Abstract
Introduction
Breast cancer is the most common cancer in Asian American women, and the number of Asian American breast cancer survivors is rapidly increasing. Although Asian Americans are one of the fastest growing and most heterogeneous ethnic groups in the United States, limited data exist in regard to their breast cancer experience and survivorship.
Methods
A systematic review of the breast cancer experience literature was conducted and included studies of Asian Americans or their subgroups as a major category of study participants. Of the 125 studies reviewed, 10 qualitative studies, 10 quantitative studies, 5 studies that used a mixed-method approach, and 1 intervention study met the criteria for inclusion.
Results
Qualitatively, Asian Americans reported unmet physical and emotional needs and challenges during survivorship. Quantitative studies consistently found that socioeconomic status, cultural health beliefs, immigration stress, acculturation level, English proficiency, social support, and spirituality associated with Asian American breast cancer patients' health behaviors and health-related quality of life (HRQOL). Studies also revealed significant variation in breast cancer reaction and HRQOL within Asian American subgroups.
Conclusions
Although research on Asian American breast cancer experience and survivorship is sparse, we concluded that Asian Americans experience disrupted HRQOL following breast cancer diagnosis and treatment, interwoven with their cultural and socio-ecological system, and that programs focused on improving cancer survivorship outcomes among this ethnic minority group are limited. Most studies have concentrated on the West coast population, and there is significant underrepresentation of longitudinal and intervention studies. Implications for study design, measurement, and future research areas are also included.
Implications for Cancer Survivors
The results highlight a need to understand ethnic differences and to take into account social, cultural, and linguistic factors in breast cancer survivorship experiences among Asian American subgroups as a means to develop culturally relevant and linguistically appropriate interventions designed to improve HRQOL.
Similar content being viewed by others
References
Siegel R, Naishadham D, Jemal A. Cancer statistics. CA Cancer J Clin. 2012;62:10–29.
Deapen D, Liu L, Perkins C, Bernstein L, Ross RK. Rapidly rising breast cancer incidence rates among Asian-American women. Int J Cancer. 2002;99:747–50.
Liu L, Zhang J, Wu AH, Pike MC, Deapen D. Invasive breast cancer incidence trends by detailed race/ethnicity and age. Int J Cancer. 2012;130:395–404.
Smith BD, Smith GL, Hurria A, Hortobagyi GN, Buchholz TA. Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol. 2009;27:2758–65.
Powe BD, Hamilton J, Hancock N, Johnson N, Finnie R, Ko J, et al. Quality of life of African American cancer survivors: a review of the literature. Cancer. 2007;109:435–45.
Montazeri A. Health-related quality of life in breast cancer patients: a bibliographic review of the literature from 1974 to 2007. J Exp Clin Cancer Res. 2008;27:32.
Yu ES. Health of the Chinese elderly in America. Res Aging. 1986;8:84–109.
Nguyen TT, Somkin CP, Ma Y. Participation of Asian-American women in cancer chemoprevention research: physician perspectives. Cancer. 2005;104:3006–14.
Tu SP, Chen H, Chen A, Lim J, May S, Drescher C. Clinical trials: understanding and perceptions of female Chinese-American cancer patients. Cancer. 2005;104:2999–3005.
Reich M, Lesur A, Perdrizet-Chevallier C. Depression, quality of life and breast cancer: a review of the literature. Breast Cancer Res Treat. 2008;110:9–17.
Wong-Kim E, Sun A, DeMattos MC. Assessing cancer beliefs in a Chinese immigrant community. Cancer Control. 2003;10:22–8.
Ma GX, Shive SE, Wang MQ, Tan Y. Cancer screening behaviors and barriers in Asian Americans. Am J Health Behav. 2009;33:650–60.
Ashing-Giwa KT. The contextual model of HRQoL: a paradigm for expanding the HRQoL framework. Qual Life Res. 2005;14:297–307.
Yanez B, Thompson EH, Stanton AL. Quality of life among Latina breast cancer patients: a systematic review of the literature. J Cancer Surviv. 2011;5:191–207.
Kagawa-Singer M, Wellisch DK, Durvasula R. Impact of breast cancer on Asian American and Anglo American women. Cult Med Psychiatry. 1997;21:449–80.
Wellisch D, Kagawa-Singer M, Reid SL, Lin YJ, Nishikawa-Lee S, Wellisch M. An exploratory study of social support: a cross-cultural comparison of Chinese-, Japanese-, and Anglo-American breast cancer patients. Psychooncology. 1999;8:207–19.
Chiu L. Spiritual resources of Chinese immigrants with breast cancer in the USA. Int J Nurs Stud. 2001;38:175–84.
Gotay CC, Holup JL, Pagano I. Ethnic differences in quality of life among early breast and prostate cancer survivors. Psychooncology. 2002;11:103–13.
Ashing-Giwa KT, Padilla G, Tejero J, Kagawa-Singer M. Understanding the breast cancer experience of Asian American women. Psychooncology. 2003;12:38–58.
Kagawa-Singer M, Wellisch DK. Breast cancer patients' perceptions of their husbands' support in a cross-cultural context. Psychooncology. 2003;12:24–37.
Ashing-Giwa KT, Padilla G, Tejero J, Kraemer J, Wright K, Coscarelli A, et al. Understanding the breast cancer experience of women: a qualitative study of African American, Asian American, Latina and Caucasian cancer survivors. Psychooncology. 2004;13:408–28.
Wong-Kim E, Sun A, Merighi JR, Chow EA. Understanding quality-of-life issues in Chinese women with breast cancer: a qualitative investigation. Cancer Control. 2005;12 Suppl 2:6–12.
Kim J, Ashing-Giwa KT, Kagawa Singer M, Tejero JS. Breast cancer among Asian Americans: is acculturation related to health-related quality of life? Oncol Nurs Forum. 2006;33:E90–9.
Levine EG, Yoo G, Aviv C, Ewing C, Au A. Ethnicity and spirituality in breast cancer survivors. J Cancer Surviv. 2007;1:212–25.
Lim JW, Gonzalez P, Wang-Letzkus MF, Ashing-Giwa KT. Understanding the cultural health belief model influencing health behaviors and health-related quality of life between Latina and Asian-American breast cancer survivors. Support Care Cancer. 2009;17:1137–47.
Levine EG, Aviv C, Yoo G, Ewing C, Au A. The benefits of prayer on mood and well-being of breast cancer survivors. Support Care Cancer. 2009;17:295–306.
Ashing-Giwa KT, Lim JW. Predicting physical quality of life among a multiethnic sample of breast cancer survivors. Qual Life Res. 2010;19:789–802.
Ashing-Giwa KT, Lim JW. Exploring the association between functional strain and emotional well-being among a population-based sample of breast cancer survivors. Psychooncology. 2010;19:150–9.
Yi JK, Swartz MD, Reyes-Gibby CC. English proficiency, symptoms, and quality of life in Vietnamese- and Chinese-American breast cancer survivors. J Pain Symptom Manage. 2011;42:83–92.
Tsai TI, Morisky DE, Kagawa-Singer M, Ashing-Giwa KT. Acculturation in the adaptation of Chinese-American women to breast cancer: a mixed-method approach. J Clin Nurs. 2011;20:3383–93.
Ashing-Giwa KT, Lim JW. Examining emotional outcomes among a multiethnic cohort of breast cancer survivors. Oncol Nurs Forum. 2011;38:279–88.
Lu Q, Zheng D, Young L, Kagawa-Singer M, Loh A. A pilot study of expressive writing intervention among Chinese-speaking breast cancer survivors. Health Psychol. 2012;31:548–51.
Quach T, Nuru-Jeter A, Morris P, Allen L, Shema SJ, Winters JK, et al. Experiences and perceptions of medical discrimination among a multiethnic sample of breast cancer patients in the Greater San Francisco Bay Area, California. Am J Public Health. 2012;102:1027–34.
Lee S, Chen L, Ma GX, Fang CY. What is lacking in patient-physician communication: Perspectives from Asian American breast cancer patients and oncologists. J Behav Health. 2012;1:102–9.
Wang JH, Adams I, Huang E, Ashing-Giwa K, Gomez SL, Allen L. Physical distress and cancer care experiences among Chinese-American and non-Hispanic White breast cancer survivors. Gynecol Oncol. 2012;124:383–8.
