cancer in the elderly - National Cancer Centre Singapore
cancer in the elderly - National Cancer Centre Singapore cancer in the elderly - National Cancer Centre Singapore
Issue No. 24 • MICA (P) 061/10/2010 AN NCCS QUARTERLY PUBLICATION January – March 2013 ...HELPING READERS TO ACHIEVE GOOD HEALTH Salubris is a Latin word which means healthy, in good condition (body) and wholesome. CANCER IN THE ELDERLY - TO TREAT OR NOT TO TREAT?
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Issue No. 24 • MICA (P) 061/10/2010<br />
AN NCCS QUARTERLY PUBLICATION<br />
January – March 2013<br />
...HELPING READERS TO ACHIEVE GOOD HEALTH<br />
Salubris is a Lat<strong>in</strong> word which means healthy, <strong>in</strong> good condition (body) and wholesome.<br />
CANCER IN THE<br />
ELDERLY - TO TREAT<br />
OR NOT TO TREAT?
2 SALUBRIS JANUARY – MARCH 2013 SALUBRIS JANUARY – MARCH 2013 3<br />
CANCER IN THE ELDERLY<br />
DR RAVINDRAN KANESVARAN<br />
Associate Consultant<br />
Department of Medical Oncology, NCCS<br />
Madam L, 85 years old, found a small lump <strong>in</strong> her breast. She ignored it. She<br />
thought it was normal after menopause. Besides it didn’t seem to bo<strong>the</strong>r her.<br />
Six months later, she noticed <strong>the</strong> lump had grown and she started to worry.<br />
Shy to see a doctor, she went for a traditional massage <strong>in</strong>stead, hop<strong>in</strong>g <strong>the</strong><br />
lump would disappear. Instead, <strong>the</strong> lump got bigger and <strong>the</strong>re was blood<br />
com<strong>in</strong>g out from <strong>the</strong> nipple. Alarmed, she went to a doctor and her worst<br />
fears were confirmed. She was diagnosed as hav<strong>in</strong>g locally advanced breast<br />
<strong>cancer</strong> and she was advised to undergo surgery followed by chemo<strong>the</strong>rapy<br />
and radiation as part of her treatment. Prior to this diagnosis, she was a<br />
very healthy and physically active person who attended aerobics classes!<br />
However she and her family felt she was too old to undergo such procedures.<br />
Is chronological age alone a good guide to decide on someth<strong>in</strong>g like this?<br />
AN AGING SOCIETY<br />
S<strong>in</strong>gapore is fast becom<strong>in</strong>g an age<strong>in</strong>g society. By <strong>the</strong> year<br />
2030, more than 20% of <strong>the</strong> local population will be<br />
considered geriatric based on <strong>the</strong> World Health Organisation<br />
cut off of above 65 years old. There are many implications to<br />
hav<strong>in</strong>g an age<strong>in</strong>g population, one of it be<strong>in</strong>g that more chronic<br />
diseases are associated with it. As we age, cardiovascular<br />
diseases, stroke and <strong>cancer</strong> become more common. Four out<br />
of five persons aged 65 years and above will have one or more<br />
chronic diseases. Once acquired, <strong>the</strong>se chronic conditions can<br />
lead to significant morbidity and eventually mortality.<br />
CANCER IN SINGAPORE<br />
<strong>Cancer</strong> is <strong>the</strong> lead<strong>in</strong>g cause of death <strong>in</strong> S<strong>in</strong>gapore. Twenty<br />
eight people are diagnosed with <strong>cancer</strong> every day <strong>in</strong><br />
S<strong>in</strong>gapore. One <strong>in</strong> four S<strong>in</strong>gaporeans die of <strong>cancer</strong>. The most<br />
common <strong>cancer</strong> diagnosed <strong>in</strong> males is colorectal <strong>cancer</strong> while<br />
<strong>the</strong> commonest <strong>cancer</strong> afflict<strong>in</strong>g females is breast <strong>cancer</strong><br />
(S<strong>in</strong>gapore <strong>Cancer</strong> Registry 2006-2010). Data shows that, as<br />
one grows older, <strong>the</strong> potential for develop<strong>in</strong>g <strong>cancer</strong> <strong>in</strong>creases.<br />
About 60% of malignant (harmful) tumours occur <strong>in</strong> <strong>the</strong> age group<br />
65 years and older. Older persons are also 11 times more likely to<br />
develop a <strong>cancer</strong> than persons under <strong>the</strong> age of 65.<br />
TREATMENT FOR CANCER<br />
Treatment for <strong>cancer</strong> varies, depend<strong>in</strong>g on its extent and<br />
severity. It takes <strong>the</strong> follow<strong>in</strong>g forms: surgery to remove <strong>the</strong><br />
<strong>cancer</strong>, chemo<strong>the</strong>rapy by <strong>in</strong>fus<strong>in</strong>g medication <strong>in</strong>to <strong>the</strong> blood to<br />
kill <strong>the</strong> <strong>cancer</strong>ous cells, radio<strong>the</strong>rapy for direct<strong>in</strong>g radiation to<br />
<strong>the</strong> <strong>cancer</strong>ous tissues, and molecular targeted <strong>the</strong>rapy which<br />
are medic<strong>in</strong>es that specifically home <strong>in</strong> on <strong>cancer</strong> cells that<br />
have a particular marker. Each of <strong>the</strong>se <strong>the</strong>rapies has <strong>the</strong>ir list<br />
of side effects. These effects may not be as well tolerated <strong>in</strong> <strong>the</strong><br />
<strong>elderly</strong> as compared to <strong>the</strong> young. It is fears like this that have<br />
discouraged many <strong>elderly</strong> patients from undergo<strong>in</strong>g <strong>cancer</strong><br />
treatment. The reality is that even amongst <strong>the</strong> <strong>elderly</strong>, <strong>the</strong>re<br />
is heterogeneity <strong>in</strong> ag<strong>in</strong>g which translates to heterogeneity <strong>in</strong><br />
terms of <strong>the</strong>ir ability to tolerate treatment effects. As such <strong>the</strong>y<br />
should not rule <strong>the</strong>mselves out from undergo<strong>in</strong>g treatment<br />
based on <strong>the</strong>ir age alone. Many o<strong>the</strong>r factors should also be<br />
taken <strong>in</strong>to consideration.<br />
HOW TO ASSESS TREATMENT<br />
FITNESS IN THE ELDERLY<br />
Although much progress has been made <strong>in</strong> <strong>the</strong><br />
development of newer, more effective <strong>the</strong>rapeutic<br />
modalities for <strong>cancer</strong>, very little of <strong>the</strong>se studies<br />
were done <strong>in</strong> <strong>the</strong> <strong>elderly</strong>. As such, little is known on<br />
who to treat and how best to treat this large group of<br />
<strong>cancer</strong> patients. Currently, many treatment decisions<br />
are based on chronological age and <strong>the</strong> patient’s<br />
performance status (us<strong>in</strong>g scales like <strong>the</strong> Eastern<br />
Co-operative Oncology Group (ECOG) functional<br />
status scale). Performance status refers to <strong>the</strong> ability<br />
of <strong>the</strong> patient to mobilise and to perform activities of<br />
daily liv<strong>in</strong>g. This method has time and aga<strong>in</strong> shown<br />
to be a poor predictor of a <strong>cancer</strong> patient’s ability to<br />
