Incidence trends of lung cancer by immigration status among Chinese Americans

Cross-Cultural Adaptation of Lung Cancer Screening Health Belief Scale in Chinese Americans: A Methodological Study

Background and Purpose: The purpose of this study is to report the process of adapting the existing Lung Cancer Screening Health Belief Scale to be used in Chinese Americans. Methods: Guided by Flaherty et al.'s cross-cultural equivalency model, the methodology used in the adaptation process consists of four steps, including preliminary modification after a comprehensive literature review, forward and backward translation, expert review, and cognitive interviews among participants. Results: The modified culturally fitted Lung Cancer Screening Health Belief Scale included 57 items and 6 subscales, which proved highly reliable and valid through the expert review and participants' review. Conclusions: This study provided an example for a novice cross-cultural researcher to adapt an instrument to be used in another population with a different language. Further research is needed to work out a standard guideline for cross-cultural instrument adaptation.

Age-period-cohort analysis and projection of cancer mortality in Hong Kong, 1998-2030

OBJECTIVES

To explore the relationship between immigration groups and cancer mortality, this study aimed to explore age, period, birth cohort effects and effects across genders and immigration groups on mortality rates of lung, pancreatic, colon, liver, prostate and stomach cancers and their projections.

DESIGN, SETTING, AND PARTICIPANTS

Death registry data in Hong Kong between 1998 and 2021, which were stratified by age, sex and immigration status. Immigration status was classified into three groups: locals born in Hong Kong, long-stay immigrants and short-stay immigrants.

METHODS

Age-period-cohort (APC) analysis was used to examine age, period, and birth cohort effects for genders and immigration groups from 1998 to 2021. Bayesian APC models were applied to predict the mortality rates from 2022 to 2030.

RESULTS

Short-stay immigrants revealed pronounced fluctuations of mortality rates by age and of relative risks by cohort and period effects for six types of cancers than those of long-stay immigrants and locals. Immigrants for each type of cancer and gender will be at a higher mortality risk than locals. After 2021, decreasing trends (p<0.05) or plateau (p>0.05) of forecasting mortality rates of cancers occur for all immigration groups, except for increasing trends for short-stay male immigrants with colon cancer (p<0.05, Avg+0.30 deaths/100 000 per annum from 15.47 to 18.50 deaths/100 000) and long-stay male immigrants with pancreatic cancer (p<0.05, Avg+0.72 deaths/100 000 per annum from 16.30 to 23.49 deaths/100 000).

CONCLUSIONS

Findings underscore the effect of gender and immigration status in Hong Kong on mortality risks of cancers that immigrants for each type of cancer and gender will be at a higher mortality risk than locals.

Health beliefs toward lung cancer screening among Chinese American high-risk smokers: Interviews based on Health Belief Model

Objective

This study aims to explore health beliefs toward lung cancer screening with low dose computed tomography among Chinese American high-risk smokers.

Methods

Guided by the Health Belief Model, semi-structured individual interviews were conducted with Chinese American high-risk smokers via phone. Additional questionnaires on demographic information, history of smoking and lung cancer screening were collected via email or phone before the interview, depending on participants' preference. Content analysis was used to extract meaningful and significant themes in the dataset. Constant comparison analysis and process coding were used to categorize and code data.

Results

Data saturation was reached after interviewing 12 participants. Chinese American high-risk smokers perceived a low susceptibility to lung cancer, since they believed various protective factors of lung cancer (e.g., doing exercise, healthy diet, etc.) reduced their risk of getting lung cancer. All the participants perceived a high severity of lung cancer. They acknowledged lung cancer would have a huge impact on their life. Perceived benefits of lung cancer screening were accurate in most aspects although minor confusions were still noticed among this population. Perceived barriers varied on participants', physicians', and institutional levels. High-risk Chinese American smokers had little confidence to screening for lung cancer. Cues to action for them to screening for lung cancer included recommendations from health care providers, support from family members and friends, and information shared on Chinese-based social media.

Conclusions

Misconceptions and barriers to screening for lung cancer existed widely among Chinese American high-risk smokers. Intervention programs and targeted health education should be implemented to promote lung cancer screening among this population.

Health Disparities Across Lung Cancer Continuum Among Asian Americans: A Systematic Review

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.

Trajectory of smoking behavior change among Chinese immigrant smokers

BACKGROUND

The incidence and mortality rates of smoking-associated lung cancer are high among Chinese immigrant smokers. Coming from a country with different smoking policies, culture, and economic background than the U.S., Chinese smokers may change their smoking behaviors after immigrating to the U.S.

