Abstract PR02: Randomized controlled trial to increase quality of life and reduce perceived stress among Korean American breast cancer survivors
Authors: Lee Sunmin , Jung Mary Y. , Sim Jamie H. 
Published: March 2017

Background: Despite large increases in breast cancer incidence among Korean women, there have been remarkably few empirical studies to improve survivorship among Korean American breast cancer survivors (KBCS), many of whom experience linguistic and cultural barriers. According to limited research on Asian Americans, KBCS report low quality of life (QOL) and high perceived stress (henceforth referred to as “stress”). To address this gap, we tested the effectiveness of one of the first linguistically appropriate and culturally sensitive cognitive-behavioral stress management programs that was developed to improve QOL and reduce stress in KBCS.

Methods: The TOGETHER (Together Overcome and Get Empowered Through Health Education and Relationships) program consists of seven 2-hour sessions and one follow-up seven weeks post-intervention. These findings are preliminary results based on cycles one to four of the program, consisting of 66 KBCS in the Washington, D.C. metropolitan area of which complete data was available for 61 participants (92.4%). The standard intervention (SI) group (n=28) received linguistically and culturally tailored health information related to breast cancer, while the enhanced intervention (EI) group (n=33) received this and additional information/practice on relaxation, stress reduction techniques, mindfulness, utilizing social support, anger management, and assertiveness training.

Outcomes were measured at baseline, upon completion of the program, and at follow-up. QOL was assessed using the Functional Assessment of Cancer Therapy-Breast (FACT-B), which includes five subscales (physical well-being (PWB), social well-being (SWB), emotional well-being (EWB), functional well-being (FWB), and breast cancer subscale (BCS)), while stress was assessed using the Perceived Stress Scale (PSS). Generalized estimating equation (GEE) models were used to examine program effects on QOL and PSS separately. Moreover, the impact of program site (Maryland vs. Virginia), cycle (one to four), and age (less than 65 vs. 65 and over) on these relationships was assessed.

Results: Randomization was effective in that SI and EI participants were similar in regards to sociodemographic, breast cancer-related, and acculturation variables. Program site and cycle did not impact program effects on QOL and PSS and were thus not included in subsequent models. For QOL, the SI group had better quality of life at baseline (mean FACT-B score: 103.3) compared to the EI group (mean FACT-B score: 100.7). Changes in mean FACT-B, SWB, and FWB scores significantly differed between the SI and EI group from baseline to the end of the program. Specifically, the EI group had a 7.0 unit greater increase in mean FACT-B scores, 2.6 unit greater increase in mean SWB scores, and 2.5 unit greater increase in mean FWB scores from baseline to the end of the program as compared to the SI group on average. For stress, the EI group had a higher level of stress (mean PSS score: 18.82) than the SI group (mean PSS score: 17.25) at baseline. Changes in mean PSS scores significantly differed across time between the SI and EI groups. Those in the EI group had a 2.7 unit greater decrease in mean PSS scores from baseline to the end of the program as compared to those in the SI group on average. For age, those who were less than 65 showed overall decreases in stress from baseline to follow-up, while those 65 and over showed initial decreases from baseline to the end of the program and then increases from the end of the program to follow-up beyond the baseline values.

Conclusions: The TOGETHER program is effective in increasing QOL and reducing stress among KBCS and can potentially be adapted and implemented for other socially or linguistically isolated groups in the U.S.

Citation Format: Sunmin Lee, Mary Y. Jung, Jamie H. Sim. Randomized controlled trial to increase quality of life and reduce perceived stress among Korean American breast cancer survivors. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr PR02.