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Kim JHJ, Kagawa Singer M, Bang L, Ko A, Nguyen B, Chen Stokes S, Lu Q, Stanton AL. Supportive Care Needs in Chinese, Vietnamese, and Korean Americans With Metastatic Cancer: Mixed Methods Protocol for the DAWN Study. JMIR Res Protoc 2024; 13:e50032. [PMID: 38648633 PMCID: PMC11074895 DOI: 10.2196/50032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/06/2024] [Accepted: 03/11/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Asian Americans with metastatic cancer are an understudied population. The Describing Asian American Well-Being and Needs in Cancer (DAWN) Study was designed to understand the supportive care needs of Chinese-, Vietnamese-, and Korean-descent (CVK) patients with metastatic cancer. OBJECTIVE This study aims to present the DAWN Study protocol involving a primarily qualitative, convergent, mixed methods study from multiple perspectives (patients or survivors, caregivers, and health care professionals). METHODS CVK Americans diagnosed with solid-tumor metastatic cancer and their caregivers were recruited nationwide through various means (registries, community outreach newsletters, newspapers, radio advertisements, etc). Potentially eligible individuals were screened and consented on the web or through a phone interview. The study survey and interview for patients or survivors and caregivers were provided in English, traditional/simplified Chinese and Cantonese/Mandarin, Vietnamese, and Korean, and examined factors related to facing metastatic cancer, including quality of life, cultural values, coping, and cancer-related symptoms. Community-based organizations assisted in recruiting participants, developing and translating study materials, and connecting the team to individuals for conducting interviews in Asian languages. Health care professionals who have experience working with CVK patients or survivors with metastatic solid cancer were recruited through referrals from the DAWN Study community advisory board and were interviewed to understand unmet supportive care needs. RESULTS Recruitment began in November 2020; data collection was completed in October 2022. A total of 66 patients or survivors, 13 caregivers, and 15 health care professionals completed all portions of the study. We completed data management in December 2023 and will submit results for patients or survivors and caregivers to publication outlets in 2024. CONCLUSIONS Future findings related to this protocol will describe and understand the supportive care needs of CVK patients or survivors with metastatic cancer and will help develop culturally appropriate psychosocial interventions that target known predictors of unmet supportive care needs in Chinese, Vietnamese, and Korean Americans with metastatic cancer. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50032.
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Affiliation(s)
- Jacqueline H J Kim
- Department of Medicine, University of California, Irvine, Irvine, CA, United States
| | - Marjorie Kagawa Singer
- Department of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Lisa Bang
- Department of Medicine, University of California, Irvine, Irvine, CA, United States
| | - Amy Ko
- Department of Medicine, University of California, Irvine, Irvine, CA, United States
| | - Becky Nguyen
- Vietnamese American Cancer Foundation, Fountain Valley, CA, United States
| | - Sandy Chen Stokes
- Chinese American Coalition for Compassionate Care, Cupertino, CA, United States
| | - Qian Lu
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Annette L Stanton
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
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Celis-Seposo AK, Madaniyazi L, Seposo X, Hashizume M, Yoshida LM, Toizumi M. Incidence and seasonality of Kawasaki disease in children in the Philippines, and its association with ambient air temperature. Front Pediatr 2024; 12:1358638. [PMID: 38711494 PMCID: PMC11070490 DOI: 10.3389/fped.2024.1358638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/08/2024] [Indexed: 05/08/2024] Open
Abstract
Background Despite an unknown cause, Kawasaki disease (KD) is currently the primary leading cause of acquired heart disease in developed countries in children and has been increasing in recent years. Research efforts have explored environmental factors related to KD, but they are still unclear especially in the tropics. We aimed to describe the incidence of KD in children, assess its seasonality, and determine its association with ambient air temperature in the National Capital Region (NCR), Philippines from January 2009 to December 2019. Methods Monthly number of KD cases from the Philippine Pediatric Society (PPS) disease registry was collected to determine the incidence of KD. A generalized linear model (GLM) with quasi-Poisson regression was utilized to assess the seasonality of KD and determine its association with ambient air temperature after adjusting for the relevant confounders. Results The majority of KD cases (68.52%) occurred in children less than five years old, with incidence rates ranging from 14.98 to 23.20 cases per 100,000 population, and a male-to-female ratio of 1.43:1. Seasonal variation followed a unimodal shape with a rate ratio of 1.13 from the average, peaking in March and reaching the lowest in September. After adjusting for seasonality and long-term trend, every one-degree Celsius increase in the monthly mean temperature significantly increased the risk of developing KD by 8.28% (95% CI: 2.12%, 14.80%). Season-specific analysis revealed a positive association during the dry season (RR: 1.06, 95% CI: 1.01, 1.11), whereas no evidence of association was found during the wet season (RR: 1.10, 95% CI: 0.95, 1.27). Conclusion We have presented the incidence of KD in the Philippines which is relatively varied from its neighboring countries. The unimodal seasonality of KD and its linear association with temperature, independent of season and secular trend, especially during dry season, may provide insights into its etiology and may support enhanced KD detection efforts in the country.
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Affiliation(s)
| | - Lina Madaniyazi
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Japan Environment and Children's Study Programme Office, National Institute for Environmental Studies, Tsukuba, Japan
| | - Xerxes Seposo
- Department of Hygiene, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
- Ateneo Center for Research and Innovation, Ateneo School of Medicine and Public Health, Ateneo de Manila University, Pasig, Philippines
| | - Masahiro Hashizume
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Lay Myint Yoshida
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Michiko Toizumi
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
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Yom S, Lor M. Advancing Health Disparities Research: The Need to Include Asian American Subgroup Populations. J Racial Ethn Health Disparities 2022; 9:2248-2282. [PMID: 34791615 PMCID: PMC8598103 DOI: 10.1007/s40615-021-01164-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/13/2021] [Accepted: 09/29/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Despite recognition that the health outcomes of Asian American subgroups are heterogeneous, research has mainly focused on the six largest subgroups. There is limited knowledge of smaller subgroups and their health outcomes. This scoping review identifies trends in the health outcomes, reveals those which are under-researched, and provide recommendations on data collection with 24 Asian American subgroups. METHODS Our literature search of peer-reviewed English language primary source articles published between 1991 and 2018 was conducted across six databases (Embase, PubMed, Web of Sciences, CINAHL, PsychINFO, Academic Search Complete) and Google Scholar, yielding 3844 articles. After duplicate removal, we independently screened 3413 studies to determine whether they met inclusion criteria. Seventy-six studies were identified for inclusion in this review. Data were extracted on study characteristics, content, and findings. FINDINGS Seventy-six studies met the inclusion criteria. The most represented subgroups were Chinese (n = 74), Japanese (n = 60), and Filipino (n = 60), while Indonesian (n = 1), Malaysian (n = 1), and Burmese (n = 1) were included in only one or two studies. Several Asian American subgroups listed in the 2010 U.S. Census were not represented in any of the studies. Overall, the most studied health conditions were cancer (n = 29), diabetes (n = 13), maternal and infant health (n = 10), and cardiovascular disease (n = 9). Studies showed that health outcomes varied greatly across subgroups. CONCLUSIONS More research is required to focus on smaller-sized subgroup populations to obtain accurate results and address health disparities for all groups.
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Affiliation(s)
| | - Maichou Lor
- University of Wisconsin – Madison, Madison, WI USA
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Escobedo LA, Morey BN, Sabado-Liwag MD, Ponce NA. Lost on the frontline, and lost in the data: COVID-19 deaths among Filipinx healthcare workers in the United States. Front Public Health 2022; 10:958530. [PMID: 36091528 PMCID: PMC9452815 DOI: 10.3389/fpubh.2022.958530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/08/2022] [Indexed: 01/24/2023] Open
Abstract
Background Filipinx Americans working in healthcare are at risk for COVID-19 death but lack consistent mortality data on healthcare worker deaths. The lack of disaggregated data for Asian subgroups proliferates anti-Asian structural racism as the needs of high-risk groups are systematically undetected to merit a proper public health response. We work around this aggregated data problem by examining how the overrepresentation of Filipinxs in healthcare contributes to COVID-19 mortality among Asian American populations. Methods To overcome the lack of COVID-19 mortality data among Filipinx American healthcare workers, we merged data from several sources: Kanlungan website (the only known public-facing source of systematically reported mortality data on Filipinx healthcare workers nationally and globally), National Center for Health Statistics, and 2014-2018 American Community Survey. We examined county-level associations using t-tests, scatterplots, and linear regression. Findings A higher percentage of Filipinxs among Asian Americans was correlated with a higher percentage of COVID-19 decedents who are Asian Americans (r = 0.24, p = 0.01). The percentage of Filipinx in healthcare remained a strong predictor of COVID-19 deaths among Asian Americans even after adjusting for age, poverty, and population density (coef = 1.0, p < 0.001). For every 1% increase in Filipinx among the healthcare workforce, the percentage of Asian American COVID-19 decedents increased by 1%. Interpretation Our study shows that the overrepresentation of Filipinxs in healthcare contributes to COVID-19 mortality disparities among Asian Americans. Our findings advocate for systems change by practicing anti-racist data agendas that collect and report on Asian subgroups for effective real-time targeted approaches against health inequities.
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Affiliation(s)
- Loraine A. Escobedo
- Cancer Research Center for Health Equity, Cedars-Sinai Cancer, West Hollywood, CA, United States,*Correspondence: Loraine A. Escobedo
| | - Brittany N. Morey
- Department of Health, Society, and Behavior, University of California, Irvine, Irvine, CA, United States
| | - Melanie D. Sabado-Liwag
- Filipinx/a/o Community Health Association, Los Angeles, CA, United States,Department of Public Health, California State University, Los Angeles, CA, United States
| | - Ninez A. Ponce
- Filipinx/a/o Community Health Association, Los Angeles, CA, United States,UCLA Center for Health Policy Research, Los Angeles, CA, United States,Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
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Wang F, Shu X, Pal T, Berlin J, Nguyen SM, Zheng W, Bailey CE, Shu XO. Racial/Ethnic Disparities in Mortality Related to Access to Care for Major Cancers in the United States. Cancers (Basel) 2022; 14:3390. [PMID: 35884451 PMCID: PMC9318931 DOI: 10.3390/cancers14143390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 12/04/2022] Open
Abstract
Importance: The reasons underlying racial/ethnic mortality disparities for cancer patients remain poorly understood, especially regarding the role of access to care. Participants: Over five million patients with a primary diagnosis of lung, breast, prostate, colon/rectum, pancreas, ovary, or liver cancer during 2004-2014, were identified from the National Cancer Database. Cox proportional hazards models were applied to estimate hazard ratios (HR) and 95% confidence intervals (CI) for total mortality associated with race/ethnicity, and access to care related factors (i.e., socioeconomic status [SES], insurance, treating facility, and residential type) for each cancer. Results: Racial/ethnic disparities in total mortality were observed across seven cancers. Compared with non-Hispanic (NH)-white patients, NH-black patients with breast (HR = 1.27, 95% CI: 1.26 to 1.29), ovarian (HR = 1.20, 95% CI: 1.17 to 1.23), prostate (HR = 1.31, 95% CI: 1.30 to 1.33), colorectal (HR = 1.11, 95% CI: 1.10 to 1.12) or pancreatic (HR = 1.03, 95% CI: 1.02 to 1.05) cancers had significantly elevated mortality, while Asians (13-31%) and Hispanics (13-19%) had lower mortality for all cancers. Racial/ethnic disparities were observed across all strata of access to care related factors and modified by those factors. NH-black and NH-white disparities were most evident among patients with high SES or those with private insurance, while Hispanic/Asian versus NH-white disparities were more evident among patients with low SES or those with no/poor insurance. Conclusions and Relevance: Racial/ethnic mortality disparities for major cancers exist across all patient groups with different access to care levels. The influence of SES or insurance on mortality disparity follows different patterns for racial/ethnic minorities versus NH-whites. Impact: Our study highlights the need for racial/ethnic-specific strategies to reduce the mortality disparities for major cancers.
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Affiliation(s)
- Fei Wang
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37203, USA or (F.W.); (S.M.N.); or (W.Z.)
- Department of Breast Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, China
| | - Xiang Shu
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Tuya Pal
- Division of Genetic Medicine, Department of Medicine, Vanderbilt Genetics Institute, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37203, USA;
| | - Jordan Berlin
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37203, USA;
| | - Sang M. Nguyen
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37203, USA or (F.W.); (S.M.N.); or (W.Z.)
