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BACKGROUND: A growing number of studies suggest that job loss has detrimental effects on cancer survivors. However, the underlying mechanisms are not well understood. Furthermore, minorities including Asian American cancer survivors remain understudied, yet they suffer from job loss more often. The present study examined the prevalence of job loss in Chinese American breast cancer survivors (CABCS) and investigated the relationship between job loss and well-being in this group and the underlying mechanisms.
METHODS: CABCS completed a questionnaire that included demographic, employment, and clinical information, as well as measures of psychosocial well-being. Descriptive analyses were conducted to gauge the prevalence of job loss, linear regressions were used to test associations between job loss and well-being, and path analyses were conducted to test mediations.
RESULTS: About 45.4% of survivors lost their job after being diagnosed with cancer, and only 35.2% of those who lost their job regained employment up to the assessment time. Job loss was associated with reduced income, which was associated with higher perceived stress, which, in turn, was associated with lower overall quality of life (QoL) and greater depressive symptoms.
CONCLUSIONS: Findings highlight the high prevalence of job loss and its negative effects on QoL and depression among CABCS. It is important for health care professionals to be sensitive to adverse financial events affecting minority BCS. In addition to offering BCS necessary practical assistance, psychosocial interventions focusing on reducing perceived stress associated with the cancer experience may be effective in mitigating some long-term consequences of job loss.

OBJECTIVE: The purpose of this study was to investigate improvements in quality of life and psychological well-being among Chinese American breast cancer survivors who participated in a pilot community education and peer-mentor support program.
METHODS: One hundred and twenty-nine Chinese American breast cancer survivors who recently completed treatment participated in eight cohorts of the program, Joy Luck Academy, which included weekly education and peer-mentor support sessions. The education sessions covered topics designed to help participants adjust to new life after breast cancer treatment. The peer-mentor support component was designed to provide social support. Quality of life and psychological well-being (e.g., depressive symptoms, anxiety, and low- and high-arousal positive and negative affect) were assessed at baseline and immediately after the intervention.
RESULTS: Paired samples t tests indicated improvements in quality of life, low- and high-arousal positive affect, and reductions in depressive symptoms, anxiety, and low-arousal negative affect.
CONCLUSIONS: Our findings suggest that a psychosocial group intervention may improve quality of life and psychological well-being among Chinese American breast cancer survivors. Our intervention has the potential to be applied to other ethnic-minority cancer survivors. Future randomized controlled trials are warranted.

This study investigated the potential benefit of a pilot culturally sensitive group support intervention, named Joy Luck Academy (JLA), in fostering posttraumatic growth among Chinese American breast cancer survivors. Eighty-six Chinese American breast cancer survivors participated in an eight-week single-arm pre-/post-test trial of an intervention program, which included educational lectures and peer mentor support. The JLA participants were compared with an independent sample of 109 Chinese American breast cancer survivors who went through routine care. Both groups completed baseline and eight-week follow-up assessments of the five facets of posttraumatic growth (meaningful interpersonal relationships, finding new possibilities in life, personal strength, appreciation of life, and spirituality). From baseline to follow-up, the JLA participants displayed significant improvements in the total score of posttraumatic growth, meaningful interpersonal relationships, appreciation of life, finding new possibilities in life, and personal strength. In contrast, the routine care participants showed no significant change in any of these outcome variables. The findings suggest the potential benefit of a culturally sensitive group support intervention in facilitating posttraumatic growth for Chinese American breast cancer survivors, indicating the need for a randomized controlled trial. The educational lectures and peer mentor support may be adapted to tailor the needs of other ethnic minority cancer patients.

Despite the increasing scholarly attention toward self-stigma among Asian breast cancer survivors, research is limited about the underlying psychological mechanisms by which self-stigma may influence quality of life for this population. The present study investigated how self-stigma is associated with quality of life among Chinese American breast cancer survivors by examining the serial mediating effects of concerns about breast cancer, self-efficacy for coping with cancer, and depressive symptoms.
Chinese American breast cancer survivors (n = 112) completed a questionnaire packet assessing self-stigma related to breast cancer, concerns about breast cancer, self-efficacy for coping with cancer, depressive symptoms, and quality of life. Path analysis was conducted to test the hypothesized serial multiple mediation model.
The hypothesized model was supported: self-stigma was negatively associated with quality of life through concerns about breast cancer, self-efficacy, and depressive symptoms. After the mediators were controlled for, the direct effect of self-stigma on quality of life was no longer significant.
Our findings suggest that concerns about breast cancer, self-efficacy for coping, and depressive symptoms are important pathways through which self-stigma may influence quality of life among Chinese American breast cancer survivors. Healthcare practitioners should be aware of survivors\' self-stigma and make efforts to alleviate survivors\' excessive cancer concerns, facilitate their self-efficacy, and offer emotional support to improve quality of life for this population.

