Anxiety- and Health-Related Quality of Life Among Patients With Breast Cancer: A Cross-Cultural Comparison of China and the United States.

PURPOSE: Literature has documented the prevalence of anxiety and its adverse effect on quality of life among patients with breast cancer from Western countries, yet cross-cultural examinations with non-Western patients are rare. This cross-cultural study investigated differences in anxiety and its association with quality of life between US and Chinese patients with breast cancer. METHODS: Patients with breast cancer from the United States and China completed measures for anxiety (Spielberger State-Trait Anxiety Inventory) and quality of life (Functional Assessment of Cancer Therapy-Breast). RESULTS: After controlling for demographic and medical characteristics, Chinese patients reported higher levels of trait and state anxiety than US patients. Although there was an association between anxiety and quality of life in both groups of patients, the association between state anxiety and quality of life was stronger among Chinese patients than among US patients, with the association between trait anxiety and quality of life the same between the two cultural samples. CONCLUSION: These findings suggest that anxiety and its association with quality of life among patients with breast cancer varies depending on cultural context, which reveals greater anxiety and poorer quality of life among Chinese patients compared with US patients. This suggests greater unmet psychosocial needs among Chinese patients and highlights the need to build comprehensive cancer care systems for a better quality of life in Chinese populations.

Depressive symptoms and positive affect in Chinese and United States breast cancer survivors: a cross-cultural comparison.

PURPOSE: Research in the area of cultural response pattern on questionnaires in the oncological setting and direct cross-cultural comparisons are lacking. This study examined response pattern in the reporting of depressive symptoms in Chinese and US women with breast cancer. We hypothesized that Chinese women are less likely to endorse positive affect items compared to their US counterparts. Additionally, we explored cultural differences in the association between positive affect and QOL. METHODS: Secondary analyses of baseline assessments of two mind-body intervention studies for women with breast cancer undergoing radiotherapy in the USA (N = 62) and China (N = 97) are presented. All participants completed measures of depressive symptoms (CES-D) and cancer-specific QOL (FACT-B). We examined cultural differences on positive and negative affect items on the CES-D. RESULTS: Controlling for demographic factors, ANCOVA revealed a significant cultural difference in positive (F = 7.99, p = 0.005) but not negative affect (p = 0.82) with Chinese women reporting lower positive affect compared to US women (Chinese = 6.97 vs. US = 8.31). There was also a significant cultural difference (F = 3.94, p = 0.03) in the association between positive affect and QOL so that lower positive affect was more strongly associated with worse emotional well-being in Chinese (beta = 0.57, p < 0.0001) than US women (beta = 0.35, p < 0.01). CONCLUSIONS: Chinese women reported lower positive affect compared to US women and lower levels of positive affect were more strongly associated with worse QOL. Special attention is needed when examining mental health in different cultures to ascertain effective delivery of clinical services to those in need.