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37203, USA or (F.W.); (S.M.N.); or (W.Z.)
| | - Christina E. Bailey
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37203, USA;
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37203, USA or (F.W.); (S.M.N.); or (W.Z.)
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Chen MS, Lee RJ, Madan RA, Ta Park V, Shinagawa SM, Sun T, Gomez SL. Charting a Path Towards Asian American Cancer Health Equity: A Way Forward. J Natl Cancer Inst 2022; 114:792-799. [PMID: 35437573 PMCID: PMC9194616 DOI: 10.1093/jnci/djac055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/17/2022] [Accepted: 02/24/2022] [Indexed: 12/30/2022] Open
Abstract
On July 29, 2021, the US Food and Drug Administration’s Oncology Center of Excellence convened Conversations on Cancer. This Conversation, the first ever by the US Food and Drug Administration, focused on Asian Americans and served as the platform for this Commentary. Panelists elaborated on topics ranging from heterogeneity in Asian American demographics to racism through a path to health equity and supplemented this Commentary with literature citations. Asian Americans are the fastest-growing US race group, yet data aggregation obscures distinctions and cancer disparities within the more than 24 million Asians living in the United States with harmful impacts on communities and patients, as illustrated by breast cancer survivor Susan Shinagawa’s patient-to-advocate journey. Bigotry against Asian Americans has been pervasive since the 19th century, but especially during the COVID-19 pandemic. Asian Americans are unique as the first US population to experience cancer as the leading cause of death. Asian Americans are disproportionately affected by cancers because of infectious origins and have the highest rates of lung cancer among never-smoking women. The infinitesimal proportion of the National Institutes of Health’s budget compared with experiencing the highest percentage increases of any US racial population more than 3 decades highlights the dearth of focused research among Asian Americans. Recognizing the heterogeneity of Asian Americans and that disaggregated data are critical for accurately characterizing distinct ethnic groups, focusing on the impact of racism and COVID-19 on cancer disparities, and focusing and prioritizing funding resources are necessary steps forward for achieving health equity for Asian Americans.
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Affiliation(s)
- Moon S Chen
- Department of Internal Medicine, UC Davis School of Medicine, Sacramento, CA, USA
| | - Richard J Lee
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Ravi A Madan
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Van Ta Park
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA
| | - Susan M Shinagawa
- Asian and Pacific Islander National Cancer Survivors Network, Spring Valley, CA, USA
| | - Tracy Sun
- Asian and Pacific Islander American Health Forum, Washington, DC, USA
| | - Scarlett L Gomez
- Department of Epidemiology and Biostatistics, UC San Francisco School of Medicine and the Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
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Lee AW, Mendoza RA, Aman S, Hsu R, Liu L. Thyroid cancer incidence disparities among ethnic Asian American populations, 1990-2014. Ann Epidemiol 2021; 66:28-36. [PMID: 34774744 DOI: 10.1016/j.annepidem.2021.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 10/27/2021] [Accepted: 11/02/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Asian/Pacific Islanders (APIs) are at high risk of thyroid cancer, hence we examined thyroid cancer's incidence among disaggregated API subgroups in the United States (U.S.) to identify potential ethnic-specific disparities. METHODS Data from 1990 to 2014 in the Surveillance, Epidemiology, and End Results Program (SEER) were used to compare age-adjusted incidence rates (AAIRs) of thyroid cancer for seven API ethnic subgroups to non-Hispanic whites (NHWs) using incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Sex, age, tumor histotype, and year of diagnosis were considered. Trends were evaluated using average annual percent change (AAPC) statistics. RESULTS The highest AAIRs (per 100,000 person-years) were among Filipinos (female AAIR=20.49, male AAIR=7.06) and the lowest among Japanese (female AAIR=8.36, male AAIR=3.20). However, Filipinos showed significantly lower incidence of medullary tumors when compared to NHWs (female IRR=0.60, 95% CI 0.40-0.87, male IRR=0.26, 95% CI 0.26-0.51). The largest increasing trends were among Asian Indian/Pakistanis for females (AAPC=5.19, 95% CI 3.81 to 6.58) and Koreans for males (AAPC=4.57, 95% CI 3.14 to 6.03). CONCLUSIONS There are clear differences in thyroid cancer incidence and trends when U.S. API ethnic subgroups are examined separately. Disaggregating APIs in research can provide critical information for understanding thyroid cancer risk.
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Key Words
- average annual percent change, APC, annual percent change, API, Asian/Pacific Islander, ASIR, age-specific incidence rate, CI, confidence interval, ICD-O-3, International Classification of Diseases for Oncology, Third Edition, IRR, incidence rate ratio, NHW, non-Hispanic white, NOS, not otherwise specified002C SEER, Surveillance, Epidemiology, and End Results Program, U.S., United States
- thyroid cancer, Asian Americans, racial/ethnic disparities, AAIR, age-adjusted incidence rate, AAPC
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Affiliation(s)
- Alice W Lee
- Department of Public Health, California State University, Fullerton, 800 N. State College Blvd., KHS-127, Fullerton, CA, 92831, USA.
| | - Roy A Mendoza
- Department of Biological Sciences, California State University, Fullerton, 800 N. State College Blvd., MH-112, Fullerton, CA, 92831, USA
| | - Shehla Aman
- Department of Public Health, California State University, Fullerton, 800 N. State College Blvd., KHS-127, Fullerton, CA, 92831, USA
| | - Robert Hsu
- Department of Oncology, Keck School of Medicine, University of Southern California, 1975 Zonal Ave., Los Angeles, CA, 90033, USA
| | - Lihua Liu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto St., Los Angeles, CA, 90033, USA; Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, 1441 Eastlake Ave., Los Angeles, CA, 90033, USA
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Medina HN, Callahan KE, Morris CR, Thompson CA, Siweya A, Pinheiro PS. Cancer Mortality Disparities among Asian American and Native Hawaiian/Pacific Islander Populations in California. Cancer Epidemiol Biomarkers Prev 2021; 30:1387-1396. [PMID: 33879454 PMCID: PMC8254771 DOI: 10.1158/1055-9965.epi-20-1528] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/03/2021] [Accepted: 04/13/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Asian American and Native Hawaiian/Pacific Islanders (AANHPI) are the fastest growing minority in the United States. Cancer is the leading cause of death for AANHPIs, despite relatively lower cancer morbidity and mortality. Their recent demographic growth facilitates a detailed identification of AANHPI populations with higher cancer risk. METHODS Age-adjusted, sex-stratified, site-specific cancer mortality rates from California for 2012 to 2017 were computed for AANHPI groups: Chinese, Filipino, South Asian, Vietnamese, Korean, Japanese, Southeast Asian (i.e., Cambodian, Hmong, Laotian, Thai), and Native Hawaiian and Other Pacific Islander (NHOPI). Regression-derived mortality rate ratios (MRR) were used to compare each AANHPI group to non-Hispanic whites (NHW). RESULTS AANHPI men and women (total 40,740 deaths) had lower all-sites-combined cancer mortality rates (128.3 and 92.4 per 100,000, respectively) than NHWs (185.3 and 140.6) but higher mortality for nasopharynx, stomach, and liver cancers. Among AANHPIs, both NHOPIs and Southeast Asians had the highest overall rates including for colorectal, lung (men only), and cervical cancers; South Asians had the lowest. NHOPI women had 41% higher overall mortality than NHWs (MRR = 1.41; 95% CI, 1.25-1.58), including for breast (MRR = 1.33; 95% CI, 1.08-1.65) and markedly higher for endometrial cancer (MRR = 3.34; 95% CI, 2.53-4.42). CONCLUSIONS AANHPI populations present with considerable heterogeneous cancer mortality patterns. Heightened mortality for infection, obesity, and tobacco-related cancers in Southeast Asians and NHOPI populations highlight the need for differentiated priorities and public health interventions among specific AANHPI populations. IMPACT Not all AANHPIs have favorable cancer profiles. It is imperative to expand the focus on the currently understudied populations that bear a disproportionate cancer burden.
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Affiliation(s)
- Heidy N Medina
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida.
| | - Karen E Callahan
- School of Public Health, University of Nevada, Las Vegas, Nevada
| | - Cyllene R Morris
- California Cancer Reporting and Epidemiologic Surveillance Program, UC Davis Comprehensive Cancer Center/UC Davis Health, Davis, California
| | - Caroline A Thompson
- School of Public Health, San Diego State University, Sutter Health Palo Alto Medical Foundation Research Institute, University of California San Diego School of Medicine, San Diego, California
| | - Adugna Siweya
- School of Public Health, University of Nevada, Las Vegas, Nevada
| | - Paulo S Pinheiro
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
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Health Disparities Across Lung Cancer Continuum Among Asian Americans: A Systematic Review. J Immigr Minor Health 2021; 24:526-545. [PMID: 34156594 DOI: 10.1007/s10903-021-01212-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 10/21/2022]
Abstract
The purpose of this systematic review is to synthesize lung cancer associated health disparities across the cancer continuum among Asian Americans. A systematic review design with the narrative method was used for conducting this study. Electronic literature databases, including PubMed, Google Scholar, and CINAHL, were searched. After applying filter information, inclusion and exclusion criteria, a total of 20 articles were included in the review. Findings related to lung cancer prevention, screening, incidence rates, diagnosis, treatment, survival rates, and mortality rates among Asian Americans were synthesized. Results showed the prevalence of smoking quit attempts in the past year was high among Asian Americans, although the prevalence of receiving advice to quit and using counseling and/or medication services was low among this population. Also, the smoking cessation rate among Asian Americans was the second lowest among all racial groups, although the abstinence rate was highest among this population. Compared with other races, Asian Americans are more likely to be diagnosed with lung cancer at a distant stage of disease, and they tend to be less likely to undergo surgery than other races in the United States. The incidence and mortality rates of lung cancer were low among Asian Americans compared with other races in the United States, while the survival rate of lung cancer was high among this population. Further research focusing on lung cancer associated health disparities in specific Asian American ethnic groups should be conducted. Culturally relevant programs that tackle cultural and genetic factors related to lung cancer risk as well as early screening, diagnosis and treatment in this vulnerable population are also necessary.
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Chu Q, Wu IHC, Tang M, Tsoh J, Lu Q. Temporal relationship of posttraumatic stress disorder symptom clusters during and after an expressive writing intervention for Chinese American breast cancer survivors. J Psychosom Res 2020; 135:110142. [PMID: 32485623 DOI: 10.1016/j.jpsychores.2020.110142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 05/07/2020] [Accepted: 05/13/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is a significant condition and frequently observed among breast cancer survivors. Extant literature has demonstrated the effectiveness of expressive writing interventions in reducing PTSD among breast cancer survivors. However, little is known about how different PTSD symptom clusters influence each other over time during and after the expressive writing intervention among breast cancer survivors. We investigated how the three PTSD symptom clusters (reexperiencing, avoidance and hyperarousal) influence each other during and after an expressive writing intervention among Chinese American breast cancer survivors. METHODS Chinese American breast cancer survivors (n = 136) completed an expressive writing intervention. Their PTSD symptoms were assessed at baseline, 1-, 3-, and 6-month follow-ups. RESULTS Using cross-lagged panel analysis, the model with hyperarousal symptoms at each assessment wave predicting the subsequent severity of avoidance and reexperiencing symptoms indicated the best fit, χ2(52) = 65.422, p = .100; CFI = 0.990, RMSEA = 0.044, 95% CI [0.000, 0.074]. CONCLUSION The results suggest that hyperarousal symptoms predict the subsequent severity of reexperiencing and avoidance symptoms over time during and after the expressive writing intervention. The findings highlight the importance of early diagnosis, monitoring and treatment of hyperarousal symptoms in enhancing the efficacy of PTSD interventions and reducing the chronicity in PTSD among Chinese American breast cancer survivors. Clinical Trial Registration atClinicalTrials.gov: NCT02946619.
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Affiliation(s)
- Qiao Chu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Ivan Haw Chong Wu
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Moni Tang
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Janice Tsoh
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA.
| | - Qian Lu
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Psychology, University of Houston, Houston, TX, USA.
