Match between culture and social support: Acculturation moderates the relationship between social support and well-being of Chinese American breast cancer survivors

Purpose

Social support does not always lead to health benefits; the outcomes depend on the match between the need and the provision of social support. Culture shapes individuals’ preference of social support types (e.g., supportive communication, social companionship, and tangible support). The present study examined how the association between social support and well-being may vary as a function of acculturation among minority cancer survivors.

Methods

One hundred and twenty-three Chinese American breast cancer survivors were invited to complete a questionnaire package.

Results

Findings showed that acculturation moderated the association of social support subtypes with psychological and physical well-being. Higher emotional/information support was associated with better quality of life and less physical symptoms among highly acculturated cancer survivors but more physical symptoms among those who were less acculturated. Tangible support was associated with more physical symptoms among highly acculturated cancer survivors but less physical symptoms among those who are less acculturated. Positive social interaction was associated with better quality of life and less physical symptoms among less acculturated cancer survivors but not associated with quality of life or physical symptoms among their highly acculturated counterparts.

Conclusion

The findings pointed to the significance of acculturation in breast cancer experience among minority women, especially its interplay with social support transactions.

     

The relation between negative emotional suppression and emotional distress in breast cancer diagnosis and treatment

Our objective was to investigate differences in emotional distress between negative emotional suppression and expression patients in the progress of medical treatment, including the operation. We studied the differences in affective response between patients who suppress negative emotion and those who express negative emotion by using Profile of Mood States (McNair, Lorr, & Droppleman, 1971) at four sessions: (a) at the first visit to the clinic, (b) immediately after being told the diagnosis of breast cancer, (c) after the operation, and (d) at 3 months after discharge. Our results showed that emotional suppression patients tended to report more emotional distress (in particular, anxiety, depression, and anger) than did emotional expression patients on 3 sessions, the exception being after the operation. Also, patients who suppress anger and anxiety felt strong psychological distress. We suggest that it is essential to encourage suppressive patients to express both negative and positive emotion clearly and appropriately.     

Weight change and its correlates among breast cancer survivors

We assessed weight change from diagnosis to approximately 18 mo after cancer diagnosis and evaluated its correlates in a large, population-based, cohort study of women diagnosed with stage 0-IV breast cancer. A total of 4,561 cases with weight information 1 yr prior to diagnosis, at diagnosis, and at the 18-mo postdiagnosis interview were included in the study. Multinomial logistic regression models were conducted to examine the association of weight change from diagnosis to 18 mo after diagnosis with sociodemographic, clinical, and lifestyle factors. The mean weight change from diagnosis to 18 mo after diagnosis was a gain of 1.7 kg (median: 2.0). Overall, 61% of women gained weight, 27% gained 2-5 kg, and 24% gained ≥5 kg, while approximately 14% lost >2 kg during the 18-mo postdiagnosis period. Greater weight gain was significantly related to younger age, premenopausal status, mixed receptor status, more advanced disease stage, prediagnosis weight loss, higher dietary intake, and cigarette smoking. Women with obesity and serious comorbidity were more likely to lose weight. Moderate exercise was not significantly related to weight change. Weight gain is common among breast cancer survivors. Sociodemographic, clinical, and lifestyle factors are related to weight change. Appropriate intervention strategies should be developed.     

Acculturation and breast cancer screening among Hispanic women in New York City.

OBJECTIVES: This study investigated whether acculturation was associated with the receipt of clinical breast examinations and mammograms among Colombian, Ecuadorian, Dominican, and Puerto Rican women aged 18 to 74 years in New York City in 1992. METHODS: A bilingual, targeted, random-digit-dialed telephone survey was conducted among 908 Hispanic women from a population-based quota sample. Outcome measures included ever and recent use of clinical breast examinations and mammograms. Multivariate logistic regression models were used to assess the effect of acculturation on screening use. RESULTS: When demographic, socioeconomic, and health system characteristics and cancer attitudes and beliefs were controlled for, women who were more acculturated had significantly higher odds of ever and recently receiving a clinical breast examination (P < or = .01) and of ever (P < or = .01) and recently (P < or = .05) receiving a mammogram than did less acculturated women. For all screening measures, there was a linear increase in the adjusted probability of being screened as a function of acculturation. CONCLUSIONS: Neighborhood and health system interventions to increase screening among Hispanic women should target the less acculturated.     