tolerate treatment. Hence, <strong>in</strong> order to improve on this,<br />
oncologists tak<strong>in</strong>g <strong>the</strong> cue from geriatricians have<br />
<strong>in</strong>corporated <strong>the</strong> use of a comprehensive geriatric<br />
assessment (CGA) <strong>in</strong> <strong>the</strong>ir assessment of <strong>the</strong>se patients.<br />
The CGA consists of a number of doma<strong>in</strong>s. It typically<br />
consists of assessment of a patient’s functional<br />
status, co-morbid medical conditions, cognition,<br />
psychological state, social support, nutritional status<br />
and review of <strong>the</strong> medications taken by <strong>the</strong> patient<br />
(poly-pharmacy). Each of <strong>the</strong>se <strong>in</strong>dividual doma<strong>in</strong>s<br />
has been shown <strong>in</strong> many studies to be predictive of<br />
survival <strong>in</strong> <strong>elderly</strong> <strong>cancer</strong> patients. In a relatively large<br />
study conducted <strong>in</strong> NCCS two years ago, we found<br />
certa<strong>in</strong> factors like age, stage of disease, nutritional<br />
status, ECOG performance status, album<strong>in</strong> level <strong>in</strong><br />
<strong>the</strong> blood and <strong>the</strong> geriatric depression scale to be<br />
predictive of survival. These factors <strong>in</strong> comb<strong>in</strong>ation<br />
were made <strong>in</strong>to a tool to help survival prediction <strong>in</strong><br />
<strong>cancer</strong> patients with ra<strong>the</strong>r good accuracy. This study<br />
was published <strong>in</strong> <strong>the</strong> <strong>in</strong>fluential Journal of Cl<strong>in</strong>ical<br />
Oncology last year.<br />
The use of <strong>the</strong> CGA has been found not only to<br />
better predict survival <strong>in</strong> <strong>elderly</strong> <strong>cancer</strong> patients but<br />
also has also shown to predict <strong>the</strong>ir toxicity from<br />
chemo<strong>the</strong>rapy as well. Aga<strong>in</strong>, <strong>the</strong> use of <strong>the</strong> CGA has<br />
shown that it is important to assess <strong>the</strong> <strong>elderly</strong> <strong>cancer</strong><br />
patient holistically and not merely base <strong>the</strong>ir treatment<br />
tolerance on age alone.<br />
Unfortunately CGA use <strong>in</strong> <strong>the</strong> cl<strong>in</strong>ics is limited by<br />
a number of factors <strong>in</strong>clud<strong>in</strong>g its time consum<strong>in</strong>g<br />
nature. As such researchers are currently work<strong>in</strong>g<br />
hard at com<strong>in</strong>g up with shorter and more user friendly<br />
versions of this tool. In NCCS, <strong>the</strong> use of <strong>the</strong> CGA is<br />
still limited to a few select cl<strong>in</strong>ics on a research basis.<br />
We hope to someday extend this to all our <strong>elderly</strong><br />
<strong>cancer</strong> patients.<br />
<strong>Cancer</strong> is a journey, but you walk <strong>the</strong><br />
road alone. There are many places to stop<br />
along <strong>the</strong> way and get nourishment -<br />
you just have to be will<strong>in</strong>g to take it.<br />
EMILY HOLLENBERG
4 SALUBRIS JANUARY – MARCH 2013 SALUBRIS JANUARY – MARCH 2013 5<br />
SEMINARS / FORUMS / TUMOUR BOARDS /<br />
SMC-CME ACTIVITIES<br />
For Medical Professionals<br />
SEMINARS / FORUMS / TUMOUR BOARDS /<br />
SMC-CME ACTIVITIES<br />
For Medical Professionals<br />
FEBRUARY 2013<br />
MARCH 2013<br />
Date Time Event Information CME Pt Registration Contact<br />
Date Time Event Information CME Pt Registration Contact<br />
1, 8, 15, 22<br />
6, 13, 20, 27<br />
6, 13, 20, 27<br />
4, 18, 25<br />
5.00 pm<br />
4.30 pm<br />
5.00 pm<br />
5.00 pm<br />
NCCS Tumour Board Meet<strong>in</strong>gs<br />
Breast Tumour Board Meet<strong>in</strong>g<br />
Sarcoma Tumour Board Meet<strong>in</strong>g<br />
General Surgery Tumour Board Meet<strong>in</strong>g<br />
Head & Neck Tumour Board Meet<strong>in</strong>g<br />
@ NCCS Level 2, Cl<strong>in</strong>ic C, Discussion Room<br />
1<br />
1<br />
1<br />
1<br />
V. Kalai / Lim Shufen<br />
6436 8294 / 6436 8283<br />
nsokal@nccs.com.sg /<br />
dsolsf@nccs.com.sg<br />
1, 8, 15, 22<br />
6, 13, 20, 27<br />
6, 13, 20, 27<br />
4, 11, 18, 25<br />
5.00 pm<br />
4.30 pm<br />
5.00 pm<br />
5.00 pm<br />
NCCS Tumour Board Meet<strong>in</strong>gs<br />
Breast Tumour Board Meet<strong>in</strong>g<br />
Sarcoma Tumour Board Meet<strong>in</strong>g<br />
General Surgery Tumour Board Meet<strong>in</strong>g<br />
Head & Neck Tumour Board Meet<strong>in</strong>g<br />
@ NCCS Level 2, Cl<strong>in</strong>ic C, Discussion Room<br />
1<br />
1<br />
1<br />
1<br />
V. Kalai / Lim Shufen<br />
6436 8294 / 6436 8283<br />
nsokal@nccs.com.sg /<br />
dsolsf@nccs.com.sg<br />
5, 19, 26 5.15 pm<br />
Weekly Comb<strong>in</strong>ed Cl<strong>in</strong>ical & Radiology Reviews<br />
@ NCCS Level 2, Cl<strong>in</strong>ic C, Discussion Room<br />
1<br />
Low Peak Wah / Rachel Tan<br />
6436 8165 / 6436 8172<br />
nmolpw@nccs.com.sg /<br />
nmotsk@nccs.com.sg<br />
5, 12, 19, 26 5.15 pm<br />
Weekly Comb<strong>in</strong>ed Cl<strong>in</strong>ical & Radiology Reviews<br />
@ NCCS Level 2, Cl<strong>in</strong>ic C, Discussion Room<br />
1<br />
Low Peak Wah / Rachel Tan<br />
6436 8165 / 6436 8172<br />
nmolpw@nccs.com.sg /<br />
nmotsk@nccs.com.sg<br />
6, 13, 20, 27 1.00 pm<br />
Hepatobiliary Conference<br />
@ NCCS Level 4, Lecture Hall<br />
1<br />
Lim Shufen / V Kalai<br />
64368283 / 8294<br />
dsolsf@nccs.com.sg /<br />
nsokal@nccs.com.sg<br />
6, 13, 20, 27 1.00 pm<br />
Hepatobiliary Conference<br />
@ NCCS Level 4, Peter & Mary Fu Auditorium<br />
1<br />
Lim Shufen / V Kalai<br />
64368283 / 8294<br />
dsolsf@nccs.com.sg /<br />
nsokal@nccs.com.sg<br />
6, 13, 20, 27 2.30 pm<br />
Gynae-Oncology Tumour Board Meet<strong>in</strong>g<br />
@ NCCS Level 2, Cl<strong>in</strong>ic D, Discussion Room<br />
1<br />
Lim Shufen / V Kalai<br />
64368283 / 8294<br />
dsolsf@nccs.com.sg /<br />
nsokal @nccs.com.sg<br />
6, 13, 20, 27 2.30 pm<br />
Gynae-Oncology Tumour Board Meet<strong>in</strong>g<br />
@ NCCS Level 2, Cl<strong>in</strong>ic D, Discussion Room<br />
1<br />
Lim Shufen / V Kalai<br />
64368283 / 8294<br />
dsolsf@nccs.com.sg /<br />
nsokal @nccs.com.sg<br />
7, 21 5.00 pm<br />
NCC-SGH Jo<strong>in</strong>t Lymphoma Workgroup Meet<strong>in</strong>g<br />
@ NCCS Level 2, Cl<strong>in</strong>ic C, Discussion Room<br />
1<br />
Tan Si Xuan / Rachel Tan<br />
6436 8280 / 6436 8172<br />
nmogyy@nccs.com.sg /<br />
nmotsk@nccs.com.sg<br />
7, 21 5.00 pm<br />
NCC-SGH Jo<strong>in</strong>t Lymphoma Workgroup Meet<strong>in</strong>g<br />
@ NCCS Level 2, Cl<strong>in</strong>ic C, Discussion Room<br />
1<br />
Tan Si Xuan / Rachel Tan<br />
6436 8280 / 6436 8172<br />
nmogyy@nccs.com.sg /<br />
nmotsk@nccs.com.sg<br />
7, 14, 21, 28 12.00 pm<br />
Lung Tumour Board Comb<strong>in</strong>e SGH-NCCS Meet<strong>in</strong>g<br />
