APPROACH: Asian Patient Perspectives Regarding Oncology Awareness, Care, and Health

Principal Investigator:

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

Study Team:

Semra Özdemir, Chetna Malhotra, Irene Teo Eng Ai, Ssu Wynn Mon, Gayatri Palat, Ning Xiao Hong, Thushari Hapuarachchi, Sushma Bhatnagar, Anjum Khan Joad, Pham Nguyen Tuong, Rubayat Rahman, Lubna Mariam, Maria Fidelis Manalo, Rudi Putranto


As with many countries around the world, countries in Asia have experienced a shift in causes of death from infectious to chronic diseases, resulting in a protracted dying process that the current healthcare infrastructure, particularly in the low- and middle-income countries of the region, is struggling to address. Moreover, these countries do not have the adequate resources or infrastructure to provide the best available treatments or systematic coverage of basic palliative care and home based services.


The study aims to fill the knowledge gap of understanding advanced cancer patients’ quality of life and treatment relative to their expectations in this region.


Between 2016 and 2018, we conduct a one-time survey of 200 advanced cancer patients in each participating hospital in Asia. The core research domains aim to assess quality of life, quality of care, awareness and preferences for prognostic information, and involvement in treatment decision making. Additionally, patient’s use of complementary and alternative medicine, psychological distress, self-blame and social stigma are assessed according to their relevance in the subject country.

We also conduct a structured interview with the site-PIs (proxy) of the institutions to assess the end of life and palliative care services/systems in place which helps in comparing the different types of institutions involved within and across countries and investigate how institutional characteristics are associated with patient health outcomes. The study is funded by Lien Centre for Palliative Care with support from Asia Pacific Hospice Palliative Care Network and the collaborating institutions. To the best of our knowledge, this is the first study which aims to provide a cross-country comparison of end-of-life care services for cancer patients in middle and low-income countries in Asia.

Study sites:

The survey is conducted in collaboration with 12 investigators from institutions across Bangladesh, China, India, Indonesia, Sri Lanka, Myanmar, the Philippines, and Vietnam.


The study primarily has implications for increasing the standard of palliative care in the low- and middle income countries in Asia. The findings from this study will be helpful for policy makers to identify the key areas for improvement of end-of-life care within and across countries.


The prevalence of perceived stigma and self-blame and their associations with depression, emotional well-being and social well-being among advanced cancer patients: Evidence from the APPROACH cross-sectional study in Vietnam

Pham, N. T., Lee, J. J., Pham, N. H., Phan, T., Tran, K., Dang, H. B., Teo, I., Malhotra, C., Finkelstein, E. A., & Ozdemir, S. (2021). BMC palliative care, 20(1), 104.

High anxiety and depression scores and mental health service use among South Asian advanced cancer patients: A multi-country study

Teo, I., Ozdemir, S., Malhotra, C., Yang, G. M., Ocampo, R. R., Bhatnagar, S., Hapuarachchi, T., Joad, A. K., Mariam, L., Palat, G., Rahman, R., Finkelstein, E. A., & APPROACH study group (2021). Journal of pain and symptom management, S0885-3924(21)00285-2. Advance online publication.

Patients' Awareness of Advanced Disease Status, Psychological Distress and Quality of Life Among Patients With Advanced Cancer: Results From the APPROACH Study, India

Satija, A., Bhatnagar, S., Ozdemir, S., Finkelstein, E., Maholtra, C., Teo, I., & Yang, G. M. (2021). The American journal of hospice & palliative care, 10499091211042837. Advance online publication.

Socio-economic Inequalities in Suffering at the End of Life among Advanced Cancer Patients: Results from the APPROACH Study in Five Asian Countries

Malhotra C, Krishnan A, Yong JR, Teo I, Ozdemir S, Ning XH, Hapuarachchi T, Palat G, Bhatnagar S, Joad AK, Nguyen TM, Mon SW, Finkelstein EA. International Journal for Equity in Health.2020; 19(1):158.

Awareness of and Preference for Disease Prognosis and Participation in Treatment Decisions among Advanced Cancer Patients in Myanmar: Results from the APPROACH Study

Mon SW, Myint Z, Myint M, Win H, Zin T, Yang GM, Malhotra C, Teo I, Finkelstein EA, Ozdemir S. Asia-Pacific Journal of Clinical Oncology.2020. Published Online First. doi: 10.1111/ajco.13430

Perceived Quality of Care and its Associated Factors among Chinese Patients with Advanced Cancer: Findings from the APPROACH study in Beijing

Ning X, Krishnan A, Li X, Liu Z, Li J, Dai X, Ozdemir S, Malhotra C, Finkelstein EA, Teo I. Journal of Supportive Care in Cancer.2020; 10.1007/s00520-020-05559-x.

The association of self-blame with treatment preferences in a multi-country cohort of advanced cancer patients from the APPROACH study

Doble B, Lau E, Malhotra C, Ozdemir S, Teo I, Finkelstein EA, APPROACH study group. Journal of psychosomatic research.2020. Published Online First. doi: 10.1016/j.jpsychores.2020.110284

End of Life Experiences of Patients with Advanced Cancer in Myanmar: Results from the APPROACH Study

Mon SW, Ozdemir S, Zu WWM, Win H, Maw MM, Win KC, Thant KZ, Teo I, Krishnan A, Goh CR, Finkelstein EA, Malhotra C. Asia-Pacific Journal of Clinical Oncolgy.2020: 10.1111/ajco.13371.

Health-related Quality of Life and Its Socio-Economic and Cultural Predictors Among Advanced Cancer Patients: Evidence from the APPROACH Cross-Sectional Survey in Hyderabad-India

Jacob J, Palat G, Verghese NR, Chandran P, Rapelli V, Kumari S, Malhotra C, Teo I, Finkelstein EA, Ozdemir S. BMC Palliative Care.2019;18(1):94.


25 September 2020

S.No Title PDF / Video link
1 The APPROACH Study (Asian Patient Perspectives Regarding Oncology Awareness, Care, and Health).
2 Presentation slides Webinar Slide Deck (pdf)

Project Start Date:

January 2015

Contact Person: