dunkel-Schetter, C., DeLongis, A., & Gruen, R. J. (1986). Dynamics of a stressful encounter: Cognitive appraisal, coping, and encounter outcomes. Journal of Personality and Social Psychology, 50(5), 992–1003.

    Article  PubMed  CAS  Google Scholar 

  4. Kagawa-Singer, M., & Blackhall, L. J. (2001). Negotiating cross-cultural issues at the end of life: “You got to go where he lives”. JAMA, 286(23), 2993–3001.

    Article  PubMed  CAS  Google Scholar 

  5. Ashing-Giwa, K. T., Padilla, G., Tejero, J., Kraemer, J., Wright, K., Coscarelli, A., et al. (2004). Understanding the breast cancer experience of women: A qualitative study of African American, Asian American, Latina and Caucasian cancer survivors. Psychooncology, 13(6), 408–428.

    Article  PubMed  Google Scholar 

  6. Levine, E. G., Yoo, G., Aviv, C., Ewing, C., & Au, A. (2007). Ethnicity and spirituality in breast cancer survivors. Journal of Cancer Survivorship, 1(3), 212–225.

    Article  PubMed  Google Scholar 

  7. Kagawa-Singer, M., Padilla, G. V., & Ashing-Giwa, K. (2010). Health-related quality of life and culture. Seminars in Oncology Nursing, 26(1), 59–67.

    Article  PubMed  Google Scholar 

  8. Centers for Disease Control and Prevention. (2010). 10 leading causes of death Asian American & Pacific Islander population, U.S., 2007. http://www.cdc.gov/omhd/populations/asianam/asianam.htm#Ten. Accessed October 11, 2012.

  9. Pew Research Center. (2012). The rise of Asian Americans. http://www.pewsocialtrends.org/files/2012/06/SDT-The-Rise-of-Asian-Americans-Full-Report.pdf. Accessed July 18, 2012.

  10. Bond, M. H. (1986). The social psychology of Chinese people. In M. H. Bond (Ed.), The psychology of the Chinese people (pp. 216–266). New York: Oxford University Press.

    Google Scholar 

  11. Wu, D., & Tseng, W. (1985). Introduction: The characteristics of Chinese culture. In S. Tseng & D. Wu (Eds.), Chinese culture and mental health (pp. 1–13). Orlando, FL: Academic Press.

    Google Scholar 

  12. Pasick, R. J., Stewart, S. L., Bird, J. A., & D’Onofrio, C. N. (2001). Quality of data in multiethnic health surveys. Public Health Report, 1(116 Suppl), 223–243.

  13. Wong-Kim, E., Sun, A., Merighi, J. R., & Chow, E. A. (2005). Understanding quality-of-life issues in Chinese women with breast cancer: a qualitative investigation. Cancer Control, 12(2 Suppl), 6–12.

    Google Scholar 

  14. Tsai, T. I., Morisky, D. E., Kagawa-Singer, M., & Ashing-Giwa, K. T. (2011). Acculturation in the adaptation of Chinese-American women to breast cancer: A mixed-method approach. Journal of Clinical Nursing, 20(23–24), 3383–3393.

    Article  PubMed  Google Scholar 

  15. Elliott, A. C. (2001). Health care ethics: Cultural relativity of autonomy. Journal of Transcultural Nursing, 12(4), 326–330.

    Article  PubMed  CAS  Google Scholar 

  16. Kim, J., Ashing-Giwa, K. T., Kagawa-Singer, M., & Tejero, J. S. (2006). Breast cancer among Asian Americans: Is acculturation related to health-related quality of life? Oncology Nursing Forum, 33(6), E90–E99.

    Article  PubMed  Google Scholar 

  17. Gomez, S. L., Quach, T., Horn-Ross, P. L., Pham, J. T., Cockburn, M., Chang, E. T., et al. (2010). Hidden breast cancer disparities in Asian women: disaggregating incidence rates by ethnicity and migrant status. American Journal of Public Health, 100(S1), S125–S131.

    Google Scholar 

  18. Creswell, J. W., Klassen, A. C., Plano Clark, V. L., & Smith, K. C. (2012). Best practices for mixed methods research in the health sciences. Office of Behavioral and Social Sciences Research, National Institutes of Health. http://obssr.od.nih.gov/scientific_areas/methodology/mixed_methods_research/index.aspx. Accessed September 15, 2012.

  19. Krueger, R. A., & Casey, M. A. (2009). Focus groups: A practical guide for applied research (4th ed.). Thousand Oaks, CA: Sage Publications.

    Google Scholar 

  20. Kvale, S., & Brinkman, S. (2009). Interviews: Learning the craft of qualitative research interviewing. Los Angeles, CA: Sage Publications, Inc.

