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: 10595060
• 负责人: Judy Huei-yu Wang
• 金额: $ 61.6万
• 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/10595060
• 关键词: Acculturation; Adherence; Affect; Age; Anxiety; Asian; Authorization documentation; Baseline Surveys; 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; Diet Surveys; Dietary Practices; Disparity; 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; 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; Subgroup; Surveys; Symptoms; Telephone; Time; Translating; Unhealthy Diet; Vegetables; Work; authority; 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; longitudinal, prospective study; malignant breast neoplasm; preference; psychologic; psychological stressor; psychosocial; racial difference; racial population; 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.

项目概要 美国癌症幸存者人数正在迅速增长，其中包括大量华裔美国人 (CA)，该群体的乳腺癌年增长率为 1.1%，且由于移民导致人口增长较快。 超过63%的CA是移民，我们的初步研究表明，更多的CA是移民乳腺癌。 与非西班牙裔白人 (NHW) BCS 相比，幸存者 (BCS) 感到疲劳、疼痛和身体机能较差。 文化程度较低的 CA 报告称，其社会心理压力更大（例如，感知到的威胁更大，害怕失去 然而，自相矛盾的是，他们的抑郁症却比 NHW 少，我们不得而知。 为什么 CA BCS 在身体脆弱且经常缺乏社交资源时表现出情绪弹性 应对措施（即社会支持、社会资源和医疗保健获取）是否如此尚不清楚。 当许多CA认为情绪压力会导致癌症时，复原力实际上是一种文化反应，并且 因此，他们可能低估了自己的痛苦。未表达的慢性压力与皮质醇和皮质醇水平升高有关。 炎症对健康造成的疼痛也不清楚。CA BCS 的症状负担是否持续存在也不得而知。 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 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。 大豆摄入量可减轻更年期症状和疲劳，但 CA BCS 的体力活动依从性较低。 心理社会压力、不良饮食、运动不足、疲劳和疼痛都与这些因素有关。 然而，中国人的健康饮食和情绪平衡可能会减少炎症。 我们的初步调查结果基于自我报告，因此我们无法解释这些多方面的社会文化如何 个体因素交织在一起影响体内的炎症和结果差异 全面了解社会文化对个人应对行为的影响和 它们如何反过来影响种族影响生物反应的差异（即炎症和皮质醇应激标记）， 症状严重程度和生活质量，我们建议对 260 名 CA BCS（术后 1-5 年）进行一项双种族队列研究 诊断），他们将与 260 名 NHW BCS 进行年龄和阶段匹配。 多层次框架中，我们将研究社会文化、心理和行为（饮食和行为）的动态 运动）对症状严重程度、生物反应和功能结果的影响。 完成电话调查访谈并提供基线以及术后 6 个月和 12 个月的血液样本 接下来，将对一部分样本进行深入的个人访谈。 深入研究路径中的致病因素，以实现个体和文化的发展 有利于改善目标癌症幸存者人群的临床护理的适当干预措施。 与旨在加强症状控制和提高生存率的癌症登月计划完全一致。