COMPASS: Costs and Medical Care of Patients with Advanced Serious Illness in Singapore


Principal Investigator:

Eric Finkelstein, Executive Director, Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore

Study Team:

Rebecca Dent, Nesaretnam Barr Kumarakulasinghe, Lee Lai Heng, Irene Teo Eng Ai, Chetna Malhotra Semra Özdemir, Rahul Malhotra, Cheung Yin Bun, Nivedita Nadkarni, Alethea Yee, Grace Yang, Ravindran Kanesvaran, Patricia Yeo, Noreen Chan, Wu Huei Yaw, Chin Soh Mun, Hum Yin Mei Allyn, Wee Lee Yeo, Richard Harding


In Singapore, little is known about the experiences of patients with advanced cancer, such as quality of care received and how patients transition across different health care settings, or about the factors that influence patient and caregiver quality of life. This study, is a first-of-its-kind longitudinal study in Singapore to prospectively capture health care utilization, cost, quality of care and quality of life indicators for a sample of patients with advanced cancer, their primary informal caregivers and their physicians using both administrative and survey data collected until patient’s death.


The primary objective of this study is to describe trajectories of quality of life of patients with advanced cancer and their predictors, to describe the transitions between care settings for such patients and to quantify healthcare utilization and costs. Secondary objectives are to investigate preferences for diagnostic and prognostic information, preferences in end of life care, perceived quality of care, and to assess the areas of burden reported by caregivers over time as patients approach end of life.


Prospective study of patients with advanced cancer. 650 patients and their primary informal caregivers are followed every 3 months until death of patient. Treating physicians of the patients are invited to take part in the study.

Study sites:

National Cancer Centre Singapore

National University Hospital


The results from this study will help assess patient and caregiver preferences for end-of-life care, perceived quality of communication with the physicians and the extent to which pain and other symptoms are adequately managed in patients. Each of these is a priority area identified in Singapore’s National Strategy for Palliative Care as having significant knowledge gaps.


Cost of Medical Care of Patients with Advanced Serious Illness in Singapore (COMPASS): Prospective Cohort Study Protocol.

Teo I, Singh R, Malhotra C, Ozdemir S, Dent RA, Kumarakulasinghe NB, Yeo WL, Cheung YB, Malhotra R, Kanesvaran R, Yee ACP, Chan N, Wu HY, Soh MC, Hum AYM, Yang GMJ, Soek PHN, Nadkarni N, Harding R, Finkelstein EA. BMC Cancer.2018;18:459.

Palliative Care Awareness among Advanced Cancer Patients and Their Family Caregivers in Singapore

Ozdemir S, Malhotra C, Teo I, Yang GM, Kanesvaran R, YEE ACP, Finkelstein EA. Annals Academy of Medicine, Singapore.2019; 48(8):241-246.

Family Caregivers of Advanced Cancer Patients: Self-perceived Competency and Meaning-making

Teo I, Baid D, Ozdemir S, Malhotra C, Singh R, Harding R, Malhotra R, Yang GM, Neo SHS, Cheung YB, Neo PSH, Kanesvaran R, Kumarakulasinghe NB, Lee LH, Koh G, Finkelstein EA, COMPASS study group. BMJ Supportive & Palliative Care.2019. Published Online First.

Financial Difficulties are Associated with Greater Total Pain and Suffering among Patients with Advanced Cancer: Results from the COMPASS study

Malhotra C, Harding R, Teo I, Ozdemir S, Koh GCH, Neo P, Lee LH, Kanesvaran R, Finkelstein EA, COMPASS study group. Supportive Care in Cancer.2020; 28(8):3781-3789.

End-of-life cost trajectories and the trade-off between treatment costs and life-extension: Findings from the Cost and Medical Care of Patients with Advanced Serious Illness (COMPASS) cohort study

Doble, B., Wong, W., Finkelstein, E., & COMPASS study team (2021). Palliative medicine, 269216321999576. Advance online publication.

Patient-Caregiver Treatment Preference Discordance and Its Association With Caregiving Burden and Esteem

Ozdemir, S., Ng, S., Malhotra, C., Teo, I., Finkelstein, E. A., & COMPASS Study Group (2021). Innovation in aging, 5(3), igab020Z.

Experiences with health care practitioners among advanced cancer patients and their family caregivers: A longitudinal dyadic study

Malhotra, C., Chaudhry, I., Ozdemir, S., Teo, I., Kanesvaran, R., & COMPASS Study Group (2021). Cancer, 10.1002/cncr.33592. Advance online publication.

A Prospective Cohort Study of Stability in Preferred Place of Death Among Patients With Stage IV Cancer in Singapore

Malhotra, C., Koh, L. E., Teo, I., Ozdemir, S., Chaudhry, I., Finkelstein, E., & COMPASS Study Team (2021). Journal of the National Comprehensive Cancer Network : JNCCN, jnccn20334. Advance online publication.

Trajectories of Suffering in the Last Year of Life Among Patients With a Solid Metastatic Cancer

Malhotra, C., Malhotra, R., Bundoc, F., Teo, I., Ozdemir, S., Chan, N., & Finkelstein, E. (2021). Journal of the National Comprehensive Cancer Network : JNCCN, 1–8. Advance online publication.

Discordance Between Advanced Cancer Patients' Perceived and Preferred Roles in Decision Making and its Association with Psychological Distress and Perceived Quality of Care

Ozdemir, S., Tian, Y., Malhotra, C., Harding, R., Koh, G., Kumarakulasinghe, N. B., Lee, L. H., Mon, S. W., Finkelstein, E., & COMPASS Study Group (2021). The patient, 10.1007/s40271-020-00480-1. Advance online publication.

Trajectories of physical symptom burden and psychological distress during the last year of life in patients with a solid metastatic cancer

Shafiq, M., Malhotra, R., Teo, I., Ozdemir, S., Kanesvaran, R., Malhotra, C., & COMPASS Study Group (2021). Psycho-oncology, 10.1002/pon.5792. Advance online publication.



Webinar 31 August 2020

S.No Title PDF / Video link
1 COMPASS Study Webinar Part 1: Introduction
Prof Eric Andrew Finkelstein gives a short introduction of the COMPASS Cohort Study.
2 COMPASS Study Webinar Part 2: Asst Prof Semra Ozdemir
Asst Prof Semra Ozdemir discusses the following topics:
Awareness of palliative care services
Discordance between experienced and preferred role in decision making
3 COMPASS Study Webinar Part 3: Asst Prof Chetna Malhotra
Asst Prof Chetna Malhotra discusses the following topics:
Instability in preferences for end of life care
End-of-life suffering
4 COMPASS Study Webinar Part 4: Asst Prof Irene Teo
Asst Prof Irene Teo discusses the following topics:
Caregiving for advanced cancer patients: Psychological outcomes and protective factors
Bereavement adjustment of caregivers
5 COMPASS Study Webinar Part 5: Prof Eric Andrew Finkelstein
Prof Eric Andrew Finkelstein talks about healthcare costs at the end-of-life.
6 Presentation slides Webinar Slide Deck (pdf)

Project Start Date:

18 January 2016

Contact Person: