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

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 2006–2011, 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 wellbeing” (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.

Socioeconomic status and quality of life among Chinese American breast cancer survivors: The mediating roles of social support and social constraints

“…A qualitative study reported that, low‐ to middle‐income Chinese immigrant survivors cannot afford cancer care services at convenient locations and were preoccupied with concerns for cancer care costs. Such difficulties brought negative impact on household duties, productivity at work, and family prosperity . Taken together, these findings from cancer populations suggest that education and income are interrelated but distinct SES resources and could be transformed into unique patterns of health impacts after cancer.…”

“…While the incidence rate of breast cancer has been declining among non‐Hispanic White people (NHWs), there is a dramatically rising trend among Asian Americans . Compared with NHWs, Asian American breast cancer survivors are largely underserved due to the status of being immigrants and cultural barriers in recruiting psychosocial resources, despite the increasing need for cancer care …”

“…A recent meta‐analysis revealed that CABCS, especially immigrant survivors, had lower education and income levels and reported smaller social networks and greater difficulties in explicitly soliciting social support. A mixed‐methods study revealed that Chinese immigrant breast cancer survivors perceived inadequate economic resources and social support, which constituted foremost barriers to quality care and cancer recovery …”

Neutrophil to lymphocyte ratio (NLR) for prediction of distant metastasis-free survival (DMFS) in early breast cancer: a propensity score-matched analysis

“…Besides, the survival of Asian patients with breast cancer is known to be longer than that of Caucasian women, probably owing more to lifestyle habits than to genetic susceptibility; however, this matter needs to be clarified by further studies. [37][38][39][40][41][42][43] Another issue concerns the best approach to define the optimal cut-off value for LNR, as median, quartiles and ROC curve analysis have been variably used by different authors.…”

Differences in quality of life between American and Chinese breast cancer survivors

“…For example, Asian American breast cancer survivors have reported lower QOL than their European counterparts [9, 10]; Chinese American survivors are more likely to experience poorer socioeconomic well-being than non-Hispanic White survivors [11]. Qualitative evidence has also shown that Chinese survivors describe more distress than Americans [12].…”