Self-perceived burden mediates the relationship between self-stigma and quality of life among Chinese American breast cancer survivors

  • Nelson C. Y. YeungEmail author
  • Qian LuEmail author
  • Winnie W. S. Mak
Original Article



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 (χ2(100) = 123.041, CFI = 0.982, TLI = 0.975, RMSEA = 0.041) and emotional QoL (χ2(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.


Cancer Oncology Quality of life Burden Self-stigma Chinese 


Funding information

This study was supported by the American Cancer Society MRSGT-10-011-01-CPPB (PI: Qian Lu) and National Cancer Institute R01CA180896-01A1 (PI: Qian Lu).

Compliance with ethical standards

This study protocol was approved by the Institutional Review Board at the University of Houston.

Conflict of interest

The authors declare that they have no conflicts of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Jockey Club School of Public Health and Primary Care The Chinese University of Hong KongShatinHong Kong
  2. 2.Health Disparities Research Department – UNIT 1440UT MD Anderson Cancer CenterHoustonUSA
  3. 3.Department of PsychologyThe Chinese University of Hong KongShatinHong Kong

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