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To supply proper and sufficient information and coaching through cancer education, it is important to decide who are risk groups among a target population. A decision tree analysis could help decide the characteristics of the risk groups. This study aimed to identify the combined characteristics of Asian American breast cancer survivors that were closely linked to high needs for help during their breast cancer survivorship process. The data on the needs for help among 185 Asian American breast cancer survivors from a parent clinical trial were included in this analysis. The instruments included the Supportive Care Needs Survey-Short Form 34 (SCNS-SF34) and multiple scales to measure the factors influencing the women's needs for help. The data were analyzed using latent profile analyses and decision tree analyses. The characteristics of the group with the highest needs for help were different depending on the types of needs. For instance, the group with the highest patient care/support needs for help score had high global symptom distress scores (cut point = 2.25) and high physical symptom distress (cut point = 1.57) and did not have regular access to health care (mean = 95.00; node 10). The findings suggest several risk groups to target in future interventions for cancer education to reduce the needs for help among this specific population. Multiple factors that could influence the needs for help among Asian American breast cancer survivors need to be considered in future intervention development for cancer education., (© 2024. The Author(s) under exclusive licence to American Association for Cancer Education.)

Cancer survivors including Asian American breast cancer survivors have reported their high needs for help during their survivorship process. With the COVID-19 pandemic, the necessity of technology-based programs to address their needs for help without face-to-face interactions has been highlighted. The purpose of this randomized intervention study was to determine the efficacy of a technology-based program in reducing various types of needs for help among this specific population. This was a randomized clinical trial with repeated measures. A total of 199 participants were included in the data analysis. The recruitment settings included both online and offline communities/groups for Asian Americans. The needs for help were assessed using the Support Care Needs Survey-34 Short Form (SCNS) subscales measuring psychological, information, physical, support, and communication needs. Data analysis was conducted through an intent-to-treat approach. In the mixed effect models, psychological needs, information needs, physical needs, and communication needs decreased over time (P < .001). However, there were no significant group * time effects. Social support significantly mediated the effects of a technology-based intervention on psychological, information, and support needs at the pre-test and the post-1 month. This study supported significant decreases in the needs for help of Asian American breast cancer survivors by a technology-based intervention. Further studies are needed with other racial/ethnic groups of cancer survivors to confirm the efficacy of a technology-based intervention in reducing cancer survivors' needs for help during their survivorship process., (© 2024. The Author(s) under exclusive licence to American Association for Cancer Education.)

Background: Mainly due to their cultural attitudes toward symptoms and breast cancer, Asian American breast cancer survivors tend to suffer from symptoms and often delay in getting treatments, information, and support. To improve their symptom management, it would be important to determine risk groups among them. Decision tree analyses reportedly help determine risk groups by identifying the characteristics that are directly associated with target health outcomes., Objective: Using a decision tree analysis, this study aimed at identifying the characteristics that were closely linked to the symptom experience of Asian American breast cancer survivors., Methods: This was a part of a parent randomized controlled trial among Asian American breast cancer survivors. Only the data from 135 women at the pre-test were included. Multiple instruments were used to collect the data: the Memorial Symptom Assessment Scale-Short Form, the Cancer Behavior Inventory, the PRQ-2000, the Perceived Isolation Scale, and the Supportive Care Needs Survey-Short Form 34. The data were analyzed using latent profile analysis and decision tree analyses., Results: Two most frequently found profiles included the low symptom experience profile (72.6%) and the high symptom experience profile (27.4%). The high symptom experience profile was predicted by 2 combined characteristics; (a) high psychological needs for help (over 60.00 points), and (b) low psychological needs for help (cut point = 60.00), high perceived barriers (cut point = 1.62), and high social isolation (social support) (cut point = 2.33)., Conclusions: These characteristics linked to Asian American breast cancer survivors with high symptom experience need to be considered in future intervention development., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

A culturally tailored virtual program could meet the survivorship needs of Asian American women breast cancer survivors (AABC). This study aims to determine the efficacy of a culturally tailored virtual information and coaching/support program (TICAA) in improving AABC's survivorship experience. A randomized clinical trial (NCT02803593) was conducted from January 2017 to June 2020 among 199 AABC. The intervention group utilized TICAA and the American Cancer Society [ACS] website while the control group used only ACS website for 12 weeks. The outcomes were measured using the SCNS-34SF (needs; primary), the MSAS-SF (symptoms; secondary), and the FACT-B (quality of life; secondary). The data were analyzed using an intent-to-treat approach. The intervention group showed significant reductions in their needs from the baseline (T0) to post 4 weeks (T1) and to post 12 weeks (T2). Although the changes were not statistically significant, the intervention group had decreased symptoms from T0 to T2 while the control group had an increase in their symptoms. The intervention group had a significant increase in their quality of life from T0 to T2. A culturally tailored virtual program could therefore improve quality of life in AABC patients. Trial Registration: To Enhance Breast Cancer Survivorship of Asian Americans (TICAA), NCT02803593, https://clinicaltrials.gov/ct2/show/NCT02803593?titles=TICAA&draw=2&rank=1., (© 2023. Springer Nature Limited.)

