Longitudinal investigation of sociocultural and behavioral influences on symptom management, biological response, and functioning between Chinese and White breast cancer survivors.

项目总结 美国癌症幸存者的数量正在迅速增长，其中包括相当数量的华裔美国人 (CA)，这一群体的乳腺癌年增长率为1.1%，人口因移民而快速增长。 超过63%的CA是移民。我们的初步研究表明，更多的CA迁入性乳腺癌 幸存者(BCS)与非西班牙裔白人(NHW)BCS相比，有疲倦、疼痛和较差的身体功能。 低文化程度的CA报告了更大的心理社会压力(例如，更大的感知威胁和对失去的恐惧 社会经济资源)；然而，自相矛盾的是，他们报告的抑郁症比卫生保健工作者要少。我们不知道 为什么CA BC在身体脆弱且往往缺乏社会资源的情况下表现出情绪上的弹性 应对措施(即社会支持、社会经济资源和医疗保健服务)。目前还不清楚这种情况是否会 当许多CA认为情绪压力会导致癌症时，弹性实际上是一种文化反应，而且 因此，他们可能会低估自己的痛苦。未表达的慢性压力与较高的皮质醇和 对健康有害的炎症水平。CA BCS的症状负担是否会持续下去也是未知的 时间以及文化和社会资源如何影响他们管理症状和进一步改进的方式 生活质量。先前的数据显示，CA BCS比NHW吃更多的大豆食品和十字花科蔬菜。更高 摄入大豆可以减少更年期症状和疲劳。然而，CA BCS对体力活动的依从性较低 指南比卫生保健服务更好。心理社会压力、不良饮食、运动不足、疲劳和疼痛都与 慢性炎症。然而，中国人在健康饮食和情绪平衡方面的做法可能会减少炎症。 我们的初步发现是基于自我报告，所以我们不能解释这些多方面的社会文化 而个体因素相互交织在一起，影响体内的炎症和结果之间的差异 两个种族群体。全面了解社会文化对个体应对行为的影响 它们如何反过来影响生物反应的种族差异(即炎症和皮质醇应激标记物)， 症状严重程度和生活质量，我们建议在260名CA BCS(1-5年后)中进行一项混血队列研究 诊断)谁的年龄和阶段与260 nhw BCS相匹配。利用社会-行为-生物学 多层次框架，我们将调查社会文化、心理和行为(饮食和 运动)对症状严重程度、生物反应和功能结果的影响。参与者将 完成电话调查访谈，并在基线和6个月和12个月后提供血样 基线随访。接下来，将对部分样本进行深入的个人访谈，以 深入研究路径中的致病因素，以促进个人和文化的发展 适当的干预措施有助于改善对癌症幸存者目标人群的临床护理。这是 与旨在加强症状控制和提高存活率的癌症登月行动相一致。

PROJECT SUMMARY The number of US cancer survivors is growing rapidly, including a significant number of Chinese Americans (CA), a group with an annual breast cancer growth rate of 1.1% and fast population growth due to immigration. Over 63% of CAs are immigrants. Our preliminary study showed that more CA immigrant breast cancer survivors (BCS) had fatigue, pain, and poor physical functioning relative to non-Hispanic White (NHW) BCS. Low-acculturated CAs reported greater psychosocial stress (e.g. greater perceived threat and fear of losing socioeconomic resources); however, they paradoxically reported less depression than NHWs. We do not know why CA BCS appear emotionally resilient when they are physically vulnerable and often lack social resources for coping (i.e., social support, socioeconomic resources and healthcare access). It is unclear whether such resilience is actually a cultural response when many CAs believe that emotional stress causes cancer, and thus they may underreport their distress. Unexpressed chronic stress is related to higher cortisol and inflammation levels detrimental to health. It is also unknown whether CA BCS’ symptom burden persists over time and how culture and social resources influence their ways of managing symptoms and further improving quality of life. Prior data showed CA BCS eating more soy food and cruciferous vegetables than NHWs. Higher soy intake reduces menopausal symptoms and fatigue. Yet, CA BCS had lower adherence to physical activity guidelines than NHWs. Psychosocial stress, poor diet, insufficient exercise, fatigue, and pain are all related to chronic inflammation. Yet, Chinese practices in healthy diet and emotional balance may decrease inflammation. Our preliminary findings were based on self-reports, so we cannot explain how those multifaceted sociocultural and individual factors are intertwined to affect inflammation in the body and outcome differences between the two racial groups. To comprehensively understand sociocultural influence on individual coping behaviors and how they in turn affect racial differences in biological responses (i.e., inflammation and cortisol stress markers), symptom severity, and quality of life, we propose a bi-racial, cohort study among 260 CA BCS (1-5 years post diagnosis) who will be age- and stage-matched to 260 NHW BCS. Utilizing a society-behavior-biology multilevel framework, we will investigate the dynamics of sociocultural, psychological, and behavioral (diet and exercise) influences on symptom severity, biological responses, and functional outcomes. Participants will complete telephone survey interviews and provide blood samples at baseline and 6- and 12-month post- baseline follow-ups. Next, in-depth individual interviews with a subset of samples will be conducted to investigate in depth the causative factors in the pathways in order to develop individually and culturally appropriate interventions conducive to improving clinical care for targeted cancer survivor populations. This is well aligned with the Cancer Moonshot Initiative aimed at increasing symptom control and improving survival.