Acupressure Intervention to Improve Fatigue and Physical Functioning of Chinese Immigrant Breast Cancer Survivors

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ABSTRACT Minority and immigrant cancer patients are more likely to have poorer physical functioning than Non-Hispanic White patients. Cancer-related fatigue (CRF) is one of the most common symptoms associated with declines in physical functioning. Chinese Americans are the largest subgroup of Asian Americans and the fastest growing immigrant group in the US. Our data suggests that Chinese immigrant breast cancer survivors have poorer physical functioning than NHW survivors; in part because the former are more likely to experience CRF than the latter. Chinese immigrants have fewer socioeconomic resources and experience cultural and linguistic challenges when attempting to access quality care, making their adjustment to cancer even harder. Despite these documented disparities, there are no interventions designed to improve Chinese immigrant survivors’ CRF or physical functioning. Self-administered acupressure, a low-cost and low-toxicity approach originating from Traditional Chinese Medicine, is emerging to help cancer patients reduce CRF and boost energy to meet daily demands at work and home. Therefore, we propose a randomized controlled trial (RCT) to develop and pilot test the efficacy of a home-based, self-administered acupressure intervention in improving CRF (proximal outcome), physical functioning and other quality of life outcomes (distal outcomes) of Chinese immigrant breast cancer survivors (versus usual care control group). We will use the patient-reported outcomes measurement information system (PROMIS®) short forms to assess our outcome variables. Using Los Angeles (LA) cancer registry cases, we will enroll 124 first-generation, Chinese-speaking immigrant women with moderate to severe levels of fatigue, diagnosed with stage 0-III breast cancer, aged 21-69, and 1-5 years post-primary treatment. Based on an adaptive treatment strategy design, participants will be randomized to either the self-acupressure intervention or control groups. The self-acupressure group will learn how to press three chief energy acupoints on each side of the body through a 10-minute Chinese-language video (DVD) and practice self-acupressure every day (one minute per acupoint; a total of 6 minutes per day) for a six-week intervention period. Participants will be telephone interviewed twice: at baseline and 6-weeks post-intervention. The research examining CRF and functional status of Chinese immigrant cancer survivors is lacking, and the impact of self- acupressure on cancer survivorship has not been sufficiently tested. PROMIS® is also underused in immigrant populations. Our proposed intervention study is the first of its kind that we are aware of. Knowledge gained from this study will be significant and innovative in advancing the measurement and intervention approaches of cancer survivorship and directing scientifically sound efforts to reduce cancer disparities experienced by the growing yet underserved Chinese immigrant population.