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

项目摘要 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)这个群体的乳腺癌年增长率为1.1%，由于移民，人口增长迅速。 超过63%的CA是移民。我们的初步研究表明，更多的CA移民乳腺癌， 幸存者（BCS）相对于非西班牙裔白色（NHW）BCS具有疲劳、疼痛和身体功能差。 低文化适应的CA报告了更大的心理社会压力（例如更大的感知威胁和害怕失去 社会经济资源）;然而，矛盾的是，他们报告的抑郁症比NHWs少。我们不知道 为什么CA BCS在身体脆弱且经常缺乏社会资源时表现出情绪弹性 为了应对（即，社会支持、社会经济资源和医疗保健机会）。目前尚不清楚， 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， 因此，他们可能会少报他们的痛苦。未表达的慢性压力与较高的皮质醇有关， 炎症水平对健康有害。还不清楚CA BCS的症状负担是否持续超过 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善的方式 生活质量先前的数据显示，CA BCS比NHWs吃更多的大豆食品和十字花科蔬菜。更高 大豆摄入量减少更年期症状和疲劳。然而，CA BCS对体力活动的坚持性较低 比NHWS的指导方针。社会心理压力、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。 我们的初步研究结果是基于自我报告，所以我们无法解释这些多方面的社会文化因素是如何影响我们的生活的。 和个体因素交织在一起，影响体内的炎症反应， 两个种族。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中的种族差异（即，炎症和皮质醇应激标志物）， 症状严重程度和生活质量，我们建议在260名CA BCS患者中进行一项双种族队列研究（1-5年后 诊断），年龄和分期与260 NHW BCS匹配。利用社会行为生物学 多层次的框架，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个月后提供血液样本， 基线随访。接下来，将对一部分样本进行深入的个人访谈， 深入调查途径中的致病因素，以发展个人和文化 适当的干预措施有助于改善针对癌症幸存者群体的临床护理。这是 与旨在加强症状控制和提高生存率的癌症登月计划保持一致。

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.