    Google Scholar 

  21. Liang, W., Yuan, E., Mandelblatt, J. S., & Pasick, R. J. (2004). How do older Chinese women view health and cancer screening? Results from focus groups and implications for interventions. Ethnicity and Health, 9(3), 283–304.

    Article  PubMed  Google Scholar 

  22. Warnecke, R. B., Johnson, T. P., Chavez, N., Sudman, S., O’Rourke, D. P., Lacey, L., et al. (1997). Improving question wording in surveys of culturally diverse populations. Annals of Epidemiology, 7(5), 334–342.

    Article  PubMed  CAS  Google Scholar 

  23. LeCompte, M. D., & Schensul, J. J. (2009). Analyzing and interpreting ethnographic data. In J. J. Schensul & M. D. LeCompte (Eds.), Ethnographer’s toolkit. Baltimore MD: Altamira Press.

    Google Scholar 

  24. Fossey, E., Harvey, C., McDermott, F., & Davidson, L. (2002). Understanding and evaluating qualitative research. Australian and New Zealand Journal of Psychiatry, 36, 717–732.

    Article  PubMed  Google Scholar 

  25. Saldana, J. (2009). The coding manual for qualitative researchers. Thousand Oaks, CA: Sage Publication.

    Google Scholar 

  26. Head, B. A., & Faul, A. C. (2008). Development and validation of a scale to measure socioeconomic well-being in persons with cancer. The Journal of Supportive Oncology, 6(4), 185–192.

    Google Scholar 

  27. Anderson, J., Moeschberger, M., Chen, M. S, Jr, Kunn, P., Wewers, M. E., & Guthrie, R. (1993). An acculturation scale for Southeast Asians. Social Psychiatry and Psychiatric Epidemiology, 28(3), 134–141.

    Article  PubMed  CAS  Google Scholar 

  28. Wang, J. H., Liang, W., Schwartz, M. D., Lee, M. M., Kreling, B., & Mandelblatt, J. S. (2008). Development and evaluation of a culturally tailored educational video: Changing breast cancer-related behaviors in Chinese women. Health Education & Behavior, 35(6), 806–820.

    Article  Google Scholar 

  29. Wang, J. H., Mandelblatt, J., Liang, W., Yi, B., Ma, I. J., & Schwartz, M. (2009). Knowledge, cultural, and attitudinal barriers to mammography screening among non-adherent immigrant Chinese women: Ever versus never screened status. Cancer, 115(20), 4828–4838.

    Article  PubMed  Google Scholar 

  30. Chuang, S. C., Chen, W., Hashibe, M., Li, G., & Zhang, Z. F. (2006). Survival rates of invasive breast cancer among ethnic Chinese women born in East Asia and the United States. Asian Pacific Journal of Cancer Prevention, 7(2), 221–226.

    PubMed  Google Scholar 

  31. Kimman, M., Jan, S., Kingston, D., Monaghan, H., Sokha, E., Thabrany, H., et al. (2012). Socioeconomic impact of cancer in member countries of the Association of Southeast Asian Nations (ASEAN): The ACTION study protocol. Asian Pacific Journal of Cancer Prevention, 13(2), 421–425.

    Article  PubMed  Google Scholar 

  32. de Castro, A. B., Gee, G. C., & Takeuchi, D. T. (2008). Examining alternative measures of social disadvantage among Asian Americans: The relevance of economic opportunity, subjective socials tatus, and financial strain for health. Journal of Immigrant Minority Health, 12, 659–671.

    Article  Google Scholar 

  33. Liao, Y., Bang, D., Cosgrove, S., Dulin, R., Harris, Z., Stewart, A., et al. (2011). Surveillance of health status in minority communities—Racial and ethnic approaches to community health across the U.S. (REACH U.S.) Risk factor survey, United States, 2009. MMWR Surveillance Summaries, 60(SS06), 1–44.

  34. Spiegel, D. (2012). Mind matters in cancer survival. Psychooncology, 21(6), 588–593.

    Article  PubMed  Google Scholar 

  35. Sloan, E. K., Priceman, S. J., Cox, B. F., Yu, S., Pimentel, M. A., Tangkanangnukul, V., et al. (2010). The sympathetic nervous system induces a metastatic switch in primary breast cancer. Cancer Research, 70(18), 7042–7052.

    Article  PubMed  CAS  Google Scholar 

  36. de Castro, A. B., Rue, T., & Takeuchi, D. T. (2010). Associations of employment frustration with self-rated physical and mental health among Asian American immigrants in the U.S. Labor force. Public Health Nursing, 27(6), 492–503.

    Article  PubMed  Google Scholar 

  37. De Jong, G. F., & Madamba, A. B. (2001). A double disadvantage? Minority group, immigrant status, and underemployment in the United States. Social Science Quarterly, 82(1), 117–130.

