Is family functioning and communication associated with health-related quality of life for Chinese- and Korean-American breast cancer survivors?

PURPOSE: This study aims to investigate direct and indirect pathways of family flexibility, social support, and family communication on health-related quality of life (HRQOL) for Chinese- and Korean-American breast cancer survivors (BCS). METHODS: A total of 157 Chinese (n = 86)- and Korean-American (n = 71) BCS were recruited from the California Cancer Surveillance Program and area hospitals in Los Angeles County. The present study was guided by the Resiliency Model of Family Stress, Adjustment, and Adaptation. RESULTS: Structural equation modeling demonstrated that (1) family communication was directly associated with HRQOL for both groups; (2) family flexibility was indirectly associated with HRQOL through family communication for Korean-Americans only; (3) social support mediated the relationship between family flexibility and family communication for Chinese-Americans only; and (4) acculturation was directly related to social support for both groups. Multigroup analysis demonstrated that the structural paths were equivalent between Chinese- and Korean-American BCS, although statistical differences in baseline parameters were noted. CONCLUSIONS: Our findings suggest that family communication impacts HRQOL among Asian-American BCS. Our results show that while there are commonalities in family characteristics among Asian-Americans, specific ethnic variations also exist. Therefore, specific cultural and familial contexts should be assessed to better inform interventions to enhance family communication strategies and improve HRQOL.

Examining the effect of minority status and neighborhood characteristics on cervical cancer survival outcomes.

OBJECTIVE: Understanding the factors that contribute to mortality and survival is central to health outcome research. The purpose of this study was to investigate the following: (1) differences in survival status by ethnicity and neighborhood median income level; and (2) individual- and neighborhood-level factors influencing cervical cancer survival. METHODS: This study was based on data from 1811 cervical cancer cases obtained through the California Cancer Surveillance Program. The dependent variable was days of survival from date of cancer diagnosis. Zip code-based neighborhood-level variables were obtained from Census 2000 data. RESULTS: Ethnicity was significantly associated with survival (χ²=20.58; p<0.001), with African-Americans showing the shortest survival. The 5-year survival rates of European-, African-, Latino-, and Asian-American patients for all stages combined were 85%, 75%, 85%, and 84%, respectively. Differences in survival between high- and low-income regions were not observed. However, when ethnicity was considered, Asian-Americans who lived in high-income regions showed longer survival than their low-income community counterparts (χ²=4.531; p<0.05). The multilevel model demonstrated ethnicity, age at diagnosis, and cancer stage stratified by surgery to be significantly associated with cervical cancer survival at the individual level. At the neighborhood level, residing in neighborhoods with a high proportion of African-Americans increased the risk of death by 1%. CONCLUSIONS: The neighborhood context may be an influential contributor to survival for Asian- and African-Americans specifically. These findings necessitate closer examination of the unique contribution of ethnicity and neighborhood on cancer survival to disentangle the role of ethnic group membership, socio-ecological contexts and stress, and medical factors on disease outcomes.

The impact of cultural characteristics on colorectal cancer screening adherence among Filipinos in the United States: a pilot study.

OBJECTIVES: Studies on colorectal cancer screening among specific Asian American groups are limited despite the fact that Asians are comprised of culturally distinct subgroups. The purpose of this study was to investigate the impact of cultural characteristics on colorectal cancer screening adherence among Filipinos in the United States. METHODS: One hundred and seventeen Filipino men and women aged 50 years or older participated in the cross-section research design. Lifetime proportion of immigration, language preference and cultural beliefs of personal control regarding health outcomes measured cultural characteristics. Demographic and healthcare variables were also measured to describe the study sample. Participant recruitment employed culturally responsive sampling methods. RESULTS: There was no significant association between language preference and screening. Likewise, perceived personal internal control of health outcome was not related to screening. However, personal external control revealed a marginally significant association. The percent of lifetime residence in the United States was significantly greater among those who were adherent to screening than those who were not adherent. After adjusting for demographic and healthcare variables, the relationship between length of immigration and screening adherence was no longer significant. Finally, age and doctor's recommendation showed significant impact on colorectal cancer screening adherence. DISCUSSION: This pilot study adds to the knowledge regarding cultural factors associated with colorectal cancer screening behaviors among Filipino Americans. Future research is needed to confirm findings that will be useful in developing culturally appropriate strategies to increase screening adherence.

