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.
