Over 1,500 studies are in Medline today on the psychosocial impact and quality of life (QOL) of breast cancer (BC) survivors. Only a small percentage of these studies have been conducted with women of color, yet most of these studies appear to use the same psycho-social theories for intervention and outcomes, developed and validated with non-Hispanic white women. This assumed universality of (EA) cultural beliefs and practices undermines the importance of cultural differences in cancer research. Often standardized questionnaires are tested for reliability in diverse groups with an α score, but many validated scales have rarely been tested for cross-cultural equivalence of concepts and metrics in diverse populations.

The absence of research exploring and testing the cross cultural equivalence of EA developed concepts, such as, self-integrity and well-being of BC survivors thwarts our ability to effectively address the QOL of diverse populations, and hinders our ability to promote health equity. Therefore, this presentation will first briefly present a consensus definition of culture, second, discuss the general lack of attention to cross-cultural equivalence of concepts and measures used in cancer survivor research, last, present an example of a mixed paradigm and mixed method study designed to identify and test such potential cultural differences in among Asian American (AA) breast cancer (BC) survivors.

AA BC survivors are reported to suffer significant emotional and social problems, but do not avail themselves of existing and available EA based services, even if they have been in the U.S. for multiple generations and/or are proficient in English. Yet, few studies have been conducted to identify why AA BC survivors do not use existing support services and how to better design high-quality programs that provide that needed support. Breast cancer support groups are designed to increase self-integrity, and well-being, but the cross-cultural equivalence of concepts of self-integrity and well-being have not been tested in breast cancer survivorship.

Study Design

This mixed paradigm and mixed method study was developed to 1) test the cultural equivalence and validity of standard measures of distress and well-being in order to investigate such potential cultural differences in the BC survivorship experience among three groups of Asian American women in three different geographic areas, 2) identify potential cultural differences in their perceptions of the cancer experience and degree of satisfaction with their strategies to manage the experience by providing context and meaning to our deductive findings, and 3) test if the cultural specific constructs and measures provide greater explanatory power to the QOL of the AA women than the set of standardized tools currently used.

We conducted, in depth ethnographic interviews with 35 key informants, 118 BC survivors and 57 family members. We also surveyed 450 Chinese-, Japanese-, Vietnamese- and European American BC survivors.

Implications for Health Disparities Research in Cancer

The findings from this study will demonstrate how mixed-paradigms and methods are essential to develop a culturally informed understanding of the lives of women with cancer from diverse cultural backgrounds. Such study designs are crucial to inform the science and practice of BC survivorship in AA communities by mobilizing more culturally appropriate assessment tools built on culturally valid concepts and constructs. Such tools may aid in designing culturally grounded and congruent programs that more adequately meet the needs of those in underrepresented communities, and, thereby, improve the QOL of BC survivors from diverse populations as well as facilitate the elimination of health disparities.

Citation Format: Marjorie Kagawa-Singer. How does Cultural Equivalence Impact Asian American Cancer Survivors? [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr IA17.