To provide appropriate and adequate information and support for Asian American breast cancer survivors, it would be essential to identify risk groups among them to target in future cancer education interventions. In this secondary analysis, the characteristics of risk groups within Asian American breast cancer survivors who had low quality of life were identified using a decision tree analysis. For this analysis, only the pre-test data of 185 women from a parent study were selected. Multiple instruments including the Functional Assessment of Cancer Therapy Scale-Breast Cancer (FACT-B) were used in the parent study. The data were analyzed using descriptive and inferential statistics and decision tree analyses. The decision tree analyses showed six combined characteristics associated with lower quality of life scores than the total mean quality of life scores. For instance, the women with lower quality of life scores (than the total mean quality of life scores) had high perceived barriers (cut point = 1.84), low self-efficacy for coping (cut point = 81.50), and high global symptom distress (cut point = 2.27). Also, the characteristics linked to the lowest quality life scores were different depending on the dimensions of the quality of life. The characteristics associated with the quality of life of Asian American breast cancer survivors need to be considered in future education programs for this specific population., (© 2023. The Author(s) under exclusive licence to American Association for Cancer Education.)

Technology-based programs using computers and mobile devices are known to be effective in providing information and support to marginalized populations including immigrants. Yet, little is still known on the factors that may influence the effectiveness of technology-based programs in improving symptom experience, including immigration transition, especially among Asian American breast cancer survivors. This study aimed to identify the characteristics related to immigration transition that significantly affected the symptom distress changes by a technology-based information and coaching/support program among Asian American breast cancer survivors. This secondary analysis was conducted with the data from 102 Asian American breast cancer survivors from a randomized clinical trial in progress. Multiple instruments were used: the questions on background characteristics and immigration transition and the Memorial Symptom Assessment Scale-Short Form. The data were analyzed using repeated-measurement analyses and decision tree analyses. The mean changes in the symptoms distress scores were as follows: -0.12 (SD, 0.47) in the Global Distress Index scores; -0.08 (SD, 0.43) in the physical symptom distress scores; and -0.15 (SD, 0.65) in the psychological symptom distress scores. The characteristics with the highest impact on the symptom distress score changes included the immigration age for Global Distress Index and physical symptom distress score and the level of acculturation for psychological symptom distress score., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: A culturally tailored technology-based cancer support program was recently developed and tested among Asian American breast cancer survivors. To explore future opportunities to sustain the program, the research team participated in the SPeeding Research-tested INTervention (SPRINT) program sponsored by the National Cancer Institute. The purpose of this discussion paper is to share the lessons that the research team gained from a customer discovery study through the SPRINT program., Methods: During the SPRINT program, a total of 73 stakeholders were recruited through a snowball sampling across the globe. Semi-structured interviews were conducted for customer discovery through WebEX, phone calls, and in-person visits (50 in-person interviews, 4 phone interviews, and 19 WebEx interviews). All the interviews were recorded using audio-taping or writing memos. Also, the research team wrote memos on the issues/concerns related to the project during the interview process. Then, the transcripts and memos were analyzed using a content analysis to provide evidence for the lessons., Results: The themes reflecting the lessons from the customer discovery study included (a) "who are the stakeholders"; (b) "depending on stakeholders"; (c) "what works or not"; (d) "personal versus family responsibilities"; and (e) "depending on countries' situations.", Conclusion: These lessons could provide directions for future development and implementation of technology-based cancer support programs for Asian American breast cancer survivors., (© 2021. The Author(s) under exclusive licence to American Association for Cancer Education.)

Through a decision tree analysis, this study aimed to determine the characteristics of Asian American breast cancer survivors who had higher decreases in their need for information by a technology-based information and coaching/support program compared with their counterparts. This is a part of a larger randomized controlled trial; only the data from 99 Asian American breast cancer survivors were used for this analysis. The measurement scales included the Memorial Symptom Assessment Scale-Short Form, the Cancer Behavior Inventory, the Questions on Attitudes, Subjective Norm, Perceived Behavioral Control and Behavioral Intention, and the Supportive Care Needs Survey-Short Form 34. The data analysis was done using t-tests, chi-square tests, repeated measurement analyses, and a decision tree analysis. The information needs scores of all the participants decreased during the 3-month intervention period (p < .005). However, only the intervention group had statistically significant decreases in the information needs scores during the 3 months (dif. =  - 8.545; p < .005). Those with low social influence scores and high self-efficacy scores had significantly larger decreases in their information needs scores compared with the average change scores (100%, p < 01). Asian American breast cancer survivors with low social influences and high self-efficacy would highly benefit from a technology-based intervention for their need for information., (© 2021. American Association for Cancer Education.)

The purpose of the study was to explore the associations of sub-ethnicity to the survivorship experience of Asian American breast cancer survivors and identify the multiple factors that influenced their survivorship experience. This was a secondary analysis of the data among 94 Asian American breast cancer survivors from a larger ongoing study. Instruments included: questions on background characteristics, the perceived isolation scale, the Personal Resource Questionnaire, the Memorial Symptom Assessment Scale-Short Form, and the Functional Assessment of Cancer Therapy-Breast Cancer. Data were analyzed using hierarchical logistic and multiple regression analyses. After controlling for other factors, being a Japanese American (ref. = being a Chinese American) was significantly associated with pain scores (odds ratio [OR] = -0.32, p  < .01), symptom distress scores ( β = -0.27, p  < .01), and the quality of life scores ( β  = 0.22, p  = .03). Sub-ethnic variations in cultural attitudes, values, and beliefs need to be considered in future research/practice with Asian American breast cancer survivors.

The purpose of this secondary analysis was to determine the clusters of Asian American breast cancer survivors by the severity scores of menopausal symptoms and to explore the characteristics associated with the identified clusters. The data from an ongoing study among 94 survivors were used. The instruments included the Perceived Isolation Scale, the Personal Resource Questionnaire, and the Memorial Symptom Assessment Scale-Short Form. The data analysis was conducted using hierarchical cluster analyses and multinomial logistic analyses. Three clusters were identified: "the cluster with high severity scores of total, psychological, physical, and psychosomatic symptoms (Cluster 1)," "the cluster with moderate severity scores of total, psychological, physical, and psychosomatic symptoms (Cluster 2)," and "the cluster with low severity scores of total, psychological, physical, and psychosomatic symptoms (Cluster 3)." The clusters had significant differences in the level of acculturation, perceived social isolation, and perceived social support ( p  < 0.05).

Using a decision tree analysis, this study aimed to identify the characteristics of the groups within Asian American breast cancer survivors whose symptom distress scores were effectively improved by a technology-based program. This was a secondary analysis of the data from an ongoing randomized controlled trial among 115 Asian American breast cancer survivors. The instruments were questions on background factors; the Memorial Symptom Assessment Scale-Short Form; the Cancer Behavior Inventory; the Questions on Attitudes, Subjective Norm, Perceived Behavioral Control, and Behavioral Intention; and the Supportive Care Needs Survey-Short Form 34. The data were analyzed using chi-square tests, t tests, repeated measurement analyses, and decision tree analyses. The decrease in the global distress index scores was the largest (1.253 points) among those with high psychological support needs. The decrease in the physical symptom distress scale scores was the largest (1.133 points) among those with high physical and daily living support needs who had a short US residence period and who were young. The decrease in the psychological symptom distress scores was the largest (1.511) among those with high psychological support needs. The findings suggest several characteristics of the groups within Asian American breast cancer survivors whose symptom distress could be highly improved by a technology-based intervention., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Technology-based intervention programs are known to be effective in approaching socially excluded groups or racial/ethnic minorities, including this specific population. However, the retention of participants in technology-based intervention studies is far more complicated and challenging compared with conventional studies targeting racial/ethnic minorities., Objective: This study aimed to identify the complex characteristics of the groups within Asian American breast cancer survivors who were successfully retained in a 3-month technology-based intervention study., Methods: This secondary analysis of the data from a larger ongoing intervention study included 155 Asian American breast cancer survivors. Major variables were measured using multiple instruments including the questions on characteristics of the participants, the Personal Resource Questionnaire, perceived isolation, Memorial Symptom Assessment Scale-Short Form, Cancer Behavior Inventory, 34-item Supportive Care Needs Survey Short Form, and Functional Assessment of Cancer Therapy Scale-Breast Cancer. Data analyses were done through χ2 tests, t tests, and decision tree analyses., Results: The retention rates differed by subethnicity (P = .025), immigration age (P < .001), and stage of breast cancer (P = .003). The decision tree indicated four groups with the highest probability of retention: (a) those who were diagnosed with stage II, III, or IV breast cancer, (b) those who immigrated to the United States after turning 31 years old, and (c) those who had high perceived barriers., Conclusion: This study provides directions for future retention strategies for technology-based interventions among Asian American breast cancer survivors., Implications for Practice: Participants' characteristics need to be considered in developing retain strategies for technology-based interventions among Asian American breast cancer survivors., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To explore the environmental characteristics of young breast cancer survivors (YBCSs) in China., Participants & Setting: 17 participants aged 18-45 years were recruited from hospitals and through participant referral in Shanghai, China., Methodologic Approach: Semistructured interviews were conducted to explore the environmental characteristics of YBCSs. Content analysis was performed to analyze the data., Findings: The following four domains emerged from the analysis., Implications for Nursing: The study provides insights into the specific issues of YBCSs at different environmental levels. Nurses should collaborate with the healthcare team, family members, and other stakeholders in addressing these issues to support YBCSs. Culturally tailored support should be developed to release the burden of socially desired roles and other cultural issues for Chinese YBCSs.