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Ghazarian AA, McGlynn KA. Increasing Incidence of Testicular Germ Cell Tumors among Racial/Ethnic Minorities in the United States. Cancer Epidemiol Biomarkers Prev 2020; 29:1237-1245. [PMID: 32385118 DOI: 10.1158/1055-9965.epi-20-0107] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/22/2020] [Accepted: 04/01/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The incidence of testicular germ cell tumors (TGCT) has been rising in the United States and is notably higher among white men. Previously, our group reported that rates were rising among Hispanic men in certain areas. This study sought to determine whether the patterns noted in our prior publication remained evident in more recent years and to determine whether any new patterns have emerged. METHODS Data from 51 U.S. cancer registries were examined. Racial/ethnic-specific incidence rates per 100,000 man-years were calculated overall and by census region. Annual percent changes (APC) were estimated, and joinpoint models were fit. Differences in regional incidence were examined using the Wald test. RESULTS During the time period 2001 to 2016, 126,575 TGCTs were recorded. TGCT incidence was highest among non-Hispanic whites (NHW; 6.63/100,000), followed by Hispanics (4.20), American Indian/Alaska Natives (AI/AN; 3.27), Asian/Pacific Islanders (A/PI; 1.72), and non-Hispanic blacks (NHB; 1.27). TGCT incidence increased significantly among all men; the greatest increase was experienced by A/PIs (APC: 2.47), followed in order by Hispanics (2.10), AI/ANs (1.71), NHBs (1.28), and NHWs (0.41). Significant differences in rates by region were seen for all men except NHBs, with the highest rates among Hispanics (5.38/100,000), AI/ANs (4.47), and A/PIs (2.37) found in the West, and among NHWs (7.60) and NHBs (1.51) found in the Northeast. CONCLUSIONS Although TGCT incidence remained highest among NHWs between 2001 and 2016, the greatest increase was experienced by A/PI men. IMPACT Rising rates of TGCTs among men of all racial/ethnic backgrounds in the United States suggest that future attention is warranted.
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Affiliation(s)
- Armen A Ghazarian
- National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Katherine A McGlynn
- National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland.
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12
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Lui NS, Benson J, He H, Imielski BR, Kunder CA, Liou DZ, Backhus LM, Berry MF, Shrager JB. Sub-solid lung adenocarcinoma in Asian versus Caucasian patients: different biology but similar outcomes. J Thorac Dis 2020; 12:2161-2171. [PMID: 32642121 PMCID: PMC7330405 DOI: 10.21037/jtd.2020.04.37] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Asian and Caucasian patients with lung cancer have been compared in several database studies, with conflicting findings regarding survival. However, these studies did not include proportion of ground-glass opacity or mutational status in their analyses. Asian patients commonly develop sub-solid lung adenocarcinomas that harbor EGFR mutations, which have a better prognosis. We hypothesized that among patients undergoing surgery for sub-solid lung adenocarcinomas, Asian patients have better survival compared to Caucasian patients. Methods We identified Asian and Caucasian patients who underwent surgical resection for a sub-solid lung adenocarcinoma from 2002 to 2015 at our institution. Sub-solid was defined as ≥10% ground-glass opacity on preoperative CT scan or ≥10% lepidic component on surgical pathology. Time-to-event multivariable analysis was performed to determine which characteristics were associated with recurrence and survival. Results Two hundred twenty-four patients were included with median follow up 48 months. Asian patients were more likely to be never smokers (76.3% vs. 29.0%, P<0.01) and have an EGFR mutation (69.4% vs. 25.6% of those tested, P<0.01), while Caucasian patients were more likely to have a KRAS mutation (23.5% vs. 4.9% of those tested, P<0.01). There was a trend towards Asian patients having a higher proportion of ground-glass opacity (38.8% vs. 30.5%, P=0.11). Time-to-event multivariable analysis showed that higher proportion of ground-glass opacity was significantly associated with better recurrence-free survival (HR 0.76 per 20% increase, P=0.02). However, mutational status and race did not have a significant impact on recurrence-free or overall survival. Conclusions Asian and Caucasian patients with sub-solid lung adenocarcinoma have different tumor biology, but recurrence-free and overall survival after surgical resection is similar.
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Affiliation(s)
- Natalie S Lui
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Jalen Benson
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Hao He
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Bartlomiej R Imielski
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA.,Department of Surgery, Northwestern University, Chicago, IL, USA
| | | | - Douglas Z Liou
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Leah M Backhus
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Mark F Berry
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Joseph B Shrager
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
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13
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Gu M, Thapa S. Colorectal cancer in the United States and a review of its heterogeneity among Asian American subgroups. Asia Pac J Clin Oncol 2020; 16:193-200. [PMID: 32129941 DOI: 10.1111/ajco.13324] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 01/28/2020] [Indexed: 11/30/2022]
Abstract
Colorectal cancer is the third most common cancer in the United States. Established risk factors include older age, unhealthy lifestyle (high consumptions of red/preserved meat, low consumptions of fruit and vegetables, smoking, high alcohol consumption, and lack of physical activities), personal and family medical histories and low socioeconomic status (low insurance coverage, education and income). Asian American subgroups vary significantly in terms of culture, socioeconomic status, and health behaviors, yet most registries and researches aggregate all Asian Americans as one group. In this review, we summarized and compared colorectal cancer incidence among different Asian American subgroups, and to explore the reasons behind the heterogeneity. Based on limited literatures, we found that Japanese Americans have the highest colorectal cancer incidence among all Asian Americans. The incidence is decreasing among most Asian American subgroups except for Korean Americans. Such heterogeneity is influenced by lifestyle factors related to the country of origin and the United States, as well as colorectal cancer screening.
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Affiliation(s)
- Mofan Gu
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Susan Thapa
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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14
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Oung B, Chea K, Oung C, Saurin JC, Ko CW. Endoscopic yield of chronic dyspepsia in outpatients: A single-center experience in Cambodia. JGH OPEN 2020; 4:61-68. [PMID: 32055699 PMCID: PMC7008163 DOI: 10.1002/jgh3.12210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/18/2019] [Accepted: 05/04/2019] [Indexed: 11/06/2022]
Abstract
Background and Aim The diagnostic evaluation and management of patients with chronic dyspepsia may differ geographically according to patient age, prevalence of Helicobacter pylori or parasitic infection, and risk of gastric cancer. The characteristics and appropriate investigation of Cambodian patients with dyspepsia have not previously been studied. The aim of this study was to investigate the characteristics of Cambodian patients with chronic dyspepsia, the yield of upper endoscopy in these patients, and the value of alarm features in identifying patients with organic causes of dyspepsia. Methods We conducted a retrospective, single-center study of 1231 adults with chronic dyspepsia who underwent upper endoscopy. We compared clinical characteristics, H. pylori prevalence, and endoscopic and histological findings of patients with functional or organic causes of dyspepsia. This study was approved by the National Ethics Committee for Health Research. Results The majority of patients had overlapping symptoms of epigastric pain/burning and postprandial fullness/early satiety (40.6%), followed by epigastric pain/burning alone (29.7%) and postprandial fullness/early satiety alone (29.7%). Organic lesions were diagnosed in 6.9% of patients. The overall prevalence of H. pylori infection was 46% and was similar in the three clinical subgroups. The sensitivity and specificity of alarm features for organic causes of dyspepsia were 14 and 96%, respectively. The majority of patients with gastric cancer were 40 years of age or older. Conclusions The majority of patients with chronic dyspepsia seen at our outpatient center were diagnosed with functional or H. pylori-associated dyspepsia. The presence of alarm features was not sensitive or specific for differentiating organic and functional dyspepsia.
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Affiliation(s)
- Borathchakra Oung
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital Hospices civils de Lyon Lyon France.,CHAKRA GI Clinic Phnom Penh Cambodia.,GI and Liver Unit Calmette Hospital Phnom Penh Cambodia
| | - Khang Chea
- CHAKRA GI Clinic Phnom Penh Cambodia.,GI and Liver Unit Calmette Hospital Phnom Penh Cambodia
| | - Chakravuth Oung
- CHAKRA GI Clinic Phnom Penh Cambodia.,GI and Liver Unit Calmette Hospital Phnom Penh Cambodia.,Faculty of Medicine University of Health Sciences Phnom Penh Cambodia.,Cambodian Association of Gastrointestinal Endoscopy Seattle Washington USA
| | - Jean-Christophe Saurin
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital Hospices civils de Lyon Lyon France.,GI and Liver Unit Calmette Hospital Phnom Penh Cambodia
| | - Cynthia W Ko
- Division of Gastroenterology University of Washington Seattle Washington USA
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15
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Ko M, Ton H. The Not Underrepresented Minorities: Asian Americans, Diversity, and Admissions. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:184-189. [PMID: 31577586 DOI: 10.1097/acm.0000000000003019] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Several lawsuits have recently been filed against U.S. universities; the plaintiffs contend that considerations of race and ethnicity in admissions decisions discriminate against Asian Americans. In prior cases brought by non-Latino whites, the U.S. Supreme Court has upheld these considerations, arguing that they are crucial to a compelling interest to increase diversity. The dissenting opinion, however, concerns the possibility that such policies disadvantage Asian Americans, who are considered overrepresented in higher education. Here, the authors explain how a decision favoring the plaintiffs would affect U.S. medical schools. First, eliminating race and ethnicity in holistic review would undermine efforts to diversify the physician workforce. Second, the restrictions on considering race/ethnicity in admissions decisions would not remedy potential discrimination against Asian Americans that arise from implicit biases. Third, such restrictions would exacerbate the difficulty of addressing the diversity of experiences within Asian American subgroups, including recognizing those who are underrepresented in medicine. The authors propose that medical schools engage Asian Americans in diversity and inclusion efforts and recommend the following strategies: incorporate health equity into the institutional mission and admissions policies, disaggregate data to identify underrepresented Asian subgroups, include Asian Americans in diversity committees and support faculty who make diversity work part of their academic portfolio, and enhance the Asian American faculty pipeline through support and mentorship of students. Asian Americans will soon comprise one-fifth of the U.S. physician workforce and should be welcomed as part of the solution to advancing diversity and inclusion in medicine, not cast as the problem.
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Affiliation(s)
- Michelle Ko
- M. Ko is assistant professor, Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, Davis, California; ORCID: https://orcid.org/0000-0001-8859-0022. H. Ton is interim associate vice chancellor, Diversity, Equity and Inclusion, associate dean, Faculty Development and Diversity, and professor, Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California
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16
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Lu Q, Gallagher MW, Loh A, Young L. Expressive Writing Intervention Improves Quality of Life Among Chinese-American Breast Cancer Survivors: A Randomized Controlled Trial. Ann Behav Med 2019; 52:952-962. [PMID: 30346497 DOI: 10.1093/abm/kax067] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Expressive writing interventions are shown to confer health benefits for Caucasian cancer survivors. However, few studies reported improved quality of life or studied ethnic minorities. Purpose The study evaluated whether a culturally sensitive expressive writing intervention improved quality of life. Methods Chinese-speaking breast cancer survivors (n = 136) in the USA were randomly assigned to one of three conditions to write three 30-min weekly essays: a cancer-fact condition to write about facts relevant to the cancer experience for three weeks; a self-regulation condition to write about deepest feelings at week 1, stress and coping at week 2, and finding benefits at week 3; or an enhanced self-regulation condition to write about stress and coping at week 1, deepest feelings at week 2, and finding benefits at week 3. Quality of life was assessed by Functional Assessment of Cancer Therapy at baseline, 1-, 3-, and 6-month follow-ups. Results Growth curve models showed that quality of life was increased in the sample from baseline to the 6-month follow-up. The enhanced self-regulation condition had a large and statistically significant effect (d = 0.90, 95% CI [0.02, 1.687]), and the self-regulation condition had a small effect (d = 0.22, 95% CI [-0.79, 1.07]) on quality of life improvement compared with the cancer-fact group. Conclusion Expressive writing is shown to be an effective intervention to improve quality of life for Chinese-American cancer survivors. Future efforts are warranted to disseminate and implement this low-dose and brief intervention in community and clinical settings. Clinical Trial Registration NCT02946619.
