EPIC: The Feasibility and Acceptability of a Psychosocial Intervention for Advanced Colorectal Cancer Patients

Principal Investigator:

Irene Teo Eng Ai, Assistant Professor, Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore

Study Team:

Tan Kwong Wei Emile John, Eric Finkelstein, Cheung Yin Bun, Tan Yee Pin, Ong Yew Kuang Simon, Choo Su Pin, Tan Bee Huat Iain, Yang Meijuan Grace


Studies have reported about one-third to half of advanced cancer patients experience psychological distress yet the mental healthcare needs of these patients are not properly assessed and addressed. Patients with advanced colorectal cancer can face unique challenges that are stoma- or bowel-related in addition to other symptom burden such as pain, fatigue, and existential distress that have deleterious consequences on their psychological and social functioning. This pilot study aims to test an intervention for patients with advanced colorectal cancer that incorporates culturally-appropriate topics. Using a randomized selection design, we will investigate the feasibility and acceptability of the intervention and obtain an initial estimate of efficacy of the intervention.


The study aims are to investigate the feasibility and acceptability of a PBI designed for advanced colorectal patients implemented in a Singapore context. The intervention will be facilitated by clinical psychologists whose specialty area is psycho-oncology, so as to allow in-depth discussions about suffering associated with cancer and confrontation of end-of-life issues. The intervention will include a) therapeutic discussion on legacy building as a way to open discussion about fear of death; b) addressing changed family dynamics, which is important in an Asian context, and c) discussing adaptation to living with bowel-related issues that are a common cause of distress for this patient population. The overall aim of the study is to establish evidence-based programs for cancer survivors to enhance their quality of life.


60 patients are recruited from the Division of Medical Oncology, Dept of Psychosocial Oncology and Division of Palliative Medicine at National Cancer Centre Singapore and Singapore General Hospital within 18 months. Study participants are randomized into either the psycho–behavioural intervention arm (PBI), or waitlist control arm (WLC). Four intervention sessions (each lasting approximately 60 minutes) are conducted with a clinical psychologist in an outpatient setting at the Department of Psychosocial Oncology, NCCS.

Study sites:

National Cancer Centre Singapore

Singapore General Hospital


Cancer is the leading cause of death in Singapore, with colorectal cancer being one of the top diagnosed cancers in men and women. Research shows that one in four colorectal cancer cases are in the advanced/ terminal stage. Patients at this stage are likely dealing with suffering from difficult symptoms (e.g., pain), and emotional stress. Having access to psychological care programs at this time can be very important. These programs teach patients skills to cope with emotional stress and common symptoms (e.g., pain, tiredness) that allow patients to feel more in control of their situation.

The changes in emotional stress during this time frame will help us understand how useful the program is to lower emotional stress of patients.


The Feasibility and Acceptability of a Cognitive Behavioral Therapy-based Intervention for Patients with Advanced Colorectal Cancer

Teo I, Tan YP, Finkelstein EA, Yang GM, Pan FT, Lew H, Tan E, Ong S, Cheung YB. Journal of Pain and Symptom Management.2020; S0885-3924(20)30530-3.

Project Start Date:

10 July 2017

Contact Person:

Kat: ekaterina.utkina@duke-nus.edu.sg