@ SGH Blk 2 Level 1, Radiology Conference Room<br />
1<br />
Christ<strong>in</strong>a Lee Siok Cheng<br />
christ<strong>in</strong>a.lee.s.c@nhc.com.sg<br />
7, 14, 21, 28 12.00 pm<br />
Lung Tumour Board Comb<strong>in</strong>e SGH-NCCS Meet<strong>in</strong>g<br />
@ SGH Blk 2 Level 1, Radiology Conference Room<br />
1<br />
Christ<strong>in</strong>a Lee Siok Cheng<br />
christ<strong>in</strong>a.lee.s.c@nhc.com.sg<br />
15 1.00 pm<br />
Journal Club<br />
Topic: To be advised<br />
Speaker:<br />
@NCCS level 1, Mammo Suite Discussion Room<br />
1<br />
Phua Chay S<strong>in</strong><br />
6436 8043<br />
ddipcs@nccs.com.sg<br />
15 1.00 pm<br />
Journal Club<br />
Topic: To be advised<br />
Speaker:<br />
@NCCS level 1, Mammo Suite Discussion Room<br />
1<br />
Phua Chay S<strong>in</strong><br />
6436 8043<br />
ddipcs@nccs.com.sg<br />
22 1.00 pm<br />
Teach<strong>in</strong>g Session<br />
Topic : To be advised<br />
Speaker :<br />
@NCCS level 1, Mammo Suite Discussion Room<br />
1<br />
Phua Chay S<strong>in</strong><br />
6436 8043<br />
ddipcs@nccs.com.sg<br />
22 1.00 pm<br />
Teach<strong>in</strong>g Session<br />
Topic : To be advised<br />
Speaker :<br />
@NCCS level 1, Mammo Suite Discussion Room<br />
1<br />
Phua Chay S<strong>in</strong><br />
6436 8043<br />
ddipcs@nccs.com.sg<br />
28 7.30 am<br />
Endocr<strong>in</strong>e and Rare Tumour Meet<strong>in</strong>g<br />
@ NCCS Level 2, Cl<strong>in</strong>ic C, Discussion Room<br />
1<br />
Tan Si Xuan / Rachel Tan<br />
6436 8280 / 6436 8172<br />
nmogyy@nccs.com.sg /<br />
nmotsk@nccs.com.sg<br />
28 7.30 am<br />
Endocr<strong>in</strong>e and Rare Tumour Meet<strong>in</strong>g<br />
@ NCCS Level 2, Cl<strong>in</strong>ic C, Discussion Room<br />
1<br />
Tan Si Xuan / Rachel Tan<br />
6436 8280 / 6436 8172<br />
nmogyy@nccs.com.sg /<br />
nmotsk@nccs.com.sg<br />
28 5.00 pm<br />
NCC Neuro Onco Tumour Board Meet<strong>in</strong>g<br />
@ NCCS Level 2, Cl<strong>in</strong>ic C, Discussion Room<br />
1<br />
Low Peak Wah / Ang Hui Lan<br />
6436 8165 / 6436 8174<br />
nmolpw@nccs.com.sg /<br />
dmoahl@nccs.com.sg<br />
28 5.00 pm<br />
NCC Neuro Onco Tumour Board Meet<strong>in</strong>g<br />
@ NCCS Level 2, Cl<strong>in</strong>ic C, Discussion Room<br />
1<br />
Low Peak Wah / Ang Hui Lan<br />
6436 8165 / 6436 8174<br />
nmolpw@nccs.com.sg /<br />
dmoahl@nccs.com.sg
6 SALUBRIS JANUARY – MARCH 2013 SALUBRIS JANUARY – MARCH 2013 7<br />
EFFECTIVE TREATMENT<br />
IN A FRACTION OF<br />
THE TIME<br />
To enable patients to have better<br />
control of breast <strong>cancer</strong>, it is<br />
common practice for patients to<br />
receive radiation <strong>the</strong>rapy after<br />
surgery. The treatment has just been<br />
made easier for our patients when<br />
NCCS launched <strong>in</strong>tra-operative<br />
radiation <strong>the</strong>rapy or IORT last month.<br />
VERONICA LEE tells you more.<br />
In manag<strong>in</strong>g breast <strong>cancer</strong>, patients can choose to<br />
have a mastectomy or breast conserv<strong>in</strong>g surgery with<br />
equally good chance of disease control. Even though<br />
breast conserv<strong>in</strong>g surgery <strong>in</strong>volves remov<strong>in</strong>g only<br />
<strong>the</strong> part of <strong>the</strong> breast with <strong>the</strong> tumour and a rim of normal<br />
tissue, followed by radiation treatment that can take up to<br />
six weeks, many patients still choose to have a mastectomy<br />
as <strong>the</strong>y were afraid that <strong>the</strong> <strong>cancer</strong> would recur and <strong>the</strong>y<br />
don’t like <strong>the</strong> <strong>in</strong>convenience of radio<strong>the</strong>rapy.<br />
Indeed, accord<strong>in</strong>g to Dr Wong Fuh Yong, radiation<br />
oncologist at NCCS, recurrence can occur <strong>in</strong> about onethird<br />
of patients. However, what is not known to many<br />
is that recurrences often happen only <strong>in</strong> <strong>the</strong> region of<br />
<strong>the</strong> orig<strong>in</strong>al tumour and occurrences <strong>in</strong> <strong>the</strong> same breast<br />
may not necessarily be a true “recurrence”, but <strong>in</strong>stead<br />
a new <strong>cancer</strong> that is not related to <strong>the</strong> orig<strong>in</strong>al <strong>cancer</strong>.<br />
Trials conducted <strong>in</strong> this area also suggested that <strong>the</strong> rate<br />
of <strong>cancer</strong>s development does not improve even when<br />
radiation treatment is given to <strong>the</strong> whole breast- and only<br />
<strong>the</strong> region near <strong>the</strong> orig<strong>in</strong>al tumour will respond to postoperative<br />
radiation treatment.<br />
The f<strong>in</strong>d<strong>in</strong>gs paved a new way <strong>in</strong> how our oncologists can<br />
treat patients more efficiently and provide partial breast<br />
irradiation s<strong>in</strong>ce whole breast irradiation is not always<br />
needed and normal organs around <strong>the</strong> tumour site such as<br />
sk<strong>in</strong>, lungs, ribs and heart can be spared of irradiation. A<br />
smaller dose of radiation is now possible and <strong>the</strong> treatment<br />
duration can be shortened to a fraction of <strong>the</strong> six weeks<br />
needed previously to irradiate <strong>the</strong> whole breast.<br />
The treatment which is called <strong>in</strong>traoperative radiation<br />
<strong>the</strong>rapy (IORT) <strong>in</strong>volves <strong>the</strong> use of <strong>the</strong> Intrabeam® device<br />
to irradiate patients dur<strong>in</strong>g <strong>the</strong> surgery to remove <strong>the</strong><br />
tumour. An applicator with a spherical end, of which <strong>the</strong><br />
size is carefully selected so that it fits snuggly aga<strong>in</strong>st <strong>the</strong><br />
walls of <strong>the</strong> excision cavity, is <strong>in</strong>serted to give <strong>the</strong> patient<br />
<strong>the</strong> entire course of radiation <strong>in</strong> one dose. The patient is<br />
under anaes<strong>the</strong>sia while <strong>the</strong> dose is adm<strong>in</strong>istered thus<br />
spar<strong>in</strong>g her of any <strong>in</strong>convenience and discomfort that<br />
she may sometimes experience if radiation <strong>the</strong>rapy was<br />
adm<strong>in</strong>istered conventionally.<br />
While <strong>the</strong> benefits from <strong>the</strong> new technique are obvious,<br />
not all breast <strong>cancer</strong> patients will be suitable for such<br />
a procedure. Dr Wong said: “Patients with high risks<br />
diseases such as large tumours, lymph nodes with <strong>cancer</strong><br />
or were diagnosed at a younger age are less suitable as <strong>the</strong><br />
risks <strong>in</strong> more distant disease <strong>in</strong> <strong>the</strong> breast are higher and<br />
such a technique may not be adequate to address <strong>the</strong>m.<br />
