A feasible and acceptable multicultural psychosocial intervention targeting symptom management in the context of advanced breast cancer
Abstract
Objective: Advanced breast cancer patients around the world experience high symptom burden (ie, distress, pain, and fatigue) and are in need of psychosocial interventions that target symptom management. This study examined the feasibility, acceptability, and engagement of a psychosocial intervention that uses cognitive‐behavioral strategies along with mindfulness and values‐based activity to enhance patients' ability to manage symptoms of advanced disease in a cross‐cultural setting (United States and Singapore). Pre‐treatment to post‐treatment outcomes for distress, pain, and fatigue were compared between intervention recipients and waitlisted controls. Methods: A pilot randomized controlled trial included women with advanced breast cancer (N = 85) that were recruited in the United States and Singapore. Participants either received the four session intervention or be put on waitlist. Descriptive statistics and effect size of symptom change were calculated. Results: The psychosocial intervention was found to be feasible as indicated through successful trial accrual, low study attrition (15% ), and high intervention adherence (77% completed all sessions). Acceptability (ie, program satisfaction and cultural sensitivity) and engagement to the study intervention (ie, practice of skills taught) were also high. Anxiety, depression, and fatigue scores remained stable or improved among intervention participants while the same symptoms worsened in the control group. In general, effect sizes are larger in the US sample compared with the Singapore sample. Conclusions: The cognitive‐behavioral, mindfulness, and values‐based intervention is feasible, acceptable, and engaging for advanced breast cancer patients in a cross‐cultural setting and has potential for efficacy. Further larger‐scaled study of intervention efficacy is warranted.
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In cross-cultural groups in the United States and Singapore, a 4-session mindfulness-based treatment in a 2020 pilot RCT resulted in significant improvement in anxiety, depression, and fatigue scores.
“Cross-cultural groups in the United States and Singapore both showed significant improvement in anxiety, depression, and fatigue scores after exposure to a 4-session, mindfulness-based treatment in a 2020 pilot RCT [31].”
From Psychological Intervention and Breast Cancer (2024) · cites this paper as [31]
Cites
The Hospital Anxiety and Depression Scale
Zigmond, A. S., & Snaith, R. P. (1983) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1983.tb09716.x · Cited by 47,139 · see citing works
Pain assessment: global use of the Brief Pain Inventory.
Cs, C., & Km, R. (1994) · PubMed · Cited by 5,178 · see citing works
Cella, D., Riley, W., Stone, A., Rothrock, N., Reeve, B., Yount, S., Amtmann, D., Bode, R., Buysse, D., Choi, S., et al. (2010) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2010.04.011 · Cited by 5,128 · see citing works
The client satisfaction questionnaire
Attkisson, C. C., & Zwick, R. (1982) · Evaluation and Program Planning · doi:10.1016/0149-7189(82)90074-x · Cited by 1,743 · see citing works
FERRELL, B. R., Twaddle, M. L., Melnick, A., & Meier, D. E. (2018) · Journal of Palliative Medicine · doi:10.1089/jpm.2018.0431 · Cited by 775 · see citing works
Differences in Breast Cancer Stage, Treatment, and Survival by Race and Ethnicity
Li, C. I., Malone, K. E., & Daling, J. R. (2003) · Archives of Internal Medicine · doi:10.1001/archinte.163.1.49 · Cited by 665 · see citing works
Randomized phase II clinical trials.