Despite the increasing usages of technology-based programs, few technology-based support programs are currently available for racial/ethnic minority cancer survivors including Korean-American cancer survivors. The purpose of this study was to explore the attitudes toward technology-based cancer support programs among Korean-American cancer survivors from a feminist perspective. In-person focus group interviews were held with 17 Korean-American cancer survivors. All the interviews were recorded by writing memos. Then, the written memos were analyzed using a content analysis. Four major themes reflecting their attitudes toward technology-based cancer-support programs were identified: (a) "easy to access"; (b) "good for peer and family support," (c) "overcoming language barriers," and (d) "providing Korean-specific and personalized trustable information." Future technology-based cancer support groups for this specific population need to incorporate peer support, support for family members, Korean language, and Korea-specific information and intervention components.

Purpose: The purpose of this study was threefold: to explore the causal attributions of breast cancer, examine underlying factors of the attributes, and determine their relationship to quality of life among Korean breast cancer survivors., Methods: The study used a descriptive correlational design, which included quantitative survey questionnaires and an open-ended question to complement the study. Three hundred and three breast cancer survivors were recruited from two university hospitals in South Korea, between January and April 2018. The causal attributions were explored using the Illness Perception Questionnaire Revised and an open-ended question. The survivors' quality of life was assessed using the Functional Assessment of Cancer Therapy for Breast Cancer. The quantitative analysis was performed using the SPSS 25.0 software package; the ATLAS.ti 8 software was used for thematic analysis., Results: Quantitative and qualitative data of 321 and 238 breast cancer survivors, respectively, were analyzed. "Stress and worry" and "diet or eating habits" were believed to be the two most likely causes of breast cancer. Eleven new causal attributes emerged from the analysis. Being diagnosed with breast cancer at an older age (p < .05), having received chemotherapy (p < .05), and holding nonbehavioral causal attributes (p < .001), were significantly related to lower quality of life., Conclusion: There were differences between the survivors' beliefs on their causes of disease, and causal factors available from the literature. As the survivors' causal attributes were significantly related to their quality of life, healthcare providers should individually assess and incorporate these attributes into their care., Competing Interests: Conflict of interest The authors declare that they have no conflict of interest., (Copyright © 2021. Published by Elsevier B.V.)

Women's self-efficacy for coping with breast cancer is one of the key factors that lead to successful breast cancer survivorship. Due to the cultural stigma linked to breast cancer (e.g., breast cancer is a genetic disease), Asian Americans are known as a high-risk group within breast cancer survivors. However, healthcare providers are challenged to promote women's self-efficacy while considering their cultural beliefs and attitudes. In this study, the efficacy of a technology-based information and coaching/support program was examined in improving self-efficacy for coping with breast cancer among Asian American survivors. A randomized repeated measures control group study was conducted with 67 Asian American breast cancer survivors. The questions on background characteristics, the Personal Resource Questionnaire, the Perceived Isolation Scale, the Supportive Care Needs Survey Short Form 34, and the Cancer Behavior Inventory were used. The data were analyzed using repeated measurement analyses, χ 2 tests, and decision tree analyses. There were significant increases in the self-efficacy scores of both control and intervention groups over time (p = .017). However, the increase in the control group's self-efficacy scores was only up to post 1 month, and there was a decrease in the scores by post 3 months. When the participants were divided into high and low-change groups based on the changes in their self-efficacy scores for 3 months, the intervention group had more participants who belonged to the high-change group (p = .036). The technology-based intervention was effective in improving self-efficacy for coping with breast cancer among Asian American breast cancer survivors., (© 2020 Wiley Periodicals LLC.)

