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

Abstract

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.