乳腺癌患者身心功能状况与夫妻关系的相关性研究

目的 了解乳腺癌患者的夫妻关系、自我效能感水平、社会支持、自尊程度和生命质量状况,并探讨家庭支持中的夫妻关系作为重要支持系统,与乳腺癌患者身心功能状况之间的关系。方法 对2016年8月-2017年8月于某地三家三级甲等医院就诊的456例乳腺癌患者采用一般资料问卷、Locke-Wallace婚姻调适量表、乳腺癌幸存者自我效能感量表、乳腺癌患者性调节和身体意象量表、乳腺癌患者生命质量测定量表和Rosenberg自尊量表、社会支持评定量表进行问卷调查。结果 本次调查的乳腺癌患者Locke-Wallace婚姻调适量表得分平均为(111.04±31.63)分。结果显示,乳腺癌患者的夫妻关系与年龄、外向性格、居住地城镇和城市、根治术、客观支持、主观支持、生命质量中的生理、社会家庭、自我效能感、身体意象、性功能、自尊程度有关,t值介于-5.231~7.133之间,12个因子的累计贡献率为68.3%。结论 夫妻关系是乳腺癌患者重要的支持系统,对患者的身心功能各个方面均产生有力影响,因此,医护人员应着重将患者配偶纳入到治疗康复计划中,给予足够的支持和关心,让患者感受到尊重、理解,从而减少功能障碍,促进躯体康复,尽快融入家庭生活和社会工作。     

Acculturation, social support, and quality of life for Korean immigrant breast and gynecological cancer survivors

Objectives. This study examines the direct and/or indirect pathways among acculturation, social support, depressive symptoms, and quality of life (QOL) for Korean immigrant breast and gynecological cancer survivors.

Design. The QOL-Cancer Survivor measure was translated and then administered to 51 survivors. This tool measured acculturation by assessing westernization, language barriers, and length of stay. In addition, the Brief Symptom Inventory-18 was used to assess depressive symptoms. Social support components were conceptualized as comprising both functional social support and social network structures.

Results. Structural equation modeling identified significant relationships among acculturation, social support, depressive symptoms, and QOL. Higher acculturation was associated with positive network structures (larger network size, diversity, and closer social ties) and lower depressive symptoms, which in turn contributed to better QOL. Simultaneously, positive social network structures strongly correlated with better emotional support and, thus, influenced lower depressive symptoms.

Conclusions. The evidence that acculturation influences QOL through social support for Korean immigrant cancer survivors should serve as a rationale for developing psychosocial interventions that enhance immigrant cancer survivors’ social participation and adjustment in the unfamiliar US environment.     

乳腺癌患者心理应对调节与生活质量相关分析

目的了解乳腺癌患者心理调节、应对方式与生活质量之间的相关性。方法采用病例对照研究方法,于2008年8月-2010年8月选择广东省广州市3家三级甲等医院确诊的女性乳腺癌患者进行调查,采用Pearson相关分析方法分析患者心理调节、应对方式及生活质量三者间相关性。结果病例组生活质量的"躯体良好和能力"与应对的"发泄"、"幻想"均呈负相关(P<0.05),生活质量的"心理良好"与应对的"幻想"、"回避与压抑"均呈负相关(P<0.05);对照组生活质量的"社会良好"与应对的"发泄"、 "幻想"、"屈服"均呈负相关(P<0.05),生活质量的"社会良好"与应对的"回避与压抑"呈正相关(r=0.259,P<0.05),生活质量的"心理良好"与应对的"屈服"呈正相关(r=0.268,P<0.05)。结论不同病程的乳腺癌患者采取不同的应对方式,长期存活者更倾向于积极乐观的应对调节。     

Different pathways in social support and quality of life between Korean American and Korean breast and gynecological cancer survivors

PURPOSE: The purpose of this study was to investigate: (1) how social support influences quality of life (QOL) and (2) whether or not the pathways for predicting QOL outcomes differ between Korean American and Korean survivors of breast and gynecological cancer. METHOD: To identify multiple dimensions of health status and psychosocial outcomes, two standardized QOL and psychological distress measures were administered to 51 Korean Americans and 110 Koreans. Social support was measured by items assessing functional social support and social network structures. Hierarchical multiple regression and path analyses were employed to investigate the effects of social support on outcomes and to compare between Korean Americans and Koreans. RESULTS: The findings indicate that functional social support directly influences QOL and psychological distress, and social network structures are directly and/or indirectly associated with outcomes. Moreover, the two groups showed different pathways from social support to outcomes. CONCLUSION: This study provides practical research information by illuminating the relationships between social support components influencing QOL for Korean American and Korean survivors. This study may increase the utility and efficacy of the research and interventions to enhance cancer survivors' social participation and to diminish barriers to follow-up care, considering the different living conditions between the United States and Korea.     

Acculturation, Discrimination, and Depressive Symptoms among Chinese American Adolescents: A Longitudinal Study

This study focused on the perceptions of discrimination for Chinese American adolescents: how perceptions changed over time, how generational status and acculturation were related to these changes, and whether earlier discrimination experiences were related to subsequent depressive symptomatology. The sample included 309 Chinese American adolescents who participated in a 2 year, three-wave longitudinal study. Findings suggest that perceptions of discrimination became more acute over time for the majority of Chinese American adolescents in our study, that greater initial levels of perceptions of discrimination predicted a slower orientation to U.S. culture, that discrimination was not related to orientation to Chinese culture, and that an increase in perceptions of discrimination was associated with an increase in depressive symptoms. Greater orientation to Chinese culture was also related to fewer depressive symptoms. The findings are discussed in light of the unique cultural context of the study.     