Acculturation in the adaptation of Chinese-American women to breast cancer: a mixed-method approach.

AIMS: To explore how and to what extent acculturation and immigration affect Chinese-American immigrant women's breast cancer experience. BACKGROUND: Acculturation is an important indicator for immigrant health. Less empirical research has been conducted on the association between acculturation and breast cancer experience among Chinese immigrant women in the USA. DESIGN: A mixed methods study. METHODS: A total of 107 Chinese-American women with breast cancer completed the structured questionnaire survey, and 16 women completed face-to-face in-depth interviews. RESULTS: In the quantitative findings, acculturation was related to health beliefs, social support and life stress. Cultural interpretations of the qualitative information are offered to show that breast cancer experience was intertwined with cultural adaptation in a given immigrant environment. Chinese cultural beliefs persistently, even after years of immigration, guide Chinese-American immigrant women to respond to breast cancer across the meaning of health and illness, family ties and involvement and social interaction. CONCLUSION: Our findings show that acculturation is related to health beliefs, social support and life stress in the trajectory of breast cancer adaptation among Chinese-American immigrant women. Life stresses derived from immigration bring additional difficulties for immigrant women living with cancer. RELEVANCE TO CLINICAL PRACTICE: This study pinpoints that traditional cultural beliefs and immigration stress may influence Chinese-American women to cope with breast cancer. To promote culturally sensitive cancer care for immigrants, healthcare professionals should be aware of and learn intercultural competence. Ethnic social support or outreach healthcare programme may benefit new immigrant families or the immigrant families, who lack social connection, to cope with cancer.

Surviving cervical cancer: does health-related quality of life influence survival?

OBJECTIVE: This study investigates the association between health-related quality of life (HRQOL) outcomes and survival status among a population-based cohort diagnosed with invasive cancer of the cervix uteri. METHODS: This study is based on data from 353 multiethnic cervical cancer survivors (CCS) recruited through the California Cancer Surveillance Program. The independent variable is HRQOL measured by the FACT-CX (FACT-G plus additional items) and the SF-12. The dependent variable is survival from date of the HRQOL survey. Kaplan-Meier estimates and univariate and multivariate Cox Proportional Hazards Regression models were used to examine the relationship between HRQOL and survival. RESULTS: In the Kaplan-Meier analyses, the FACT-CX functional well-being score equal to or above the median score was significantly associated with improved overall survival (X(2)=7.19; p=0.007). Significant differences in survival were observed for the SF-12 physical and mental health component scores. In the multivariate Cox regression analyses, the final model indicated that the FACT-CX total scores, functional well-being, and additional cervical cancer concerns subscales, and the SF-12 physical and mental component summary scores significantly influenced survival, after controlling for medical characteristics. However, the FACT components that do not include cervical cancer specific items including mean standardized FACT-G and physical, emotional, and social/family well-being subscales were not predictors of survival before and after adjustment for covariates. CONCLUSIONS: The results of this study advance the current scientific knowledge by confirming that HRQOL outcomes, in particular the physical, function and mental health dimensions are associated with survival for CCS. These findings highlight the utility of cancer site specific HRQOL data to inform the psychosocial and symptom management aspects, as well as the medical follow-up care practice and research that may extend life.

Exploring the association between functional strain and emotional well-being among a population-based sample of breast cancer survivors.

OBJECTIVE: Breast cancer survival and survivorship outcomes have improved dramatically; yet, there are still considerable morbidities associated with this illness. Functional strain is conceptualized as the unfavorable outcome of the functional well-being domain of health-related quality of life. This study intends to (1) examine the adequacy of the functional strain concept; (2) describe the level of functional strain and emotional well-being by ethnicity and job types; and (3) investigate the salient functional strain components influencing emotional well-being for breast cancer survivors (BCS) after controlling for ethnicity and job types. METHODS: A cross-sectional design with mixed sampling methods was used. BCS were recruited from the California Cancer Surveillance Program, hospital registries and community agencies in Southern California. Functional strain was measured by assessing family and work burdens. RESULTS: Confirmatory factor analysis established the adequacy of the two factors (family and work burdens) defining the functional strain. Findings demonstrated significant differences in functional strain by ethnicity and job types. Latina-Americans and homemakers/housewives showed the worst scores in functional strain variables. The final model examining the impact of functional strain components on emotional well-being explained 34% of the variance of emotional well-being. CONCLUSION: Findings suggest the impact of cancer on family and work life varies by ethnic and demographic characteristics, such that Latino ethnicity and homemaker/housewife status may be risk factors for functional strain. Our findings imply that functional strain provides a reasonable concept that can be used to deepen our understanding and examination of the impact of functional status on emotional well-being.

