HIBISCUS: Feasibility and Acceptability of a Behavioral Symptom Management Program for Patients with Advanced Breast Cancer

Principal Investigator:

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

Study Team:

Tan Yee Pin, Eric Finkelstein, Cheung Yin Bun, Lee Guek Eng, Grace Yang Meijuan


Up to two-thirds of women with advanced breast cancer experience significant symptom burden (e.g., distress, pain, fatigue), yet these symptoms are not adequately addressed. Cognitive behavioral therapy (CBT) protocols designed to teach patients strategies to improve their symptom management may be helpful in alleviating multiple symptoms. The efficacy of CBT protocols for reducing distinct symptoms in early-stage breast cancer has been shown in Western countries; however the role of CBT protocols for multiple symptoms in late-stage cancer is less clear.


This study aims to investigate the feasibility and acceptability and obtain estimates of efficacy of a novel, cross-cultural multi-symptom (i.e., anxiety and depression, pain, fatigue) CBT protocol in advanced breast cancer patients. A randomized controlled design will compare patients receiving the CBT protocol to a waitlist control condition in both Singapore and US patients.


In Singapore, 40 participants who have received a diagnosis of stage IV breast cancer are recruited from the Division of Medical Oncology, National Cancer Center Singapore. Eligible patients who consent to participate receive the standard care provided to advanced breast cancer patients. After completing the first study assessment, participants are randomized in equal ratio to: 1) the 4-session CBT protocol (CBT), conducted with a psychologist, with each session lasting 50 minutes or (2) the waitlist control (WLC) group. Both groups of participants (CBT and WLC) are assessed approximately 6 weeks following randomization. Participants in the WLC group are given the option to receive the same CBT protocol thereafter and will complete the same assessment after completing the intervention.

Study sites:

National Cancer Centre Singapore


This study will have important implications on palliative healthcare delivery, with stakeholders that include clinicians to policy-makers, as there currently are no set or defined standards for psychosocial care for patients receiving oncologic supportive services. The Singapore population is ageing, (e.g., individuals age 65 and above is expected to constitute approximately 20% of the) and as the rates of cancer continue to rise, we expect the number of individuals needing psychosocial support as part of healthcare services for cancer to increase in the coming years; thus this research is relevant and timely.


A Feasible and Acceptable Multicultural Psychosocial Intervention Targeting Symptom Management in the Context of Advanced Breast Cancer

Teo I, Vilardaga JP, Tan YP, Winger J, Cheung YB, Yang GMJ, Finkelstein EA, Shelby RA, Kamal AH, Kimmick G, Somers TJ. Psycho-oncology.2020; 29(2):389-397.

Project Start Date:

17 May 2016

Contact Person:

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