Abstract
Some subgroups of cancer survivors are more likely to have decreased health-related quality of life (HRQOL) for a prolonged period of time when compared to the average cancer survivor. Research has shown that acculturation can negatively impact the HRQOL of cancer survivors. Research have also shown that Chinese elderly immigrants are generally less acculturated when compared to Chinese immigrants of other age groups. The purpose of this examined the relationship between acculturation and HRQOL among Chinese elderly cancer survivors. Based on the phenomenological approach, a qualitative study consisting of four participants was conducted. Subjects were interviewed using a set of predetermined questions regarding demographics, language ability, social supports, experience with the healthcare system, and general well-being. The results revealed that Chinese elderly who were poorly acculturated had lower social support, experienced more barriers to access healthcare, and experienced more emotional distress. As a result, HRQOL was lower for the less acculturated Chinese elderly cancer survivors compared to those who were better acculturated.
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References
Abu-Rayya, H. (2009). Acculturation and its determinants among adult immigrants in France. International Journal of Psychology, 44(3), 195–203. https://doi.org/10.1080/00207590701700537
Applebaum, A., Stein, E., Lord-Bessen, J., Pessin, H., Rosenfeld, B., & Breitbart, W. (2013). Optimism, social support, and mental health outcomes in patients with advanced cancer. Psycho-Oncology, 23(3), 299–306. https://doi.org/10.1002/pon.3418
Aroian, K., Wu, B., & Tran, T. (2005). Health care and social service use among Chinese immigrant elders. Research in Nursing & Health, 28(2), 95–105. https://doi.org/10.1002/nur.20069
Ashing-Giwa, K., Gonzalez, P., Lim, J., Chung, C., Paz, B., Somlo, G., & Wakabayashi, M. (2010). Diagnostic and therapeutic delays among a multiethnic sample of breast and cervical cancer survivors. Cancer, 116(13), 3195–3204. https://doi.org/10.1002/cncr.25060
Ashing-Giwa, K., Lim, J., & Gonzalez, P. (2010). Exploring the relationship between physical well-being and healthy lifestyle changes among European- and Latina-American breast and cervical cancer survivors. Psycho-Oncology, 19(11), 1161–1170. https://doi.org/10.1002/pon.1687
Ashing-Giwa, K., Padilla, G., Tejero, J., Kraemer, J., Wright, K., Coscarelli, A., et al. (2004). Understanding the breast cancer experience of women: A qualitative study of African American, Asian American, Latina and Caucasian cancer survivors. Psycho-Oncology, 13(6), 408–428. https://doi.org/10.1002/pon.750
Ashing-Giwa, K., Tejero, J., Kim, J., Padilla, G., & Hellemann, G. (2007). Examining predictive models of HRQOL in a population-based, multiethnic sample of women with breast carcinoma. Quality of Life Research, 16(3), 413–428. https://doi.org/10.1007/s11136-006-9138-4
Aziz, N., & Rowland, J. (2002). Cancer survivorship research among ethnic minority and medically underserved groups. Oncology Nursing Forum, 29(5), 789–801. https://doi.org/10.1188/02.onf.789-801
Barrett, M., Chu, A., Chen, J., Lam, K., Portenoy, R., & Dhingra, L. (2016). Quality of life in community-dwelling Chinese American patients with cancer pain. Journal of Immigrant and Minority Health. https://doi.org/10.1007/s10903-016-0392-4
Barry, D. (2001). Development of a new scale for measuring acculturation: The East Asian acculturation measure (EAAM). Journal of Immigrant Health, 3(4), 193–197. https://doi.org/10.1023/a:1012227611547
Berry, J. (1992). Acculturation and adaptation in a new society. International Migration, 30(s1), 69–85. https://doi.org/10.1111/j.1468-2435.1992.tb00776.x
