Discussion
depression, anxiety
BREAST CANCER
Nurse navigation and systematic screening for symptoms provided in the REBECCA intervention showed promise in reducing several psychological symptoms and increasing quality of life. Reduced, but not significant, intervention effects were observed for the primary outcome of distress, and significant effects were observed for symptoms of depression and breast cancer–specific HRQOL. Additionally, nonsignificant effects were found for symptoms of anxiety and patient activation. The intervention effects did not meet the established MIDs, and small to moderate effect sizes were observed (ES = 0.21-0.31). In the pilot RCT (n = 50), significant improvements in distress were found after 12 months. That the effect on distress was not significant has no obvious explanation, but a possible reason is that the effect was especially pronounced in patients with few resources, as we found significant effects at all follow-up periods for patients with fewer than 12 years of education and for patients with low patient activation.