Enhancing patient-centred approaches to optimise early-breast cancer care: A review of current practice and opportunities for improvement in Singapore

May 01, 2023


Early-breast cancer care in Singapore

May 01, 2023

Emily Tiemann


Emily is a Manager with Economist Impact’s Health Policy Team. She works with global clients, developing and delivering evidence-based health policy projects across a wide range of priority areas. Prior to joining the Economist Group, Emily worked in private healthcare in Canada followed by health policy and regulation in the UK, managing strategic programs and policy reviews, and working closely with the Department of Health. 

Emily holds a Master’s degree in Women’s Health from University College London and a degree in Biology from McGill University.

“Enhancing patient-centred approaches to optimise early-breast cancer care: a review of current practice and opportunities for improvement in Singapore” is a research report by Economist Impact sponsored by MSD, which examines the existing breast cancer care pathway in Singapore and the factors that help or hinder the goal of achieving optimal patient-centred care.

Breast cancer is the most common cancer and leading cause of cancer death among women in Singapore. Incidence is also rapidly increasing, and the age-standardised incidence rate had risen from 20.1 per 100,000 population in 1968- 1972 to 73.8 per 100,000 population in 2016-2020; this accounts for a 3.5 times increase.

Breast cancer diagnosed at an early stage, when it is not too large and has not spread, is more likely to be treated successfully than breast cancer diagnosed at an advanced stage. In Singapore, a high proportion of women are diagnosed at later stages, with 10.9% being diagnosed at Stage IV between 2018-2020. Advanced breast cancer not only creates an urgent health challenge but also impedes quality of life, and brings significant economic costs for patients, their families and public health systems.

There are significant opportunities to improve breast cancer care in Singapore by understanding the patient-centred care pathway for early breast cancer diagnosis and treatment and investigating the unmet needs in managing breast cancer.

Using an evidence-based approach that incorporates a review of existing data and an expert panel meeting, we designed a force field analysis to assess existing policies and system performance across four domains of the patient journey: population awareness, screening and diagnosis, treatment, and survivorship.

Indicators within each domain were selected based on evidence of their impact on promoting or deterring optimisation of patient-centred care for early breast cancer. We then conducted a workshop to discuss our findings and gain the perspective of key experts in Singapore to flesh out key opportunities for improvement. We drafted scores for indicators within these four domains based on our research and insights from the workshop. This report combines in-depth research and force field analysis of early breast cancer care in Singapore.

Key findings:

  • Population awareness: Awareness of breast cancer and education are critical to promote increased participation in preventive care measures such as self-examination of breasts and screening, and Singapore advocacy groups play an important role.  However, lack of knowledge about the disease and poor patient-provider communication have been highlighted as barriers towards achieving patient-centred care.
  • Screening and Diagnosis: While Singapore has a robust breast cancer screening programme, low participation rates persist, particularly among women of Malay ethnicity, and cancers are often diagnosed at late stages. Targeted health campaigns to increase screening rates could help bridge this gap. International guidelines are used to guide local practice which helps ensure that global best standards are adopted, though a need for increased focus on genetic testing and counselling has been identified.
  • Treatment: Efficient navigation of services and generous financial assistance schemes contribute to driving better patient-centred early breast cancer care in Singapore. However, the lack of a meaningful patient voice in reimbursement decisions as well as poor integration of multidisciplinary teams in cancer care were identified as barriers.
  • Survivorship: The number of survivors among patients with breast cancer in Singapore has been increasing steadily, and support groups for early breast cancer survivors in Singapore play an important role in helping patients to cope by providing interaction and comfort. However, the lack of professional survivorship care programmes can be a barrier towards achieving patient-centred care.

We conclude with the following opportunities to optimise early breast cancer care and improve outcomes for people with early breast cancer in Singapore:

  1. Drive self-responsibility for health: There are barriers preventing Singaporeans from taking greater personal responsibility for their health and in order to increase screening rates, the first step is for women to prioritise themselves and their health.
  2. Shift focus from curative to preventative: Singapore’s rapidly ageing society means that the burden of cancer will continue to increase. Focusing efforts and resources on prevention and increasing knowledge of risk factors would encourage earlier detection, reduce costs for both health systems and individuals, and help save lives.
  3. Come together with a consistent message: Promoting more collaboration and partnership among stakeholders and encouraging a unified voice to share the same message could help uncover political influence, and effect change for patients with early breast cancer in Singapore.

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