Breast cancer among Asian Americans: is acculturation related to health-related quality of life?

PURPOSE/OBJECTIVES To examine the association of acculturation with health-related quality of life (HRQOL) among Asian American breast cancer survivors. DESIGN Cross-sectional. SETTING Analysis of an Asian American subsample of breast cancer survivors from a larger multiethnic study. SAMPLE 206 Asian Americans, including Chinese, Filipinos, Koreans, and Japanese. Most were diagnosed with early-stage breast cancer (stage 0-II) and were an average of 54 years old. METHODS Participants completed a mailed questionnaire or answered a telephone survey in English, Mandarin, or Korean. HRQOL was measured using the Functional Assessment of Cancer Therapy Breast Version 4. Acculturation was measured using an eight-item scale adapted from Marin's Short Acculturation Scale. MAIN RESEARCH VARIABLES HRQOL, acculturation, health insurance, life stress, and social support. FINDINGS Acculturation was significantly associated with HRQOL when demographic, medical, socioecologic, and healthcare access factors were controlled. However, the significant association between acculturation and HRQOL disappeared when Asian subgroup membership was considered. Subgroup differences in HRQOL remained after controlling for covariates, with Korean Americans reporting lower HRQOL than the other Asian American subgroups. CONCLUSIONS The absence of a significant association between acculturation and HRQOL in the final model is likely a result of the strong association between acculturation and Asian American subgroup membership. The results suggest that the correlation between acculturation and HRQOL is not an effect of having health insurance, life stress, and social support. IMPLICATIONS FOR NURSING Closer attention is needed regarding acculturation level; Asian American subgroup differences, including language capacity; and socioecologic characteristics in nursing practice and research.