Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose: Korean-American cancer survivors in the United States may experience worse quality of life (QOL) and an increased risk for social adjustment difficulties when compared to cancer survivors in Korea. These differences may be attributable to less support available to survivors who immigrated to the United States. The purpose of this study was twofold: (1) to compare differences in QOL for Korean-American and Korean breast and gynecologic cancer survivors living in the U.S. and Korea, and (2) to examine associations between social support and QOL within and across the two groups. Methods: To identify multiple dimensions of health status and psychosocial outcomes, three standardized English-language QOL measures were translated and then administered to 51 Korean-American and 110 Korean survivors. Social support components were measured by items assessing multiple aspects, including perceived social support, use of services, network size, diversity, embedded network and barriers to follow-up care. Here, social support was conceptualized as comprising functional social support and social network structures. Results: Once controlling for the effects of demographic and medical confounders, analyses of two QOL outcome measures (SF-36 and QOL-CS) did not produce significant differences between Korean Americans and Koreans, but psychological distress (BSI-18) showed significant differences at a p < .05. The models were formulated using sequential structural equation modeling multiple group analyses. In the measurement model, the two groups were equivalent; however, the structural model yielded differences between Korean Americans and Koreans. This evidence provides support for unique modeling across the two groups. In all, findings demonstrated that the association of social support to QOL outcomes differs according to geographic location. For Korean-American survivors, having health insurance and not reporting negative financial impacts or language barriers were associated with more positive QOL outcomes. For Korean women, being diagnosed with gynecologic cancer (as compared to breast cancer), and not experiencing negative financial impacts or side effects of cancer were directly associated with more positive QOL. Also, the two groups showed different patterns in the role of social support influencing QOL outcomes: for Korean Americans, network diversity (having diverse people) directly influenced QOL, while for Koreans, embedded networks (having active relationship with social ties) directly influenced QOL. Implications for Practice: Information presented here expands the knowledge base on social support, QOL, survivorship, and cultural issues. Evidence that social support influences QOL serves as a rationale for developing psychosocial interventions that (1) enhance cancer survivors' social participation and (2) diminish barriers to follow-up care. The development of intervention models must addresses the different socio-cultural conditions for Koreans living in Korea and the United States.