Exploring the relationship between physical well-being and healthy lifestyle changes among European- and Latina-American breast and cervical cancer survivors.

BACKGROUND: Cancer and its treatments have a lingering and often negative impact on survivors' physical well-being. The physical sequelae impinge on daily functioning and overall HRQOL, and perhaps influence lifestyle changes post-cancer. This study aims to examine: (1) physical well-being items that are associated with low overall health-related quality of life; and (2) the relationship between physical well-being outcomes and healthy lifestyle changes by cancer type. METHODS: This study employed a cross-sectional design with mixed sampling methods. In total 922 European- (n=452) and Latina-American (n=470) breast (BCS) or cervical cancer survivors (CCS) were recruited from the California Cancer Surveillance Program and Los Angeles area hospital registries. Item responses from survivors in the lowest quartile of total quality of life scores and percentages reflecting low physical well-being levels were calculated. RESULTS: A statistical approach to individual items provides unique and valuable measurement and clinical information above and beyond physical well-being total scores. Physical well-being item responses varied according to ethnicity, income, and education. BCS and CCS showed different patterns in the relationship between physical well-being items and lifestyle changes. Specifically, exercise was significantly related to physical well-being items for BCS, while diet changes were significantly associated with physical well-being for CCS. CONCLUSIONS: Results reveal unique correlates of physical well-being items by cancer type, ethnicity, and lifestyle changes. Clinically, this study highlights the need for greater consideration of individual and medical characteristics in developing culturally sensitive and patient responsive interventions to promote healthy lifestyles and improve survivorship outcomes.

Predicting physical quality of life among a multiethnic sample of breast cancer survivors.

BACKGROUND: This study aims to test the utility and applicability of the physical quality of life (PQOL) model based on the Contextual Model of Health-Related Quality of Life (HRQOL). Specifically, this study focuses on investigating the different patterns in the structural model of PQOL according to four major U.S. ethnic groups and the mediating effects of psychological well-being between the systemic-level constructs and PQOL. METHODS: Secondary data were used to investigate PQOL among 703 European-, African-, Latina-, and Asian-American women diagnosed with breast cancer. A cross-sectional design with mixed sampling methods was used. The study methodology was guided by the Contextual Model of HRQOL. RESULTS: Multiple group analyses demonstrated that the predicted relationships among the variables were not equivalent across ethnic groups at a P < 0.05 level. Specifically, the relationships between the socio-ecological factor and health care system variables varied across all ethnic groups. However, the direct impacts of life burden and psychological well-being on PQOL were consistent among all ethnic groups. The systemic-level constructs such as life burden and patient-doctor relationship indirectly influenced PQOL through psychological well-being for the specific ethnic groups. CONCLUSION: Our findings revealed ethnic variability in the associations among the individual- and systemic-level contexts influencing PQOL based on the Contextual Model of HRQOL. HRQOL research including studies examining physical outcomes can utilize a comprehensive and integrated conceptual approach that includes psychological, socio-ecological, and cultural aspects to deepen our understanding and advance the translational utility of the research into clinical practice.

Cervical cancer survivorship in a population based sample.

OBJECTIVE: Though cervical cancer is preventable, this cancer nonetheless poses serious mortality and morbidity threats to American women and women globally. The purpose of this study is to utilize a multidimensional framework to assess Health-related Quality of Life (HRQOL) and its salient predictors among a population based sample of cervical cancer survivors. METHODS: A cross-sectional design was used with a population-based sample ascertained from the California Cancer Surveillance Program. Descriptive, bivariate and multivariate regression analyses were conducted. RESULTS: Participants were 560 cervical cancer survivors: English-speaking Latina- (n=88), Spanish-speaking Latina- (n=199) and European- (n=273) Americans. The greatest concerns were documented for family/social and emotional well-being, and body image and sexual health. In general, Latina-Americans reported poorer overall HRQOL, functional, emotional, and social/family wellbeing compared to European-Americans. Differences in HRQOL persisted by ethnic/language group after controlling for covariates. Radiation, comorbidity, role limitations, perceived health status, psychological wellbeing, body image, sexual impact, doctor-patient relationship, and social support were significant predictors of overall HRQOL. The regression model explained 58% of the variance in predicting HRQOL. CONCLUSION: These cervical cancer survivors reported poor to moderate HRQOL with persistent psychosocial challenges. Our findings indicate that lower SES, monolingual Latinas are at greatest risk for poor HRQOL outcomes. Clinicians should pay attention to their patients' socio-ecological context as a risk factor for poorer outcomes; and provide early referrals to resources that are low cost and culturally and linguistically appropriate.