Paxton RJ, Phillips KL, Jones LA, Chang S, Taylor WC, Courneya KS, et al. Associations among physical activity, body mass index, and health-related quality of life by race/ethnicity in a diverse sample of breast cancer survivors. Cancer. 2012;118:4024–31.
Lim JW, Baik OM, Ashing-Giwa KT. Cultural health beliefs and health behaviors in Asian American breast cancer survivors: a mixed-methods approach. Oncol Nurs Forum. 2012;39:388–97.
Lim JW, Paek MS. The relationship between communication and health-related quality of life in survivorship care for Chinese-American and Korean-American breast cancer survivors. Support Care Cancer. 2013;21:1157–66.
Lee S, Chen L, Ma GX, Fang CY, Oh Y, Scully L. Challenges and needs of Chinese and Korean American breast cancer survivors: in-depth interviews. N Am J Med Sci (Boston). 2013;6:1–8.
Lim JW, Yi J, Zebrack B. Acculturation, social support, and quality of life for Korean immigrant breast and gynecological cancer survivors. Ethn Health. 2008;13:243–60.
Hewitt ME, Ganz P, Institute of Medicine (US), American Society of Clinical Oncology, American Society of Clinical Oncology, Institute of Medicine Symposium on Cancer Survivorship. From cancer patient to cancer survivor: lost in transition. Washington, DC: National Academies Press; 2006.
Barg FK, Gullatte MM. Cancer support groups: meeting the needs of African Americans with cancer. Semin Oncol Nurs. 2001;17:171–8.
Nápoles-Springer AM, Ortíz C, O'Brien H, Díaz-Méndez M. Developing a culturally competent peer support intervention for Spanish-speaking Latinas with breast cancer. J Immigr Minor Health. 2009;11:268–80.
Kwok C, Ho M. Development and evaluation of a culturally sensitive support group programme for Chinese-Australian women with breast cancer: a pilot study. Eur J Cancer Care (Engl). 2011;20:795–802.
US Department of Commerce. (2010) Facts for features: Asian/Pacific American Heritage Month: May 2010. Available from: http://www.census.gov/newsroom/releases/archives/facts_for_features_special_editions/cb10-ff07.html. Accessed 22 Oct 2013.
Kagawa-Singer M. Improving the validity and generalizability of studies with underserved U.S. populations expanding the research paradigm. Ann Epidemiol. 2000;10(8 Suppl):S92–103.
Hahn EA, Cella D. Health outcomes assessment in vulnerable populations: measurement challenges and recommendations. Arch Phys Med Rehabil. 2003;84(4 Suppl 2):S35–42.
Mols F, Vingerhoets AJ, Coebergh JW, van de Poll-Franse LV. Quality of life among long-term breast cancer survivors: a systematic review. Eur J Cancer. 2005;41:2613–9.
America's new mobile majority: a look at smartphone owners in the U.S. Reported by Nielsen. 2012, http://www.nielsen.com/us/en/newswire/2012/who-owns-smartphones-in-the-us.html. Accessed on May/13/2013.
Antoni MH, Lechner SC, Kazi A, Wimberly SR, Sifre T, Urcuyo KR, et al. How stress management improves quality of life after treatment for breast cancer. J Consult Clin Psychol. 2006;74:1143–52.
Fors EA, Bertheussen GF, Thune I, Juvet LK, Elvsaas IK, Oldervoll L, et al. Psychosocial interventions as part of breast cancer rehabilitation programs? Results from a systematic review. Psychooncology. 2011;20:909–18.
Acknowledgments
Kuang-Yi Wen is currently funded by AHRQ grant 1K01HS019001. This work was supported in part by the NIH-NCI's Community Network Program Center, ACCHDC (U54CA153513, PI: Dr. Grace Ma) and NIH P30 CA06927. We are indebted to Alison Petok and Kathy Ireton for their technical and administrative assistance.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Wen, KY., Fang, C.Y. & Ma, G.X. Breast cancer experience and survivorship among Asian Americans: a systematic review. J Cancer Surviv 8, 94–107 (2014). https://doi.org/10.1007/s11764-013-0320-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11764-013-0320-8