Simon, R. M., Wittes, R. E., & Ellenberg, S. S. (1985) · PubMed · Cited by 469 · see citing works
Prevalence of symptoms among patients with advanced cancer: An international collaborative study
Vainio, A., & Auvinen, A. (1996) · Journal of Pain and Symptom Management · doi:10.1016/0885-3924(96)00042-5 · Cited by 455 · see citing works
Homework assignments in cognitive and behavioral therapy: a meta-analysis
Kazantzis, N., Deane, F. P., & Ronan, K. R. (2000) · Clinical Psychology: Science and Practice · doi:10.1093/clipsy.7.2.189 · Cited by 412 · see citing works
Lai, J., Cella, D. F., Choi, S. W., Junghaenel, D. U., Christodoulou, C., Gershon, R. C., & Stone, A. A. (2011) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2010.08.033 · Cited by 365 · see citing works
Gielissen, M. F. M., Verhagen, S., Witjes, F., & Bleijenberg, G. (2006) · Journal of Clinical Oncology · doi:10.1200/jco.2006.06.8270 · Cited by 349 · see citing works
Block‐Lerner, J., Adair, C., Plumb, J. C., Rhatigan, D. L., & Orsillo, S. M. (2007) · Journal of Marital and Family Therapy · doi:10.1111/j.1752-0606.2007.00034.x · Cited by 318 · see citing works
Suffering in the Advanced Cancer Patient: A Definition and Taxonomy
Cherny, N. I., Coyle, N., & Foley, K. M. (1994) · Journal of Palliative Care · doi:10.1177/082585979401000211 · Cited by 234 · see citing works
Psychosocial interventions for advanced cancer patients: a systematic review
Teo, I., Krishnan, A., & Lee, G. L. (2019) · Psycho-Oncology · doi:10.1002/pon.5103 · Cited by 205 · see citing works
Self-citationBryant, M. J., Simons, A. D., & Thase, M. E. (1999) · Cognitive Therapy and Research · doi:10.1023/a:1018703901116 · Cited by 183 · see citing works
Arndt, V., Stegmaier, C., Ziegler, H., & Brenner, H. (2006) · Cancer · doi:10.1002/cncr.22274 · Cited by 164 · see citing works
Mack, J. W., Nilsson, M., Balboni, T., Friedlander, R. J., Block, S. D., Trice, E., & Prigerson, H. G. (2008) · Cancer · doi:10.1002/cncr.23476 · Cited by 155 · see citing works
Rost, A. D., Wilson, K., Buchanan, E., Hildebrandt, M. J., & Mutch, D. (2012) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2012.01.003 · Cited by 146 · see citing works
NCCN Guidelines Insights: Palliative Care, Version 2.2017
Dans, M. C., Smith, T. J., Back, A. L., Baker, J. N., Bauman, J. R., Beck, A. C., Block, S. D., Campbell, T. C., Case, A. A., Dalal, S., et al. (2017) · Journal of the National Comprehensive Cancer Network · doi:10.6004/jnccn.2017.0132 · Cited by 140 · see citing works
Acceptance and Commitment Therapy modules: Differential impact on treatment processes and outcomes
Villatte, J. L., Vilardaga, R., Villatte, M., Plumb Vilardaga, J. C., Atkins, D. C., & Hayes, S. C. (2016) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.12.001 · Cited by 136 · see citing works
Self-citationMcCaffrey, N., Bradley, S. L., Ratcliffe, J., & Currow, D. C. (2016) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2016.02.012 · Cited by 131 · see citing works
In search of meaning: Values in modern clinical behavior analysis
Plumb, J. C., Stewart, I., Dahl, J., & Lundgren, T. (2009) · The Behavior Analyst · doi:10.1007/bf03392177 · Cited by 127 · see citing works
Anxiety disorders in advanced cancer patients: Correlates and predictors of end‐of‐life outcomes
Spencer, R., Nilsson, M., Wright, A., Pirl, W., & Prigerson, H. (2010) · Cancer · doi:10.1002/cncr.24954 · Cited by 124 · see citing works
Gudenkauf, L. M., Antoni, M. H., Stagl, J. M., Lechner, S. C., Jutagir, D. R., Bouchard, L. C., Blomberg, B. B., Glück, S., Derhagopian, R. P., Giron, G. L., et al. (2015) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000020 · Cited by 108 · see citing works
Tailoring cognitive-behavioral treatment for cancer pain
Dalton, J. A., Keefe, F. J., Carlson, J. S., & Youngblood, R. (2004) · Pain Management Nursing · doi:10.1016/s1524-9042(03)00027-4 · Cited by 105 · see citing works
Mosher, C. E., Secinti, E., Li, R., Hirsh, A. T., Bricker, J., Miller, K. D., Schneider, B., Storniolo, A. M., Mina, L., Newton, E. V., et al. (2018) · Supportive Care in Cancer · doi:10.1007/s00520-018-4045-0 · Cited by 95 · see citing works
Syrjala, K. L., Abrams, J. R., Polissar, N. L., Hansberry, J., Robison, J., DuPen, S., Stillman, M. J., Fredrickson, M. G., Rivkin, S. E., Feldman, E., et al. (2008) · Pain · doi:10.1016/j.pain.2007.10.026 · Cited by 88 · see citing works
The Use of Acceptance and Commitment Therapy in Oncology Settings: A Narrative Review
Fashler, S. R., Weinrib, A. Z., Azam, M. A., & Katz, J. (2018) · Psychological Reports · doi:10.1177/0033294117726061 · Cited by 80 · see citing works
Guidry, J. J., Fagan, P., & Walker, V. (1998) · PubMed · Cited by 78 · see citing works
