There are an estimated 2.2 million breast cancer survivors alive today in the US including a significant number of Asian survivors. Breast cancer is the most common cancer in Chinese women, the largest Asian population, of which 70% are immigrants. Chinese women's breast cancer incidence rates have been steadily increasing and will considerably increase in the coming decades as this population rapidly grows and ages. Many Chinese with a cancer diagnosis are stigmatized and face cultural and language barriers to adjust their problems of distress and this may lead to their low quality of life. Research suggests that Chinese breast cancer survivors have poorer adaptation and much smaller social networks to seek for supports than White breast cancer survivors. However, we know little about this population and we even know less about Chinese survivors'quality of life and how cultural factors affect their survivorship. To fill this gap in knowledge, the aims of this study are to use the Transactional Model of Stress and Coping to 1) understand the impact of culture on self- appraisal of stress, use of coping strategies, and adaptation to daily life among Chinese and White breast cancer survivors and 2) examine whether interventions for Chinese need to be culturally tailored. To achieve these aims, we have assembled an experienced interdisciplinary, multi-cultural, and bilingual investigative team to conduct a mixed, two-phased research design. In the first phase, we will conduct 2 focus groups among Chinese and 2 among Whites (each with 8 women) to gain an in-depth understanding of survivorship experience, needs, preferences for intervention approaches and whether model constructs are differently defined in each cultural group. In addition, we will individually interview 10 Chinese women to include those who are stigmatized and unwilling to discuss their survivorship issues in person. We will use the qualitative data to refine our survey instruments. The refined surveys will be finalized through Chinese community health advisors'comments and cognitive lab testing. In the second phase, we will conduct structured telephone interviews with 100 Chinese and 100 White breast cancer survivors who are 1-3 post treatments to examine cultural differences in stress appraisal, coping, and adaptation between the two racial groups. In each phase, we will examine whether a culturally tailored intervention is needed to promote Chinese cancer survivorship. We will recruit participants from the Greater Bay Area Cancer Registry, operated by the Northern California Cancer Center. Based on the population-based survey data, this study will advance our conceptual and methodological knowledge about the role of culture in breast cancer survivorship. This study addresses the top priority of the NCI and the Institute of Medicine for improving survivorship care in minority populations. Interventions based on the study results will have the potential to optimize healthy life of Chinese breast cancer survivors and promote overall cancer survivorship in this large growing population.
The proposed pilot study examine the role of culture in an individual's perception of stress, use of coping strategies, and adaptation to daily life among Chinese breast cancer survivors in comparison with White breast cancer survivors. Chinese and White women who were diagnosed with early-stage breast cancer will be invited from a population-based cancer registry in Northern California to participate in our qualitative and quantitative assessment. The results of this study will contribute to our understanding of cultural impact in cancer survivorship and inform the development of effective interventions to promote Chinese survivors'quality of life.
