A self-help intervention for reducing time to diagnosis in Indonesian women with breast cancer symptoms

Hari Setyowibowo*, Joke A.M. Hunfeld, Aulia Iskandarsyah, Whisnu Yudiana, Jan Passchier, Sawitri S. Sadarjoen, Dharmayanti F. Badudu, Drajat R. Suardi, Edith van‘t Hof, Marit Sijbrandij

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

5 Citations (Scopus)
12 Downloads (Pure)


Objective: We investigated the effectiveness of a self-help intervention named PERANTARA, which aims to improve adherence to diagnostic procedures among women with breast cancer (BC) symptoms to reduce the time to a definitive diagnosis. Methods: With a cluster randomized crossover design across four hospitals, PERANTARA and treatment as usual (TAU) or TAU only was provided at successive periods in a randomly determined order. The main outcome was the time between the first medical consultation and the definitive diagnosis. Secondary outcomes were BC knowledge, measured by the Breast Cancer Knowledge Test (BCKT); symptoms of anxiety and depression, measured by the Hospital Anxiety and Depression Scale (HADS); quality of life, measured by the World Health Organization Quality of Life-BREF (WHOQOL-BREF); and health status, measured by the EQ-5D-5L. A linear mixed model analysis was conducted to analyse the outcomes. Results: We recruited 132 women with BC symptoms from four hospitals; 67 participants were in the intervention group, and 65 participants were in the control group. PERANTARA reduced the time to definitive diagnosis by 13.3 days (M [SD]: 25.90 [23.20] in the intervention group vs 39.29 [35.10] in the control group; mean difference = −13.26, 95% CI = −24.51 to −2.00, P =.02). No significant difference was found between the groups in BC knowledge, symptoms of anxiety, depression, quality of life, or health status. Conclusions: PERANTARA reduced the time to definitive diagnosis among Indonesian women with BC symptoms. Psychoeducation may be an important addition to regular BC care to prevent undue delays in diagnostic procedures.

Original languageEnglish
Pages (from-to)696-702
Number of pages7
Issue number4
Publication statusPublished - 1 Apr 2020

Bibliographical note

Funding Information:
We thank the staff at Al Ihsan Hospital, Al Islam Hospital, Dr. Salamun Hospital, and Cibabat Hospital for their support in data collection. This study was financed by the KWF (the Dutch Cancer Society: number VU 2012-557). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Publisher Copyright:
© 2019 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd.


Dive into the research topics of 'A self-help intervention for reducing time to diagnosis in Indonesian women with breast cancer symptoms'. Together they form a unique fingerprint.

Cite this