title: A culturally adapted survivorship programme for Asian early stage breast cancer patients in Singapore: A randomized, controlled trial.
abstract: BACKGROUND
  As cancer mortality rates improve in Singapore, there is an increasing need to improve the transition to posttreatment survivorship care. This study aimed to evaluate the effectiveness of a psychoeducation group (PEG) intervention program compared with usual care to reduce distress for physical symptom and psychological aspects in Asian breast cancer survivors who have completed adjuvant chemotherapy.
  
  
  METHODS
  This was a randomized, controlled trial comprising 72 Asian early stage breast cancer survivors who were randomized into the PEG (n = 34) or the control (n = 38) arm. The participants in the PEG arm underwent a weekly multidisciplinary PEG program delivered in a group format over 3 weeks coupled with cultural adaptation. Both arms were assessed at baseline and 2 months after intervention using the Rotterdam Symptom Checklist, Beck Anxiety Inventory, and EORTC QLQ-C30. A satisfaction questionnaire was also conducted among those survivors who have participated in the PEG program. Effective sizes were calculated using Cohen d.
  
  
  RESULTS
  The mean age ± SD of all participants was 53.0 ± 8.9 years, with the majority being Chinese (84.7%) and Malay (6.9%), and clinical characteristics were well balanced in both arms. Compared to the control arm, the PEG arm showed a significantly greater reduction in physical symptom distress (d = 0.76, P = .01) and fatigue (d = 0.49, P = .04). The 82.4% of the participants in the intervention group responded to the satisfaction questionnaire, and the majority (92.9%) agreed that the overall duration of the PEG intervention program was appropriate.
  
  
  CONCLUSIONS
  A culturally adapted PEG program was effective in reducing physical symptom distress in Asian breast cancer survivors. (ClinicalTrials.gov: NCT02600299).
authors.affiliation: Department of Pharmacy, National University of Singapore, Singapore.|Department of Pharmacy, National Cancer Centre Singapore, Singapore.|Duke-NUS Medical School Singapore, Singapore.
authors.forename: Alexandre
authors.identifier: http://orcid.org/0000-0003-4391-4219
authors.initials: A
authors.lastname: Chan
authors.affiliation: Department of Pharmacy, National Cancer Centre Singapore, Singapore.
authors.forename: Yan Xiang
authors.initials: YX
authors.lastname: Gan
authors.affiliation: Department of Pharmacy, National University of Singapore, Singapore.
authors.forename: Suan Kai
authors.initials: SK
authors.lastname: Oh
authors.affiliation: Department of Pharmacy, National University of Singapore, Singapore.|Department of Pharmacy, National Cancer Centre Singapore, Singapore.
authors.forename: Terence
authors.initials: T
authors.lastname: Ng
authors.affiliation: Department of Pharmacy, National University of Singapore, Singapore.|Department of Pharmacy, National Cancer Centre Singapore, Singapore.
authors.forename: Maung
authors.initials: M
authors.lastname: Shwe
authors.affiliation: Queensland University of Technology, Brisbane, Queensland, Australia.|Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
authors.forename: Raymond
authors.initials: R
authors.lastname: Chan
authors.affiliation: Duke-NUS Medical School Singapore, Singapore.|Division of Medical Oncology, National Cancer Centre Singapore, Singapore.
authors.forename: Raymond
authors.initials: R
authors.lastname: Ng
authors.affiliation: Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore.
authors.forename: Brandon
authors.initials: B
authors.lastname: Goh
authors.affiliation: Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore.
authors.forename: Yee Pin
authors.initials: YP
authors.lastname: Tan
authors.affiliation: Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Fan
mesh_terms: D000328:Adult; D044466:Asian People / Q000523:psychology; D001943:Breast Neoplasms / Q000523:psychology* / Q000628:therapy; D000073116:Cancer Survivors / Q000523:psychology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D011788:Quality of Life / Q000523:psychology*; D012846:Singapore; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: cancer; cancer survivors; oncology; physical symptom distress; psychoeducation group; psychological distress; survivorship