Butow, P., Bell, M., Aldridge, L., Sze, M., Eisenbruch, M., Jefford, M., et al. (2013). Unmet needs in immigrant cancer survivors: A cross-sectional population-based study. Supportive Care in Cancer, 21(9), 2509–2520. https://doi.org/10.1007/s00520-013-1819-2
Butow, P., Sze, M., Dugal-Beri, P., Mikhail, M., Eisenbruch, M., Jefford, M., et al. (2010). From inside the bubble: Migrants’ perceptions of communication with the cancer team. Supportive Care in Cancer, 19(2), 281–290. https://doi.org/10.1007/s00520-010-0817-x
Byers, T., Wolf, H., Bauer, K., Bolick-Aldrich, S., Chen, V., Finch, J., et al. (2008). The impact of socioeconomic status on survival after cancer in the United States. Cancer, 113(3), 582–591. https://doi.org/10.1002/cncr.23567
Center for Disease Control and Prevention,. (2016). HRQOL-14 – healthy days measure | HRQOL | CDC. Cdc.gov. Retrieved 4 December 2016, from http://www.cdc.gov/hrqol/hrqol14_measure.htm
Cella, D., & Tulsky, D. (1993). Quality of life in cancer: Definition, purpose, and method of measurement. Cancer Investigation, 11(3), 327–336. https://doi.org/10.3109/07357909309024860
Chee, W., Lee, Y., Im, E., Chee, E., Tsai, H., & Nishigaki, M. et al. (2016). A culturally tailored internet cancer support group for Asian American breast cancer survivors: A randomized controlled pilot intervention study. Journal of Telemedicine and Telecare. 1357633X1665836. https://doi.org/10.1177/1357633x16658369
Cheung, B., Chudek, M., & Heine, S. (2010). Evidence for a sensitive period for acculturation: Younger immigrants report acculturating at a faster rate. Psychological Science, 22(2), 147–152. https://doi.org/10.1177/0956797610394661
Clauser, S. B., Arora, N. K., Bellizzi, K. M., Haffer, S. C. (Chris) Topor, M., & Hays, R. D. (2008). Disparities in HRQOL of cancer survivors and non-cancer managed care Enrollees. Health Care Financing Review, 29(4), 23–40.
Cohen, S., & Wills, T. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98(2), 310–357. https://doi.org/10.1037/0033-2909.98.2.310
Cordasco, K., Ponce, N., Gatchell, M., Traudt, B., & Escarce, J. (2010). English language proficiency and geographical proximity to a safety net clinic as a predictor of health care access. Journal of Immigrant and Minority Health , 13(2), 260–267. http://dx.doi.org/10.1007/s10903-010-9425-6
Creswell, J. (2007). Qualitative inquiry & research design (1st ed.). Thousand Oaks, CA: Sage.
Du, X., Meyer, T., & Franzini, L. (2007). Meta-analysis of racial disparities in survival in association with socioeconomic status among men and women with colon cancer. Cancer, 109(11), 2161–2170. https://doi.org/10.1002/cncr.22664
Duffy, M. (2013). Tumor markers in clinical practice: A review focusing on common solid cancers. Medical Principles and Practice, 22(1), 4–11. https://doi.org/10.1159/000338393
Elliott, J., Fallows, A., Staetsky, L., Smith, P., Foster, C., Maher, E., & Corner, J. (2011). The health and well-being of cancer survivors in the UK: Findings from a population-based survey. British Journal of Cancer, 105, S11–S20. https://doi.org/10.1038/bjc.2011.418
Flores, G. (2005). The impact of medical interpreter services on the quality of health care: A systematic review. Medical Care Research and Review, 62(3), 255–299. https://doi.org/10.1177/1077558705275416
Fong, A., Scarapicchia, T., McDonough, M., Wrosch, C., & Sabiston, C. (2016). Changes in social support predict emotional well-being in breast cancer survivors. Psycho-Oncology. n/a-n/a. https://doi.org/10.1002/pon.4064
Garvey, G., Cunningham, J., He, V., Janda, M., Baade, P., Sabesan, S., et al. (2016). Health-related quality of life among indigenous Australians diagnosed with cancer. Quality of Life Research, 25(8), 1999–2008. https://doi.org/10.1007/s11136-016-1233-6
