The number of US cancer survivors is growing rapidly, including a significant number of Chinese Americans (CA), a group with an annual breast cancer growth rate of 1.1% and fast population growth due to immigration. Over 63% of CAs are immigrants. Our preliminary study showed that more CA immigrant breast cancer survivors (BCS) had fatigue, pain, and poor physical functioning relative to non-Hispanic White (NHW) BCS. Low-acculturated CAs reported greater psychosocial stress (e.g. greater perceived threat and fear of losing socioeconomic resources); however, they paradoxically reported less depression than NHWs. We do not know why CA BCS appear emotionally resilient when they are physically vulnerable and often lack social resources for coping (i.e., social support, socioeconomic resources and healthcare access). It is unclear whether such resilience is actually a cultural response when many CAs believe that emotional stress causes cancer, and thus they may underreport their distress. Unexpressed chronic stress is related to higher cortisol and inflammation levels detrimental to health. It is also unknown whether CA BCS? symptom burden persists over time and how culture and social resources influence their ways of managing symptoms and further improving quality of life. Prior data showed CA BCS eating more soy food and cruciferous vegetables than NHWs. Higher soy intake reduces menopausal symptoms and fatigue. Yet, CA BCS had lower adherence to physical activity guidelines than NHWs. Psychosocial stress, poor diet, insufficient exercise, fatigue, and pain are all related to chronic inflammation. Yet, Chinese practices in healthy diet and emotional balance may decrease inflammation. Our preliminary findings were based on self-reports, so we cannot explain how those multifaceted sociocultural and individual factors are intertwined to affect inflammation in the body and outcome differences between the two racial groups. To comprehensively understand sociocultural influence on individual coping behaviors and how they in turn affect racial differences in biological responses (i.e., inflammation and cortisol stress markers), symptom severity, and quality of life, we propose a bi-racial, cohort study among 260 CA BCS (1-5 years post diagnosis) who will be age- and stage-matched to 260 NHW BCS. Utilizing a society-behavior-biology multilevel framework, we will investigate the dynamics of sociocultural, psychological, and behavioral (diet and exercise) influences on symptom severity, biological responses, and functional outcomes. Participants will complete telephone survey interviews and provide blood samples at baseline and 6- and 12-month post- baseline follow-ups. Next, in-depth individual interviews with a subset of samples will be conducted to investigate in depth the causative factors in the pathways in order to develop individually and culturally appropriate interventions conducive to improving clinical care for targeted cancer survivor populations. This is well aligned with the Cancer Moonshot Initiative aimed at increasing symptom control and improving survival.
This longitudinal prospective study will investigate the dynamics of sociocultural, psychological, and behavioral (e.g., diet and exercise) influences on biological response, functional, and symptom outcomes among Chinese American and non-Hispanic White breast cancer survivors. Biological, dietary, and survey data will be collected at three time points to examine whether 1) there are racial differences in study outcomes across time, 2) outcome differences are mediated by different psychosocial and behavioral pathways, and 3) mediational pathways are moderated by race and acculturation level. In-depth individual interviews with a subset of the participants will be conducted in the fourth year of this study to grasp sociocultural and behavioral causes of the pathways in order to develop individually and culturally appropriate interventions to promote cancer survivorship outcomes.