Suitable patients are selected based on <strong>the</strong> stage of <strong>the</strong>ir<br />
<strong>cancer</strong> and how aggressive <strong>the</strong> <strong>cancer</strong> is. These patients<br />
must also have node negative <strong>cancer</strong>.” Although <strong>the</strong><br />
treatment now seems to be suitable for women who are<br />
50 years old and above, Dr Wong revealed that a study is<br />
ongo<strong>in</strong>g to explore <strong>the</strong> use of IORT <strong>in</strong> younger patients.<br />
NCCS, which sees close to 1,300 breast <strong>cancer</strong><br />
patients annually, had treated 11 patients successfully<br />
s<strong>in</strong>ce pilot<strong>in</strong>g <strong>the</strong> treatment as a trial <strong>in</strong> June 2012.<br />
The patients have coped well and experienced<br />
m<strong>in</strong>imal side effects.<br />
NEW APPROACH IN<br />
PROVIDING HOLISTIC<br />
CARE FOR CANCER<br />
PATIENTS<br />
Aim is to offer patients a better quality of life.<br />
Ano<strong>the</strong>r dimension has been added to <strong>the</strong> mean<strong>in</strong>g of<br />
<strong>cancer</strong> care for NCCS patients. Instead of just <strong>the</strong> norm of<br />
doctors and nurses do<strong>in</strong>g <strong>the</strong>ir rounds to meet <strong>the</strong> patients,<br />
<strong>the</strong> medical team now <strong>in</strong>cludes <strong>the</strong> allied professionals.<br />
These allied staff will <strong>in</strong>clude speech <strong>the</strong>rapists, dietitians,<br />
physio<strong>the</strong>rapists, cl<strong>in</strong>ical psychologists, wound care nurses and<br />
medical social workers com<strong>in</strong>g toge<strong>the</strong>r to offer <strong>the</strong> patient a true<br />
mean<strong>in</strong>g of comprehensive care. This multi-discipl<strong>in</strong>ary round<br />
was <strong>in</strong>itiated by <strong>the</strong> Head and Neck Service for <strong>the</strong>ir <strong>in</strong>-patients <strong>in</strong><br />
S<strong>in</strong>gapore General Hospital.<br />
Called <strong>the</strong> “quality of life team”, <strong>the</strong>y jo<strong>in</strong>ed <strong>the</strong> doctors and nurses<br />
each morn<strong>in</strong>g on <strong>the</strong>ir ward rounds to listen to <strong>the</strong> needs of <strong>the</strong><br />
patients and offer <strong>the</strong>ir <strong>in</strong>put and expertise where appropriate. The<br />
term ‘QOL round’ is apt as it emphasizes <strong>the</strong> importance of holistic<br />
care <strong>in</strong> <strong>the</strong> management of <strong>cancer</strong> patients.<br />
The weekly round takes place every Tuesday at 0845 hr and usually<br />
lasts for about an hour, dur<strong>in</strong>g which <strong>the</strong> entire team will go from<br />
bed to bed where <strong>the</strong> condition of each patient will be discussed<br />
<strong>in</strong> detail. Typically, <strong>the</strong> medical team will summarise <strong>the</strong> patient’s<br />
medical conditions followed by <strong>in</strong>puts from <strong>the</strong> various allied health<br />
professionals <strong>in</strong> <strong>the</strong>ir respective fields of expertise. The management<br />
plan of <strong>the</strong> patient is <strong>the</strong>n reviewed, tak<strong>in</strong>g <strong>in</strong>to consideration fresh<br />
<strong>in</strong>sights provided by members of <strong>the</strong> QOL team. The new format<br />
was <strong>in</strong>troduced <strong>in</strong> Feb 2012 because of <strong>the</strong> <strong>in</strong>creased awareness<br />
of <strong>the</strong> multi-faceted needs of patients receiv<strong>in</strong>g treatment for Head<br />
and Neck <strong>Cancer</strong>. These patients often require complex major<br />
surgery which may carry significant morbidity and <strong>in</strong> some cases<br />
complications may arise that leads to prolonged hospitalisation.<br />
In addition, major surgery for head and neck <strong>cancer</strong> may alter <strong>the</strong><br />
physical appearance or may result <strong>in</strong> <strong>the</strong> loss or impairment of<br />
important function such as speech and swallow<strong>in</strong>g. The cl<strong>in</strong>ical<br />
psychologist and social worker help <strong>the</strong>se patients cope with<br />
psychosocial issues that are often under-diagnosed by <strong>the</strong> medical staff.<br />
The expert care provided by allied staff are <strong>in</strong>valuable as <strong>the</strong>y<br />
ensure that <strong>the</strong>se patients receive <strong>the</strong> best possible holistic<br />
treatment that will <strong>in</strong>crease <strong>the</strong> chances of full recovery and<br />
m<strong>in</strong>imise possible complications. The presence of wound care<br />
nurses ensures that wound complications are swiftly dealt<br />
with by dedicated staff with specialised skillsets. All <strong>the</strong> above<br />
play a critical role to facilitate a smooth post-op recovery and<br />
potentially shorten <strong>the</strong> length of stay.<br />
“We believe that <strong>in</strong>tegrat<strong>in</strong>g auxiliary care teams <strong>in</strong>to regular<br />
cl<strong>in</strong>ical rounds will ensure best treatment outcome for our<br />
head and neck <strong>cancer</strong> patients,” expla<strong>in</strong>ed Dr Tan Hiang<br />
Khoon, Senior Consultant, Department of Surgical Oncology<br />
from NCCS. It is noteworthy that this new <strong>in</strong>itiative was first<br />
suggested by members of <strong>the</strong> speech <strong>the</strong>rapist team who first<br />
expressed <strong>the</strong> wish to jo<strong>in</strong> <strong>the</strong> doctors for <strong>the</strong>ir morn<strong>in</strong>g round<br />
so that <strong>the</strong>y can better understand <strong>the</strong> medical plan for <strong>the</strong>ir<br />
patients. The <strong>in</strong>itial experience with <strong>the</strong> speech <strong>the</strong>rapist was so<br />
mutually beneficial and educational that <strong>the</strong>y decided to <strong>in</strong>vite<br />
all <strong>the</strong> o<strong>the</strong>r allied staff to participate.”<br />
He said that over-reliance on <strong>the</strong> cl<strong>in</strong>ician to provide <strong>the</strong><br />
treatment plan may not be <strong>in</strong> <strong>the</strong> best <strong>in</strong>terest of patients.<br />
“It is an enrich<strong>in</strong>g experience to learn from all <strong>the</strong> o<strong>the</strong>r<br />
auxiliary care professionals. As cl<strong>in</strong>icians, we come up with<br />
patient management plans based on medical knowledge.<br />
Increas<strong>in</strong>gly, grow<strong>in</strong>g emphasis is placed on <strong>the</strong> overall wellbe<strong>in</strong>g<br />
of patients apart from just ensur<strong>in</strong>g <strong>the</strong>ir survival.<br />
“We tend to overlook <strong>the</strong> non-cl<strong>in</strong>ical profile of patients or how<br />
