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Purpose: As breast cancer is transforming into a chronic illness, patient selfmanagement is more important. An indicator of self-management is patient activation, defined as the knowledge, skills, and confidence a person has to manage their health and well-being. This study aimed to identify sociodemographic, clinical, and symptom experience factors associated with patient activation in breast cancer patients over time. Methods: Data from the ADAPT study were used for secondary analysis. Patient activation was measured using the Patient Activation Measure 13, at baseline, six weeks, three months, six months, and one year from diagnosis. Linear mixed-effects regression was used to analyze the repeated PAM-13 scores. Fixed effects included age, educational level, partner/children status, comorbidities, tumor and lymph node stage, receptor status, psychological distress, fatigue, and physical functioning. Results: Mean PAM-13 scores ranged from 59.3–63.2 across all time points. Psychological distress was negatively associated with patient activation over time. Other patient characteristics, tumor details, fatigue, and physical functioning were not associated. Conclusion: Patient activation is relatively high in early-stage breast cancer patients. Identifying individuals experiencing psychological distress would allow healthcare providers to target interventions effectively, potentially enhancing the efficiency of long-term breast cancer care.

Purpose: This study reports the findings from the ADAPT randomized controlled trial (RCT), concerning the impact of a digital tool for supported self-management in people affected by breast cancer on patient activation as the primary outcome, with health-related quality of life (HRQoL), and health status as secondary outcomes. Methods: Women with early-stage breast cancer were randomly assigned to standard care (control) or standard care in addition to the breast cancer digital tool (intervention). Data were collected using a demographic questionnaire, the Patient Activation Measure (PAM-13), the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30), and the EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L) at baseline, 6 weeks, 3 months, 6 months, and 1 year from diagnosis. Linear mixed effect model regression was used to assess the effect of the digital tool over the first year from diagnosis while correcting for intra-participant correlation. Results: A total of 166 participants were included, with 85 being randomized into the intervention. No significant differences (p > 0.05) in the PAM-13 scores, EORTC QLQ-C30 scales (global QoL, physical functioning, emotional functioning, pain, fatigue), and EQ-5D-5L Index between the control and intervention groups were observed. It is important to note that there was significant non-adherence within the intervention group. Conclusion: The breast cancer digital tool had no statistically significant impact on patient activation, HRQoL, and health status over time compared to standard care alone in women with early-stage breast cancer. Future research should focus on identifying and addressing barriers to digital tool engagement to improve efficacy. Clinical trial information The study was registered at https://clinicaltrials.gov (NCT03866655) on 7 March 2019 (https://clinicaltrials.gov/study/NCT03866655).