"‘I used to say, ‘I am OK’”: The unspoken realities of supportive care needs in Asian American metastatic cancer survivorship.

338 Background: With advances in treatments, more individuals are living with metastatic cancer. Supportive care improves quality of life and reduces costs, but supportive care needs (SCNs) of Asian Americans with metastatic cancer are understudied. This convergent mixed-methods study examined the SCNs of Chinese, Vietnamese, and Korean (CVK) American adults with metastatic solid tumors. Methods: Language-matched interviewers conducted semi-structured interviews. English-translated transcripts were analyzed using reflexive thematic analysis to answer the question, “What are the supportive care needs of Asian Americans with metastatic cancer?” Quantitative surveys were completed following the interview, including the SCNS-ST9, to assess five domains of SCNs (health system/information, patient care/support, physical/daily living, psychological/emotional, sexuality). Results: Participants (n = 69; M a ge = 52.03, SD = 21.18) identified as Chinese (52.17%), Vietnamese (30.43%), or Korean (17.39%). Most were female (66.67%), foreign-born (88.41%), and reported low acculturation (71.01%). Five preliminary themes were developed: 1) Greater healthcare access and education; 2) Pervasive but hidden mental health gaps; 3) Harmonized care coordination; 4) Preparing ahead for all possibilities; and 5) Addressing the needs of the collective unit. Across themes, patients conveyed that existing infrastructure was insufficient, and supplementing with external care was vital (e.g., acupuncture (Chinese), religious services (Vietnamese/Korean)). Expressing SCNs to the healthcare team varied by age and acculturation. Quantitative findings diverged from interviews, with most participants describing low need across the five SCNS-ST9 domains (25.70 ± 8.68). Patients ≤50 years old at diagnosis reported more sexuality needs ( p = 0.02) than older patients. More acculturated patients reported greater needs to be emotionally validated by healthcare staff ( p <0.01). Conclusions: Findings highlight both shared and ethnoculturally specific SCNs of CVK American metastatic cancer survivors, underscoring the importance of culture in care coordination. A mixed-methods approach revealed critical gaps that may be overlooked by quantitative data alone, particularly in domains influenced by stigma and cultural values (i.e., patients’ unspoken realities). Ongoing patient engagement and interactive assessments may provide valuable information for clinical service quality improvement.