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

社会文化和行为对中国和白人乳腺癌幸存者症状管理、生物反应和功能影响的纵向调查。

• 批准号: 10360588
• 负责人: Judy Huei-yu Wang
• 金额: $ 62.92万
• 依托单位: GEORGETOWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-03-01 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10360588
• 关键词: Acculturation; Adherence; Affect; Age; Anxiety; Asian; Behavior; Behavioral; Belief; Biological; Biology; Blood specimen; Breast Cancer survivor; Buffers; Cancer Etiology; Cancer Survivor; Cancer Survivorship; Chinese; Chinese American; Chronic; Chronic stress; Cohort Studies; Communication; Coping Behavior; Cross-Sectional Studies; Data; Development; Diagnosis; Diet; Dietary Practices; Distress; Eating; Emotional; Emotional Stress; Equilibrium; Exercise; Fatigue; Feedback; Fright; Growth; Guidelines; Health; Health Sciences; Hydrocortisone; Immigrant; Immigration; Incidence; Individual; Inflammation; Inflammatory; Intake; Intervention; Interview; Investigation; Lead; Longitudinal prospective study; Malignant Neoplasms; Mediating; Medical; Menopausal Symptom; Mental Depression; Not Hispanic or Latino; Outcome; Outcome Study; Pain; Participant; Pathway interactions; Patient Self-Report; Physical Function; Physical activity; Population; Population Growth; Prevention; Psychological Factors; Psychological Stress; Psychosocial Stress; Public Health; Quality of life; Race; Recurrence; Reporting; Research; Resources; Risk; Sampling; Severities; Social support; Societies; Soy Foods; Stress; Surveys; Symptoms; Telephone; Time; Translating; Unhealthy Diet; Vegetables; Work; authority; base; behavior influence; biracial; clinical care; coping; cruciferous vegetable; cultural values; cytokine; diet and exercise; dietary; functional decline; functional outcomes; good diet; grasp; health care availability; improved; malignant breast neoplasm; preference; psychologic; psychological stressor; psychosocial; racial difference; resilience; response; social; social culture; socioeconomic disadvantage; socioeconomics; soy; symptom management

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.

项目摘要 美国癌症的生存数量正在迅速增长，包括大量的中国美国人 （CA），一群乳腺癌的增长率为1.1％，由于移民而迅速增长。 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 相对于非西班牙裔白人（NHW）BCS，幸存者（BCS）具有疲劳，疼痛和身体功能不佳。 低培养的CAS报告了更大的社会心理压力（例如，更大的感知威胁和对失去的恐惧 社会经济资源）；但是，他们的抑郁症的抑郁症比NHWS少。我们不知道 为什么CA BC在身体脆弱而常常缺乏社会资源时会在情感上有弹性 用于应对（即社会支持，社会经济资源和医疗保健访问）。目前尚不清楚是否这样 当许多人认为情绪压力会导致癌症和 这就是为什么他们可能会低估自己的困扰。未表达的慢性应激与较高的皮质醇和 炎症水平不利于健康。尚不清楚CA BCS的症状燃烧是否持续 时间以及文化和社会资源如何影响他们管理符号的方式并进一步改善 生活质量。与NHW相比，先前的数据显示了更多的大豆食物和十字花科蔬菜。更高 大豆摄入量减少了绝经症状和疲劳。但是，CA BCS对体育锻炼的依从性较低 指南比NHWS。社会心理压力，饮食不良，运动不足，疲劳和疼痛都与 慢性炎症。然而，中国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，因此我们无法解释那些多方面的社会文化 和个体因素交织在一起以影响体内炎症，结果差异 两个种族群体。全面了解社会文化对个人应对行为的影响 它们反过来如何影响生物学反应（即炎症和皮质醇应激标志物）的种族差异， 症状严重程度和生活质量，我们提出了260个CA BC中的两种种族的队列研究（1 - 5年后 诊断），年龄和阶段匹配到260 NHW BCS。利用社会行为生物学 多级框架，我们将研究社会文化，心理和行为的动态（饮食和 锻炼）影响症状严重程度，生物学反应和功能结果。参与者会 完成电话调查采访并在基线以及6个月和12个月后提供血液样本 - 基线随访。接下来，将对样本子集进行深入的个人访谈 深入研究途径中的因果因素，以便在单独和文化上发展 进行适当的干预措施，以改善目标癌症生存群体的临床护理。这是 与癌症月球倡议良好的一致性，旨在增加症状控制和改善生存率。