Gim Chung, R., Kim, B., & Abreu, J. (2004). Asian American multidimensional acculturation scale: Development, factor analysis, reliability, and validity. Cultural Diversity and Ethnic Minority Psychology, 10(1), 66–80. https://doi.org/10.1037/1099-9809.10.1.66
Greater Montreal Chinese Family Service (2016). Mission. Famillechinoise.qc.ca. Retrieved 4 December 2016, from http://www.famillechinoise.qc.ca/index.php?option=com_content&view=article&id=1127&Itemid=29&lang=zh
Hegarty, V., Burchett, B., Gold, D., & Cohen, H. (2000). Racial differences in use of cancer prevention services among older Americans. Journal of the American Geriatrics Society, 48(7), 735–740. https://doi.org/10.1111/j.1532-5415.2000.tb04746.x
Husson, O., Mols, F., Fransen, M., van de Poll-Franse, L., & Ezendam, N. (2014). Low subjective health literacy is associated with adverse health behaviors and worse health-related quality of life among colorectal cancer survivors: results from the profiles registry. Psycho-Oncology , 24(4), 478–486. http://dx.doi.org/10.1002/pon.3678
Jacobs, E., Karavolos, K., Rathouz, P., Ferris, T., & Powell, L. (2005). Limited english proficiency and breast and cervical cancer screening in a multiethnic population. American Journal of Public Health , 95(8), 1410–1416. http://dx.doi.org/10.2105/ajph.2004.041418
Karliner, L., Jacobs, E., Chen, A., & Mutha, S. (2007). Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Services Research, 42(2), 727–754. https://doi.org/10.1111/j.1475-6773.2006.00629.x
Kobayashi, L., Wardle, J., Wolf, M., & von Wagner, C. (2015). Cognitive function and health literacy decline in a cohort of aging English adults. Journal of General Internal Medicine, 30(7), 958–964. https://doi.org/10.1007/s11606-015-3206-9
Kim, J., Ashing-Giwa, K., Singer, M., & Tejero, J. (2006). Breast cancer among Asian Americans: Is acculturation related to health-related quality of life? Oncology Nursing Forum, 33(6), E90–E99. https://doi.org/10.1188/06.onf.e90-e99
Kuo, B., Chong, V., & Joseph, J. (2008). Depression and its psychosocial correlates among older Asian immigrants in North America: A critical review of two Decades’ research. Journal of Aging and Health, 20(6), 615–652. https://doi.org/10.1177/0898264308321001
Lee, S., Ma, G., Fang, C., Chen, L., & Youngsuk, O. (2011). Abstract B28: Catering to the needs of young and older Asian American breast cancer survivors: In-depth interviews. Cancer Epidemiology Biomarkers & Prevention, 20(10 Supplement), B28–B28. https://doi.org/10.1158/1055-9965.disp-11-b28
Lee, T., Pilkington, F., & Ho, G. (2014). Living with cancer: The experiences of Chinese Canadian cancer survivors. International Journal of Psychological Studies, 6(4). https://doi.org/10.5539/ijps.v6n4p106
Leng, J., Lee, T., Sarpel, U., Lau, J., Li, Y., & Cheng, C. et al. (2012). Identifying the informational and psychosocial needs of Chinese immigrant cancer patients: a focus group study. Supportive Care in Cancer, 20(12), 3221–3229. http://dx.doi.org/10.1007/s00520-012-1464-1
Lim, J., Yi, J., & Zebrack, B. (2008). Acculturation, social support, and quality of life for Korean immigrant breast and gynecological cancer survivors. Ethnicity & Health, 13(3), 243–260. https://doi.org/10.1080/13557850802009488
Luckett, T., Goldstein, D., Butow, P., Gebski, V., Aldridge, L., McGrane, J., et al. (2011). Psychological morbidity and quality of life of ethnic minority patients with cancer: A systematic review and meta-analysis. The Lancet Oncology, 12(13), 1240–1248. https://doi.org/10.1016/s1470-2045(11)70212-1
Ma, G. X. (2000). Barriers to the use of health services by Chinese Americans. Journal of Allied Health, 29(2), 64–70.