With few existing technology-based programs to support cancer pain management, the need for culturally tailored programs to support ethnic minority cancer survivors has been highlighted. The purpose of this study was to explore the preliminary efficacy of the technology-based CAncer Pain management support Program for Asian American survivors of breast cancer, a technology-based cancer pain management program, in improving the cancer pain experience of Asian American breast cancer survivors. This pilot study adopted a randomized repeated-measures pretest/posttest control group design with a sample of 94 Asian American breast cancer survivors. Study measures included the Brief Pain Inventory-Short Form, Support Care Needs Survey-34 Short Form, and Mishel Uncertainty in Illness Scale-Community. Data were analyzed using descriptive and inferential statistics including repeated-measures analysis of covariance. Although there were no significant differences in pain, there were significant changes in perceived isolation (F = 9.937, P < .01), personal resources (F = 6.612, P < .05), support care need (F = 8.299, P < .01), and degree of uncertainty (F = 8.722, P < .01) in the intervention group from pretest to posttest. These findings support the positive effects of CAncer Pain management support Program for Asian American survivors of breast cancer on the cancer pain experience of Asian American breast cancer survivors.

Background: Pain is a common problem, especially in the first few years of breast cancer survivorship. Asian American survivors of breast cancer reportedly have inadequate cancer pain management, and subsequently report a lower quality of life compared with other racial/ethnic groups. Technology-based programs could improve the cancer pain management process. The purpose of the current study was to examine the efficacy of a technology-based information and coaching/support program on cancer pain and its accompanying symptoms among Asian American survivors of breast cancer., Methods: The current study adopted a randomized pretest/posttest group design. The sample included 115 Asian American survivors of breast cancer (49 in the control group and 66 in the intervention group). The participants' background features, pain (frequency and distress), accompanying symptom distress (global, physical, and psychological), and 4 theory-based mediators (attitude, self-efficacy, perceived barriers, and social influence) were measured using multiple instruments at 3 time points (pretest, after 1 month, and after 3 months). The current study used an intent-to-treat approach and conducted linear mixed model growth curve analyses., Results: There were significant decreases noted in all outcome variables, including pain and symptoms over time in both groups. There were greater decreases in physical symptom distress scores among the intervention group compared with the control group (P = .0229). The mediators as a whole significantly explained overall decreases in general, physical, and psychological symptom distress scores after 3 months in both groups and the intervention group's greater decreases in general, physical, and psychological symptom distress scores after 1 month., Conclusions: The technology-based program described herein could help to reduce cancer pain and its accompanying symptoms among Asian American survivors of breast cancer., (© 2019 American Cancer Society.)

Objective : The incidence of breast cancer in Chinese-Americans is increasing. This article aims to present and discuss the challenges encountered in implementing an Internet-based coaching/support program for Chinese-American breast cancer survivors and to provide direction for future Internet-based interventions targeting this specific population. Methods : The data were collected from (a) interventionists' diaries written during individual coaching/support sessions with survivors, (b) minutes taken during research meetings, and (c) written records of issues discussed during the interventions. The data were analyzed using content analysis. Results : The issues were categorized into eight themes. The following six themes were identified among the survivors: (1) low computer literacy, (2) ambivalent attitudes towards study participation (e.g., joining the project to maintain a harmonious relationship with the gatekeepers versus lack of trust in the project), (3) reticence to share opinions and experiences, (4) struggles with family affairs (e.g., intergenerational cultural dissonance), (5) overvaluing Traditional Chinese Medicine, and (6) specific participants' preferences (e.g., language, font size, timing). Among the interventionists, the following two themes were identified: (1) recruitment and retention of interventionists and (2) language barriers. Conclusions : Culture-specific challenges need to be considered when designing and implementing an Internet-based coaching/support program for Chinese-American breast cancer survivors.

