Longitudinal investigation of sociocultural and behavioral influences on symptom management, biological response, and functioning between Chinese and White breast cancer survivors. - 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. Our preliminary study showed that CA and non-Hispanic White (NHW) breast cancer survivors (BCS) experience varying levels of fatigue, pain, and poor physical functioning. While more Chinese Americans reported psychosocial stress (e.g. greater perceived threat and fear of losing socioeconomic resources), they paradoxically reported less depression than NHWs. It is unclear why CA BCS appeared emotionally resilient when they also showed physical vulnerability and reported fewer social resources for coping (i.e., social support and socioeconomic and healthcare resources). Whether such resilience is actually a cultural response, such as many Cas believing that emotional stress causes cancer and therefore underreporting their distress, needs to be further studied. Unexpressed chronic stress is related to higher cortisol and inflammation levels detrimental to health. Previous research has not investigated whether cultural differences between CA and NHW BCS affect their symptom severity and biological expression over time and their ways of managing symptoms. 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 cultural groups. To comprehensively understand sociocultural influences on individual coping behaviors and how they in turn affect biological responses (i.e., inflammation and cortisol markers), symptom severity, and quality of life, we propose a bi-racial, cohort study among 235 CA and 235 NHW women diagnosed with stage 0-III breast cancer within 10 years. 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 to develop individually and culturally appropriate interventions conducive to improving clinical care for targeted cancer survivor populations. This aligns with one of the National Cancer Institute’s strategic priorities: understanding biobehavioral models of cancer survivorship to improve symptom control and survival.