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Affiliation(s)
- Qian Lu
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Matthew W Gallagher
- Department of Psychology, University of Houston, Houston, TX, USA.,Texas Institute for Measurement, Evaluation and Statistics, University of Houston, Houston, TX, USA
| | - Alice Loh
- Herald Cancer Association, San Gabriel, CA, USA
| | - Lucy Young
- Herald Cancer Association, San Gabriel, CA, USA
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17
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Socioeconomic gradients in cancer incidence by race and ethnicity in California, 2008-2012: the influence of tobacco use or screening detectable cancers. Cancer Causes Control 2019; 30:697-706. [PMID: 31065915 DOI: 10.1007/s10552-019-01172-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 04/12/2019] [Indexed: 01/16/2023]
Abstract
PURPOSE There are clearly documented inequalities in cancer incidence by socioeconomic position, but it is unclear whether this is due primarily to differences in tobacco exposure and screening practices or to other factors. METHODS Our study included 741,373 incident cases of invasive cancer from 2008 to 2012 in California. We calculated age-standardized incidence rates across twelve categories of census tract poverty as a measure of socioeconomic position (SEP) for (1) all cancer sites combined, (2) sites not strongly related to tobacco use, (3) sites not related to screening, and (4) sites not related to tobacco use or screening. RESULTS There was higher cancer incidence among those living in areas with higher levels of poverty for sites not strongly related to tobacco use or screening, among Whites, Blacks, and Asians, but not among Latinos. Among Whites there was no relationship with census tract poverty at lower levels of poverty-the relationship with cancer incidence was primarily among those in higher poverty. For Blacks and Asians, there is a more linear relationship with cancer incidence across levels of poverty. CONCLUSIONS SEP gradients in cancer incidence remain after exclusion of cancer sites strongly related to tobacco use and screening. Our findings demonstrate a need for research on other environmental and social causes of cancer where exposures are differentially distributed by SEP.
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18
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Pham C, Fong TL, Zhang J, Liu L. Striking Racial/Ethnic Disparities in Liver Cancer Incidence Rates and Temporal Trends in California, 1988-2012. J Natl Cancer Inst 2018; 110:1259-1269. [PMID: 29617913 PMCID: PMC7191878 DOI: 10.1093/jnci/djy051] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 12/26/2017] [Accepted: 02/28/2018] [Indexed: 12/15/2022] Open
Abstract
Background Hepatocellular carcinoma (HCC) is characterized by disparate risk patterns by race/ethnicity. We examined HCC incidence patterns and temporal trends among detailed racial/ethnic populations, including disaggregated Asian-American subgroups. Methods Using data from the population-based California Cancer Registry, we identified 41 929 invasive HCC cases diagnosed during 1988-2012. Patients were grouped into mutually exclusive racial/ethnic groups of non-Hispanic (NH) white, NH black, Hispanic, and NH Asian/Pacific Islander (API), as well as Asian subgroups of Chinese, Filipino, Japanese, Korean, Vietnamese, Cambodian, Laotian, and South Asian. Age-adjusted and age-specific incidence rates by sex, race/ethnicity, and time period were calculated. The average annual percent change (AAPC) in incidence rates was estimated using joinpoint regression. All estimates were provided with the 95% confidence intervals (CIs). Results Aggregated NH API had higher HCC risk than NH whites, NH blacks, and Hispanics. When disaggregated, Southeast Asians (Vietnamese, Cambodians, and Laotians) had overall HCC incidence rates eight to nine times higher than NH whites and more than twice that of other ethnic Asians. Statistically significant rising temporal trends of HCC were found in NH whites, NH blacks, and Hispanics, especially those older than age 50 years. Overall HCC risk declined in Chinese males (AAPC = -1.3%, 95% CI = -2.0 to -0.6), but rose in Filipino (AAPC = +1.2%, 95% CI = 0.3 to 2.1) and Japanese males (AAPC = +3.0%, 95% CI = 0.4 to 5.6) and Vietnamese (AAPC = +4.5%, 95% CI = 0.7 to 8.5) and Laotian (+3.4%, 95% CI = 0.1 to 6.8) females. Conclusions Our findings provide valuable information for the identification of at-risk ethnic subgroups of Asian Americans while underscoring the importance of disaggregating ethnic populations in cancer research.
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Affiliation(s)
- Christopher Pham
- Doctor of Medicine Program, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Tse-Ling Fong
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Juanjuan Zhang
- Los Angeles Cancer Surveillance Program, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Lihua Liu
- Los Angeles Cancer Surveillance Program, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
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19
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Yoon H, Chatters L, Kao TS, Saint-Arnault D, Northouse L. Factors Affecting Quality of Life for Korean American Cancer Survivors: An Integrative Review. Oncol Nurs Forum 2017; 43:E132-42. [PMID: 27105204 DOI: 10.1188/16.onf.e132-e142] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION Understanding of Korean American cancer survivors' quality of life (QOL) within a cultural context is limited. This article examines factors associated with the QOL of Korean American cancer survivors.
. LITERATURE SEARCH A systematic literature search was conducted of PubMed, CINAHL®, Google Scholar, and EBSCO databases from January 2000 to January 2014.
. DATA EVALUATION The studies were assessed for the relevance to the purpose of the review. Each study was rated on a two-point scale using an 11-item quality criteria checklist.
. SYNTHESIS The 13 studies that met the criteria for inclusion included 7 descriptive, 5 qualitative, and 1 mixed-method.
. CONCLUSIONS Social support, communication, and acculturation were key factors associated with Korean Americans' QOL. Cultural differences were evident for Korean Americans versus other Asian American ethnic groups.
. IMPLICATIONS FOR PRACTICE More innovative and culturally driven research is needed to understand each minority group's cultural barriers, as well as to improve cancer survivors' QOL. Improving the doctor-patient relationship is critical to promoting better cancer experiences for Korean American cancer survivors.
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20
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Shah BR, Griffiths R, Hall SF. Thyroid cancer incidence among Asian immigrants to Ontario, Canada: A population-based cohort study. Cancer 2017; 123:3320-3325. [PMID: 28440952 DOI: 10.1002/cncr.30746] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 03/20/2017] [Accepted: 03/22/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND The highest rates of thyroid cancer are observed in Pacific Island nations as well as Australia and Asian countries bordering the Pacific. The objective of this study was to determine the risk for thyroid cancer among immigrants to Canada from Southeast and East Asia compared with immigrants from other regions and nonimmigrants. METHODS This was a population-based, longitudinal cohort study using health care administrative data to examine all residents of Ontario without pre-existing thyroid cancer. Individuals were followed from January 1997 or 5 years after they became eligible for health care coverage in Ontario, whichever came later. Patients were followed until March 2015 for incident-differentiated thyroid cancer, and then for recurrence. RESULTS The study followed 14,659,733 individuals for a median of 17 years. Thyroid cancer incidence was 43.8 cases per 100,000 person-years among Southeast Asian immigrants, 28.6 cases per 100,000 person-years among East Asian immigrants, 21.5 cases per 100,000 person-years among other immigrants, and 14.5 cases per 100,000 person-years among nonimmigrants. Incidence was highest among immigrants from the Philippines (52.7 cases per 100,000 person-years), South Korea (33.5 cases per 100,000 person-years), and China (30.0 cases per 100,000 person-years). Adjusted hazard ratios for thyroid cancer compared with nonimmigrants were 2.66 (95% confidence interval, 2.48-2.84) for Southeast Asian immigrants, 1.87 (95% confidence interval, 1.75-2.00) for East Asian immigrants, and 1.51 (95% confidence interval, 1.45-1.57) for other immigrants. Immigrants were more likely to have papillary histology and stage I cancer. East Asian immigrants, but not Southeast Asian immigrants, had a lower risk of recurrence (hazard ratio, 0.73 [95% confidence interval, 0.57-0.94] and 1.01 [95% confidence interval, 0.81-1.26], respectively). CONCLUSIONS Immigrants from Southeast and East Asia had markedly higher thyroid cancer incidence than nonimmigrants. At particularly elevated risk were immigrants from the Philippines, South Korea, and China. Cancer 2017;123:3320-5. © 2017 American Cancer Society.
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Affiliation(s)
- Baiju R Shah
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rebecca Griffiths
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Stephen F Hall
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada.,Department of Otolaryngology, Queen's University, Kingston, Ontario, Canada
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21
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Stewart SL, Kwong SL, Bowlus CL, Nguyen TT, Maxwell AE, Bastani R, Chak EW, Chen Jr MS. Racial/ethnic disparities in hepatocellular carcinoma treatment and survival in California, 1988-2012. World J Gastroenterol 2016; 22:8584-8595. [PMID: 27784971 PMCID: PMC5064040 DOI: 10.3748/wjg.v22.i38.8584] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/16/2016] [Accepted: 09/12/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To describe racial/ethnic differences in treatment and survival among liver cancer patients in a population-based cancer registry.
METHODS Invasive cases of primary hepatocellular carcinoma, n = 33270, diagnosed between January 1, 1988-December 31, 2012 and reported to the California Cancer Registry were analyzed by race/ethnicity, age, gender, geographical region, socio-economic status, time period of diagnosis, stage, surgical treatment, and survival. Patients were classified into 15 racial/ethnic groups: non-Hispanic White (White, n = 12710), Hispanic (n = 8500), Chinese (n = 2723), non-Hispanic Black (Black, n = 2609), Vietnamese (n = 2063), Filipino (n = 1479), Korean (n = 1099), Japanese (n = 658), American Indian/Alaskan Native (AIAN, n = 281), Laotian/Hmong (n = 244), Cambodian (n = 233), South Asian (n = 190), Hawai`ian/Pacific Islander (n = 172), Thai (n = 95), and Other Asian (n = 214). The main outcome measures were receipt of surgical treatment, and cause-specific and all-cause mortality.
RESULTS After adjustment for socio-demographic characteristics, time period, and stage of disease, compared to Whites, Laotian/Hmong [odds ratio (OR) = 0.30, 95%CI: 0.17-0.53], Cambodian (OR = 0.65, 95%CI: 0.45-0.96), AIAN (OR = 0.66, 95%CI: 0.46-0.93), Black (OR = 0.76, 95%CI: 0.67-0.86), and Hispanic (OR = 0.78, 95%CI: 0.72-0.84) patients were less likely, whereas Chinese (OR = 1.58, 95%CI: 1.42-1.77), Koreans (OR = 1.45, 95%CI: 1.24-1.70), Japanese (OR = 1.41, 95%CI: 1.15-1.72), and Vietnamese (OR = 1.26, 95%CI: 1.12-1.42) were more likely to receive surgical treatment. After adjustment for the same covariates and treatment, cause-specific mortality was higher for Laotian/Hmong [(hazard ratio (HR) = 1.50, 95%CI: 1.29-1.73)], Cambodians (HR = 1.35, 95%CI: 1.16-1.58), and Blacks (HR = 1.07, 95%CI: 1.01-1.13), and lower for Chinese (HR = 0.82, 95%CI: 0.77-0.86), Filipinos (HR = 0.84, 95%CI: 0.78-0.90), Vietnamese (HR = 0.85, 95%CI: 0.80-0.90), Koreans (HR = 0.90, 95%CI: 0.83-0.97), and Hispanics (HR = 0.91, 95%CI: 0.88-0.94); results were similar for all-cause mortality.
CONCLUSION Disaggregated data revealed substantial racial/ethnic differences in liver cancer treatment and survival, demonstrating the need for development of targeted interventions to mitigate disparities.
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22
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Sakuma KLK, Felicitas-Perkins JQ, Blanco L, Fagan P, Pérez-Stable EJ, Pulvers K, Romero D, Trinidad DR. Tobacco use disparities by racial/ethnic groups: California compared to the United States. Prev Med 2016; 91:224-232. [PMID: 27575315 PMCID: PMC5554114 DOI: 10.1016/j.ypmed.2016.08.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 07/01/2016] [Accepted: 08/24/2016] [Indexed: 02/07/2023]
Abstract
Racial/ethnic disparities in cigarette use and cessation persist. This study compared cigarette consumption and former smoking trends in California (CA) with the rest of the United States (US) by racial/ethnic categories of non-Hispanic White, Black, Hispanic/Latino, and Asian/Pacific Islander groups. Data were analyzed from the 1992 to 2011 Tobacco Use Supplement to the Current Population Survey. Consumption levels across decades were examined and adjusted logistic regression models were fit to compare across CA and US. Results indicated steady declines in ever smoking prevalence for all groups with much lower magnitudes of change among US Blacks and Whites compared to their CA counterparts. After controlling for age, gender, and education, CA had significantly fewer heavy smokers (OR=0.45, 95% CI:0.38-0.54), more light and intermittent smokers (LITS; OR=1.68, 95%CI: 1.45-1.93), and a greater proportion of former smokers (OR=1.35, 95%CI: 1.24-1.48) than the rest of US. Data were stratified by race/ethnicity and the patterns shown were mostly consistent with CA performing statistically better than their US counterparts with the exception of Black LITS and Asian/Pacific Islander former smokers. California's success in reducing tobacco use disparities may serve as a prime example of tobacco control policy for the country. CA and the US will need to continue to address tobacco use and cessation in the context of the growing diversity of the population.
