Methods: A population-based, cross-sectional design was used. A total of 156 Chinese- (n=86) and Korean-American (n=70) BCS were recruited from the California Cancer Surveillance Program in Southern California. Eligible participants included women within 6 months to 5 years of being diagnosed with breast cancer. The Functional Assessment of Cancer Therapy–General (FACT-G) was used to assess HRQOL outcomes. Family communication was measured by items assessing feelings and attitudes in family communication related to general and cancer-specific concerns (ENRICH). The F-COPES, which has five coping scales, was used to assess coping mechanism.
Results: Once controlling for the effects of demographic and medical information, analyses of univariate general linear model showed that there was a significant difference in FACT-G's social well-being domain between Chinese- and Korean-American BCS, indicating better social well-being of Chinese-Americans. Two groups also showed significant differences in three subscales of coping. Chinese-Americans were more likely to use mobilizing family support (F=12.11; p<0.001) and passive appraisal (F=18.17; p<0.001), whereas Korean-Americans were more likely to use seeking spiritual support (F=12.82; p<0.001). However, FACT-G total and other domain scores, as well as family communication did not show significant differences between two groups, after controlling for covariates. Overall, Chinese- and Korean-Americans showed the different pattern in the mediating effects of family communication and coping. More specifically, for Chinese-Americans, family communication regarding general concerns mediated the link of comorbidity and HRQOL (sobel=-2.20; p<0.05). Family communication regarding cancer-specific concerns attenuated the relationship between comorbidity and HRQOL for Korean-Americans only (sobel=-2.823; p<0.01). In our sample, coping did not act as a mediator. A hierarchical regression demonstrated that the final model, including all predictors (medical and demographic information, cultural characteristics, family communication, and coping), explained 48.7% of the variance in HRQOL. Comorbidity (b=-0.826; p<0.001), family communication-general concerns (b=2.092;p<0.05), and coping subscale-passive appraisal (b=0.603; p<0.05) remained as significant predictors in the final model.
Conclusions and Implications: The findings demonstrated that family communication and coping may play a significant role in improving HRQOL in Asian-American BCS. This study will help to better understand in whether and what ways talking about a traumatic event can be beneficial to make sense of the experiences, find meaning, and achieve emotional resolution for Asian-American BCS. Additionally, evidence that Chinese- and Korean-Americans showed the different pattern in the mediating effects of family communication on HRQOL serves as a rational for demonstrating the applicability and efficacy of the culturally tailored family communication models, and developing the evidence-based intervention program for Chinese- and Korean-American BCS and their families to increase their HRQOL.