OBJECTIVES

This study aims to explore the trajectory of smoking behavior change among Chinese immigrant smokers migrating to the U.S.

METHODS

This qualitative study was guided by the Grounded theory. Semi-structured intensive individual interviews were conducted among 10 eligible participants. A purposive theoretical sampling method was used to recruit participants through a website. Individual interviews were conducted online, via telephone, or in-person in Mandarin. Data were transcribed verbatim in Mandarin, translated into English, and triangulated with follow-up interviews and dialogues among authors to enhance trustworthiness and consistency of the study. Process coding and content analysis were used to analyze data.

RESULTS

A total of 10 participants, 7 males and 3 females, were interviewed. Results showed the trajectory of smoking behavior change among Chinese immigrant smokers went through three phases: 1) Beginning to smoke, which included learning to smoke from others, trying to smoke and learning to smoke, and hiding their smoking behaviors from others; 2) maintaining smoking, which included setting boundary around smoking, smoking as a facilitator or barrier to social interaction, feeling pressures related to smoking behavior, and making others happy: Collective smoking and controlling smoking desire; and 3) changing smoking behaviors, which included experiencing life events that were triggers to changing smoking behavior, boredom as a reason for relapses, personal will as a key to quitting smoking, and quitting smoking for a loved one. Although some differences existed between male and female Chinese immigrant smokers' smoking behaviors, their trajectories of smoking behavior change were generally similar.

DISCUSSION

Findings from this study can help health care providers to extend their understanding toward smoking behavior change among Chinese immigrant smokers across different socio-cultural contexts.

Predict multicategory causes of death in lung cancer patients using clinicopathologic factors

BACKGROUND

Random forests (RF) is a widely used machine-learning algorithm, and outperforms many other machine learning algorithms in prediction-accuracy. But it is rarely used for predicting causes of death (COD) in cancer patients. On the other hand, multicategory COD are difficult to classify in lung cancer patients, largely because they have multiple labels (versus binary labels).

METHODS

We tuned RF algorithms to classify 5-category COD among the lung cancer patients in the surveillance, epidemiology and end results-18, whose lung cancers were diagnosed in 2004, for the completeness in their follow-up. The patients were randomly divided into training and validation sets (1:1 and 4:1 sample-splits). We compared the prediction accuracy of the tuned RF and multinomial logistic regression (MLR) models.

RESULTS

We included 42,257 qualified lung cancers in the database. The COD were lung cancer (72.41%), other causes or alive (14.43%), non-lung cancer (6.85%), cardiovascular disease (5.35%), and infection (0.96%). The tuned RF model with 300 iterations and 10 variables outperformed the MLR model (accuracy = 69.8% vs 64.6%, 1:1 sample-split), while 4:1 sample-split produced lower prediction-accuracy than 1:1 sample-split. The top-10 important factors in the RF model were sex, chemotherapy status, age (65+ vs < 65 years), radiotherapy status, nodal status, T category, histology type and laterality, all of which except T category and laterality were also important in MLR model.

CONCLUSION

We tuned RF models to predict 5-category CODs in lung cancer patients, and show RF outperforms MLR in prediction accuracy. We also identified the factors associated with these COD.

Adaptation and Preliminary Evaluation of a Lung Cancer Screening Decision Tool for Older Chinese American Populations

BACKGROUND

Lung cancer is a significant health issue among Chinese Americans. The study purpose was to translate and culturally adapt the Agency for Healthcare Research and Quality's (AHRQ) lung cancer screening decision tool to the needs of older Chinese American smokers.

METHODS

This study used a mixed methods approach. In the first phase, AHRQ lung cancer screening decision aid was translated from English to Chinese. The second phase consisted of a paper and pencil survey (N = 50) designed to measure knowledge and attitudes regarding lung screening. Finally, focus groups (N = 5, 27 participants) were conducted to obtain input on the translated and culturally adapted AHRQ lung cancer screening DA.

RESULTS

The mean age of participants was 70.4 years (SD = 5.4) and the majority were male (n = 42; 84%). Seventy-four percent of the sample reported being a former smoker and 26% a current smoker. Perceived risk for lung cancer was low (26%) and the majority of participants (70%) were unaware of lung cancer screening. Perceived benefits (e.g., early cancer detection) and barriers of LDCT screening (e.g., costs) were reported by participants. The qualitative findings were largely consistent with the quantitative results. Following the revisions to the translated AHRQ DA, participants reported satisfaction with the readability and information provided.

