title: Physical distress and cancer care experiences among Chinese-American and non-Hispanic White breast cancer survivors.
abstract: OBJECTIVE
  The number of Chinese-American breast cancer survivors (BCS) is increasing as a result of increasing incidence rates. There has been little research on Chinese BCS' follow-up cancer care. This qualitative study aims to understand how Chinese-American BCS experience and cope with physical distress relative to non-Hispanic White (NHW) survivors.
  
  
  METHODS
  Seventy-one BCS (37 Chinese immigrant, 7 US-born Chinese, 27 NHW) were recruited from the Greater Bay Area Cancer Registry to participate in focus group discussions or one-on-one interviews about their survivorship experiences. All BCS were diagnosed with breast cancer at stage 0-IIA between 2006 and 2009, and had survived for 1-4 years without recurrence. Interviews were conducted in Cantonese, Mandarin, or English. Data analyses followed established qualitative methods of content analysis.
  
  
  RESULTS
  BCS experienced pain and side effects from radiation, surgery, and hormonal therapy. Physical distress subsequently caused emotional concerns about recurrence or metastasis. Most BCS consulted physicians about their physical distress. Chinese immigrant BCS were less likely to have their issues resolved compared to NHW and US-born Chinese who were more likely to question physicians, ask for referrals, and make repeat attempts if their problems were not resolved. Some Chinese immigrant BCS turned to Traditional Chinese Medicine for relief or accepted the idea that physical distress was part of survivorship.
  
  
  CONCLUSIONS
  Chinese immigrant BCS may be at risk for greater distress compared with US-born Chinese and NHW BCS because of cultural norms that make them less inclined to express their needs to physicians or challenge physicians when their needs are not met. Furthermore, they may express symptoms in culturally unique ways (e.g., hot-cold imbalances). Further research is needed to determine how to best improve survivorship care experiences in this understudied population, with the goal of decreasing BCS' physical distress and improving quality of life.
authors: Cancer Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW., Suite 4100, Washington, DC 20007, USA. jw235@georgetown.edu
authors: Judy Huei-yu
authors: JH
authors: Wang
authors: Inez
authors: I
authors: Adams
authors: Ellen
authors: E
authors: Huang
authors: Kimlin
authors: K
authors: Ashing-Giwa
authors: Scarlett Lin
authors: SL
authors: Gomez
authors: Laura
authors: L
authors: Allen
mesh_terms: D000328:Adult; D000368:Aged; D001213:Asian / Q000523:psychology*; D001943:Breast Neoplasms / Q000453:epidemiology / Q000208:ethnology* / Q000523:psychology* / Q000628:therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D010865:Pilot Projects; D017741:Survivors / Q000523:psychology*; D016896:Treatment Outcome; D044465:White People / Q000523:psychology*