Understanding the cultural health belief model influencing health behaviors and health-related quality of life between Latina and Asian-American breast cancer survivors.

PURPOSE: The purpose of this study was to (1) describe health behaviors and health-related quality of life (HRQOL) of Latina and Asian-American breast cancer survivors (BCS), (2) estimate possible culturally driven predictors of health behaviors and HRQOL, and (3) compare pathways for predicting health behaviors and HRQOL between the two groups. MATERIALS AND METHODS: Secondary data were used to investigate health behaviors and HRQOL among 183 Latina and 206 Asian Americans diagnosed with breast cancer. The study methodology was guided by the health belief model and the contextual model of HRQOL. Structural equation modeling was used to test cultural predictors on health behaviors of BCS. RESULTS: Asian Americans reported higher emotional and physical well-being scores than Latina-Americans. Confirmatory factor analyses demonstrated the adequacy of the two-factor model ("powerful others" and "sociocultural factors") in the cultural health belief construct for Latina and Asian-American BCS. In the structural model, Latinas and Asian Americans showed different pathways in the predicted relationships among the variables. For Latina-Americans, doctor-patient relationship was positively related to exercise, and in turn, influenced physical and emotional well-being. For Asian Americans, treatment decisions and the "sociocultural factor" were significantly related to stress management. CONCLUSION: This study adds to the existing literature in that no study has focused on cultural health beliefs and health behaviors between Latina and Asian-American BCS. Evidence that Latinas and Asian Americans varied in the patterns of cultural factors influencing health behaviors and HRQOL might lead to the development of culturally sensitive breast cancer interventions for promoting positive health behavior and ultimately increasing HRQOL.

Health behavior changes following breast cancer treatment: a qualitative comparison among Chinese American, Korean American, and Mexican American survivors.

This study explored how Chinese American, Korean American, and Mexican American women modify their health behaviors following breast cancer treatment and identified motivators and barriers that influence their changes. An exploratory, descriptive, qualitative study was undertaken using six focus groups. Discussions were transcribed and translated for content analysis. Significant differences among the ethnic groups were noted in the following health behavior practices which were most commonly stated as changed behaviors after a breast cancer diagnosis: 1) eating habits, 2) physical activity, 3) alternative medicine, 4) sleeping, 5) social activity, 6) weight control, and 7) alcohol consumption. Family, financial concerns, environment, and religious faith were commonly mentioned as motivators of and/or barriers to changes in health behaviors. Findings provide insight into different perspectives related to changes in health behaviors by ethnicity, which is critical for developing culturally tailored behavioral interventions to improve underserved breast cancer survivors' quality of life and to reduce health disparities.

Cultural health beliefs and health behaviors in Asian American breast cancer survivors: a mixed-methods approach.

PURPOSE/OBJECTIVES: To explore the relationships between cultural health beliefs, acculturation, treatment-related decisions, the doctor-patient relationship, and health behaviors among Asian American breast cancer survivors (AABCS), and the contextual meaning of those relationships among Korean American breast cancer survivors (KABCS) and AABCS. DESIGN: A mixed-methods triangulation design. SETTING: Community- and hospital-based support groups and hospital cancer registries in California. SAMPLE: 206 AABCS were included in the quantitative phase, and two focus groups were conducted with KABCS (N = 11) during the qualitative phase. METHODS: The quantitative phase used secondary data for AABCS. Standardized (i.e., cultural health beliefs, doctor-patient relationship, and acculturation) and newly developed instruments (i.e., health behaviors and treatment-related decisions) were used in the quantitative phase. An exploratory, descriptive, qualitative study of KABCS then was undertaken. MAIN RESEARCH VARIABLES: Cultural health beliefs, acculturation, treatment-related decisions, the doctor-patient relationship, and health behaviors. FINDINGS: Inter-intrapersonal health beliefs, doctor-patient relationship, and shared decision making were positively associated with adopting healthy lifestyle practices. Findings from the quantitative phase were explained further by the diverse themes that emerged in the KABCS focus groups. CONCLUSIONS: This study provides new knowledge about cultural health beliefs and health behaviors among KABCS using a mixed-methods approach. IMPLICATIONS FOR NURSING: The results highlight the need for greater attention to the cultural contexts of AABCS to promote healthy behaviors and recognition of the significant relationship between health professionals and breast cancer survivors.

