Ke Yu, Fok Rose Wai Yee, Tan Ngiap Chuan, Chew Lita, Wong Wei Teen, Kwan Charmaine Shuyi, Chung Wing Lam, Loh Kiley Wei-Jen, Tan Gretchen Ser Hua, Cheng Ivy, Lee Joyce Yu-Chia, Chan Alexandre
Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore.
Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
Int J Behav Med. 2025 Jun 3. doi: 10.1007/s12529-025-10372-z.
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.
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.
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.
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.
这项试点研究评估了一项随机对照试验（RCT）的可行性和可接受性，该试验旨在评估一种结合肿瘤学家和初级保健提供者专业知识的共享护理模式，以帮助癌症幸存者管理自身健康并采取更健康的行为。
这项开放标签的随机对照试验于2021年3月至2022年7月期间从新加坡国立癌症中心招募了70名乳腺癌幸存者。符合条件的参与者（年龄≥21岁，治疗后≥3年，东部肿瘤协作组（ECOG）状态为0 - 2，肿瘤学家认为风险较低）被随机分配（1:1）接受共享护理或常规护理，并进行为期1年的随访。接受共享护理的参与者在咨询家庭医生之前完成了苦恼温度计和问题清单，并接受了社区药剂师每3个月一次的远程会诊。通过幸存者护理计划协调护理。结果包括过程指标、初步有效性（生活质量、功能、苦恼、活动、合并症控制）和可接受性。
平均入组率为每周4名参与者，拒绝的常见原因是不感兴趣和日程冲突。参与者的平均（标准差）年龄为61.1（6.6）岁。接受共享护理的参与者（n = 33）平均就诊家庭医生2次（范围0 - 6次），87.9%完成了3次药剂师远程健康会诊。保留率为96%，问卷完成率≥90%。与接受常规护理的参与者（n = 35）相比，接受共享护理的参与者在1年后报告了更高的社会功能（科恩d值（95%置信区间）= 0.47（-0.04,0.98））、更低的身体症状苦恼（科恩d值（95%置信区间）= 0.54（0.02,1.05））和更高的活动水平（科恩d值（95%置信区间）= 0.38（-0.13,0.88））。
在这项试点研究中观察到的共享护理对社会功能、身体症状和活动水平的适度积极影响，值得在一项针对合并症负担更大且护理协调更优化的幸存者的全面随机对照试验中进行验证。
