Cancer Survivorship in Racial and Ethnic Minority Groups: Examining Post-Traumatic Stress Symptoms Among Chinese-Speaking Breast Cancer Survivors

Background and Purpose: The consequences of breast cancer on physical and psychological well-being have been extensively studied. One of the long-term effects of the disease is Post-Traumatic Stress Symptoms (PTSS) which have been known to affect patient’s physical, psychological, and cognitive functions. There have been a number of trials to alleviate the mental health outcomes among breast cancer survivors. However, these experiments are primarily done with non-Hispanic white women, and there is a lack of studies among survivors from racial and ethnic minority groups. Asian Americans are known to have a higher prevalence rate of breast cancer compared to other racial/ethnic groups, with most recent data suggesting that breast cancer risk is two times higher among immigrant Asian American women than their U.S.-born counterparts. Chinese are the largest Asian ethnic immigrants in the United States. They face many challenges starting from limited English language proficiency, cultural differences in beliefs and practices associated with a  cancer diagnosis, self-stigma, smaller supportive network, and difficulties in the relationship with the physician which often lead to dissatisfaction with treatment decisions. All of these factors prevent them from asking questions and expressing their concerns to others in order to maintain their family relationship. Hence, this study investigated interpersonal and physical health predictors of PTSS and explored sociodemographic and clinical factors linked to PTSS in this group. We hypothesized that higher levels of social constraints and lower levels of social support, relationship closeness, and physical health, would be associated with higher levels of PTSS. As a consequence, there may be an increased need for culturally-tailored services for immigrant Asian American women in the cancer aftermath.

Methods: Using a survey study design, a sample of 96 Chinese-speaking breast cancer survivors completed measures of PTSS, social constraints, social support, closeness, health-related quality of life, and acculturation. Bivariate correlation examined association between variables of interest. Then, a hierarchical multiple regression analysis was conducted to examine predictors of PTSS.

Results: Participants reported an average score of 14.7 (SD=10.46, range 0-44) on the severity of PTSS, with 54.2% (N=52) meeting the criteria for likelihood of posttraumatic stress disorder. PTSS was positively associated with social constraints and negatively associated with social support, closeness, and physical health. More medication usage was linked to worse PTSS. Social constraints in the ability to communicate cancer-related concerns to the caregiver predicted worse PTSS severity.

Conclusions and Implications: Present findings emphasize the need to implement protocols to monitor mental health outcomes of breast cancer survivors from racial and ethnic minority groups throughout a continuum of care that extends beyond the active treatment phase. Social workers serving cancer survivors from racial and ethnic minority groups should be attentive to the role of interpersonal factors for the psychological well-being of the individual. Additionally, these results contribute to the current reflection about the development of psychosocial interventions for Chinese American breast cancer survivors. Although expressive writing and peer support had promising findings, future investigations should be inclusive of the supportive network and its relevance for survivorship outcomes.