Examining emotional outcomes among a multiethnic cohort of breast cancer survivors.

PURPOSE/OBJECTIVES: To describe emotional concerns among a multiethnic sample of breast cancer survivors from a clinically sensitive approach and to examine differences in emotional items according to demographic characteristics. DESIGN: Cross-sectional design. SETTING: California Cancer Surveillance Program, Los Angeles-area hospitals, and community agencies in southern California. SAMPLE: 703 multiethnic, population-based breast cancer survivors, including European, African, Latina, and Asian Americans. METHODS: Two emotional outcome subscales were assessed, one each from the Functional Assessment of Cancer Therapy-General (FACT-G) and the SF-36®. MAIN RESEARCH VARIABLES: Emotional outcomes and health-related quality of life (HRQOL), as measured by FACT-G, SF-36, and demographic characteristics. FINDINGS: Emotional item responses measured by the FACT-G and SF-36 varied by ethnicity, income, education, employment status, language, and age. Overall, worry about the cancer getting worse or recurrence (FACT-G), as well as negative feelings about sadness or uncertainty (SF-36), were reported as the most bothersome concerns across all breast cancer survivors regardless of ethnic group. CONCLUSIONS: Findings reveal unique patterns relevant to emotional outcomes on overall HRQOL scores. Clinically, this study suggests the need for greater attention and appreciation of the influence of demographic contexts on emotional well-being. IMPLICATIONS FOR NURSING: The findings provide a unique observation of the use of individual item response to inform and enhance the assessment of emotional outcomes for clinical and scientific purposes.

Health-related quality of life outcomes among cervical cancer survivors: examining ethnic and linguistic differences.

BACKGROUND: This study aims to investigate the utility of an explanatory health-related quality of life (HRQOL) model for cervical cancer survivors. Specifically, this study focuses on the different patterns in the structural model of HRQOL by ethnic and language groups. METHODS: Secondary data derived from 560 European- and Latina-American cervical cancer survivors was used. The study methodology was guided by the Contextual Model of health-related quality of life. RESULTS: Structural equation modeling demonstrated significant differences in the overall structural models for HRQOL by ethnicity. For example, European-Americans showed significant association between radiation therapy and HRQOL, while life burden was related to sexual impact for Latina-Americans only. The results showed the significant mediating effects of general health status and psychological well-being between patient-doctor relationship and HRQOL, and between life burden and HRQOL, respectively, for all ethnic and language groups. While language group differences (limited English vs. English proficient) among Latina-Americans emerged in bivariate analyses; these distinctions were not upheld in the overall structural models. CONCLUSION: The unique contribution of the individual- and systemic-level components in predicting overall HRQOL outcome seems to vary by ethnic group membership. Our findings advance our understanding of the predictors and the association among the predictors of HRQOL. This study may contribute to the evolution of culturally and linguistically responsive HRQOL conceptual frameworks and instrumentation for vulnerable populations.

Diagnostic and therapeutic delays among a multiethnic sample of breast and cervical cancer survivors.

BACKGROUND: Several publications reporting on health disparities document that ethnic minorities disproportionately experience delays in healthcare access, delivery, and treatment. However, few studies examine factors underlying access and receipt of healthcare among cancer survivors from the patient perspective. This study explores diagnostic and therapeutic care delays among a multiethnic sample of breast and cervical cancer survivors and examines contextual factors influencing diagnostic and therapeutic care delays. METHODS: Population-based sampling and a cross-sectional design were used to recruit 1377 survivors (breast cancer, n = 698; cervical cancer, n = 679). This multiethnic sample included 449 European American, 185 African American, 468 Latina American, and 275 Asian American survivors. RESULTS: Latina Americans were more likely to report diagnostic delays (P = .003), whereas African Americans were more likely to report therapeutic delays (P = .007). In terms of cancer type, cervical cancer survivors were more likely to report diagnostic (P = .004) and therapeutic delays (P = .000) compared with breast cancer survivors. "Fear of finding cancer" was the most frequently cited reason for diagnostic delays, and "medical reasons" were most frequently cited for therapeutic delays. CONCLUSIONS: Due in part to a higher proportion of diagnostic and therapeutic delays, ethnic minorities endure greater cancer burden, including poorer survival and survivorship outcomes. The medical community must recognize the impact of existing psychological and cultural dimensions on diagnostic care, as well as the personal and healthcare system level barriers that contribute to therapeutic delays.

Examining the impact of socioeconomic status and socioecologic stress on physical and mental health quality of life among breast cancer survivors.

PURPOSE/OBJECTIVES: To examine how physical and mental health quality of life (QOL) varies in relation to the socioeconomic status and ethnicity among breast cancer survivors; to determine key socioecologic factors influencing outcomes. DESIGN: Cross-sectional. SETTING: Participants were recruited from the California Cancer Surveillance Program, from hospital registries, and from community agencies in southern California. SAMPLE: 703 multiethnic population-based breast cancer survivors, including European, African, Latina, and Asian Americans. METHODS: Participants completed a mailed questionnaire or answered a telephone survey. To identify socioeconomic status and socioecologic stress, four measures were used: household income, education, job type, and the Life Stress Scale. MAIN RESEARCH VARIABLES: Physical and mental health QOL, socioeconomic status (income, education, and job type), and socioecologic stress. FINDINGS: After controlling for the demographic and medical information, health-related QOL was significantly correlated to socioeconomic status, such that higher socioeconomic status groups expressed better QOL. Ethnic variations existed in QOL according to socioeconomic status. Socioecologic stress was the most important factor influencing physical and mental health QOL. CONCLUSIONS: The findings provide additional evidence that low socioeconomic status and high socioecologic stress exacerbate negative QOL sequelae. IMPLICATIONS FOR NURSING: Practice and research implications include the need for greater attention to QOL outcomes among at-risk lower socioeconomic status survivors and the recognition of the unique contributions of socioeconomic status, socioecologic stress, and ethnicity on physical and mental health QOL.

Enhancing physical well-being and overall quality of life among underserved Latina-American cervical cancer survivors: feasibility study.

INTRODUCTION: Evidence for the effectiveness of behavioral interventions are lacking for cervical cancer survivors (CCS). Disparities in survivorship outcomes exist for CCS, especially Latina-Americans. This study assessed the feasibility of implementing a culturally sensitive intervention delivered in a telephonic format. METHODS: A convenience sample of 23 Latina-Americans diagnosed with stages 1-3 invasive cervical cancer who were 1-3 years post diagnosis and disease free participated. A random assignment, pre- and post-test design was used with 15 intervention and 8 control participants. Intervention group participants completed 6 sessions that included problem-focused, telephone counseling. The areas covered included family and partner concerns and communication; relaxation and stress management; psychological, medical and treatment concerns; and self-nurturing activities. Outcomes were measured by the FACT-G QOL scale. RESULTS: Increases in physical well-being and overall QOL were observed for the intervention group only (p < 0.05). The intervention group showed a non significant trend towards improvements in family/social, emotional and functional well-being from pre- to post-test. DISCUSSION: Results demonstrate the feasibility of implementing a culturally responsive, telephonic behavioral intervention. The intervention was associated with an improvement in physical and overall quality of life. A randomized controlled trial with a long term follow-up is warranted. IMPLICATIONS FOR CANCER SURVIVORS: An ethnically sensitive, behaviorally based telephone counseling approach with Latina Americans cervical cancer survivors can achieve short term improvements in physical well-being and overall QOL.

Measuring quality of life among cervical cancer survivors: preliminary assessment of instrumentation validity in a cross-cultural study.

BACKGROUND: With growing interest in cross-cultural and multicultural cancer-related quality of life studies, the need to assess reliability and validity of quality of life measures for linguistically and culturally diverse cancer survivors is pressing. METHODS: Reliability and validity of the English and Spanish versions of the Functional Assessment of Cancer Therapy (FACT)-G subscales were tested with a sample of English-speaking European American (n = 273) and ethnic minority American (n = 194), and Spanish-speaking Latina (n = 199) cervical cancer survivors in the U.S. RESULTS: Reliability coefficients (Cronbach's alpha) were 0.76 or higher across ethnic/linguistic groups except for the emotional wellbeing subscale among Spanish-speaking Latinas (alpha = 0.64). Factor analyses demonstrated overall measurement equivalence across groups with some ethnic/linguistic variations: there were greater differences between linguistic groups than between ethnic groups. Additionally, the scale's factor structure was less satisfactory for Spanish-speaking Latinas. The subscales had good concurrent validity with appropriate subscales of the Short Form (SF)-12 and Rand/SF-36 General Health subscale (Pearson's r 0.53-0.66), suggesting each subscale was assessing its intended construct. CONCLUSION: The overall psychometric properties of the FACT-G were cross-culturally equivalent. However, more validation studies are needed for non-English speaking populations particularly with emotional wellbeing. In addition, disaggregated analyses on linguistic groups are recommended unless cross-cultural equivalence is established.

Examining predictive models of HRQOL in a population-based, multiethnic sample of women with breast carcinoma.

BACKGROUND: This study examined health related quality of life (HRQOL) and its predictors among African-, Asian-, Latina-, and European American breast cancer survivors (BCS) using a socio-ecologically and culturally contextual theoretical model of HRQOL. METHODS: We employed a case-control, cross sectional design with a population-based sample from the California Cancer Registry. Descriptive, bivariate, and multivariate regression analyses were conducted. RESULTS: The sample included 703 BCS: 135 (19%) African-, 206 (29%) Asian-, 183 (26%) Latina-, and 179 (26%) European Americans. Latinas reported the lowest HRQOL (p < 0.0001). The final regression model explained 70% of variance in HRQOL. Years since diagnosis, number of comorbidities, role limitation, emotional wellbeing, quality of doctor-patient relationship, social support, and life stress are significant HRQOL determinants. Exploratory regression analyses indicate ethnic differences in significant predictors for HRQOL. CONCLUSIONS: HRQOL among this multiethnic sample ranged from fair to good. Bivariate analysis suggests that ethnic differences in HRQOL exist. However, regression analyses demonstrated that socio-ecological factors in conjunction with medical characteristics are more salient to HRQOL outcomes, and that ethnic group membership may be a proxy for socio-ecological context. Furthermore, the influence of ethnicity, culture, and social-ecology are complex; research with large, population-based samples are necessary to disentangle the impact of contextual factors on HRQOL.

Breast cancer among Asian Americans: is acculturation related to health-related quality of life?

PURPOSE/OBJECTIVES: To examine the association of acculturation with health-related quality of life (HRQOL) among Asian American breast cancer survivors. DESIGN: Cross-sectional. SETTING: Analysis of an Asian American subsample of breast cancer survivors from a larger multiethnic study. SAMPLE: 206 Asian Americans, including Chinese, Filipinos, Koreans, and Japanese. Most were diagnosed with early-stage breast cancer (stage 0-II) and were an average of 54 years old. METHODS: Participants completed a mailed questionnaire or answered a telephone survey in English, Mandarin, or Korean. HRQOL was measured using the Functional Assessment of Cancer Therapy Breast Version 4. Acculturation was measured using an eight-item scale adapted from Marin's Short Acculturation Scale. MAIN RESEARCH VARIABLES: HRQOL, acculturation, health insurance, life stress, and social support. FINDINGS: Acculturation was significantly associated with HRQOL when demographic, medical, socioecologic, and healthcare access factors were controlled. However, the significant association between acculturation and HRQOL disappeared when Asian subgroup membership was considered. Subgroup differences in HRQOL remained after controlling for covariates, with Korean Americans reporting lower HRQOL than the other Asian American subgroups. CONCLUSIONS: The absence of a significant association between acculturation and HRQOL in the final model is likely a result of the strong association between acculturation and Asian American subgroup membership. The results suggest that the correlation between acculturation and HRQOL is not an effect of having health insurance, life stress, and social support. IMPLICATIONS FOR NURSING: Closer attention is needed regarding acculturation level; Asian American subgroup differences, including language capacity; and socioecologic characteristics in nursing practice and research.