Culture in cancer survivorship interventions for Asian Americans: A systematic review and critical analyses.

Abstract

Frequently hard to reach and underserved, Asian Americans are the racial group whose chief cause of mortality is cancer. Efficacious survivorship care is important, but little is known about extant intervention efforts for this community and how culture has been integrated into these efforts. This study examined cancer survivorship interventions for Asian Americans and how culture has been addressed, using an integrated framework consisting of goals, theory, methods, and cultural concordance in the persons of the interventions. Mixed methods comprising a systematic review and critical analyses were employed. Results indicate that only 13 interventions have been delivered to this community, with six of them pilot studies, and that they used a narrow range of focus on cancer type, with all interventions focusing on breast cancer survivorship. Applications of theory and methods were incongruent with cultural valuation of emotion expression and help seeking behavior. Cultural concordance was operationalized mostly as the racial ethnic match between interventionists and survivors. Deep culture factors including cultural beliefs and values were rarely specified. Theory and research should move beyond the currently prevalent definition of culture as race, ethnicity, or language, and interventions should consider the role of culture in their goals, theory, methods, and persons. Advances in theory and research are needed, as neither reliance on the Western paradigm nor assumptions about Asian Americans can be appropriate for achieving cultural validity. Future conceptualization and operationalization should consider culture more than race, ethnicity, or language. Public Significance StatementExisting cancer survivorship interventions for Asian American are small in number and limited in focus and scope. Future research should examine the role of culture in the goals, theories, and methods of these interventions, and the concordance between interventionist and intervention participants.

A systematic review of the impact of cancer survivorship interventions with Asian American cancer survivors.

“…Findings. The ICSG-AA (reported in one article) and CAPAA (reported in one article), which were 1-month interventions, did not find any significant differences in outcomes, such as QOL, cancer pain, or physical and psychological symptoms, between the intervention and control groups (Chee et al, , 2017. However, the CAPAA intervention group reported reduced perceived isolation, reduced uncertainty, and increased personal resources, compared to the control group.…”

“…Sources of gray literature were searched through Google Scholar (first 100 search results) and https://ClinicalTrials.gov. Reference lists of included studies and other relevant systematic reviews (Cao & Cho, 2021; Chou et al, 2016; Wen, Fang, et al, 2014) were also hand searched. Our search terms included terms related to: (Asian) AND (cancer OR cancer survivor) AND (health behavior OR intervention OR social support OR health education OR exercise OR self care OR psychological adaptation OR QOL; see for the MEDLINE search strategy).…”

“…Table 1 summarizes the impact of cancer survivorship interventions on outcomes. For two articles (Chee et al, 2017;Im et al, 2019), the authors considered p values under .10 as statistically significant due to the small sample sizes; to facilitate the synthesis of findings across articles in this systematic review, we only considered p values under .05 as statistically significant. Out of the 18 articles, eight reported a statistic for effect sizes Lu et al, , 2014Lu et al, , 2012Lu et al, , 2017Warmoth et al, 2020).…”

“…Previous research has highlighted the centrality of culture in one’s perspective of the cancer survivorship experience, decision-making, and coping. There have been calls for greater consideration of culture in intervention development, design, content, measurement, and implementation (Ashing-Giwa et al, 2004; Aziz & Rowland, 2002; Cao & Cho, 2021; Lockhart et al, 2020). Previous systematic reviews focusing on Asian Americans have synthesized studies of the cancer experience and survivorship (Wen, Fang, et al, 2014) and support group interventions (Chou et al, 2016) but these reviews were limited to breast cancer survivors only.…”

“…Previous systematic reviews focusing on Asian Americans have synthesized studies of the cancer experience and survivorship (Wen, Fang, et al, 2014) and support group interventions (Chou et al, 2016) but these reviews were limited to breast cancer survivors only. A recent systematic review assessed how culture was incorporated into the goals, theories, methods, and design of cancer survivorship interventions for Asian Americans but did not focus on the impact of these interventions on outcomes (Cao & Cho, 2021). The aims of our review were to (a) assess the types of psychosocial or behavioral interventions that have been conducted for Asian American and Asian immigrant cancer survivors, and (b) assess these cancer survivorship interventions’ impact on psychosocial and behavioral outcomes.…”