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Affiliation(s)
- Kari-Lyn K Sakuma
- Oregon State University, College of Public Health and Human Sciences, School of Social and Behavioral Health Sciences, Corvallis, OR, United States.
| | | | - Lyzette Blanco
- Claremont Graduate University, School of Community and Global Health, Claremont, CA, United States
| | - Pebbles Fagan
- University of Hawaii, Cancer Center, Honolulu, HI, United States
| | - Eliseo J Pérez-Stable
- Division of General Internal Medicine, Department of Medicine, Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, United States
| | - Kim Pulvers
- California State University San Marcos, San Marcos, CA, United States
| | - Devan Romero
- California State University San Marcos, San Marcos, CA, United States
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Tran HN, Li Y, Udaltsova N, Armstrong MA, Friedman GD, Klatsky AL. Risk of cancer in Asian Americans: a Kaiser Permanente cohort study. Cancer Causes Control 2016; 27:1197-207. [PMID: 27562672 DOI: 10.1007/s10552-016-0798-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 08/10/2016] [Indexed: 01/26/2023]
Abstract
PURPOSE To supplement published cohort data about incident cancer in Asian Americans (Asians) including risk of specific Asian ethnic groups. METHODS A cohort study in 124,193 persons (13,344 Asians) with baseline examination data in 1978-1985 used Cox proportional hazards models with seven covariates to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs). RESULTS Through 2012 cancer was diagnosed in 18,687 persons including 1,522 Asians. Compared to Whites, the HR (CIs) for any cancer in Asians was 0.8 (0.7-0.9, p < 0.001). Lower Asian risk was stronger for men (HR = 0.7, p < 0.001) than for women (HR = 0.9, p = 0.003). Lower Asian vs. White risks with p < 0.05 were found for cancers of the upper airway digestive area, hematologic malignancies, melanoma, and cancers of the prostate, bladder, and brain. Melanoma contributed substantially to lower Asian risk, especially in women. HRs for specific Asian groups versus Whites follow: Chinese = 0.9 (p < 0.001), Japanese = 0.9 (p = 0.01), Filipinos = 0.8 (p < 0.001), South Asians = 0.5 (p < 0.001), and Other Asians = 0.7 (p = 0.006). Both South Asian men and women had lower risk than Whites, and South Asians had lower risk than any other racial/ethnic group. CONCLUSIONS Asians had lower cancer risk than Whites, due to lower risk of several cancer types. Each Asian ethnic group had lower risk than Whites with South Asians at the lowest risk.
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Affiliation(s)
- H Nicole Tran
- Department of Internal Medicine, Kaiser Permanente Medical Center, 275 W MacArthur Blvd, Oakland, CA, 94611, USA.
| | - Yan Li
- Department of Hematology and Oncology, Kaiser Permanente Medical Center, Oakland, CA, USA
| | - Natalia Udaltsova
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Mary Anne Armstrong
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Gary D Friedman
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Arthur L Klatsky
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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Abstract
Breast cancer is the second deadliest cancer for women in the demographically unique mountainous west state of Nevada. This study aims to accurately characterize breast cancer survival among the diverse women of the flourishing Silver State. Nevada Central Cancer Registry data was linked with the National Death Index and the Social Security Administration Masterfile. Overall 5-year age-adjusted cause-specific survival, survival stratified by race/ethnicity, and stage-specific survival stratified by region of Nevada were calculated. Adjusted hazard ratios were computed with Cox proportional hazards regression. 11,111 cases of breast cancer were diagnosed from 2003 to 2010. Overall 5-year breast cancer survival in Nevada was 84.4 %, significantly lower than the US, at 89.2 %. Black and Filipina women had a higher risk of death than white women. Poor survival in the racially and ethnically diverse Las Vegas metropolitan area, with a large foreign-born population, drives Nevada's low overall survival. System-wide changes are recommended to reduce the racial/ethnic disparities seen for black and Filipina women and improve outcomes for all.
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Validity of Race, Ethnicity, and National Origin in Population-based Cancer Registries and Rapid Case Ascertainment Enhanced With a Spanish Surname List. Med Care 2016; 54:e1-8. [PMID: 23938598 DOI: 10.1097/mlr.0b013e3182a30350] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Accurate information regarding race, ethnicity, and national origins is critical for identifying disparities in the cancer burden. OBJECTIVES To examine the use of a Spanish surname list to improve the quality of race-related information obtained from rapid case ascertainment (RCA) and to estimate the accuracy of race-related information obtained from cancer registry records collected by routine reporting. SUBJECTS Self-reported survey responses of 3954 participants from California enrolled in the Cancer Care Outcomes Research and Surveillance Consortium. MEASURES Sensitivity, specificity, positive predictive value, and percent agreement. We used logistic regression to identify predictors of underreporting and overreporting of a race/ethnicity. RESULTS Use of the Spanish surname list increased the sensitivity of RCA for Latino ethnicity from 37% to 83%. Sensitivity for cancer registry records collected by routine reporting was ≥95% for whites, blacks, and Asians, and specificity was high for all groups (86%-100%). However, patterns of misclassification by race/ethnicity were found that could lead to biased cancer statistics for specific race/ethnicities. Discordance between self-reported and registry-reported race/ethnicity was more likely for women, Latinos, and Asians. CONCLUSIONS Methods to improve race and ethnicity data, such as using Spanish surnames in RCA and instituting data collection guidelines for hospitals, are needed to ensure minorities are accurately represented in clinical and epidemiological research.
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Kim SS, Kim SH, Fang H, Kwon S, Shelley D, Ziedonis D. A Culturally Adapted Smoking Cessation Intervention for Korean Americans: A Mediating Effect of Perceived Family Norm Toward Quitting. J Immigr Minor Health 2015; 17:1120-9. [PMID: 24878686 PMCID: PMC4250475 DOI: 10.1007/s10903-014-0045-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Korean men and women have the highest current smoking rates across all Asian ethnic subgroups in the United States. This is a 2-arm randomized controlled study of a culturally adapted smoking cessation intervention. The experimental condition received eight weekly 40-min individualized counseling sessions that incorporated Korean-specific cultural elements, whereas the control condition received eight weekly 10-min individualized counseling sessions that were not culturally adapted. All participants also received nicotine patches for 8 weeks. One-hundred nine Korean immigrants (91 men and 18 women) participated in the study. The rate of biochemically verified 12-month prolonged abstinence was significantly higher for the experimental condition than the control condition (38.2 vs. 11.1 %, χ (2) = 10.7, p < 0.01). Perceived family norm significantly mediated the effect of cessation intervention on abstinence. Smoking cessation intervention for Korean Americans should be culturally adapted and involve family members to produce a long-term treatment effect.
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Affiliation(s)
- Sun S Kim
- University of Massachusetts Medical School, Department of Psychiatry, Worcester MA, USA
| | - Seong-Ho Kim
- Korean Bible University, Department of Social Welfare, Seoul, South Korea
| | - Hua Fang
- University of Massachusetts Medical School, Department of Quantitative Health Sciences, Worcester MA, USA
| | - Simona Kwon
- New York University, School of Medicine, New York, NY, USA
| | - Donna Shelley
- New York University, School of Medicine, New York, NY, USA
| | - Douglas Ziedonis
- University of Massachusetts Medical School, Department of Psychiatry, Worcester MA, USA
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Strong VE, Wu AW, Selby LV, Gonen M, Hsu M, Song KY, Park CH, Coit DG, Ji JF, Brennan MF. Differences in gastric cancer survival between the U.S. and China. J Surg Oncol 2015; 112:31-7. [PMID: 26175203 DOI: 10.1002/jso.23940] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 05/07/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Previous comparisons of gastric cancer between the West and the East have focused predominantly on Japan and Korea, where early gastric cancer is prevalent, and have not included the Chinese experience, which accounts for approximately half the world's gastric cancer. METHODS Patient characteristics, surgical procedures, pathologic information, and survival were compared among gastric cancer patients who underwent curative intent gastrectomy at two large volume cancer centers in China and the US between 1995 and 2005. RESULTS Median age and body mass index were significantly higher in US patients. The proportion of proximal gastric cancer was comparable. Gastric cancer patients in China had larger tumors and a later stage at presentation. The median number of positive lymph nodes was higher (5 vs 4, P < 0.02) despite a lower lymph node retrieval (16 vs 22, P < 0.001) in Chinese patients. The probability of death due to gastric cancer in Chinese patients was 1.7 fold of that in the US (P < 0.0001) after adjusting for important prognostic factors. CONCLUSIONS Even after adjusting for important prognostic factors Chinese gastric cancer patients have a worse outcome than US gastric cancer patients. The differences between Chinese and US gastric cancer are a potential resource for understanding the disease.
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Affiliation(s)
- Vivian E Strong
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York
| | - Ai-Wen Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, China
| | - Luke V Selby
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York
| | - Mithat Gonen
- Departments of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York
| | - Meier Hsu
- Departments of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York
| | - Kyo Young Song
- Department of Surgery, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Cho Hyun Park
- Department of Surgery, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Daniel G Coit
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York
| | - Jia-Fu Ji
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, China
| | - Murray F Brennan
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York
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Wu TY, Lin C. Developing and evaluating an individually tailored intervention to increase mammography adherence among Chinese American women. Cancer Nurs 2015; 38:40-9. [PMID: 24621965 PMCID: PMC4161668 DOI: 10.1097/ncc.0000000000000126] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Breast cancer consistently is the most commonly diagnosed cancer and the second most common cause of cancer mortality among Asian Americans in the United States. The incidence of breast cancer in Asian American women has been increasing at a much higher rate than in white women. OBJECTIVES A randomized control single-blind study was conducted comparing the efficacy of an individually tailored telephone counseling and National Cancer Institute brochure. METHODS The sample consisted of 193 Chinese American women with no breast cancer history. The participants were randomly assigned to either an intervention or a control group. Self-reported data that included demographic variables, knowledge, beliefs, and screening behaviors were collected at baseline and 4 months. RESULTS The intervention group had increased screening to 40% compared with 33% for the control group at 4 months; the difference was not statistically significant. When the subanalyses were performed, the intervention is effective in certain demographic groups (ie, elderly women aged ≥65 years and recent immigrants). The study intervention was well accepted by participants and perceived as feasible and culturally appropriate based on process evaluation. CONCLUSIONS The study also demonstrates the feasibility of recruiting and retaining eligible women to participate, and the results show that both study intervention and printed materials increase awareness of the importance of breast cancer screening and screening behaviors for Chinese American women. IMPLICATIONS FOR PRACTICE Oncology nurses and advanced practice nurses can play critical roles on this medically underserved population that experiences disparities in breast cancer mortality by providing culturally appropriate counseling to promote screening adherence.
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Affiliation(s)
- Tsu-Yin Wu
- Author Affiliations: School of Nursing, Eastern Michigan University, Ypsilanti, Michigan
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Lee HY, Jung Y. Older Korean American men's prostate cancer screening behavior: the prime role of culture. J Immigr Minor Health 2014; 15:1030-7. [PMID: 23504334 DOI: 10.1007/s10903-013-9804-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
East and South Asian male immigrants show markedly low odds of prostate cancer screening as compared to U.S.-born men. However, knowledge about these immigrants' culture-based screening behavior and barriers to screening is extremely limited. This study investigates factors influencing receipt of prostate cancer screening among Korean American immigrant men, particularly investigating culture's impact on screening behaviors. Data were collected through a convenience and purposive sampling technique from 134 Korean American males aged 50 and older recruited in New York City. A structured questionnaire was used and cultural variables were measured by adopting items from Tang and colleagues' work. Approximately 60 % of the sample had received a prostate-specific antigen (PSA) test in their lifetime, and of these, about 66 % reported having done so in the previous 12 months. Logistic regression analysis revealed that a crisis-oriented intervention approach was associated with a substantially reduced likelihood of screening. A positive correlation was noted between the use of Eastern medicine and PSA test receipt. Further analysis revealed a significant interaction effect between use of Eastern medicine and age in predicting PSA test uptake. Culture-specific intervention strategies for increasing prostate cancer screening in this group are discussed, with particular attention to increasing pertinent health literacy. Health professionals should consider the cultural domain when working with Korean immigrant men in order to provide culturally competent care.
