title: Differences in quality of life between American and Chinese breast cancer survivors.
abstract: It has been speculated that cancer survivors in Asia may have lower quality of life (QOL) compared with their Western counterparts. However, no studies have made international comparisons in QOL using a comprehensive measure. This study aimed to compare Chinese breast cancer survivors' QOL with US counterparts and examine if demographic and medical factors were associated with QOL across groups.
  
  
  
  The sample consisted of 159 breast cancer patients (97 Chinese and 62 American) who completed the Functional Assessment for Cancer Therapy Breast Cancer (FACT-B) scale before the start of radiotherapy in Shanghai, China and Houston, USA.
  
  
  
  Higher income was associated with higher QOL total scores in both Chinese and American cancer patients, but QOL was not significantly associated with other factors including age, education, disease stage, mastectomy, and chemotherapy. Consistent with hypotheses, compared to their US counterparts, Chinese breast cancer survivors reported lower QOL and all four subdimensions including functional well-being (FWB), physical well-being (PWB), emotional well-being (EWB), and social well-being (SWB); they also reported more breast cancer-specific concerns (BCS). Differences were also clinically significant for Functional Assessment for Cancer Therapy General (FACT-G) scale total scores and the FWB subscale. After controlling for demographic and medical covariates, these differences remained except for the SWB and BCS. Furthermore, Chinese breast cancer survivors receiving chemotherapy reported significantly lower FACT-G scores than those who did not, but this difference did not emerge among US breast cancer survivors.
  
  
  
  Chinese breast cancer survivors reported poorer QOL on multiple domains compared to US women. Findings indicate that better strategies are needed to help improve the QOL of Chinese breast cancer survivors, especially those who underwent chemotherapy.
authors.affiliation: Department of Psychology, University of Houston, 126 Heyne Building, Houston, 77204, TX, USA. qlu3@uh.edu.
authors.forename: Qian
authors.initials: Q
authors.lastname: Lu
authors.affiliation: WuHan University, Wuhan, China.
authors.forename: Jin
authors.initials: J
authors.lastname: You
authors.affiliation: The University of Texas School of Public Health, Houston, USA.
authors.forename: April
authors.initials: A
authors.lastname: Kavanagh
authors.affiliation: Department of Psychology, University of Houston, 126 Heyne Building, Houston, 77204, TX, USA.
authors.forename: Krystal
authors.initials: K
authors.lastname: Warmoth
authors.affiliation: Fudan University Shanghai Cancer Center, Shanghai, China.
authors.forename: Zhiqiang
authors.initials: Z
authors.lastname: Meng
authors.affiliation: Fudan University Shanghai Cancer Center, Shanghai, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Chen
authors.affiliation: University of Texas Health Science Center, Houston, USA.
authors.forename: Kavita D
authors.initials: KD
authors.lastname: Chandwani
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: George H
authors.initials: GH
authors.lastname: Perkins
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: Jennifer Leigh
authors.initials: JL
authors.lastname: McQuade
authors.affiliation: Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, India.
authors.forename: Nelamangala V
authors.initials: NV
authors.lastname: Raghuram
authors.affiliation: Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, India.
authors.forename: Raghuram
authors.initials: R
authors.lastname: Nagarathna
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: Zhongxing
authors.initials: Z
authors.lastname: Liao
authors.affiliation: Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, India.
authors.forename: Hongasandra Ramarao
authors.initials: HR
authors.lastname: Nagendra
authors.affiliation: Fudan University Shanghai Cancer Center, Shanghai, China.
authors.forename: Jiayi
authors.initials: J
authors.lastname: Chen
authors.affiliation: Fudan University Shanghai Cancer Center, Shanghai, China.
authors.forename: Xiaoma
authors.initials: X
authors.lastname: Guo
authors.affiliation: Fudan University Shanghai Cancer Center, Shanghai, China.
authors.forename: Luming
authors.initials: L
authors.lastname: Liu
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: Banu
authors.initials: B
authors.lastname: Arun
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, USA. lcohen@mdanderson.org.|Department of Palliative, Rehabilitation, and Integrative Medicine, Section of Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA. lcohen@mdanderson.org.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality / Q000523:psychology*; D002681:China; D005260:Female; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D017741:Survivors; D014481:United States
keywords: Breast cancer; Country; Culture; Quality of life