CONCLUSIONS

Lung cancer screening represents an evidence-based approach for reducing lung cancer morbidity and mortality among chronic high frequency smokers. Culturally targeting evidence-based lung cancer screening decision-aids to the language, cultural and health literacy needs of high risk populations may increase uptake of lung cancer early detection screening.

The Influence of Smoking Status on the Health Profiles of Older Chinese American Men

OBJECTIVE

To examine the influence of smoking status on the health profiles of community-dwelling older Chinese American men in the greater Chicago, IL, area.

DESIGN

This study utilized a cross-sectional study design to analyze data obtained from the larger Population Study of Chinese Elderly in Chicago (PINE).

SETTING

A population-based study conducted in Chicago.

PARTICIPANTS

Baseline data from Chinese American men who participated in PINE (N = 1492).

MEASURES

Demographic characteristics measured included age, education years, marital status, income, health insurance coverage, and smoking pack-years. Self-reported smoking status included never smoker, current smoker, and former smoker. Health profile indicators included perceived health status, past 12-month changes in health, chronic medical conditions (heart diseases, stroke, cancer, diabetes, hypertension, high cholesterol, thyroid disease, and osteoarthritis), quality of life, and depression and anxiety.

RESULTS

The mean age of the study sample was 72.5 years. Of the sample, 65% reported a smoking history, with 25.1% current smokers and 40.1% former smokers. Current smokers were younger, less educated, and uninsured. Former smokers had the poorest overall health profiles. Compared to former smokers, current smokers were less likely to have heart disease (odds ratio [OR] = 0.59; 95% confidence interval [CI] = 0.39-0.90), hypertension (OR = 0.54; 95% CI = 0.41-0.72), high cholesterol (OR = 0.74; 95% CI = 0.56-0.99), thyroid disease (OR = 0.44; 95% CI = 0.21-0.90), depression (rate ratio [RR] = 0.76; 95% CI = 0.58-0.99), and anxiety (RR = 0.72; 95% CI = 0.59-0.89), and they had fewer overall chronic medical conditions (RR = 0.79; 95% CI = 0.70-0.88) after controlling for demographic factors and smoking pack-year history. Compared to never smokers, former and current smokers reported poorer self-rated health (OR = 1.58; 95% CI = 1.11-2.26) and lower perceived quality of life (OR = 2.11; 95% CI = 1.04-4.29).

CONCLUSIONS

Consistent with prior research, smoking rates were elevated among this sample of older Chinese men. Counter to study hypotheses, former smokers had worse overall health. Study findings suggest the need for health promotion interventions for both current and former smokers. J Am Geriatr Soc 67:S577-S583, 2019.

Incidence and survival of non-small cell lung cancer in Shanghai: a population-based cohort study

OBJECTIVES

Large population-based studies on the incidence and outcome of non-small cell lung cancer (NSCLC) are lacking in mainland China. This study aimed to investigate the NSCLC incidence, demographic features and survival as well as factors affecting survival of patients with NSCLC in Shanghai.

DESIGN

Prospective observational cohort study.

SETTING

Baseline information was collected from Shanghai Health Information Network, which is based on the Health Information Systems from all the comprehensive hospitals and specialist hospitals qualified for cancer diagnosis in the Shanghai metropolitan area.

PARTICIPANTS

All NSCLC cases identified from the database between 2011 and 2013 were recruited (15,020 patients).

MAIN RESULTS

The crude and age-adjusted incidences of NSCLC were 54.20 per 100,000 people (55.90 per 100,000 for men, 52.39 per 100,000 for women) and 39.05 per 100,000 people (41.43 per 100,000 for men and 37.13 per 100,000 for women), respectively. The median survival time was 22.7 months (95% CI 21.8 to 24.2 months) with an overall 1-year survival rate of 71.8% (95% CI 69.8% to 73.8%). The 1-year survival rate was 96.5% (95% CI 94.0% to 98.6%) in patients with stage I NSCLC, 89.1% (95% CI 83.3% to 94.9%) in patients with stage II NSCLC, 78.8% (95% CI 74.1% to 83.5%) in patients with stage IIIa NSCLC and 58.9% (95% CI 56.1% to 61.7%) in patients with stage IIIb/IV NSCLC. Multivariate analysis showed surgical resection (HR=0.607, 95% CI 0.511 to 0.722) and chemotherapy (HR=0.838, 95% CI 0.709 to 0.991) significantly improved survival. Factors associated with poor survival included older age, male sex, larger tumour size, lymph node metastasis, distant metastasis and squamous cell carcinoma.

CONCLUSIONS

A higher incidence and better survival rates for patients with NSCLC were identified when compared with previously published studies, which may provide evidence on the incidence and survival of NSCLC in China.