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Affiliation(s)
- Hee Yun Lee
- School of Social Work, University of Minnesota, Twin Cities,105 Peters Hall, 1404 Gortner Avenue, St. Paul, MN, 55108, USA,
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30
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Abstract
The incidence of hepatocellular carcinoma (HCC) is higher in Asian Americans than in other ethnicities. While hepatitis B virus (HBV) is common, hepatitis C virus (HCV) is more prevalent in some subgroups. Our goal was to determine the etiology of liver disease associated with HCC in subgroups of Asian Americans. This was an analysis of 510 Asian HCC patients at a US medical center. Patients were identified using ICD9 diagnosis. Multivariate logistic regression was used to study predictors of HCV as the cause of HCC. Patients were Southeast Asian, Chinese, and Korean, with similar gender, age, and foreign-born status. Southeast Asians had a similar proportion of HBV- and HCV-related HCC, while Chinese and Korean patients had a higher proportion of HBV-related HCC. HCC was usually associated with HBV in Chinese and Korean patients, but both HCV and HBV were important associations in Southeast Asians.
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Lee MM. Using cancer incidence and mortality data to guide cancer control program. ANNALS OF TRANSLATIONAL MEDICINE 2014; 2:65. [PMID: 25333040 PMCID: PMC4202466 DOI: 10.3978/j.issn.2305-5839.2014.06.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 06/09/2014] [Indexed: 01/20/2023]
Affiliation(s)
- Marion M Lee
- Professor Emeritus of Epidemiology, School of Medicine, University of California, San Francisco, CA, USA
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Cancer Mortality among Asians and Pacific Islanders in New York City, 2001-2010. J Cancer Epidemiol 2013; 2013:986408. [PMID: 24454374 PMCID: PMC3876672 DOI: 10.1155/2013/986408] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 10/07/2013] [Indexed: 12/23/2022] Open
Abstract
Asians and Pacific Islanders' (APIs) leading cause of death is cancer. We compared APIs' age-adjusted cancer mortality rates to other racial/ethnic groups and by API subgroup (i.e., Chinese, Koreans, Asian Indians, and Filipinos) using New York City (NYC) Mortality data and Census Bureau population estimates for 2001-2010. While other racial/ethnic groups' overall cancer mortality rates declined in NYC during the last decade, APIs remained stable. APIs overall had the lowest mortality rates for more common cancer types (i.e., lung, colorectal, breast, and prostate), but the highest mortality rates for certain less common cancers (i.e., nasopharyngeal, stomach, and liver). Chinese New Yorkers' lung cancer death rates were very high compared to other APIs and comparable to non-Hispanic whites (47.1/100,000 versus 49.5/100,000, resp.). Chinese men had much higher nasopharyngeal cancer mortality rates (4.5/100,000 versus 0.3/100,000 for non-Hispanic whites). Korean men had the highest liver and stomach cancer mortality rates (25.3/100,000 and 27.7/100,000, resp., versus 7.9/100,000 and 6.0/100,000 for non-Hispanic whites). Analysis of cancer rates by API subgroup provides the detailed information needed to plan cancer prevention efforts. These findings warrant consideration of targeted cancer mortality prevention efforts for affected subgroups, including hepatitis vaccination, screening, and treatment; smoking cessation; and cancer screening.
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Ryu SY, Crespi CM, Maxwell AE. What factors explain disparities in mammography rates among Asian-American immigrant women? A population-based study in California. Womens Health Issues 2013; 23:e403-10. [PMID: 24183415 PMCID: PMC3833860 DOI: 10.1016/j.whi.2013.08.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 07/30/2013] [Accepted: 08/22/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The purpose of this study was to compare rates of screening mammography among immigrant women in five Asian-American ethnic groups in California, and ascertain the extent to which differences in mammography rates among these groups are attributable to differences in known correlates of cancer screening. METHODS Using 2009 data from the California Health Interview Survey, we compared the rates of mammography among Chinese, Filipino, Japanese, Korean, and Vietnamese immigrants 40 years and older. To assess the impact of Asian ethnicity on participation in screening, we performed multiple logistic regression analysis with models that progressively adjusted for acculturation, sociodemographic characteristics, access to health care, and breast cancer risk factors, and examined the predicted probabilities of screening after adjusting for these factors. FINDINGS Participation in screening mammography differed according to ethnicity, with Filipina and Vietnamese Americans having the highest rates and Korean Americans having the lowest rates of lifetime and recent (past 2 years) screening. These differences decreased substantially after adjusting for acculturation, sociodemographic factors, and risk factors of breast cancer, but differences remained, most notably for Korean Americans, who continued to have the lowest predicted probability of screening even after adjustment for these factors. CONCLUSIONS This analysis draws attention to low mammography screening rates among Asian-American immigrants, especially recent immigrants who lack health insurance. Given that their breast cancer incidence is rising with length of stay in the United States, it is important to increase regular mammography screening in these groups.
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Affiliation(s)
- So Yeon Ryu
- Department of Preventive Medicine, Chosun University Medical School, 309 Pilmun-daero, Dong-gu, Gwangju, 501-759, Korea; Tel:+82-62-230-6483;
| | - Catherine M. Crespi
- University of California, Los Angeles, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, 650 Charles Young Drive South, Room A2-125, CHS, Los Angeles, CA 90095, USA; Tel:+1-310-206-9364;
| | - Annette E. Maxwell
- University of California, Los Angeles, Fielding School of Public Health, Department of Health Policy and Management & Jonsson Comprehensive Cancer Center, 650 Charles Young Drive South, Room A2-125, CHS, Los Angeles, CA 90095, USA; Tel:+1-310-794-9282;
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Gomez SL, Noone AM, Lichtensztajn DY, Scoppa S, Gibson JT, Liu L, Morris C, Kwong S, Fish K, Wilkens LR, Goodman MT, Deapen D, Miller BA. Cancer incidence trends among Asian American populations in the United States, 1990-2008. J Natl Cancer Inst 2013; 105:1096-110. [PMID: 23878350 PMCID: PMC3735462 DOI: 10.1093/jnci/djt157] [Citation(s) in RCA: 215] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 04/17/2013] [Accepted: 04/18/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND National cancer incidence trends are presented for eight Asian American groups: Asian Indians/Pakistanis, Chinese, Filipinos, Japanese, Kampucheans, Koreans, Laotians, and Vietnamese. METHODS Cancer incidence data from 1990 through 2008 were obtained from 13 Surveillance, Epidemiology, End Results (SEER) registries. Incidence rates from 1990 through 2008 and average percentage change were computed using SEER*Stat and Joinpoint software. The annual percentage change (APC) in incidence rates was estimated with 95% confidence intervals (95% CIs) calculated for both the rate and APC estimates. Rates for non-Hispanic whites are presented for comparison. RESULTS Prostate cancer was the most common malignancy among most groups, followed by lung, colorectal, liver, and stomach cancers. Breast cancer was generally the most common cancer in women, followed by colorectal and lung cancers; liver, cervix, thyroid, and stomach cancers also ranked highly. Among men, increasing trends were observed for prostate (Asian Indians and Pakistanis: APC 1990-2003 = 2.2, 95% CI = 0.3 to 4.1; Filipinos: APC 1990-1994 = 19.0, 95% CI = 4.5 to 35.4; Koreans: APC 1990-2008 = 2.9, 95% CI = 1.8 to 4.0), colorectal (Koreans: APC 1990-2008 = 2.2, 95% CI = 0.9 to 3.5), and liver cancers (Filipinos: APC 1990-2008 = 1.6, 95% CI = 0.4 to 2.7; Koreans: APC 1990-2006 = 2.1, 95% CI = 0.4 to 3.7; Vietnamese: APC 1990-2008 = 1.6, 95% CI = 0.3 to 2.8), whereas lung and stomach cancers generally remained stable or decreased. Among women, increases were observed for uterine cancer (Asian Indians: APC 1990-2008 = 3.0, 95% CI = 0.3 to 5.8; Chinese: APC 2004-2008 = 7.0, 95% CI = 1.4 to 12.9; Filipina: APC 1990-2008 = 3.0, 95% CI = 2.4 to 3.7; Japanese: APC 1990-2008 = 1.1, 95% CI = 0.1 to 2.0), colorectal cancer (Koreans: APC 1990-2008 = 2.8, 95% CI = 1.7 to 3.9; Laotians: APC: 1990-2008 = 5.9, 95% CI = 4.0 to 7.7), lung cancer (Filipinas: APC 1990-2008 = 2.1, 95% CI = 1.4 to 2.8; Koreans: APC 1990-2008 = 2.1, 95% CI = 0.6 to 3.6), thyroid cancer (Filipinas: APC 1990-2008 = 2.5, 95% CI = 1.7 to 3.3), and breast cancer in most groups (APC 1990-2008 from 1.2 among Vietnamese and Chinese to 4.7 among Koreans). Decreases were observed for stomach (Chinese and Japanese), colorectal (Chinese), and cervical cancers (Laotians and Vietnamese). CONCLUSIONS These data fill a critical knowledge gap concerning the cancer experience of Asian American groups and highlight where increased preventive, screening, and surveillance efforts are needed-in particular, lung cancer among Filipina and Korean women and Asian Indian/Pakistani men, breast cancer among all women, and liver cancer among Vietnamese, Laotian, and Kampuchean women and Filipino, Kampuchean, and Vietnamese men.
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Liu L, Noone AM, Gomez SL, Scoppa S, Gibson JT, Lichtensztajn D, Fish K, Wilkens LR, Goodman MT, Morris C, Kwong S, Deapen D, Miller BA. Cancer incidence trends among native Hawaiians and other Pacific Islanders in the United States, 1990-2008. J Natl Cancer Inst 2013; 105:1086-95. [PMID: 23878354 PMCID: PMC3735461 DOI: 10.1093/jnci/djt156] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Lack of annual population estimates for disaggregated Native Hawaiian and Other Pacific Islander (NHOPI) populations limits the ability to examine cancer incidence rates and trends to understand the cancer burdens among NHOPIs. METHODS Utilizing 1990 and 2000 population census data, we estimated the annual populations by age and sex for Native Hawaiians, Samoans, and Guamanians/Chamorros for 1990-2008 in regions covered by 13 of the National Cancer Institute's SEER registries. Cancer diagnoses during 1990-2008 from these registries were used to calculate the age-adjusted (2000 US Standard) incidence rates by sex, calendar year/period, and cancer type for each population. The annual percentage change (APC) in incidence rates was estimated with the 95% confidence intervals (95% CIs) calculated for both the rate and APC estimates. RESULTS Statistically significant declining trends were found in Native Hawaiians, in men for lung and stomach cancers (APC = -2.3%; 95% CI = -3.3 to -1.3; and APC = -3.8%; 95% CI = -6.0 to -1.6, respectively), and in women for breast cancer (APC = -4.1%; 95% CI = -5.7 to -2.5) since 1998 and lung cancer (APC = -6.4%; 95% CI = -10.7 to -1.8) since 2001. Rising incidence trends were experienced by Samoans, especially by Samoan women for breast (APC = 2.7%; 95% CI = 0.9 to 4.5) and uterus (APC = 7.3%; 95% CI = 6.2 to 8.4) cancers. With limited data, Guamanians/Chamorros demonstrated lower, but increasing, incidence rates than other NHOPIs. CONCLUSIONS Population-based cancer incidence rates for disaggregated NHOPI populations help identify disparities in cancer burden and provide valuable information to improve cancer control efforts among NHOPIs.
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Affiliation(s)
- Lihua Liu
- Los Angeles Cancer Surveillance Program, University of Southern California, Los Angeles, CA 90089-9238, USA.