Research has demonstrated the association between social constraints and posttraumatic stress disorder (PTSD) symptoms among breast cancer survivors. Although perceived social support can buffer stress and improve emotional well-being, little is known about which type of social support is most effective in buffering the negative effects of social constraints among cancer survivors. We investigated the moderation of four types of social support (i.e., positive interaction, tangible support, emotional/informational support and affectionate support) on the association between social constraints and PTSD symptoms among Chinese American breast cancer survivors. One hundred and thirty-six Chinese American breast cancer survivors completed questionnaires that assessed social constraints, PTSD symptoms and perceived social support. Results of hierarchical regression analysis indicated that only support of positive interaction exerted a buffering effect, with social constraints associated with greater PTSD severity among survivors with low but not high levels of support of positive interaction. In contrast, high levels of tangible support potentiated the association between social constraints and PTSD symptoms. There were no moderating effects of emotional/informational support and affectionate support. These results demonstrated the roles of different types of social support in moderating the stress imposed by social constraints. Our findings highlight the importance of recognizing the potential cultural sensitivity of ethnic minorities in PTSD intervention and mental health services for cancer patients.

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.
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.
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].
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.

OBJECTIVE: Posttraumatic stress disorder (PTSD) is a significant condition among breast cancer survivors (BCSs). However, few intervention studies for cancer-related PTSD were conducted among Asian cancer survivors. We evaluated a culturally sensitive expressive writing intervention, which combined cognitive reappraisal and emotional disclosure, in reducing PTSD among Chinese American BCSs. We also tested social constraints (defined as social conditions when individuals feel misunderstood or alienated when they desire to disclose their thoughts and feelings) as a moderator.
METHODS: Chinese American BCSs (n = 136) were randomly assigned to three groups with assigned writing topics for 3 weeks: a self-regulation group, which wrote about the deepest feelings related to cancer in week 1, cognitive reappraisal about stress and coping in week 2, and benefit finding in week 3; an enhanced self-regulation group, with the same instructions, except weeks 1 and 2 were reversed; and a cancer-fact group, which wrote about cancer experiences objectively for 3 weeks. PTSD symptoms were measured at baseline and 1-, 3-, and 6-month follow-ups. Social constraints were measured at baseline.
RESULTS: Both the self-regulation and enhanced self-regulation groups showed reduced PTSD symptoms compared to the cancer-fact group. For reexperiencing and hyperarousal symptoms, expressive writing was more effective for BCSs who experienced high vs. low levels of social constraints; the opposite was found for avoidance symptoms.
CONCLUSIONS: Findings demonstrated the effectiveness of expressive writing intervention in reducing PTSD for this minority population, and that the moderating role of survivors\' social network varies among different PTSD symptom clusters. ClinicalTrials.gov Identifier: NCT02946619.

OBJECTIVE: Low socioeconomic status and limited social support may put older residents in subsidized housing at high risk for developing fears of Alzheimer\'s disease or related dementias. This study examined the perceived threat of Alzheimer\'s disease or related dementias among older Chinese Americans in subsidized housing facilities in Phoenix, Arizona of the United States, and focused on the effect of cultural beliefs (i.e., beliefs toward Alzheimer\'s disease or related dementias, and beliefs toward intergenerational support) on the perceived threat of Alzheimer\'s disease or related dementias.
METHODS: Analyses were based upon a survey of 207 Chinese American older adults (Mage = 75.37, SD = 7.47) living in subsidized housing facilities in the Phoenix metropolitan area. Standardized survey questionnaires were delivered through face-to-face interviews.
RESULTS: Multivariate analyses suggest that fatalism related beliefs about Alzheimer\'s disease or related dementias, rather than stigmatization, were related to higher levels of concerns for developing Alzheimer\'s disease or related dementias, while beliefs in intergenerational support were related to lower levels of perceived threat of Alzheimer\'s disease or related dementias. However, the protective effect of beliefs in intergenerational support tended to diminish in those living with higher levels of depressive symptoms.
CONCLUSIONS: Cultural beliefs can entail both risks and strengths when low-income Chinese American elders attempt to comprehend the implications of Alzheimer\'s disease or related dementias. Health education or intervention programs need to address their fatalism beliefs toward Alzheimer\'s disease or related dementias, and facilitate the accessibility of intergenerational support for this group.

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