Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 508, Postgraduate Education Centre, Prince of Wales Hospital, School of Medicine, Shatin, Hong Kong.
Health Disparities Research Department - UNIT 1440, UT MD Anderson Cancer Center, P.O. Box 301402, Houston, TX, 77230-1402, USA.
Support Care Cancer. 2019 Sep;27(9):3337-3345. doi: 10.1007/s00520-018-4630-2. Epub 2019 Jan 8.
Cancer-related self-stigma (the internalized sense of shame about having cancer) has been found to associate with poorer quality of life (QoL) among cancer survivors. However, culturally salient illness beliefs (e.g., cancer is contagious; cancer is a result of karma; and cancer brings shame to the family) may make Chinese cancer survivors vulnerable to self-stigmatization. This study examined the association between self-stigma and QoL among Chinese American breast cancer survivors (BCS). To understand the potential mechanism, the mediating role of self-perceived burden to caregivers between self-stigma and QoL was also examined.
Chinese American BCS (n = 136) were recruited through community-based cancer associations. Participants' self-stigma, self-perceived burden, and QoL were measured in a questionnaire package.
Structural equation modeling results supported the proposed mediation model in predicting physical QoL (χ(100) = 123.041, CFI = 0.982, TLI = 0.975, RMSEA = 0.041) and emotional QoL (χ(84) = 137.277, CFI = 0.958, TLI = 0.940, RMSEA = 0.069), with satisfactory model fit indices. Both the indirect effects from self-stigma to QoL via self-perceived burden (physical: β = - 0.13; 95% CI = - 0.22, - 0.07 and emotional: β = - 0.11; 95% CI = - 0.22, - 0.04) and the direct effects from self-stigma to poorer QoL were significant (physical: β = - 0.22; 95% CI = -0.34, -0.10 and emotional: β = - 0.39; 95% CI = - 0.54, - 0.23), suggesting a partial mediation effect of self-perceived burden between self-stigma and QoL.
Self-stigma could reduce physical and emotional QoL through increasing self-perceived burden. Interventions aiming to reduce Chinese American BCS' self-stigma and perceptions of burdensomeness may facilitate improvement in QoL, which in turn promotes better cancer survivorship.
癌症相关的自我污名（对患有癌症的羞耻感内化）已被发现与癌症幸存者的生活质量（QoL）较差有关。然而，文化上显著的疾病信念（例如，癌症具有传染性；癌症是因果报应的结果；癌症给家庭带来耻辱）可能使中国癌症幸存者容易受到自我污名化的影响。本研究调查了美籍华裔乳腺癌幸存者（BCS）中自我污名化与 QoL 之间的关联。为了理解潜在的机制，还研究了自我污名化和自我感知对照顾者的负担在 QoL 中的中介作用。
通过社区癌症协会招募美籍华裔 BCS（n=136）。通过问卷包测量参与者的自我污名、自我感知负担和 QoL。
结构方程模型结果支持了预测身体 QoL（χ(100)=123.041，CFI=0.982，TLI=0.975，RMSEA=0.041）和情绪 QoL（χ(84)=137.277，CFI=0.958，TLI=0.940，RMSEA=0.069）的拟议中介模型，具有令人满意的模型拟合指数。自我污名化通过自我感知负担对 QoL 的间接影响（身体：β=-0.13；95%CI=-0.22，-0.07 和情绪：β=-0.11；95%CI=-0.22，-0.04）和自我污名化对较差 QoL 的直接影响均具有统计学意义（身体：β=-0.22；95%CI=-0.34，-0.10 和情绪：β=-0.39；95%CI=-0.54，-0.23），表明自我感知负担在自我污名化和 QoL 之间存在部分中介效应。
自我污名化通过增加自我感知负担，降低身体和情绪 QoL。旨在降低美籍华裔 BCS 自我污名化和负担感的干预措施，可能有助于提高 QoL，从而促进更好的癌症生存。
