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Psychologically vulnerable breast cancer patients with less education, low social support, low patient activation, and younger age benefited most from nurse navigation intervention.

Breast cancer patients with high levels of distress at the time of diagnosis tend to be at risk for physical symptoms and long-term distress. This randomized controlled trial (RCT) evaluated whether breast cancer patients receiving the Rehabilitation After Breast Cancer (REBECCA) intervention attained beneficial effects on psychological distress and other health measures. The findings are published in the journal JAMA Network Open.

Baseline Characteristics

This parallel RCT recruited 309 female breast cancer patients, of whom 153 were randomized to the usual care group and 156 to the intervention group.

Changes in Distress, Depression, and Anxiety

The largest reduction in distress in the intervention group patients was observed at 12 months of follow-up; however, the decrease in distress level was not significant. Health-related quality of life concerning breast cancer and depression was significantly reduced at 12 months and 6 months, respectively. There were no significant changes in the anxiety symptoms at 6 and 12 months of follow-up.

Changes in Other Health Measures

There were no significant changes in patient activation, fear of recurrence, cognitive function, health behavior, sleep, or unmet needs for support at 18 months of follow-up

Effects of Nurse Navigation Intervention in Subgroups

The effects of nurse navigation intervention were relatively stronger for vulnerable breast cancer patients, which included patients ≥ 60 years of age, and those with low social support, less patient activation, and less education. Patient satisfaction was calculated to be 91%, and the trial reported no harmful effects of the intervention.

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The effects of nurse navigation intervention were relatively stronger for psychologically vulnerable breast cancer patients who had less education, less social support, low patient activation, and were of younger age; however, no significant improvement in distress was reported in this study.


Bidstrup, P. E., Johansen, C., Kroman, N., Belmonte, F., Duriaud, H., Dalton, S. O., Andersen, K. G., & Mertz, B. (2023). Effect of a Nurse Navigation Intervention on Mental Symptoms in Patients With Psychological Vulnerability and Breast Cancer. JAMA Network Open, 6(6), e2319591. https://doi.org/10.1001/jamanetworkopen.2023.19591