    Article  Google Scholar 

  38. Masland, M. C., Kang, S. H., & Ma, Y. (2011). Association between limited English proficiency and understanding prescription labels among five ethnic groups in California. Ethnicity & Health, 16(2), 125–144.

    Article  Google Scholar 

  39. Wang, J. H., Adams, I., Huang, E., Ashing-Giwa, K., Gomez, S. L., & Allen, L. (2012). Physical distress and cancer care experiences among Chinese-American and non-Hispanic White breast cancer survivors. Gynecologic Oncology, 124(3), 383–388.

    Article  PubMed  Google Scholar 

  40. Zick, S. M., Wyatt, G. K., Murphy, S. L., Arnedt, J. T., Sen, A., & Harris, R. E. (2012). Acupressure for persistent cancer-related fatigue in breast cancer survivors (AcuCrft): A study protocol for a randomized controlled trial. BMC complementary and Alternative Medicine, 12(1), 132. doi:10.1186/1472-6882-12-132.

    Article  PubMed  Google Scholar 

  41. Chandwani, K. D., Ryan, J. L., Peppone, L. J., Janelsins, M. M., Sprod, L. K., Devine, K., et al. (2012). Cancer-related stress and complementary and alternative medicine: A review. Evidence-Based Complementary and Alternative Medicine. doi:10.1155/2012/979213.

    PubMed  Google Scholar 

  42. Mao, J. J., Palmer, C. S., Healy, K. E., Desai, K., & Amsterdam, J. (2011). Complementary and alternative medicine use among cancer survivors: A population-based study. Journal of Cancer Survivorship, 5(1), 8–17.

    Article  PubMed  Google Scholar 

  43. Meneses, K., & Benz, R. (2010). Quality of life in cancer survivorship: 20 years later. Seminars in Oncology Nursing, 26, 36–46.

    Article  PubMed  Google Scholar 

  44. Moinpour, C. M., Feigl, P., Metch, B., Hayden, K. A., Meyskens, F. L, Jr, & Crowley, J. (1989). Quality of life end points in cancer clinical trials: Review and recommendations. Journal of the National Cancer Institute, 81, 485–495.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This research was supported by a Lance Armstrong Foundation Young Investigator Award and the National Cancer Institute R21 research award (Grant# CA139408-01 to J. H. Wang) and K01 career development award (Grant# CA169041-01 to R. Tucker-Seeley). This research was also supported by the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201000040C awarded to the Cancer Prevention Institute of California. The collection of cancer incidence data used in this study was supported by the California Department of Health Services as part of the statewide cancer reporting program mandated by California Health and Safety Code Sect. 103885; the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program under contract HHSN261201000140C awarded to the Cancer Prevention Institute of California, contract HHSN261201000035C awarded to the University of Southern California, and contract HHSN261201000034C awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement #1U58 DP000807-01 awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the authors, and endorsement by the State of California, the California Department of Health Services, the National Cancer Institute, or the Centers for Disease Control and Prevention or their contractors and subcontractors is not intended nor should be inferred. We appreciate field staff at CPIC, Pagan Morris, Mei-Chin Kuo, Kathie Lau, and Daisy Lubag for their efforts in participant enrollment and preparation for focus groups. We sincerely thank Dr. Grace X. Ma and Dr. Frances M. Lewis for their constructive comments on our study materials, which enhanced our data collection.

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Authors and Affiliations

  1. Cancer Prevention and Control Program, Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW., Suite 4100, Washington, DC, 20007, USA

    Judy Huei-yu Wang, Ellen Huang & Yiru Wang

  2. Department of Social and Behavioral Sciences, Harvard School of Public Health, 401 Park Dr., Room 403-E, Boston, MA, 02215, USA

    Inez F. Adams

  3. Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02215, USA

    Reginald Tucker-Seeley

  4. Center for Community Based Research, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA

    Reginald Tucker-Seeley

  5. Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94538, USA

    Scarlett Lin Gomez & Laura Allen

  6. Department of Medicine, Division of General Internal Medicine, University of California San Francisco, 1450 3rd Street, San Francisco, CA, 94158, USA

    Rena J. Pasick

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  1. Judy Huei-yu Wang
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  2. Inez F. Adams
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  4. Scarlett Lin Gomez
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  6. Ellen Huang
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  8. Rena J. Pasick
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Correspondence to Judy Huei-yu Wang.

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Wang, J.Hy., Adams, I.F., Tucker-Seeley, R. et al. A mixed method exploration of survivorship among Chinese American and non-Hispanic White breast cancer survivors: the role of socioeconomic well-being. Qual Life Res 22, 2709–2720 (2013). https://doi.org/10.1007/s11136-013-0374-0

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