<strong>the</strong>y would respond to <strong>the</strong> prescribed treatment psychologically<br />
and socially. This may affect <strong>the</strong> patients as <strong>the</strong>ir specific needs<br />
are not met and <strong>the</strong>ir quality of life suffers.”<br />
Dr Tan believes <strong>the</strong> new approach places greater focus on<br />
patients’ preferences and needs. “Professionals <strong>in</strong> <strong>the</strong>ir respective<br />
fields share <strong>in</strong>formation about a patient’s medical conditions,<br />
physiological and social needs and preferences, support network<br />
and even f<strong>in</strong>ancial status. It rem<strong>in</strong>ded us all that <strong>the</strong> care for a<br />
patient is more than just <strong>the</strong> treatment of his illness.”<br />
“We are thus more empowered to provide a plan that addresses<br />
<strong>the</strong> patient’s needs and preferences more holistically. We are<br />
able to take a differentiated approach that would provide an<br />
enhanced level of care, which translates <strong>in</strong>to greater patient<br />
satisfaction that could help <strong>in</strong> <strong>the</strong>ir recovery and overall wellbe<strong>in</strong>g,”<br />
he added.<br />
Ms Tan Yee P<strong>in</strong>, NCCS cl<strong>in</strong>ical psychologist and medical social<br />
worker, who is part of <strong>the</strong> quality of life team, said that such<br />
an approach provides patients and <strong>the</strong>ir families with more<br />
holistic care. “The approach provides <strong>the</strong> various healthcare<br />
professionals <strong>in</strong>volved with a common platform to discuss and<br />
allows a better <strong>in</strong>tegration of care among <strong>the</strong> various discipl<strong>in</strong>es<br />
for <strong>the</strong> benefit of our patients. Information shar<strong>in</strong>g from o<strong>the</strong>r<br />
discipl<strong>in</strong>es helps us appreciate <strong>the</strong> various facets that can<br />
impact <strong>the</strong> patient’s well-be<strong>in</strong>g. Synergistically, we hope to<br />
provide better care for our patients and <strong>the</strong>ir families.”<br />
BY VERONICA LEE
8 SALUBRIS JANUARY – MARCH 2013 SALUBRIS JANUARY – MARCH 2013 9<br />
SPECIAL CONSIDERATIONS OF CANCER THERAPY<br />
FOR ELDERLY PATIENTS<br />
BY YEOH TING TING<br />
Senior Cl<strong>in</strong>ical Pharmacist<br />
NCCS<br />
S<strong>in</strong>gapore is experienc<strong>in</strong>g a rapidly ag<strong>in</strong>g population. By year 2030, <strong>the</strong> number of<br />
its residents aged 65 and above will <strong>in</strong>crease to 900,000 from <strong>the</strong> current 300,000.<br />
Ag<strong>in</strong>g is l<strong>in</strong>ked to a higher risk of <strong>cancer</strong>. In <strong>the</strong> USA, more than 60% of <strong>cancer</strong><br />
cases were found <strong>in</strong> persons aged 65 and above.<br />
TREATMENT OPTIONS IN ELDERLY<br />
PERSONS WITH CANCER<br />
The treatment plan for <strong>cancer</strong> <strong>in</strong> an <strong>elderly</strong> patient depends on <strong>the</strong><br />
type of <strong>cancer</strong>, <strong>the</strong> stage of disease and <strong>the</strong> general health status of<br />
<strong>the</strong> patient. The goal of treatment may be cure, control of disease,<br />
or symptom control for as long as possible. Your doctor may offer<br />
surgery, radio<strong>the</strong>rapy, chemo<strong>the</strong>rapy, hormone <strong>the</strong>rapy, biological<br />
<strong>the</strong>rapy, or a comb<strong>in</strong>ation of a few modalities for <strong>cancer</strong> treatment.<br />
This article will focus on drug <strong>the</strong>rapy for <strong>cancer</strong> treatment.<br />
Chemo<strong>the</strong>rapy uses drugs that kill <strong>cancer</strong> cells. Most of <strong>the</strong><br />
time, it is given by mouth (oral) or <strong>in</strong>jected through a ve<strong>in</strong><br />
(<strong>in</strong>travenous). Oral chemo<strong>the</strong>rapy medications are usually<br />
dispensed to patients to be taken at home. More often than not,<br />
<strong>in</strong>travenous chemo<strong>the</strong>rapy medications are given <strong>in</strong> a <strong>cancer</strong><br />
centre or <strong>in</strong> a hospital by specialist nurses. However, certa<strong>in</strong><br />
<strong>in</strong>travenous chemo<strong>the</strong>rapy drugs that need to be adm<strong>in</strong>istered<br />
over long hours can be given via a portable <strong>in</strong>fusion pump which<br />
can be brought home by patients.<br />
Chemo<strong>the</strong>rapy is usually given <strong>in</strong> cycles. The <strong>in</strong>terval between<br />
each dose is dependent on <strong>the</strong> type of <strong>cancer</strong> and medications<br />
prescribed.<br />
• Poor appetite<br />
• Hair loss<br />
• Nausea and vomit<strong>in</strong>g<br />
• Diarrhoea or constipation<br />
• Mouth or lip ulcers<br />
• Sk<strong>in</strong> problems<br />
CO-EXISTING HEALTH<br />
CONDITIONS<br />
Some <strong>elderly</strong> patients may have o<strong>the</strong>r chronic conditions, for<br />
example hypertension, diabetes and so on. When deal<strong>in</strong>g with<br />
<strong>the</strong> physical, emotional and social challenges that come with<br />
a <strong>cancer</strong> diagnosis, patients may neglect <strong>the</strong> care of <strong>the</strong>ir o<strong>the</strong>r<br />
conditions. However, how you manage your chronic condition<br />
is closely related to <strong>the</strong> success of your <strong>cancer</strong> <strong>the</strong>rapy. Your<br />
doctor or healthcare provider can work with you to reduce <strong>the</strong><br />
risk of <strong>in</strong>teractions between <strong>cancer</strong> <strong>the</strong>rapy and your chronic<br />
medications, aggravation of a chronic condition by <strong>the</strong> <strong>cancer</strong><br />
treatment, <strong>in</strong>terruption to <strong>cancer</strong> treatment due to worsen<strong>in</strong>g of<br />
chronic condition, and slower recovery after <strong>cancer</strong> treatment<br />
because of o<strong>the</strong>r chronic conditions.<br />
SPECIAL CONSIDERATIONS IN<br />
ELDERLY PATIENTS<br />
In order to prescribe <strong>the</strong> most appropriate <strong>cancer</strong> <strong>the</strong>rapy<br />
to you, your doctor may need to understand <strong>the</strong> follow<strong>in</strong>g:<br />
• your kidney and liver health;<br />
• your nutritional status;<br />
• your ability to carry out self-care needs;<br />
• your ability to care for tasks that allow <strong>in</strong>dependence <strong>in</strong><br />
<strong>the</strong> community;<br />
• your physical performance (that is, a measure of mobility,<br />
balance and fall risk);<br />
• your o<strong>the</strong>r disease conditions and medications (<strong>in</strong>clud<strong>in</strong>g<br />
over- <strong>the</strong>-counter medications and health supplements)<br />