Somers, T. J., Abernethy, A. P., Edmond, S. N., Kelleher, S. A., Wren, A. A., Samsa, G., & Keefe, F. J. (2015) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2015.04.013 · Cited by 77 · see citing works
Self-citationTeo, P., Mehta, K. K., Thang, L. L., & Chan, A. W.-M. (2006) · Routledge eBooks · doi:10.4324/9780203966921 · Cited by 57 · see citing works
Somers, T. J., Kelleher, S. A., Westbrook, K. W., Kimmick, G. G., Shelby, R. A., Abernethy, A. P., & Keefe, F. J. (2016) · Pain Research and Treatment · doi:10.1155/2016/2473629 · Cited by 53 · see citing works
Self-citationSerfaty, M., Armstrong, M., Vickerstaff, V., Davis, S., Gola, A., McNamee, P., Omar, R. Z., King, M., Tookman, A., Jones, L., et al. (2019) · Psycho-Oncology · doi:10.1002/pon.4960 · Cited by 50 · see citing works
Ageing in Singapore: Service Needs and the State
Teo, P. (2006) · Cited by 49 · see citing works
Garcia, S. F., Rosenbloom, S. K., Beaumont, J. L., Merkel, D. E., Roenn, J. H. V., Rao, D., & Cella, D. F. (2011) · Value in Health · doi:10.1016/j.jval.2011.08.1739 · Cited by 43 · see citing works
Trajectories of the Multidimensional Dying Experience for Terminally Ill Cancer Patients
Tang, S. T., Liu, L. N., Lin, K., Chung, J.-H., Hsieh, C., Chou, W.-C., & Su, P. (2014) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2014.01.011 · Cited by 42 · see citing works
Somers, T. J., Kelleher, S. A., Dorfman, C. S., Shelby, R. A., Fisher, H. M., Rowe Nichols, K., Sullivan, K. M., Chao, N. J., Samsa, G. P., Abernethy, A. P., et al. (2018) · JMIR mHealth and uHealth · doi:10.2196/mhealth.8565 · Cited by 40 · see citing works
Self-citationYang, G. M., Teo, I., Neo, S. H., Tan, D. S. W., & Cheung, Y. B. (2018) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909118756095 · Cited by 17 · see citing works
Self-citation
Flagged first, then by citations
1 of the 39 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Psychoeducation for breast cancer: A systematic review and meta-analysis
Setyowibowo, H., Yudiana, W., Hunfeld, J. A. M., Iskandarsyah, A., Passchier, J., Arzomand, H., Sadarjoen, S. S., de Vries, R., & Sijbrandij, M. (2022) · The Breast · doi:10.1016/j.breast.2022.01.005 · Cited by 74 · see citing works
Ostovar, S., Chahardehi, A. M., Hashim, I. H. M., Othman, A., Kruk, J., & Griffiths, M. D. (2022) · European Journal of Cancer Care · doi:10.1111/ecc.13669 · Cited by 50 · see citing works
Danon‐Hersch, N., Al‐Gobari, M., Burnand, B., & Rodondi, P. (2021) · Psycho-Oncology · doi:10.1002/pon.5821 · Cited by 51 · see citing works
Review of Psychological Interventions in Oncology: Current Trends and Future Directions
Anghel, T., MELANIA, B. L., Costea, I., Albai, O., Marinca, A., Levai, C. M., & Hogea, L. (2025) · Medicina · doi:10.3390/medicina61020279 · Cited by 41 · see citing works
Cancer patients’ participation and commitment to psychological interventions: a scoping review
Savioni, L., Triberti, S., Durosini, I., Sebri, V., & Pravettoni, G. (2021) · Psychology and Health · doi:10.1080/08870446.2021.1916494 · Cited by 38 · see citing works
Plumb Vilardaga, J. C., Winger, J. G., Teo, I., Owen, L., Sutton, L. M., Keefe, F. J., & Somers, T. J. (2020) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2019.09.005 · Cited by 36 · see citing works
Self-citationYuan, Y., Lü, L., Xie, C., Lu, Y., Liang, J., Qi, Y., Dong, B., Chen, Q., Fang, Q., & Tian, L. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.04.152 · Cited by 27 · see citing works
Vrdoljak, E., Gligorov, J., Wierinck, L., Conte, P., Grève, J. D., Meunier, F., Palmieri, C., Travado, L., Walker, A., Wiseman, T., et al. (2020) · The Breast · doi:10.1016/j.breast.2020.12.005 · Cited by 26 · see citing works
Teo, I., Tan, Y. P., Finkelstein, E. A., Yang, G. M., Pan, F. T., Lew, H. Y. F., Tan, E., Ong, S. Y. K., & Cheung, Y. B. (2020) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2020.06.016 · Cited by 22 · see citing works
Self-citationWinger, J. G., Ramos, K., Kelleher, S. A., Somers, T. J., Steinhauser, K. E., Porter, L. S., Kamal, A. H., BREITBART, W. S., & Keefe, F. J. (2021) · Journal of Palliative Medicine · doi:10.1089/jpm.2021.0081 · Cited by 22 · see citing works
Self-citationNursing, psychotherapy and advanced cancer: A scoping review
Malakian, A., Mohammed, S., Fazelzad, R., Ajaj, R., Artemenko, A., & Mayo, S. J. (2021) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2021.102090 · Cited by 21 · see citing works
Psychological Intervention and Breast Cancer
Ashton, K., & Oney, K. (2024) · Current Breast Cancer Reports · doi:10.1007/s12609-024-00559-w · Cited by 21 · see citing works
“Cross-cultural groups in the United States and Singapore both showed significant improvement in anxiety, depression, and fatigue scores after exposure to a 4-session, mindfulness-based treatment in a 2020 pilot RCT [31].”