Masland, M., Kang, S., & Ma, Y. (2011). Association between limited English proficiency and understanding prescription labels among five ethnic groups in California. Ethnicity & Health , 16(2), 125–144. http://dx.doi.org/10.1080/13557858.2010.543950
Mitchell, A., Ferguson, D., Gill, J., Paul, J., & Symonds, P. (2013). Depression and anxiety in long-term cancer survivors compared with spouses and healthy controls: A systematic review and meta-analysis. The Lancet Oncology, 14(8), 721–732. https://doi.org/10.1016/s1470-2045(13)70244-4
Moustakas, C. (1994). Phenomenological research methods (1st ed.). Thousand Oaks, CA: Sage.
Mui, A., Kang, S., Kang, D., & Domanski, M. (2007). English language proficiency and health-related quality of life among Chinese and Korean immigrant elders. Health & Social Work, 32(2), 119–127. https://doi.org/10.1093/hsw/32.2.119
Naughton, M., & Weaver, K. (2014). Physical and mental health among cancer survivors. North Carolina Medical Journal, 75(4), 283–286. https://doi.org/10.18043/ncm.75.4.283
Nguyen, D. (2012). The effects of sociocultural factors on older Asian Americans’ access to care. Journal of Gerontological Social Work, 55(1), 55–71. https://doi.org/10.1080/01634372.2011.618525
Osann, K., Hsieh, S., Nelson, E., Monk, B., Chase, D., Cella, D., & Wenzel, L. (2014). Factors associated with poor quality of life among cervical cancer survivors: Implications for clinical care and clinical trials. Gynecologic Oncology, 135(2), 266–272. https://doi.org/10.1016/j.ygyno.2014.08.036
Patrick, D., & Erickson, P. (1993). Health status and health policy (1st ed., p. 22). New York, NY: Oxford University Press.
Pfeiffer, P., Heisler, M., Piette, J., Rogers, M., & Valenstein, M. (2011). Efficacy of peer support interventions for depression: A meta-analysis. General Hospital Psychiatry, 33(1), 29–36. https://doi.org/10.1016/j.genhosppsych.2010.10.002
Reblin, M., & Uchino, B. (2008). Social and emotional support and its implication for health. Current Opinion in Psychiatry, 21(2), 201–205. https://doi.org/10.1097/yco.0b013e3282f3ad89
Roy, R., Symonds, R., Kumar, D., Ibrahim, K., Mitchell, A., & Fallowfield, L. (2005). The use of denial in an ethnically diverse British cancer population: A cross-sectional study. British Journal of Cancer, 92(8), 1393–1397. https://doi.org/10.1038/sj.bjc.6602523
Schroevers, M., Ranchor, A., & Sanderman, R. (2006). Adjustment to cancer in the 8 years following diagnosis: A longitudinal study comparing cancer survivors with healthy individuals. Social Science & Medicine, 63(3), 598–610. https://doi.org/10.1016/j.socscimed.2006.02.008
Sentell, T., & Braun, K. (2012). Low health literacy, limited English proficiency, and health status in Asians, Latinos, and other racial/ethnic groups in California. Journal of Health Communication, 17(sup3), 82–99. https://doi.org/10.1080/10810730.2012.712621
Shi, L., Lebrun, L., & Tsai, J. (2009). The influence of English proficiency on access to care. Ethnicity & Health, 14(6), 625–642. https://doi.org/10.1080/13557850903248639
Song, L., Northouse, L., Braun, T., Zhang, L., Cimprich, B., Ronis, D., & Mood, D. (2010). Assessing longitudinal quality of life in prostate cancer patients and their spouses: a multilevel modeling approach. Quality of Life Research , 20(3), 371–381. http://dx.doi.org/10.1007/s11136-010-9753-y
Statistics Canada (2016). 2011 National Household Survey: Data tables | Visible Minority (15), Immigrant Status and Period of Immigration (11), Age Groups (10) and Sex (3) for the Population in Private Households of Canada, Provinces, Territories, Census Metropolitan Areas and Census Agglomerations, 2011 National Household Survey. Www12.statcan.ca. Retrieved 4 December 2016, from http://www12.statcan.ca/nhs-enm/2011/dp-pd/dt-td/Rp-eng.cfm?LANG=E&APATH=3&DETAIL=0&DIM=0&FL=A&FREE=0&GC=0&GID=1118296&GK=0&GRP=1&PID=105392&PRID=0&PTYPE=105277&S=0&SHOWALL=0&SUB=0&Temporal=2013&THEME=95&VID=0&VNAMEE=&VNAMEF=
Sung, H., Kearney, K., Miller, M., Kinney, W., Sawaya, G., & Hiatt, R. (2000). Papanicolaou smear history and diagnosis of invasive cervical carcinoma among members of a large prepaid health plan. Cancer, 88(10), 2283–2289. https://doi.org/10.1002/(sici)1097-0142(20000515)88:10<2283::aid-cncr12>3.3.co;2-4
Tehrani, A. M., Farajzadegan, Z., Rajabi, F. M., & Zamani, A. R. (2011). Belonging to a peer support group enhance the quality of life and adherence rate in patients affected by breast cancer: A non-randomized controlled clinical trial*. Journal of Research in Medical Sciences: The Official Journal of Isfahan University of Medical Sciences, 16(5), 658–665.
Torsch, V., & Ma, G. (2000). Cross-cultural comparison of health perceptions, concerns, and coping strategies among Asian and Pacific islander American elders. Qualitative Health Research, 10(4), 471–489. https://doi.org/10.1177/104973200129118589
Tran, T., Fitzpatrick, T., Berg, W., & Wright, R. (1996). Acculturation, health, stress, and psychological distress among elderly Hispanics. Journal of Cross-Cultural Gerontology, 11(2), 149–165. https://doi.org/10.1007/bf00114858
Tsai, J., Ying, Y., & Lee, P. (2000). The Meaning of “Being Chinese” and “Being American”. Journal of Cross-Cultural Psychology , 31(3), 302–332. http://dx.doi.org/10.1177/0022022100031003002
U.S. Department of Health and Human Services. (2016). Health literacy – fact sheet: Health literacy basics. Health.gov. Retrieved 4 December 2016, from https://health.gov/communication/literacy/quickguide/factsbasic.htm
Wang, J., Adams, I., Tucker-Seeley, R., Gomez, S., Allen, L., Huang, E., et al. (2013). A mixed method exploration of survivorship among Chinese American and non-Hispanic white breast cancer survivors: The role of socioeconomic well-being. Quality of Life Research, 22(10), 2709–2720. https://doi.org/10.1007/s11136-013-0374-0
Weaver, K., Forsythe, L., Reeve, B., Alfano, C., Rodriguez, J., Sabatino, S., et al. (2012). Mental and physical health-related quality of life among U.S. Cancer survivors: Population estimates from the 2010 National Health Interview Survey. Cancer Epidemiology Biomarkers & Prevention, 21(11), 2108–2117. https://doi.org/10.1158/1055-9965.epi-12-0740
Wen, K., Fang, C., & Ma, G. (2013). Breast cancer experience and survivorship among Asian Americans: A systematic review. Journal of Cancer Survivorship, 8(1), 94–107. https://doi.org/10.1007/s11764-013-0320-8
Williams, K., Jackson, S., Beeken, R., Steptoe, A., & Wardle, J. (2015). The impact of a cancer diagnosis on health and well-being: A prospective, population-based study. Psycho-Oncology, 25(6), 626–632. https://doi.org/10.1002/pon.3998
Wilson, E., Hm Chen, A., Grumbach, K., Wang, F., & Fernandez, A. (2005). Effects of limited English proficiency and physician language on health care comprehension. Journal of General Internal Medicine, 20(9), 800–806. https://doi.org/10.1111/j.1525-1497.2005.0174.x
Woloshin, S., Schwartz, L., Katz, S., & Welch, H. (1997). Is language a barrier to the use of preventive services?. Journal of General Internal Medicine , 12(8), 472–477. http://dx.doi.org/10.1046/j.1525-1497.1997.00085.x
Wong-Kim, E., Sun, A., Merighi, J., & Chow, E. (2016). Understanding quality-of-life issues in Chinese women with breast cancer: A qualitative investigation. Cancer Control: Journal of the Moffitt Cancer Center, 12(2), 6–12.
Wyatt, L., Trinh-Shevrin, C., Islam, N., & Kwon, S. (2014). Health-related quality of life and health behaviors in a population-based sample of older, foreign-born, Chinese American adults living in New York City. Health Education & Behavior, 41(1 Suppl), 98S–107S. https://doi.org/10.1177/1090198114540462
Yi, J., Swartz, M., & Reyes-Gibby, C. (2011). English proficiency, symptoms, and quality of life in Vietnamese- and Chinese-American breast cancer survivors. Journal of Pain and Symptom Management , 42(1), 83–92. http://dx.doi.org/10.1016/j.jpainsymman.2010.09.014
Zabalegui, A., Sanchez, S., Sanchez, P., & Juando, C. (2005). Nursing and cancer support groups. Journal of Advanced Nursing, 51(4), 369–381. https://doi.org/10.1111/j.1365-2648.2005.03508.x
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Appendix 1 Questionnaire for Interview Based on Modified EAAM, GEQ, and HRQOL 14
Appendix 1 Questionnaire for Interview Based on Modified EAAM, GEQ, and HRQOL 14
Demographics
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1.
Age
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2.
Marital status
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3.
Year of immigration
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4.
Type of cancer
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5.
Gender
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6.
Education level
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7.
Identity: Canadian/Chinese/others
Language
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1.
How would you rate your English/French?
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2.
What language do you speak at home?
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3.
Do you feel comfortable speaking in English or French?
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4.
What language do you prefer to speak?
Relationships
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1.
How would most of your friends identify themselves culturally (e.g., Chinese, Canadian, Chinese-Canadian, American, etc.)?
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(a)
With whom do you feel more comfortable expressing your feelings?
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(a)
Experience with Health System
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1.
How was your experience with the healthcare system?
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2.
Do you feel that you have a good understanding of the healthcare system here in Canada?
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3.
What were some barriers that you encountered in trying to obtain healthcare?
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(a)
Was language a barrier?
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(a)
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4.
How would you describe the relationship between you and your doctor?
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(a)
Do you trust them?
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(b)
How was the communication?
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(a)
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5.
Did you experience any difficulties during the course of the illness? After you have recovered? If so, what are they?
Social Support
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How well do you understand the social support or community services that can help you?
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2.
Have you ever attended a support group?
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(a)
If not, why?
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(b)
If yes, did you feel that it was helpful?
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(a)
General Well-Being (QOL)
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How do you feel about your general health?
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2.
What are the symptoms you are experiencing?
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3.
How have symptoms impacted your daily function?
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4.
How is your energy level?
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5.
How would you describe your general mood?
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6.
How often do you feel stressed, anxious, or depressed?
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Xiao, Y., Fitzpatrick, T.R. (2018). The Influence of Acculturation and Health-Related Quality of Life Among Chinese Elderly Cancer Survivors. In: Fitzpatrick, T. (eds) Quality of Life Among Cancer Survivors . Springer, Cham. https://doi.org/10.1007/978-3-319-75223-5_3
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