Physical distress and cancer care experiences among Chinese-American and non-Hispanic White breast cancer survivors

Abstract

Objective The number of Chinese-American breast cancer survivors (BCS) is increasing as a result of increasing incidence rates. There has been little research on Chinese BCS’ follow-up cancer care. This qualitative study aims to understand how Chinese-American BCS experience and cope with physical distress relative to non-Hispanic White (NHW) survivors. Methods Seventy-one BCS (37 Chinese immigrant, 7 US-born Chinese, 27 NHW) were recruited from the Greater Bay Area Cancer Registry to participate in focus group discussions or one-on-one interviews about their survivorship experiences. All BCS were diagnosed with breast cancer at stage 0-IIA between 2006-2009, and had survived for 1-4 years without recurrence. Interviews were conducted in Cantonese, Mandarin, or English. Data analyses followed established qualitative methods of content analysis. Results BCS experienced pain and side effects from radiation, surgery, and hormonal therapy. Physical distress subsequently caused emotional concerns about recurrence or metastasis. Most BCS consulted physicians about their physical distress. Chinese immigrant BCS were less likely to have their issues resolved compared to NHW and US-born Chinese who were more likely to question physicians, ask for referrals, and make repeat attempts if their problems were not resolved. Some Chinese immigrant BCS turned to Traditional Chinese Medicine for relief or accepted the idea that physical distress was part of survivorship. Conclusion Chinese immigrant BCS may be at risk for greater distress compared with US-born Chinese and NHW BCS because of cultural norms that make them less inclined to express their needs to physicians or challenge physicians when their needs are not met. Furthermore, they may express symptoms in culturally unique ways (e.g., hot-cold imbalances). Further research is needed to determine how to best improve survivorship care experiences in this understudied population, with the goal of decreasing BCS’ physical distress and improving quality of life.

Perceptions, expectations, and attitudes about communication with physicians among Chinese American and non-Hispanic white women with early stage breast cancer

“…Thus, physicians’ ability to communicate helpful advice and complete information was key to patients’ comfort regarding prognosis and treatment. For cancer patients, unresolved physical problems often prompt emotional uncertainty about prognosis, [19;32;33]. Our findings support prior survivor-physician research [34;35] showing that survivors perceived optimal quality of care when they experienced satisfactory patient-centered communication with physicians.…”

“…It is likely that the former have less access to scientific based, linguistically appropriate materials about cancer treatments and survivorship care than the other groups. Previous studies indicate that NHW, and more educated patients are more likely to have satisfactory communication with their physicians and get their physical problems resolved [3;19;42;43]. Given the qualitative nature of this study, our current findings could not explain to what extent acculturation and sociodemographics compound the dynamics of patient-physician communication.…”

“…Chinese Americans consistently report poorer communication with their clinical providers compared with Whites [10;12;13]. Chinese American breast cancer survivors also report more unresolved physical problems compared to Non-Hispanic White (NHW) survivors [13;19]. In this paper, we report our qualitative investigation of similarities and differences between Chinese American and NHW patients’ perceptions and expectations of communication with physicians along the continuum of breast cancer care (i.e., diagnosis, treatment, and follow-up care).…”

Communication with Patients Suffering from Serious Physical Illness

“…In another study, immigrant Chinese breast cancer survivors expressed symptoms in a culturally unique way (e.g. hot-cold imbalances) and were also at higher risk for emotional distress compared with US-born Chinese and non-Hispanic breast cancer survivors because of cultural norms that influence the tendency to express one's own needs to physicians or to challenge physicians when one's own needs are not met [37] .…”

Using expressive writing to explore thoughts and beliefs about cancer and treatment among Chinese American immigrant breast cancer survivors

“…The primary goal of this article was to understand beliefs about cancer, its treatment, and relevant concerns among Chinese American breast cancer survivors (BCS). Compared to non-Hispanic White BCS in the United States, Chinese immigrant BCS were less likely to have treatment-related issues (i.e., physical distress) resolved, potentially due to their lower tendency to ask physicians questions, ask for referrals, and make repeated attempts to cope with physical distress [1]. A recent study also highlights that unmet psychosocial needs (e.g., lack of opportunities for open discussions of feelings, needs for medical information, needs for culturally- and linguistically-appropriate support groups) disrupted quality of life among Chinese American BCS [2].…”