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Nelson R, Ko EB, Arrington A, Lee W, Kim J, Garcia-Aguilar J, Kim J. Race and correlations between lymph node number and survival for patients with gastric cancer. J Gastrointest Surg 2013; 17:471-81. [PMID: 23288716 DOI: 10.1007/s11605-012-2125-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 12/10/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is ongoing debate whether extended lymphadenectomy improves survival in gastric cancer patients who undergo surgical resection. We previously observed that Korean-American patients had the highest overall survival in Los Angeles County. Our objective was to assess lymph node (LN) number and its impact on survival for Korean-American gastric cancer patients. METHODS We utilized the National Cancer Institute's Surveillance, Epidemiology, and End Results registry to identify Korean-Americans with gastric adenocarcinoma treated with curative-intent gastrectomy between 1988 and 2008. We grouped patients according to examined LN number (1-15 and 16+) and compared characteristics. We performed similar analysis for white patients. RESULTS Out of 982 Korean-American patients with gastric adenocarcinoma, most patients had 1-15 examined LNs (60 %). When we compared LN groups, we observed higher overall survival in the 1-15 group than the 16+ group (5-year survival, 59 % vs 52 %, respectively; p = 0.04). However, LN number was not prognostic of overall survival on stepwise Cox proportional hazards analysis. In contrast, LN number was prognostic for white patients. CONCLUSIONS Although examined LN number may impact survival for white patients, outcomes of Korean-American gastric cancer patients were independent of LN number. Our data suggest that survival of Korean-American gastric cancer patients are comparable with outcomes from East Asian hospitals and may be independent of surgical technique.
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Affiliation(s)
- Rebecca Nelson
- Departments of Biostatistics (RN) and Surgery (EBK, AA, WL, JK, JK), City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
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Antitumour activity of Lycium chinensis polysaccharides in liver cancer rats. Int J Biol Macromol 2012; 51:314-8. [DOI: 10.1016/j.ijbiomac.2012.05.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 04/22/2012] [Accepted: 05/02/2012] [Indexed: 11/17/2022]
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Kim SS, Kim SH, Ziedonis D. Tobacco dependence treatment for Korean Americans: preliminary findings. J Immigr Minor Health 2012; 14:395-404. [PMID: 21785963 DOI: 10.1007/s10903-011-9507-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The study was conducted to examine the relative effectiveness of cognitive behavior therapy with a cultural tailoring intervention compared to brief medication management. The study used a two-arm randomized controlled trial in which participant assignment was stratified by gender. The intervention condition received eight weekly 40-min individualized counseling sessions of culturally tailored cognitive behavior therapy, while the control condition received eight weekly 10-min individualized counseling sessions of medication management. Both conditions received nicotine patches for 8 weeks. Data were collected at baseline and at four follow-up points (one and 4 weeks, and three and 6 months post-quit). Treatment outcomes were presented as an intention-to-treat analysis. Thirty Korean immigrants participated in the study. At 6-month follow-up, 57.1% of participants in the intervention and 18.8% of participants in the control had 7-day point prevalence abstinence (odds ratio = 5.8, 95% confidence interval = 1.12-26.04, P = 0.04). Participants' self-reported abstinence was biochemically verified with exhaled carbon monoxide and salivary cotinine levels. A combination of the culturally tailored cognitive behavior therapy and nicotine replacement therapy had a better treatment outcome compared to brief medication management. The promising result suggests a need to further test the intervention in larger samples and longer follow-up assessments before it can be adapted in clinical settings.
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Affiliation(s)
- Sun S Kim
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA.
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Going against the tide: increasing incidence of colorectal cancer among Koreans, Filipinos, and South Asians in California, 1988-2007. Cancer Causes Control 2012; 23:691-702. [PMID: 22460700 DOI: 10.1007/s10552-012-9937-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 03/02/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Colorectal cancer has declined markedly in California for all major racial/ethnic groups, including Asian/Pacific Islanders as a whole. Analyzing cancer data for Asian/Pacific Islanders collectively masks important differences that exist between individual Asian subgroups. This study examines secular, sex-, age-, and socioeconomic-specific trends in colorectal cancer incidence among six Asian subgroups-Chinese, Japanese, Filipino, Korean, Vietnamese, and South Asian-to determine whether these groups experienced a decline in colorectal cancer incidence and to assess possible differences in colorectal cancer incidence trends among these groups. METHODS Cases of invasive colorectal cancer diagnosed among Japanese, Chinese, Filipinos, Koreans, Vietnamese, and South Asians between 1988 and 2007 were identified using the California Cancer Registry database. Secular, sex-, age-, and socioeconomic-specific trends in the age-adjusted colorectal cancer incidence rates for each Asian subgroup were examined using joinpoint analysis to estimate the annual percent change (APC). RESULTS Among males, Koreans (APC, 3.6 %) were the only group that experienced a significant increase in colorectal cancer incidence. Among females, Koreans (APC, 2.7 %), South Asians (APC, 2.8 %), and Filipinos (APC, 1.6 %) experienced significant increases. Stratification by age at diagnosis revealed that Korean males (APC, 3.4 %) and females (APC, 2.9 %) as well as Filipino females (APC, 1.8 %) aged 50 years and older experienced a significant increase in colorectal cancer incidence. Korean males aged less than 50 years (APC, 3.4 %) also experienced a significant increase. Japanese (APC, -1.2 %) and Chinese (APC, -1.6 %) males aged 50 years and older experienced a significant decrease in colorectal cancer incidence. Stratification by socioeconomic status (SES) revealed that Korean males (APC, 2.5 %) and females (APC, 2.9 %) as well as Filipino females (APC, 2.1 %) in the lowest SES category experienced a significant increase in colorectal cancer incidence. Korean males (APC, 5.2 %) and females (APC, 3.1 %) as well as Filipino males (APC, 1.5 %) in the highest SES category also experienced a significant increase. Japanese males (APC, -2.5 %) and females (APC, -2.0 %) as well as Chinese males (APC, -2.8 %) and females (APC, -2.9 %) in the lowest SES category experienced a significant decrease. Chinese males in the middle (APC, -3.4 %) and highest (APC, -3.5 %) SES categories also experienced significant decreases in colorectal cancer incidence. CONCLUSIONS In contrast to the decreasing trends in colorectal cancer incidence reported among all major racial/ethnic groups including Asian/Pacific Islanders, colorectal cancer is actually increasing among some Asian subgroups in California including Korean males and females, as well as South Asian and Filipino females. Furthermore, the colorectal cancer incidence trends for these Asian subgroups differ with respect to age at diagnosis and socioeconomic status. These findings suggest that more efforts need to be made to target these populations with culturally sensitive cancer prevention and screening programs. More research is needed to examine the differences in the colorectal cancer burden among these populations.
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Ashing-Giwa K, Lam CN, Xie B. Assessing health-related quality of life of Chinese-American breast cancer survivors: a measurement validation study. Psychooncology 2012; 22:704-7. [PMID: 22302455 DOI: 10.1002/pon.3030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 12/09/2011] [Accepted: 12/14/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND This study reports on the internal consistency and construct validity of the Functional Assessment of Cancer Therapy - General (FACT-G v.4) and 12-item Short Form Health Survey (SF-12 v.2) health-related quality of life (HRQOL) instruments with Chinese-American breast cancer survivors (BCS). METHODS Participants completed mailed questionnaires at baseline and 12-month follow-up. HRQOL was measured using the FACT-G and the SF-12. The measures were evaluated by construct validity and reliability tests. Factor analyses were performed in a two-wave assessment through exploratory and confirmatory analyses at baseline and follow-up. RESULTS Seventy-four Chinese-American BCS participated. Excellent internal consistency (α > 0.85) and good construct validity for the FACT-G (five factors) and the SF-12 (two factors) were observed. Factor structure of both measures accounted for 70% of the common variance in physical, social/family, emotional, and functional well-being subscales for the FACT-G and in physical and mental components for the SF-12. CONCLUSIONS Our data demonstrated good internal consistency and construct validity of the measures. The psychometric findings demonstrate the utility of the FACT-G and the SF-12 to assess HRQOL among Chinese-American BCS.
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Affiliation(s)
- Kimlin Ashing-Giwa
- Center of Community Alliance for Research and Education (CCARE), Department of Population Sciences, City of Hope National Medical Center, San Dimas, CA 91773, USA.
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Liu L, Zhang J, Wu AH, Pike MC, Deapen D. Invasive breast cancer incidence trends by detailed race/ethnicity and age. Int J Cancer 2012; 130:395-404. [PMID: 21351091 PMCID: PMC3196818 DOI: 10.1002/ijc.26004] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 02/07/2011] [Indexed: 01/07/2023]
Abstract
Racial/ethnic disparities in breast cancer incidence may contain important evidence for understanding and control of the disease. Monitoring the incidence trends of breast cancer by race/ethnicity allows identification of high risk groups and development of targeted prevention programs. Using population-based cancer registry data from the Los Angeles Cancer Surveillance Program, we examined the invasive female breast cancer incidence trends among the diverse racial/ethnic populations in Los Angeles County, California, from 1972 to 2007. Age-adjusted incidence rates (AAIRs) and age-specific incidence rates (ASIRs) were calculated and examined respectively for non-Hispanic (NH) white, black, Hispanic, Chinese, Filipina, Japanese and Korean women by calendar year and time period. Rising trends of AAIRs were found in all racial/ethnic groups during the 1980s and 1990s. The breast cancer risk increased more substantially in Japanese and Filipinas than in Chinese and Koreans. During 2000-2007, the trends of AAIRs declined significantly among NH white women and slightly in blacks, remained unchanged for Hispanics and continued to rise significantly among all Asian subgroups. The patterns of ASIRs by race/ethnicity changed dramatically over time. By 2000-2007, younger Hispanic women had the lowest breast cancer risk, replacing the Chinese and Koreans who formerly had the lowest risk. Rapidly increasing breast cancer incidence trends among Asian-Americans underline the importance of behavioral and lifestyle changes as a result of acculturation on the development of the disease. The unique trends of breast cancer incidence by race/ethnicity suggest the need for targeted breast cancer control programs for different racial/ethnic populations.
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Affiliation(s)
- Lihua Liu
- Los Angeles Cancer Surveillance Program, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
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Lu Q, Zheng D, Young L, Kagawa-Singer M, Loh A. A pilot study of expressive writing intervention among Chinese-speaking breast cancer survivors. Health Psychol 2012; 31:548-51. [PMID: 22229930 DOI: 10.1037/a0026834] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Little attention has been focused on Asian American breast cancer survivor's psychological needs. No outcome-based psychosocial interventions have been reported to target at this population. Expressive writing interventions have been previously shown to improve health outcomes among non-Hispanic White breast cancer populations. This pilot study aimed to test the cultural sensitivity, feasibility, and potential health benefits of an expressive writing intervention among Chinese-speaking breast cancer survivors. METHODS Participants (N = 19) were asked to write about their deepest thoughts and feelings, their coping efforts, and positive thoughts and feelings regarding their experience with breast cancer each week for 3 weeks. Health outcomes were assessed at baseline, 3, and 6 months after the intervention. A Community-Based Participatory Research Approach (CBPR) is used. RESULTS Expressive writing was associated with medium and large effect sizes (η(p)² = 0.066∼0.208) in improving multiple health outcomes (quality of life, fatigue, posttraumatic stress, intrusive thoughts, and positive affect) at follow-ups. Participants perceived the study to be valuable. The study yielded high compliance and completion rates. CONCLUSION Expressive writing is associated with long-term improvement of health outcomes among Chinese breast cancer survivors and has the potential to be utilized as a support strategy for minority cancer survivors. In addition, CBPR is valuable in improving feasibility and cultural sensitivity of the intervention in understudied populations. Future studies employing randomized, controlled trial designs are warranted.
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Affiliation(s)
- Qian Lu
- Department of Psychology, University of Houston, Houston, TX 77204-5022, USA.