Background: Difficulties in recruiting and retaining Asian Americans in traditional research have been well documented. Despite an increasing number of technology-based cancer studies among racial/ethnic minorities, little is still known about potential issues in recruiting and retaining racial/ethnic minority cancer survivors for technology-based intervention research., Objective: This discussion article aims to examine issues in recruiting and retaining a group of racial/ethnic minorities-Asian American breast cancer survivors-for a technology-based intervention study., Methods: The parent study is an ongoing large-scale, national-scope, technology-based intervention study among a target number of 330 Asian American breast cancer survivors. During the recruitment and retention process, research diaries were written by research team members, and the written records of weekly research team meetings were kept. The written records were analyzed using a content analysis. Then, the themes were used to support the discussion points made in the article., Results: There existed subethnic differences in research participation; it was easier to recruit Chinese participants compared with other subethnic groups. The use of culturally matched research team members and multiple languages was essential. Gatekeepers were also elemental for recruitment and retention. Various motivation strategies were needed to retain the participants. Each subethnic group used different communication apps. Finally, trust building was essential to retain the participants in the intervention., Conclusions: Researchers need to consider these practical issues in future technology-based intervention research., Implications for Practice: These issues need to be considered in future program/intervention development and implementation among racial/ethnic minority cancer survivors.

Introduction: Increasing evidence suggests that acupuncture may be helpful to manage common symptoms and treatment side effects among breast cancer (BC) survivors. Acupuncture usage among BC survivors remains low with little known about the barriers to its utilization. We evaluated perceived barriers to acupuncture use among BC survivors and explored the sociodemographic variations of such barriers., Methods: We conducted a cross-sectional analysis at an urban academic cancer center on 593 postmenopausal women with a history of stage I-III hormone receptor-positive BC who were taking or had taken an aromatase inhibitor. We used the modified Attitudes and Beliefs about Complementary and Alternative Medicine instrument to evaluate patients' perceived barriers to acupuncture. Multiple linear regression analysis was performed to determine sociodemographic factors associated with perceived barrier scores., Results: The most common barriers were lack of knowledge about acupuncture (41.6%), concern for lack of insurance coverage (25.0%), cost (22.3%), and difficulty finding qualified acupuncturists (18.6%). Compared with whites, minority patients had higher perceived barriers to use acupuncture (β coefficient = 1.63, 95% confidence interval = 0.3-2.9, P = .013). Patients with lower education had higher barriers to use acupuncture (β coefficient = 4.23, 95% confidence interval = 3.0-5.4, P < .001) compared with patients with college education or above., Conclusion: Lack of knowledge and concerns for insurance coverage and cost are the common barriers to acupuncture use among BC survivors, especially among minority patients with lower education. Addressing these barriers may lead to more equitable access to acupuncture treatment for BC survivors from diverse backgrounds.

Purpose: Fatigue is the most common and distressing symptom experienced by cancer survivors. This study sought to determine the prevalence and risk factors for fatigue among breast cancer (BC) survivors receiving aromatase inhibitors (AIs)., Material and Methods: We conducted a cross-sectional survey study among postmenopausal women with stage 0 to III BC receiving adjuvant AI therapy at the outpatient breast oncology clinic of a large university hospital. Participants with a score ≥4 on the 'worst fatigue' item of the Brief Fatigue Inventory were classified as having moderate or severe fatigue. Multivariate logistic regression analyses were performed to evaluate risk factors., Results: Among 1103 participants, 616 (55.8%) had moderate or severe fatigue. In the multivariate logistic regression model, women younger than 55 years were significantly more likely to report moderate to severe fatigue than women older than 65 years (adjusted odds ratio [AOR] = 1.58, 95% confidence interval [CI] = 1.07-2.35; p = 0.023). Compared to women with high school or less education, women with college or more education were significantly more likely to report moderate to severe fatigue (AOR = 1.40, 95% CI = 1.02-1.91; p = 0.037). Increasing body mass index (BMI) was significantly associated with increased risk of experiencing moderate to severe fatigue (overweight: AOR = 1.37, 95% CI = 1.01-1.84, p = 0.042; obesity: AOR = 2.08, 95% CI = 1.53-2.81, p < 0.001). Fatigue was significantly correlated with pain severity (r = 0.48, p < 0.001) and insomnia (r = 0.62, p < 0.001)., Conclusion: Moderate to severe fatigue complaints exceed 50% among AI users. Fatigue is highly related to younger age, higher education level, higher BMI, pain severity and insomnia., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

The purpose of this article is to identify practical issues in implementing a culturally tailored technology-based intervention among Asian American survivors of breast cancer. In a large-scale technology-based breast cancer intervention study, research team members wrote memos on issues in implementing a culturally tailored technology-based intervention and plausible reasons for the issues. Then, the content of the research diaries was analyzed, along with written records of the research team. The practical issues found in the research process included those related to (1) technology literacy and preferences; (2) language issues; (3) cultural attitudes, beliefs, and values; (4) intervention staff competence; (5) security and confidentiality issues; and (6) time and geographical constraints. Based on the issues, several recommendations are proposed for future research using culturally tailored technology-based interventions among racial and ethnic minorities.