Zimbrean, P. C., Ernst, C. L., Forray, A., Beach, S. R., Lavakumar, M., Siegel, A. M., Soeprono, T. M., & Schwartz, A. C. (2020) · Psychosomatics · doi:10.1016/j.psym.2020.05.004 · Cited by 14 · see citing works
Stadnyk, A., Casimiro, H. J., & Reis-Pina, P. (2023) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/10499091231190879 · Cited by 12 · see citing works
Vilardaga, J. P., Kelleher, S. A., Diachina, A. K., Riley, J. A., & Somers, T. J. (2022) · Pilot and Feasibility Studies · doi:10.1186/s40814-022-01121-0 · Cited by 13 · see citing works
Self-citationWu, Y., Pan, J., Lü, Y., Chao, J., & Yu, H. (2022) · Palliative & Supportive Care · doi:10.1017/s1478951522000694 · Cited by 10 · see citing works
Beatty, L., Kemp, E., Butow, P. N., Girgis, A., Hulbert-Williams, N., Kaambwa, B., Schofield, P. E., Turner, J., Woodman, R. J., Boyle, F. M., et al. (2022) · BMC Cancer · doi:10.1186/s12885-022-10410-z · Cited by 9 · see citing works
Biener, S. N., Høeg, B. L., Saltbæk, L., Dalton, S. O., Johansen, C., Karlsen, R. V., Belmonte, F., Zoffmann, V., & Bidstrup, P. E. (2025) · Acta Oncologica · doi:10.2340/1651-226x.2025.42253 · Cited by 6 · see citing works
Mikkonen, H., Hökkä, M., Saarto, T., Stenberg, J.-H., & Junttila, K. (2025) · BMJ Supportive & Palliative Care · doi:10.1136/spcare-2024-005043 · Cited by 5 · see citing works
Nursing Interventions for Symptom Management in Breast Cancer: A Systematic Review
Yanny Trisyani, W., Nuraeni, A., Anna, A., Priambodo, A. P., & Sugiharto, F. (2026) · International Journal of Women s Health · doi:10.2147/ijwh.s573338 · Cited by 5 · see citing works
Ong, S., Loh, T., Wong, P. Z. E., & Teo, I. (2023) · Palliative & Supportive Care · doi:10.1017/s1478951523000299 · Cited by 4 · see citing works
Self-citationPsychoeducational and Psychological Distress Levels in Women with Breast Cancer: A Systematic Review
Mustikaningsih, D., Prajoko, Y. W., Anggorowati, A., Wilandika, A., Utomo, S. F. P., & Alamsyah, R. M. (2024) · The Malaysian Journal of Nursing · doi:10.31674/mjn.2024.v15i04.020 · Cited by 4 · see citing works
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Teo, I., Tan, Y. P., Goh, A., Pan, F. T., Tan, T. J., Özdemir, S., Cheung, Y. B., Chaudhry, I., Razali, N. S., & Tewani, K. G. (2024) · Psycho-Oncology · doi:10.1002/pon.70037 · Cited by 4 · see citing works
Self-citationYang, M., He, P., Xu, X., Wang, J., Wang, Y., Liu, K., Wen, L., Xiao, X., Yuqing, H., Tang, W., et al. (2020) · doi:10.21203/rs.3.rs-27400/v1 · Cited by 4 · see citing works
Li, X., Jia, F., Wu, P., & Wen, Q. (2026) · Current Oncology Reports · doi:10.1007/s11912-026-01734-1 · Cited by 3 · see citing works
Saragih, I. S., Tarihoran, D. E. T. A. U., Tzeng, H., & Saragih, I. D. (2026) · Journal of research in nursing · doi:10.1177/17449871261419719 · Cited by 3 · see citing works
Sánchez-Castro, S., Pueyo‐Garrigues, M., Canga‐Armayor, N., Alfaro‐Díaz, C., Lavilla‐Gracia, M., & Esandi, N. (2026) · Seminars in Oncology Nursing · doi:10.1016/j.soncn.2026.152242 · Cited by 2 · see citing works
Cognitive behavioural interventions for palliative care in adult patients: A scoping review
Wilaras, A. (2024) · Progress in Palliative Care · doi:10.1080/09699260.2024.2408127 · Cited by 2 · see citing works
