A Breast cAncer Survivorship Inter-Professional Community (BASIC) Shared Care Model to Promote Healthy Behaviors in Singapore: A Pilot Randomized Controlled Trial.

BACKGROUND

This pilot study assessed the feasibility and acceptability of a randomized controlled trial (RCT) to evaluate a shared care model combining oncologists' and primary care providers' expertise to help cancer survivors manage their health and adopt healthier behaviors.

METHOD: This open-label RCT recruited 70 breast cancer survivors from the National Cancer Centre Singapore between 03/2021-07/2022. Eligible participants (≥ 21 years, ≥ 3 years post-treatment, ECOG status 0-2, deemed low risk by oncologists), were randomized (1:1) to receive shared care or usual care with 1-year follow-up. Shared care recipients completed the Distress Thermometer and Problem List before consulting a family physician and received 3-monthly teleconsultations with community pharmacists. Care was coordinated through survivorship care plans. Outcomes included process measures, preliminary effectiveness (quality of life, functioning, distress, activity, comorbidity control), and acceptability.

RESULTS

Average enrolment rate was four participants/week, with disinterest and scheduling conflicts cited as common reasons for rejection. The mean(SD) age of participants was 61.1 (6.6) years. Shared care recipients (n = 33) attended a median of 2 (range 0-6) family physician visits, with 87.9% completing three pharmacist telehealth consults. Retention rate was 96% and questionnaire completion rate was ≥ 90%. Compared to usual care recipients (n = 35), shared care recipients reported higher social functioning (Cohen's d(95%CI) = 0.47(- 0.04,0.98)), lower physical symptom distress (Cohen's d(95%CI) = 0.54(0.02,1.05)), and higher activity levels (Cohen's d(95%CI) = 0.38(- 0.13,0.88)) after 1 year.

CONCLUSION

The moderate positive effects of shared care observed on social functioning, physical symptoms, and activity levels in this pilot warrant validation in a full-scale RCT targeting survivors with greater comorbidity burden and optimized care coordination.