Background and Objectives: With an increasing number of racial/ethnic minorities in the U.S., nursing research frequently involves the use of multiple languages, especially to promote the understanding of educational materials related to nursing care. Furthermore, with a recent emphasis on innovation in health-related research, the use of technology is prominent in nursing research. However, practical issues in the use of multiple languages, especially in technology-based intervention studies, have rarely been reported and/or discussed in nursing literature. The purpose of this paper is to identify practical issues in conducting a technology-based intervention study using multiple languages among Asian American breast cancer survivors., Methods: In a large-scale technology-based breast cancer intervention study, research team members wrote memos on issues in translation process and plausible reasons for the issues. Then, the memos and written records were analyzed using a content analysis. By using individual words as the unit of analysis, line-by-line coding was done, and idea categories representing practical issues were extracted from the codes., Results: Six themes representing the practical issues were extracted. Issues were found in recruiting and retaining bilingual research team members; maintaining consistency in translation process; keeping cultural and conceptual equivalence; repeating IRB protocol modifications; finding and using existing translated versions; and arranging technological aspects related to electronic multiple-language versions., Conclusion: The use of multiple languages in a technology-based intervention study is feasible. However, it is necessary to effectively manage unforeseen challenges through various strategies., (Copyright © 2017. Published by Elsevier Inc.)

Introduction The necessity of culturally competent Internet Cancer Support Groups (ICSGs) for ethnic minorities has recently been highlighted in order to increase its attractiveness and usage. The purpose of this study was to determine the preliminary efficacy of a culturally tailored registered-nurse-moderated ICSG for Asian American breast cancer survivors in enhancing the women's breast cancer survivorship experience. Methods The study included two phases: (a) a usability test and an expert review; and (b) a randomized controlled pilot intervention study. The usability test was conducted among five Asian American breast cancer survivors using a one-month online forum, and the expert review was conducted among five experts using the Cognitive Walkthrough method. The randomized controlled pilot intervention study (a pre-test and post-test design) was conducted among 65 Asian American breast cancer survivors. The data were analysed using content analysis and descriptive and inferential statistics including the repeated ANOVA. Results All users and experts positively evaluated the program and provided their suggestions for the display, educational contents, and user-friendly structure. There were significant positive changes in the support care needs and physical and psychological symptoms ( p < 0.05) of the control group. There were significant negative changes in the uncertainty level of the intervention group ( p < 0.10). Controlling for background and disease factors, the intervention group showed significantly greater improvements than the control group in physical and psychological symptoms and quality of life ( p < 0.10). Discussion The findings supported the positive effects of ICSGs on support care needs, psychological and physical symptoms, and quality of life.

Introduction: Treatment-related joint pain affects almost half of all women with breast cancer using aromatase inhibitors and is a major reason for terminating treatment. Although acupuncture is becoming an increasingly popular, evidence-based option for treating pain, little is known about the potential influence of psychological factors on acupuncture use., Objective: We aimed to evaluate the association between pain catastrophising and use of acupuncture in breast cancer survivors experiencing arthralgia., Methods: We conducted a cross-sectional survey of arthralgic breast cancer patients. Patients were asked if they had used acupuncture since their cancer diagnosis. The Pain Catastrophising Scale (PCS) was used to measure negative coping styles related to the experience of pain. We performed multiple logistic regression analysis to evaluate the relationship between pain catastrophising and acupuncture use, adjusting for covariates., Results: Of the 424 participants, 69 (16%) reported use of acupuncture since their breast cancer diagnosis. In multivariate analyses, compared to those in the lowest PCS score tertile, patients with the highest PCS scores were more likely to have used acupuncture (p=0.03). In particular, patients with high levels of rumination (p=0.005) and magnification (p=0.008) were more likely to have used acupuncture. Helplessness was not associated with acupuncture use (p=0.23)., Conclusions: High levels of pain catastrophising, and specifically the processes of rumination and magnification, were associated with greater acupuncture use. We believe this could have important implications for understanding which population is more likely to seek acupuncture treatment and how this alternative therapy could be better targeted to these patients., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

The purpose of this article is to identify practical issues in Internet recruitment of racial/ethnic minorities by analyzing an Internet intervention study conducted with Asian American breast cancer survivors, and to propose directions for recruitment of racial/ethnic minorities for future Internet research. Six practical issues were identified: (a) a relatively fewer number of Internet communities/groups; (b) hindrances in establishing authenticity;, ((c) difficulties in gaining entrée from the webmasters or Web site owners of Internet communities/groups; (d) the necessity of racially/ethnically matched research team members; (e) flexibility required in recruitment strategies; and (f) strategies to overcome the low response rate.)