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Gwede CK, Jean-Francois E, Quinn GP, Wilson S, Tarver WL, Thomas KB, Vadaparampil ST, Meade CD. Perceptions of colorectal cancer among three ethnic subgroups of US blacks: a qualitative study. J Natl Med Assoc 2011; 103:669-80. [PMID: 22046844 PMCID: PMC3999593 DOI: 10.1016/s0027-9684(15)30406-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Colorectal cancer (CRC) is currently associated with one of the highest burdens of morbidity and mortality among American men and women. Racial/ethnic disparities are well documented and the subject of intense research and intervention. Our understanding of disparities related to awareness and perceptions about causes, risk factors, and screening for CRC among subgroups of blacks in the United States is limited. This may be in part because grouping US-born blacks and foreign-born blacks as one homogeneous group obscures possible within-group differences. This study aimed to explore the cultural perceptions of CRC among 3 ethnic subgroups of blacks: African Americans (US born), foreign-born blacks from English-speaking Caribbean countries, and Haitian-born blacks. The study was informed by a community-based participatory research approach, using a cross-sectional mixed qualitative and quantitative methods design. A total of 62 individuals from the 3 ethnic subgroups participated in semistructured, in-depth qualitative and structured quantitative interviews. Qualitative findings revealed no stark differences among the 3 ethnic subgroups in their overall perceptions of cancer as well as their attitudes related to barriers, motivation, and resources for CRC screening. However, there were subtle differences in perceptions of curability, preventive practices, and preferred sources of information among the three ethnic subgroups of US blacks. The study has important implications for the design of educational materials and targeted interventions for diverse groups of US blacks.
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Affiliation(s)
- Clement K Gwede
- H. Lee Moffitt Cancer Center, Division of Population Sciences, Tampa, Florida 33612, USA.
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Horn-Ross PL, McClure LA, Chang ET, Clarke CA, Keegan THM, Rull RP, Quach T, Gomez SL. Papillary thyroid cancer incidence rates vary significantly by birthplace in Asian American women. Cancer Causes Control 2011; 22:479-85. [PMID: 21207130 DOI: 10.1007/s10552-010-9720-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 12/21/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate how birthplace influences the incidence of papillary thyroid cancer among Asian American women. METHODS Birthplace- and ethnic-specific age-adjusted and age-specific incidence rates were calculated using data from the California Cancer Registry for the period 1988-2004. Birthplace was statistically imputed for 30% of cases using a validated imputation method based on age at Social Security number issuance. Population estimates were obtained from the US Census. Incidence rate ratios (IRR) and 95% confidence intervals (CI) were estimated for foreign-born vs. US-born women. RESULTS Age-adjusted incidence rates of papillary thyroid cancer among Filipina (13.7 per 100,000) and Vietnamese (12.7) women were more than double those of Japanese women (6.2). US-born Chinese (IRR = 0.48, 95% CI: 0.40-0.59) and Filipina women (IRR = 0.74, 95% CI: 0.58-0.96) had significantly higher rates than those who were foreign-born; the opposite was observed for Japanese women (IRR = 1.55, 95% CI: 1.17-2.08). The age-specific patterns among all foreign-born Asian women and US-born Japanese women showed a slow steady increase in incidence until age 70. However, among US-born Asian women (except Japanese), substantially elevated incidence rates during the reproductive and menopausal years were evident. CONCLUSIONS Ethnic- and birthplace-variation in papillary thyroid cancer incidence can provide insight into the etiology of this increasingly common and understudied cancer.
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Affiliation(s)
- Pamela L Horn-Ross
- Cancer Prevention Institute of California, 2201 Walnut Ave., Suite 300, Fremont, CA 94538, USA.
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Lowry R, Eaton DK, Brener ND, Kann L. Prevalence of health-risk behaviors among Asian American and Pacific Islander high school students in the U.S., 2001-2007. Public Health Rep 2011; 126:39-49. [PMID: 21337930 PMCID: PMC3001821 DOI: 10.1177/003335491112600108] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES We provided national prevalence estimates for selected health-risk behaviors for Asian American and Pacific Islander high school students separately, and compared those prevalence estimates with those of white, black, and Hispanic students. METHODS We analyzed data from the Youth Risk Behavior Surveillance System. To generate a sufficient sample of Asian American and Pacific Islander students, we combined data from four nationally representative surveys of U.S. high school students conducted in 2001, 2003, 2005, and 2007 (total n = 56,773). RESULTS Asian American students were significantly less likely than Pacific Islander, white, black, or Hispanic students to have drunk alcohol or used marijuana. Asian American students also were the least likely to have carried a weapon, to have been in a physical fight, to have ever had sexual intercourse, or to be currently sexually active. Once sexually active, Asian American students were as likely as most other racial/ethnic groups to have used alcohol or drugs at last sexual intercourse or to have used a condom at last sexual intercourse. Pacific Islander students were significantly more likely than Asian American, white, black, or Hispanic students to have seriously considered or attempted suicide. CONCLUSIONS The prevalence estimates of health-risk behaviors exhibited by Asian American students and Pacific Islander students are very different and should be reported separately whenever feasible. To address the different health-risk behaviors exhibited by Asian American and Pacific Islander students, prevention programs should use culturally sensitive strategies and materials.
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Affiliation(s)
- Richard Lowry
- Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, MS K-33, Atlanta, GA 30341, USA.
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Chen JG, Zhang SW. Liver cancer epidemic in China: past, present and future. Semin Cancer Biol 2010; 21:59-69. [PMID: 21144900 DOI: 10.1016/j.semcancer.2010.11.002] [Citation(s) in RCA: 175] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 11/17/2010] [Accepted: 11/30/2010] [Indexed: 12/11/2022]
Abstract
Primary liver cancer is the second most common malignancy, and currently results in 360,000 incident cases, and 350,000 deaths a year in China. For the past four decades, three national surveys on cancer mortality during the periods of 1973-1975, 1990-1992, and 2004-2005 have made it possible to estimate China's past and present liver cancer epidemic. The mortality rates of liver cancer were 17.6 and 7.3 per 100,000 for males and females in 1973-1975, 29.0 and 11.2 per 100,000 in 1990-1992, and 37.55 and 14.45 per 100,000 in 2004-2005, respectively. Recent monitoring from some regional cancer registries, which cover 5.7% of the total population in China, has revealed the distribution, disparities and trends of liver cancer in rural and urban areas. HBV and aflatoxins have been identified as major causal factors, that act individually and synergistically of liver cancer in the etiology. Other agents such as HCV, genetic susceptibility or genetic polymorphisms may also play important roles in the development of liver cancer. Great effort aimed at primary and Secondary prevention of this cancer, such as universal hepatitis B vaccination in children, chemoprevention in selected population, and early detection in at-risk population, has been undertaken. These strategies might be further emphasized in the future for the effective prevention of liver cancer in China.
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Affiliation(s)
- Jian Guo Chen
- Qidong Cancer Registry, Qidong Liver Cancer Institute, 785 Jianghai Zhong Road, Qidong 226200, Jiangsu, China.
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Kwong SL, Stewart SL, Aoki CA, Chen MS. Disparities in hepatocellular carcinoma survival among Californians of Asian ancestry, 1988 to 2007. Cancer Epidemiol Biomarkers Prev 2010; 19:2747-57. [PMID: 20823106 PMCID: PMC3016919 DOI: 10.1158/1055-9965.epi-10-0477] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) represents a significant health disparity affecting Asian Americans, a population comprised of distinct ethnic groups. The purpose of this article is to analyze Californians of Asian ancestry with HCC with respect to socioeconomic status, demographic factors, stage of disease, treatment received, and survival. METHODS To investigate ethnic differences in survival, we analyzed ethnically disaggregated data from 6,068 Californians of Asian ancestry with HCC diagnosed in 1988 to 2007 and reported to the California Cancer Registry. RESULTS Compared with the average of all ethnic groups, cause-specific mortality was significantly higher among Laotian/Hmong [hazard ratio, 2.08; 95% confidence interval (95% CI), 1.78-2.44] and Cambodian patients (hazard ratio, 1.26; 95% CI, 1.06-1.51), groups with higher proportions of their populations at low levels of socioeconomic status; in addition, Laotian/Hmong patients disproportionately presented at later stages of disease, with only 3% receiving local surgical treatment, resection, or liver transplantation. After adjustment for time of diagnosis, age at diagnosis, gender, geographic region, stage at diagnosis, type of surgery, and socioeconomic status, survival disparities remained for both groups (Laotian/Hmong hazard ratio, 1.51; 95% CI, 1.28-1.79; Cambodian hazard ratio, 1.24; 95% CI, 1.03-1.48). CONCLUSIONS Our hypothesis that survival outcomes would differ by ethnicity was verified. IMPACT Research is needed not only to develop more effective treatments for HCC but also to develop community-based interventions to recruit Asian Americans, particularly Laotian/Hmong and Cambodians, for hepatitis B screening and into medical management to prevent or detect this tumor at an early stage.
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Affiliation(s)
- Sandy L Kwong
- Cancer Surveillance Research Unit, Cancer Surveillance and Research Branch, California Department of Public Health, San Francisco, CA, USA
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Gwede CK, William CM, Thomas KB, Tarver WL, Quinn GP, Vadaparampil ST, Kim J, Lee JH, Meade CD. Exploring disparities and variability in perceptions and self-reported colorectal cancer screening among three ethnic subgroups of U. S. Blacks. Oncol Nurs Forum 2010; 37:581-91. [PMID: 20797950 PMCID: PMC2946332 DOI: 10.1188/10.onf.581-591] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE/OBJECTIVES To explore perceptions of colorectal cancer (CRC) and self-reported CRC screening behaviors among ethnic subgroups of U. S. blacks. DESIGN Descriptive, cross-sectional, exploratory, developmental pilot. SETTING Medically underserved areas in Hillsborough County, FL. SAMPLE 62 men and women aged 50 years or older. Ethnic subgroup distribution included 22 African American, 20 English-speaking Caribbean-born, and 20 Haitian-born respondents. METHODS Community-based participatory research methods were used to conduct face-to-face individual interviews in the community. MAIN RESEARCH VARIABLES Ethnic subgroup, health access, perceptions of CRC (e.g., awareness of screening tests, perceived risk, perceived barriers to screening), healthcare provider recommendation, and self-reported CRC screening. FINDINGS Awareness of CRC screening tests, risk perception, healthcare provider recommendation, and self-reported use of screening were low across all subgroups. However, only 55% of Haitian-born participants had heard about the fecal occult blood test compared to 84% for English-speaking Caribbean-born participants and 91% for African Americans. Similarly, only 15% of Haitian-born respondents had had a colonoscopy compared to 50% for the English-speaking Caribbean and African American subgroups. CONCLUSIONS This exploratory, developmental pilot study identified lack of awareness, low risk perception, and distinct barriers to screening. The findings support the need for a larger community-based study to elucidate and address disparities among subgroups. IMPLICATIONS FOR NURSING Nurses play a major role in reducing cancer health disparities through research, education, and quality care. Recognition of the cultural diversity of the U. S. black population can help nurses address health disparities and contribute to the health of the community.
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Affiliation(s)
- Clement K Gwede
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
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A comparison study of clinicopathologic characteristics of Southern California Asian American Non-small Cell Lung Cancer (NSCLC) patients by smoking status. J Thorac Oncol 2010; 5:158-68. [PMID: 20040896 DOI: 10.1097/jto.0b013e3181c8cc62] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND We previously reported that Asian ethnicity is a favorable prognostic factor for overall survival (OS) in non-small cell lung cancer (NSCLC) patients independent of smoking status. However, Asian ethnicity represents a diverse and heterogeneous population. In this report, we compared the clinicopathologic characteristics of Asian American NSCLC patient subgroups by smoking status. METHODS Clinicopathologic characteristics of the five major Asian American NSCLC patient subgroups diagnosed between 1991 and 2005 from three Southern California counties were analyzed. Prognostic factors for OS were evaluated by Cox multivariate analysis. RESULTS One thousand one hundred twenty-four NSCLC patients were analyzed: Filipino American (37.0%), Vietnamese American (32.8%), Japanese American (11.8%), Chinese American (11.7%), and Korean American (6.7%). A total of 25.7% of these patients were never smokers. With the exception of Japanese American, most of Asian American were native born. Median age of never smokers was marginally younger than ever smokers (66 years versus 68 years, respectively, p = 0.0507). The proportion of never smokers who were women was 72.7% and ranged from the lowest among Korean American women (66.7%) to the highest among Japanese American women (84.2%). Among female patients, Vietnamese American patients had the highest proportion of being never smokers (65.5%). Significantly more never smokers (60.9%) than ever smokers (47.9%) presented with stage 4 disease. There was no statistical significant difference in OS between never smokers and ever smokers (11 versus 10 months; p = 0.3040). Tumor-related factors (stage and histologic differentiation) and treatment (surgery and chemotherapy) were independent prognostic factors for survival. CONCLUSIONS We found no statistical significant difference in clinicopathologic features or survival outcome between individual Asian American subgroup when analyzed according to smoking status.
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