Research That Matters (January 17 - 20, 2008)

Purpose: Korean- and Chinese-American breast cancer survivors may experience the different quality of life (QOL) and unique emotional and social concerns, in spite of similar characteristics of both Asian-Americans and geographical location. However, little were known about their QOL, as well as emotional and social factors influencing QOL for the both groups. The purpose of this study was twofold: (1) to compare differences in QOL outcomes between Korean- and Chinese-American breast cancer survivors, (2) to investigate the mediating effects of emotional and social factors between demographic and medical information and QOL, and (3) to examine the most salient predictor influencing QOL for the both groups.

Methods: A cross-sectional design with mixed sampling methods was used. Participants were recruited from the California Cancer Surveillance Program, from hospital registries and from community agencies in southern California. Physical and mental health QOL was assessed through the Rand 36-item health survey (SF-36) administered to 73 Korean-, and 84 Chinese-American women. Emotional and social factors were measured by items assessing emotional distress, perceived social support, and the impacts of cancer on job performance.

Results: Once controlling for the effects of demographic and medical confounders, analyses of multivariate general linear model showed significant differences in all sub-dimensions of SF-36 between Korean- and Chinese-Americans at a p < 0.01, indicating better QOL outcomes of Chinese-Americans. For Chinese Americans specifically, ‘the impacts of cancer on job performance' mediated the link of medical characteristics (chemotherapy and recurrence) and physical health QOL (PHQOL). Moreover, in the relationship between cancer stage and mental health QOL (MHQOL), emotional distress significantly attenuated their link. However, Korean-Americans did not show any mediating effects between demographic and medical information and QOL. A hierarchical regression model was used to find predictors influencing each PHQOL and MHQOL. The final models, including all predictors (medical and demographic characteristics, spoken language, emotional distress, perceived social support, the impacts of cancer on job performance, and ethnicity), explained 40.9%, and 47.6% of the variances in PHQOL and MHQOL, respectively. Ethnicity (b = -16.675, p < .001 for PHQOL; and b = -18.410, p < .001 for MHQOL) was the most important factor influencing both PHQOL and MHQOL. Furthermore, ‘the impacts of cancer on job performance' (b=-16.214, p< .001) and cancer stage (b=-4.924, p< .05) were salient in PHQOL model, and emotional distress (b = -5.904, p < .001), as well as perceived social support (b = -8.057, p < .05), influenced MHQOL.

Implications for Practice: Information presented here will help to expand the knowledge about QOL, emotional and social factors, and cultural/ethnic issues. Moreover, evidence that QOL outcomes between Korean- and Chinese-American survivors differ may suggest the importance of culturally tailored strategies based on the unique ethnic characteristics. Also, low QOL for Korean-American breast cancer survivors would require more appropriate and effective social work interventions to improve their overall QOL.