Longitudinal change of quality of life in the first five years of survival among disease-free Chinese breast cancer survivors

Quality of Life Research - This study aimed to investigate changes of QoL during the first 5 years of survival among disease-free Chinese breast cancer survivors. A prospective cohort study...     

Using a Delphi technique to determine the needs of African American breast cancer survivors

A qualitative study was designed in collaboration with the Sisters Network, Inc., the only nonprofit national Black breast cancer support group, to identify the needs of Black breast cancer survivors. This article describes the use of the Delphi technique as a methodological tool for listening to culturally different speakers and building consensus among members of a racial minority group regarding their most important needs as breast cancer survivors. The specific objective of the study was to determine if the seldom-used Delphi technique could serve as a tool for deriving consensus on a significant health care concern among members of a racial minority group. Sixty-two survivors from different geographical regions of the United States participated in the study. The Delphi technique proved to be a useful qualitative method for encouraging discussion among a group of women with a vested interest in a specific health issue.     

Improvement of metabolism among obese breast cancer survivors in differing weight loss regimens

OBJECTIVE: To compare the efficacy of different weight loss regimens on body weight loss and metabolic improvement in breast cancer survivors. RESEARCH METHODS AND PROCEDURES: Forty-eight obese breast cancer survivors were randomly divided into four groups and were followed for 1 year: 1) the Control group (subjects did not receive specific nutrition counseling); 2) the Weight Watchers group (subjects were given free coupons to attend weekly Weight Watchers meetings); 3) the Individualized group (a registered dietitian provided one-on-one nutritional counseling); and 4) the Comprehensive group (subjects received individualized dietary counseling and free coupons for the weekly Weight Watchers meetings). At baseline and 3-, 6-, and 12-month data collection visits, a fasting blood sample was obtained for assays. A three-day dietary record was kept during the week before these visits and dietary intake was analyzed. RESULTS: Subjects in the three intervention groups lost weight (Control: 1.1 +/- 1.7 kg; Weight Watchers: -2.7 +/- 2.1 kg; Individualized: -8.0 +/- 1.9 kg; Comprehensive: -9.5 +/- 2.7 kg) and percentage body fat, but only the Individualized and Comprehensive groups had significant losses. Subjects in the Comprehensive group showed the most improvement in cholesterol levels and had reductions in blood leptin levels. DISCUSSION: Because insulin resistance and high blood leptin levels are associated with breast cancer, losing weight to improve these parameters may reduce the risk of recurrence. Only subjects in the Comprehensive group showed significant reductions in body weight and fat, energy intake, and leptin levels. For breast cancer survivors, different weight loss strategies should be considered to assist them in losing weight.     

Real-time moment-to-moment emotional responses to narrative and informational breast cancer videos in African American women

In a randomized experiment using moment-to-moment audience analysis methods, we compared women's emotional responses with a narrative versus informational breast cancer video. Both videos communicated three key messages about breast cancer: (i) understand your breast cancer risk, (ii) talk openly about breast cancer and (iii) get regular mammograms. A community-based convenience sample of African American women (n = 59) used a hand-held audience response device to report the intensity of their emotional reaction while watching one of the two videos. Strong emotions were more likely to correspond to contextual information about characters in the video and less likely to correspond to health content among women who watched the narrative video compared with those who watched the informational video (P < 0.05). Women who watched the narrative video were more likely to report feeling attentive (41 versus 28%, respectively), inspired (54 versus 34%) and proud (30 versus 18%) and less likely to feel upset (8 versus 16%) (all P < 0.05). Women in the narrative group were more likely to mention women's personal stories than health information in open-ended recall questions, but this did not detract from obtaining health information. Findings suggest that stories can be used to communicate health information without distracting from core health content.     

Sexuality after breast cancer treatment: changes and coping strategies among Japanese survivors

Sexuality after a cancer diagnosis has long been neglected in the clinical and research settings in many countries. In particular, research in Asia on sexuality and cancer among women is extremely scarce. Semi-structured interviews were conducted with 21 Japanese women with breast cancer (mean age 42.2 years; median length between surgery and first interview 17 months) to explore their views on sexuality following breast cancer treatment. Analysis using the Grounded Theory approach revealed four major themes: (a) hesitation in resuming sex after treatment, (b) sexual changes after resuming sex, (c) coping attitudes to the changes, and (d) long-term outcomes of the relationship with partners. Contrary to Japanese breast surgeons' optimistic outlooks, the majority of informants referred to the impact of treatment on the physical as well as psychological aspects of their sexuality. Factors that influenced women's experiences included the pace of their psychological and physical recovery after treatment, fear of their partner's negative response, the importance of the sexual relationship for the couple, and their partner's understanding and support. Suggestions for medical professionals on how to support women's sexuality after cancer are discussed with reference to the Japanese socio-cultural and medical context.