The purpose of the study was to explore Korean women's attitudes toward breast cancer screening tests from a feminist perspective. Twenty Korean women working in Dong-Dae-Moon Market in Seoul, South Korea were recruited using a convenience sampling method. Semi-structured in-depth interviews were conducted using an interview guideline that was developed for the study. The data were analyzed using a thematic analysis. The themes emerged from the analysis process included: "importance of breasts to women", "fearful, but not related to me", "bad previous experience", and "no need for a breast exam." Based on the findings, implications for nursing practice are proposed., (Copyright 2004 Elsevier Ltd.)

The purpose of this study was to explore cultural meanings of breast cancer among Korean women in South Korea. A descriptive longitudinal study using methodological triangulation was conducted, and only qualitative findings are presented in this article. Ten Korean women who were newly diagnosed with a plan of surgery and subsequent chemotherapy, who did have severe fatigue at the time of recruitment, were recruited through Seoul National University Hospital. Data were collected using in-depth, 2-hour interviews and analyzed using thematic analysis. The themes emerged through the analysis process included: (a) "I did wrong," (b) "I cannot ask male physicians." (c) "I don't want to show the operation site to my husband." and (d) "I do household tasks by myself." The overriding theme was marginalization of the women within the context of their patriarchal culture. The findings suggest that culture is an important context circumscribing women's health/illness experience.

We have compared the anti-proliferative effects of ursodeoxycholic acid (UDCA), chenodeoxycholic acid (CDCA) and their derivatives, HS-1183, HS-1199 and HS-1200, on MCF-7 (wild-type p53) and MDA-MB-231 (mutant p53) cells. While UDCA and CDCA exhibited no significant effect, their novel derivatives inhibited the proliferation of both cell lines in a concentration-dependent manner, concomitant with apoptotic nuclear changes and the increase of a sub-G1 population and DNA fragmentation. Furthermore, we also observed an increase in the ratio of pro-apoptotic protein Bax to anti-apoptotic protein Bcl-2 and cleavages of lamin B and poly(ADP-ribose) polymerase (PARP) in MCF-7 and MDA-MB-231 cells. Cell cycle related proteins, cyclin D1 and D3, as well as retinoblastoma protein (pRb) were down-regulated, while the level of cyclin-dependent kinase inhibitor p21(WAF1/CIP1) was increased in both cancer cells after treatment with novel bile acids. These findings suggest that these cytotoxic effects of novel bile acid derivatives on human breast carcinoma cells were mediated via apoptosis through a p53-independent pathway.

The effects of retinoic acid (RA) and its analogs, all-trans RA, 9-cis RA and 13-cis RA, were investigated in human breast cancer MCF-7 cells and immortalized breast epithelial cell line MCF-10A. RA inhibited the telomerase activity of MCF-7 cells in a wide range of concentrations. RA at 10 microM also inhibited the growth of MCF-7 cells in a time-dependent manner. However, no significant growth inhibition was found between untreated control and RA-treated MCF-10A cells. Moreover, a marked inhibition of telomerase activity by RA was detected early in MCF-7 cells (after 24 h of RA treatment), which was preceded by a reduction of hTERT mRNA expression (after 12 h of RA treatment). However, MCF-10A cells showed a reduction of telomerase activity and down-regulation of hTERT after 4 days of RA treatment. Simultaneous changes in hTERT mRNA expression and telomerase activity were found for MCF-10A cells. The expressions of hTR and hTEP1 telomerase component genes were not changed after RA treatment. These results indicate that the anti-breast cancer activity of RA could be mediated by its ability to down-regulate the expression of hTERT telomerase gene.

Studies indicate ethnic differences in incidence, mortality, and survival rate of breast cancer. Despite the low incidence rate of breast cancer among the Korean population, Koreans are reported to be less likely to survive breast cancer. In this article, using a feminist perspective, the reasons why Korean women have been reported to be less likely to survive breast cancer are analyzed through a critical review of research among Korean women. A total of 469 studies (145 unpublished master's theses and doctoral dissertations and 324 articles published in South Korea and in the United States) were reviewed, analyzed, and critiqued in terms of biases present in the research process. Through a feminist critique of the literature, four possible reasons are proposed: androcentric views and assumptions underlying the research, modesty issues imbedded in Korean culture, the victim-blaming tendency of Korean culture, and intense emotions without adequate support.