Winger, J. G., Kelleher, S. A., Yu, J. A., Ma, J. E., Majestic, C. M., Martinson, E. B., Olsen, M. K., Lerebours, R. C., Sutton, L., & Somers, T. J. (2025) · Contemporary Clinical Trials · doi:10.1016/j.cct.2025.108053 · Cited by 1 · see citing works
Self-citationNeo, S. H., Ong, W. S., Liao, K., Sim, D. K.-L., Ng, E. S.-L., Foo, C., Yang, G. M., Dionne-Odom, J. N., Bakitas, M. A., & Cheung, Y. B. (2026) · BMJ Open · doi:10.1136/bmjopen-2025-113749 · Cited by 1 · see citing works
Self-citationMa, X., & Cheung, Y. B. (2023) · Journal of Biopharmaceutical Statistics · doi:10.1080/10543406.2023.2275755 · Cited by 1 · see citing works
Self-citationO efeito do reiki no manejo de sintomas de pessoas em cuidados paliativos oncológicos
Souza, S. D. F. (2021) · Digital Library of Theses and Dissertations (Universidade de São Paulo) · doi:10.11606/d.22.2021.tde-07052021-153220 · Cited by 1 · see citing works
Vilardaga, J. P., Kelleher, S. A., Diachina, A. K., Riley, J. A., & Somers, T. J. (2022) · Research Square · doi:10.21203/rs.3.rs-1182374/v1 · Cited by 1 · see citing works
Self-citationda Silva, J. C., Silva, H. F., Magalhães, I. B. M., Gomes, J. Y. H., de Alencar, N. B. M., & Fiorelli, S. K. A. (2024) · International Journal of Health Science · doi:10.22533/at.ed.1594772417089
Beatty, L., Kemp, E., Butow, P. N., Girgis, A., Hulbert-Williams, N., Kaambwa, B., Schofield, P. E., Turner, J., Woodman, R. J., Boyle, F. M., et al. (2023) · Figshare · doi:10.6084/m9.figshare.22606379
Mapping programmes for mental health promotion in Singapore: A scoping review
Asharani, P. V., Ong, X. E., Karuvetil, M. Z., Chen, C. S. M., Ther, L., Cheng, L., Subramaniam, M., & Liu, T. (2026) · PLoS ONE · doi:10.1371/journal.pone.0347518
Langer, D., Hillel, S., & Erez, A. B.-H. (2026) · OTJR Occupational Therapy Journal of Research · doi:10.1177/15394492261466170
- Authors
- Teo, I., Vilardaga, J. P., Tan, Y. P., Winger, J., Cheung, Y. B., Yang, G. M., Finkelstein, E. A., Shelby, R. A., Kamal, A. H., Kimmick, G., & Somers, T. J.
- Affiliations
- Duke-NUS Medical School (SG)
- Duke University (US)
- National Cancer Centre Singapore (SG)
- Tampere University (FI)
- Corresponding author
- Teo, Irene
- ORCID
- Venue
- Psycho-Oncology
- Publisher
- Wiley
- Published
- 2019-11-19
- Volume
- 29
- Issue
- 2
- Pages
- 389-397
- ISSN
- 1057-9249 (ISSN-L)
- 1099-1611
- OpenAlex
- W2987217785
- Cited by
- 37
- References
- 39
- Citations by year
- 2026: 7 · 2025: 4 · 2024: 5 · 2023: 4 · 2022: 7 · 2021: 5 · 2020: 4 · 2019: 1
- FWCI
- 1.77
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psycho-Oncology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Keywords
- advanced breast cancer, psychosocial interventions, symptom management, cognitive behavioral therapy, mindfulness, cross-cultural adaptation, feasibility, acceptability, distress, pain, fatigue, anxiety, depression, intervention adherence
- MeSH terms
- Adult, Anxiety, Breast Neoplasms, Depression, Fatigue, Female, Humans, Middle Aged, Palliative Care, Self Care, Severity of Illness Index, Singapore, United States, Treatment Outcome, Self Efficacy, Mindfulness
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