that you are tak<strong>in</strong>g;<br />
• your ability to make decisions;<br />
• your psychological status;<br />
• your social support<br />
QUESTIONS TO ASK YOUR<br />
DOCTOR BEFORE YOUR<br />
TREATMENT STARTS:<br />
• Has <strong>the</strong> <strong>cancer</strong> spread? If so, where? What is <strong>the</strong> stage<br />
of <strong>the</strong> <strong>cancer</strong>?<br />
• What is <strong>the</strong> treatment goal? What are <strong>the</strong> treatment<br />
choices? Which do you recommend? Why?<br />
• What are <strong>the</strong> expected benefits of each k<strong>in</strong>d of treatment?<br />
• What are <strong>the</strong> risks and possible side effects of<br />
each treatment?<br />
• How can side effects be managed?<br />
• What can I do to prepare for treatment?<br />
• How often will I have treatments? How long will<br />
treatment last?<br />
• Would a cl<strong>in</strong>ical trial be appropriate for me?<br />
USEFUL INFORMATION<br />
CANCER SCREENING RECOMMENDATIONS<br />
Health Promotion Board, S<strong>in</strong>gapore<br />
http://www.hpb.gov.sg<br />
CARING FOR ELDERLY PATIENTS<br />
Ag<strong>in</strong>g Care.com<br />
http://www.ag<strong>in</strong>gcare.com<br />
CANCER IN OLDER ADULTS<br />
<strong>Cancer</strong>.net<br />
http://www.<strong>cancer</strong>.net/cop<strong>in</strong>g/age-specific-<strong>in</strong>formation/<br />
<strong>cancer</strong>-older-adults<br />
Side effects of chemo<strong>the</strong>rapy depend on <strong>the</strong> medication type and<br />
<strong>the</strong> dose prescribed. Besides kill<strong>in</strong>g <strong>cancer</strong> cells, chemo<strong>the</strong>rapy<br />
may cause damage to o<strong>the</strong>r normal cells that grow rapidly, for<br />
example blood cells, hair follicles and oral l<strong>in</strong><strong>in</strong>g. Common side<br />
effects of chemo<strong>the</strong>rapy are:<br />
• Tiredness<br />
• Bruis<strong>in</strong>g or bleed<strong>in</strong>g easily<br />
• More prone to <strong>in</strong>fections / fever<br />
REFERENCES:<br />
Solitto M. Treatment for <strong>Cancer</strong>. [Available onl<strong>in</strong>e: http://www.ag<strong>in</strong>gcare.com/Articles/<strong>cancer</strong>-treatments-for-<strong>the</strong><strong>elderly</strong>-136535.htm<br />
; last assessed: 26/10/2012]<br />
Mohile SG et al. Considerations and Controversies <strong>in</strong> <strong>the</strong> Management of Older Patients with Advanced <strong>Cancer</strong>. American<br />
Society of Cl<strong>in</strong>ical Oncology (ASCO) 2012 Educational Book. [ Available onl<strong>in</strong>e: http://www.asco.org/ASCOv2/Home/<br />
Education%20&%20Tra<strong>in</strong><strong>in</strong>g/Educational%20Book/PDF%20Fils/2012/zds00112000321.PDF ; last assessed: 26/10/2012]<br />
Chronic Conditions: When <strong>Cancer</strong> is Not your only Health Concern.<strong>Cancer</strong>.Net. [Available onl<strong>in</strong>e: http://www.<strong>cancer</strong>.net/<br />
all-about-<strong>cancer</strong>/<strong>cancer</strong>net-feature-articles/side-effects/chronic-conditions-when-<strong>cancer</strong>-not-your-only-health-concern ; last<br />
assessed 04/11/2012]
10 SALUBRIS JANUARY – MARCH 2013 SALUBRIS JANUARY – MARCH 2013 11<br />
年 长 病 患 的 癌 症 治 疗 应 特 别 注 意 的 事 项<br />
杨 婷 婷<br />
新 加 坡 国 立 癌 症 中 心<br />
高 级 临 床 药 剂 师<br />
新 加 坡 正 面 临 人 口 迅 速 老 化 的 问 题 。 到 了 2030 年 , 年 龄 在 65 岁 及 以 上 的 人 口 ,<br />
将 从 目 前 的 30 万 人 增 加 至 90 万 人 。<br />
年 长 者 罹 患 癌 症 的 风 险 更 高 。 在 美 国 , 超 过 60% 的 癌 症 病 例 发 生 在 65 岁 及 以<br />
上 的 人 身 上 。<br />
• 反 胃 及 呕 吐<br />
• 腹 泻 或 便 秘<br />
• 口 腔 或 嘴 唇 溃 疡<br />
• 皮 肤 问 题<br />
其 他 同 时 出 现 的 健 康 问 题<br />
有 些 年 长 病 患 可 能 有 其 他 慢 性 疾 病 , 如 高 血 压 、 糖 尿 病 等 。<br />
确 诊 患 癌 后 , 病 患 也 许 会 因 面 对 身 体 、 情 绪 和 社 会 挑 战 ,<br />
而 忽 略 了 其 他 疾 病 的 护 理 。 不 过 , 如 何 护 理 慢 性 疾 病 与 癌<br />
症 治 疗 的 成 功 有 着 密 切 关 系 。 医 生 或 医 务 人 员 会 与 病 患 合<br />
作 , 减 少 癌 症 治 疗 与 慢 性 疾 病 药 物 相 互 作 用 、 慢 性 疾 病 因<br />
癌 症 治 疗 而 恶 化 、 癌 症 治 疗 因 慢 性 疾 病 恶 化 而 中 断 , 以 及<br />
因 其 他 慢 性 疾 病 导 致 癌 症 治 疗 复 原 缓 慢 的 风 险 。<br />
进 行 治 疗 前 , 应 向 医 生 提<br />
出 以 下 问 题 :<br />
• 癌 细 胞 是 否 已 扩 散 ? 如 有 , 扩 散 到 哪 里 ?<br />
癌 症 处 于 哪 个 阶 段 ?<br />
• 治 疗 目 标 是 什 么 ? 有 哪 些 治 疗 方 案 ?<br />
你 建 议 采 用 哪 个 方 案 ? 为 什 么 ?<br />
• 每 个 治 疗 方 案 的 预 期 效 果 是 什 么 ?<br />
• 每 个 治 疗 方 案 有 哪 些 风 险 和 可 能 出 现 的 副 作 用 ?<br />
• 如 何 应 对 副 作 用 ?<br />
• 如 何 为 治 疗 作 好 准 备 ?<br />
• 我 多 久 须 要 进 行 一 次 治 疗 ? 治 疗 时 间 多 长 ?<br />
• 我 适 合 进 行 临 床 试 验 吗 ?<br />
年 长 癌 症 病 患 的 治 疗 方 案<br />
年 长 癌 症 病 患 的 治 疗 方 案 , 须 视 癌 症 类 型 、 患 癌 阶 段 及 病 患<br />
整 体 健 康 状 况 而 定 。 治 疗 目 标 可 以 是 治 愈 、 控 制 病 情 或 尽 可<br />
能 控 制 症 状 。 医 生 可 能 建 议 进 行 手 术 、 放 疗 、 化 疗 、 激 素 治<br />
疗 、 生 物 治 疗 , 或 结 合 几 种 治 疗 方 式 。<br />
本 文 将 着 重 于 癌 症 的 药 物 治 疗 方 案 。<br />
化 疗 使 用 可 杀 死 癌 细 胞 的 药 物 。 这 些 药 物 多 数 时 候 , 它 是 通<br />
过 口 服 或 静 脉 注 射 。 一 般 上 , 口 服 化 疗 药 物 是 让 病 患 在 家 服<br />
用 的 。 静 脉 注 射 则 通 常 是 由 专 科 护 士 在 癌 症 中 心 或 医 院 里 执<br />
行 。 不 过 , 某 些 需 要 长 时 间 注 射 的 静 脉 注 射 化 疗 药 物 , 可 通 过<br />
便 携 式 输 液 泵 注 射 入 体 内 , 所 以 病 患 可 以 带 回 家 进 行 化 疗 。<br />
化 疗 一 般 按 周 期 计 算 , 化 疗 的 周 期 是 根 据 癌 症 类 型 和 药 方<br />
而 定 。<br />
化 疗 的 副 作 用 也 因 药 方 种 类 和 剂 量 的 不 同 而 有 所 差 异 。 除 了<br />
杀 死 癌 细 胞 外 , 化 疗 也 可 能 损 坏 其 他 迅 速 生 长 的 正 常 细 胞 ,<br />
如 血 液 细 胞 、 毛 囊 及 口 腔 内 膜 。 化 疗 的 常 见 副 作 用 如 下 :<br />
对 待 年 长 病 患 应 特 别 注 意<br />
的 事 项<br />
医 生 可 能 需 要 向 病 患 了 解 下 列 情 况 , 以 提 供 最 适 当 的 治 疗<br />
方 案 :<br />
• 肾 脏 与 肝 脏 的 健 康 状 况 ;<br />
• 营 养 状 况 ;<br />
• 自 理 能 力 ;<br />
• 自 力 更 生 的 能 力 ;<br />
• 体 能 ( 即 灵 活 性 、 平 衡 感 , 以 及 跌 倒 风 险 );<br />
• 其 他 疾 病 及 正 在 服 用 的 药 物 ( 包 括 非 处 方 药 和 保<br />
健 品 );<br />
• 做 决 定 的 能 力 ;<br />
• 心 理 状 态 ;<br />
• 社 会 支 援<br />
实 用 信 息<br />
癌 症 检 查 建 议<br />
新 加 坡 保 健 促 进 局<br />
http://www.hpb.gov.sg<br />
年 长 病 患 的 护 理<br />
Ag<strong>in</strong>g Care.com<br />
http://www.ag<strong>in</strong>gcare.com<br />
老 年 人 的 癌 症<br />
<strong>Cancer</strong>.net<br />
http://www.<strong>cancer</strong>.net/cop<strong>in</strong>g/age-specific-<strong>in</strong>formation/<br />
<strong>cancer</strong>-older-adults<br />
癌 症 援 助 热 线<br />
新 加 坡 国 立 癌 症 中 心<br />
www.nccs.com.sg<br />
• 疲 劳<br />
• 容 易 瘀 伤 或 出 血<br />
• 更 容 易 受 到 感 染 / 发 烧<br />
• 食 欲 不 振<br />
• 脱 发<br />
参 考 资 料 : Solitto M.《 癌 症 的 治 疗 》[ 可 在 线 阅 读 :http://www.ag<strong>in</strong>gcare.com/Articles/<strong>cancer</strong>-treatments-for-<strong>the</strong>-<strong>elderly</strong>-136535.htm ;<br />
最 近 评 估 日 期 :26/10/2012]<br />
Mohile SG et al. 《 治 疗 年 长 末 期 癌 症 病 患 的 考 虑 因 素 与 争 议 》, 美 国 临 床 肿 瘤 学 会 2012 年 学 术 年 会 [ 可 在 线 阅 读 :http://www.<br />
asco.org/ASCOv2/Home/Education%20&%20Tra<strong>in</strong><strong>in</strong>g/Educational%20Book/PDF%20Fils/2012/zds00112000321.PDF ;<br />
最 近 评 估 日 期 :26/10/2012]<br />
《 慢 性 疾 病 : 当 癌 症 不 是 你 唯 一 的 健 康 问 题 时 》<strong>Cancer</strong>.Net [ 可 在 线 阅 读 : http://www.<strong>cancer</strong>.net/all-about-<strong>cancer</strong>/<br />
<strong>cancer</strong>net-feature-articles/side-effects/chronic-conditions-when-<strong>cancer</strong>-not-your-only-health-concern ; 最 近 评 估 日<br />
期 :04/11/2012]
12 SALUBRIS JANUARY – MARCH 2013 SALUBRIS JANUARY – MARCH 2013 13<br />
OUTREACH – PUBLIC FORUMS<br />
& CANCERWISE WORKSHOPS<br />
Event Date, Time, Venue Registration<br />
Bil<strong>in</strong>gual Public Forum – Role of<br />
Traditional Medic<strong>in</strong>e In <strong>Cancer</strong> Care<br />
TOPICS:<br />
• Overview Of Traditional Medic<strong>in</strong>e<br />
• How does it complement conventional<br />
<strong>cancer</strong> treatment?<br />
• Potential herb and drug <strong>in</strong>teractions<br />
• Understand<strong>in</strong>g <strong>the</strong> side effects<br />
Bil<strong>in</strong>gual Public Forum – Colorectal <strong>Cancer</strong><br />
TOPICS:<br />
• Anatomy & functions of <strong>the</strong> colon and rectum<br />
• Common bowel problems<br />
• What is Colorectal <strong>Cancer</strong>?<br />
• Risk factors & Signs and Symptoms of<br />
colorectal <strong>cancer</strong><br />
• Early detection & prevention<br />
• Screen<strong>in</strong>g & diagnostic procedures<br />
• Treatment options<br />
• New development <strong>in</strong> Colorectal <strong>Cancer</strong><br />
<strong>Cancer</strong>Wise Workshop –<br />
Targeted Therapies In <strong>Cancer</strong> Treatment<br />
TOPICS:<br />
• What are targeted <strong>cancer</strong> <strong>the</strong>rapies?<br />
• How do targeted <strong>cancer</strong> <strong>the</strong>rapies work?<br />
• How are targeted <strong>the</strong>rapies developed?<br />
• What are <strong>the</strong> targeted <strong>the</strong>rapies available?<br />
• Side effects of targeted <strong>the</strong>rapies<br />
<strong>Cancer</strong>Wise Workshop –<br />
Basics Of <strong>Cancer</strong> Part 1<br />
TOPICS:<br />
• What is <strong>cancer</strong>?<br />
• How does <strong>cancer</strong> spread?<br />
• Terms to describe <strong>the</strong> type of <strong>cancer</strong><br />
• What causes <strong>cancer</strong>?<br />
• Risk, Signs & Symptoms<br />
• Prevention & Screen<strong>in</strong>g<br />
• What are <strong>Cancer</strong> Tumour Makers?<br />
• Common Types of Tumor Makers<br />
• How are Tumour Markers used?<br />
• Can Tumour Markers be used as a screen<strong>in</strong>g<br />
test for <strong>cancer</strong>?<br />
• Types of Screen<strong>in</strong>g tests for Men & Women<br />
23 February 2013, Saturday<br />
MANDARIN SESSION<br />
Time: 9.15am to 10.30am<br />
(Registration: 9am to 9.15am)<br />
ENGLISH SESSION<br />
Time: 11.15am to 12.30pm<br />
(Registration: 11am to 11.15am)<br />
Peter & Mary Fu Auditorium<br />
<strong>National</strong> <strong>Cancer</strong> <strong>Centre</strong> S<strong>in</strong>gapore<br />
11 Hospital Drive, S<strong>in</strong>gapore 169610<br />
16 March 2012, Saturday<br />
MANDARIN SESSION<br />
Time: 9.15am to 10.30am<br />
(Registration: 9am to 9.15am)<br />
ENGLISH SESSION<br />
Time: 11.15am to 12.30pm<br />
(Registration: 11am to 11.15am)<br />
Peter & Mary Fu Auditorium<br />
<strong>National</strong> <strong>Cancer</strong> <strong>Centre</strong> S<strong>in</strong>gapore<br />
11 Hospital Drive, S<strong>in</strong>gapore 169610<br />
16 March 2012, Saturday<br />
Session will be conducted <strong>in</strong> English.<br />
1pm – Registration<br />
1.30pm to 4pm – Workshop starts<br />
Function Room, Level 4<br />
<strong>National</strong> <strong>Cancer</strong> <strong>Centre</strong> S<strong>in</strong>gapore<br />
11 Hospital Drive, S<strong>in</strong>gapore 169610<br />
13 April 2013, Saturday<br />
Session will be conducted <strong>in</strong> English.<br />
1pm – Registration<br />
1.30pm to 4pm – Workshop starts<br />
Peter & Mary Fu Auditorium<br />
<strong>National</strong> <strong>Cancer</strong> <strong>Centre</strong> S<strong>in</strong>gapore<br />
11 Hospital Drive, S<strong>in</strong>gapore 169610<br />
FREE ADMISSION<br />
Strictly no admission for children below<br />
12 years old. Registration is a MUST as<br />
seats are limited.<br />
REGISTRATION IS BY PHONE ONLY<br />
Please call: 6225 5655 / 6236 9432 /<br />
6236 9447<br />
Monday to Friday:<br />
9am to 5pm<br />
FREE ADMISSION<br />
Strictly no admission for children below<br />
12 years old. Registration is a MUST as<br />
seats are limited.<br />
REGISTRATION IS BY PHONE ONLY<br />
Please call: 6225 5655 / 6236 9432 /<br />
6236 9447<br />
Monday to Friday:<br />
9am to 5pm<br />
FREE ADMISSION<br />
Strictly no admission for children below<br />
12 years old. Registration is a MUST as<br />
seats are limited.<br />
REGISTRATION IS BY PHONE ONLY<br />
Please call: 6225 5655 / 6236 9432 /<br />
6236 9447<br />
Monday to Friday:<br />
9am to 5pm<br />
FREE ADMISSION<br />
Strictly no admission for children below<br />
12 years old. Registration is a MUST as<br />
seats are limited.<br />
REGISTRATION IS BY PHONE ONLY<br />
Please call: 6225 5655 / 6236 9432 /<br />
6236 9447<br />
Monday to Friday:<br />
9am to 5pm<br />
THAT WAS A<br />
CLOSE SHAVE!<br />
The Ch<strong>in</strong>ese have a say<strong>in</strong>g “ 旁 观 者 清 ”.<br />
It means bystanders understand one’s<br />
situation more clearly than oneself.<br />
Indeed, many of us lead such hectic<br />
lifestyles that we often have little time<br />
to spare for ourselves. And, <strong>in</strong> this<br />
<strong>in</strong>stance it was a mo<strong>the</strong>r who noticed<br />
someth<strong>in</strong>g unusual about a bulge on<br />
her daughter’s throat. Ca<strong>the</strong>r<strong>in</strong>e Tay,<br />
a 27 year-old former sales executive,<br />
shares her story.<br />
On her mo<strong>the</strong>r’s <strong>in</strong>sistence, Ca<strong>the</strong>r<strong>in</strong>e<br />
underwent some blood tests. It suggested<br />
that she might have a thyroid disease. She<br />
was <strong>the</strong>n referred to a surgical oncologist<br />
at <strong>the</strong> <strong>National</strong> <strong>Cancer</strong> <strong>Centre</strong> S<strong>in</strong>gapore (NCCS). Dr<br />
Tan Hiang Khoon found Ca<strong>the</strong>r<strong>in</strong>e had not just a thyroid<br />
nodule on <strong>the</strong> right side of her throat. She also had<br />
several smaller nodules around <strong>the</strong> neck region.<br />
Fortunately for early detection, <strong>the</strong>se nodules were<br />
still benign, and surgery was not a necessity. To be<br />
sure, and tak<strong>in</strong>g <strong>in</strong>to consideration her busy lifestyle,<br />
Ca<strong>the</strong>r<strong>in</strong>e decided to rid herself of <strong>the</strong> nodules. Between<br />
conventional and robotic surgeries, she opted for <strong>the</strong><br />
latter, which requires only three p<strong>in</strong>-hole excisions and<br />
less scarr<strong>in</strong>g.<br />
The three-hour surgery was successful. The post-surgery<br />
effect was a hoarse voice, some pa<strong>in</strong> and soreness <strong>in</strong> <strong>the</strong><br />
throat. But <strong>the</strong>se side effects were overcome soon enough.<br />
Two years on, Ca<strong>the</strong>r<strong>in</strong>e’s condition is well-managed. All<br />
she needs are annual follow-ups at NCCS, for blood tests<br />
and ultrasound scans as rout<strong>in</strong>e exam<strong>in</strong>ations.<br />
Recount<strong>in</strong>g her experience, Ca<strong>the</strong>r<strong>in</strong>e wished she had led<br />
a healthier lifestyle. “I was a frequent dr<strong>in</strong>ker and smoker<br />
due to stress,” she confessed. “Before I knew it, I was<br />
develop<strong>in</strong>g symptoms of thyroid disease.”<br />
Now Ca<strong>the</strong>r<strong>in</strong>e is a changed person. She is cautious<br />
about her food choices, and makes an effort to steer clear<br />
of carc<strong>in</strong>ogenic substances. She has quit smok<strong>in</strong>g. She<br />
avoids hard liquor.<br />
She looks at life with a different perspective. She is<br />
grateful for hav<strong>in</strong>g a car<strong>in</strong>g husband who gave her<br />
encouragement dur<strong>in</strong>g her time of need. Then <strong>the</strong>re is her<br />
four-year old daughter whom Ca<strong>the</strong>r<strong>in</strong>e is determ<strong>in</strong>ed to<br />
see her through to adulthood. Ca<strong>the</strong>r<strong>in</strong>e quit her job and<br />
spends time also giv<strong>in</strong>g care to her parents.<br />
Her advice to those who may face a similar predicament<br />
- stay strong and make <strong>the</strong> brave and right decision.<br />
“Don’t worry,” she said. “Face up to reality; do not make<br />
decisions that hurt yourself. Better days are ahead…<br />
stay positive.”<br />
“Face up to reality; do not<br />
make decisions that hurt<br />
yourself. Better days are ahead…<br />
stay positive.”
14 SALUBRIS JANUARY – MARCH 2013 SALUBRIS JANUARY – MARCH 2013 15<br />
MDM LEE SOO CHEE...THROUGH MY EYES...<br />
MS DEBBIE TAN<br />
Senior Executive Community Partnership<br />
Division of Community Outreach and Philanthropy<br />
A famous quote by Confucius ( 孔 子 ) – “ 仁 者 不 忧 , 智 者 不 惑 , 勇 者 不 惧 ” – enlightens that one who<br />
has <strong>the</strong> compassion is able to return k<strong>in</strong>dness, empathy and forgiveness when negativities<br />
fall upon <strong>the</strong>m; one who has <strong>the</strong> wisdom is able to rise above all <strong>the</strong> <strong>in</strong>tricacies of mank<strong>in</strong>d<br />
and to appreciate what is right from wrong; and one who has <strong>the</strong> courage is fearless <strong>in</strong><br />
fac<strong>in</strong>g life challenges and is able to brave through all adversities. These are <strong>the</strong> values that<br />
Mdm Lee Soo Chee, an artist and calligrapher, holds close to her heart and <strong>in</strong>spires her to<br />
look ahead.<br />
In April 2004, an acute dengue fever struck Mdm Lee<br />
and put her <strong>in</strong>to a deep coma. She awoke after more<br />
than a week, but was torn by a dilemma between life<br />
and death. She had to make a pa<strong>in</strong>ful decision, that<br />
her limbs would have to be amputated <strong>in</strong> order to live. A<br />
perfectionist, who appreciates beauty <strong>in</strong> life and is manifested<br />
by her love for Ch<strong>in</strong>ese pa<strong>in</strong>t<strong>in</strong>g and calligraphy, her loss<br />
made her felt that she was imperfect without her limbs – her<br />
utmost regret <strong>in</strong> life.<br />
Mdm Lee is a devout Buddhist. We clicked at first sight; an<br />
unexpla<strong>in</strong>able chemistry. She is like a mo<strong>the</strong>rly figure to me,<br />
but yet <strong>the</strong>re is no generation gap between us. We could talk<br />
very comfortably and share our sentiments about <strong>the</strong> religion.<br />
It is her strong belief <strong>in</strong> her religion and her undy<strong>in</strong>g passion<br />
for Ch<strong>in</strong>ese art that keeps her <strong>in</strong> one piece and one m<strong>in</strong>d.<br />
These are her treasures of life and someth<strong>in</strong>g that completes<br />
her even without her limbs.<br />
As Mdm Lee cont<strong>in</strong>ued shar<strong>in</strong>g with me her life experiences<br />
- her childhood, her family, her appreciation of Ch<strong>in</strong>ese<br />
pa<strong>in</strong>t<strong>in</strong>g. I could see <strong>the</strong> smile on her face and feel <strong>the</strong><br />
s<strong>in</strong>cerity flow<strong>in</strong>g through her eyes and <strong>the</strong> sooth<strong>in</strong>g calmness<br />
emerg<strong>in</strong>g through her voice. This is how Mdm Lee exudes<br />
her personality as a cheerful, humble and benevolent lady.<br />
The most touch<strong>in</strong>g part of her story is when she related her<br />
journey of darkness – <strong>the</strong> trauma of los<strong>in</strong>g her limbs forever,<br />
<strong>the</strong> apprehension of liv<strong>in</strong>g without her limbs and eventually<br />
overcom<strong>in</strong>g this cruelty <strong>in</strong> life that was bestowed upon her.<br />
It shook my emotions and I could not help but have to hold<br />
back my tears while listen<strong>in</strong>g to her.<br />
Even so, her positive outlook <strong>in</strong> life and strong willpower to<br />
live surpassed <strong>the</strong> ordeal and she comforted herself by say<strong>in</strong>g<br />
at least she was glad and fortunate to be still alive.<br />
But more impressive is her perseverance to pursue <strong>the</strong> passion<br />
of her life, her love and appreciation for <strong>the</strong> Ch<strong>in</strong>ese pa<strong>in</strong>t<strong>in</strong>g<br />
and calligraphy that she chose to go through a pa<strong>in</strong>stak<strong>in</strong>g<br />
process of restor<strong>in</strong>g a pros<strong>the</strong>tic right limb. I could see that <strong>the</strong><br />
love for her art as be<strong>in</strong>g a core motivator and a guid<strong>in</strong>g light that<br />
makes her cont<strong>in</strong>ue fight<strong>in</strong>g for her passion.<br />
Her magnificent strength and positivity <strong>in</strong> life makes me feel<br />
<strong>in</strong>ferior and guilty. The challenges most of us face are noth<strong>in</strong>g<br />
compared to hers. Her fight<strong>in</strong>g spirit encompass<strong>in</strong>g her<br />
enormous mental strength, her perseverance and willpower<br />
to live, and her strong beliefs and values, not limited by her<br />
physical <strong>in</strong>capability, are motivat<strong>in</strong>g and empower<strong>in</strong>g to me. I<br />
believe it will be so for many o<strong>the</strong>r <strong>cancer</strong> patients and <strong>cancer</strong><br />
survivors too!<br />
From her support for <strong>the</strong> <strong>cancer</strong> cause, many would have<br />
thought that Mdm Lee had been affected by <strong>cancer</strong>, but this<br />
is not true. Her aff<strong>in</strong>ity with <strong>the</strong> fight aga<strong>in</strong>st <strong>cancer</strong> by giv<strong>in</strong>g<br />
through her artistic talents began more than a decade ago. She<br />
was <strong>the</strong>n seek<strong>in</strong>g op<strong>in</strong>ion for ano<strong>the</strong>r medical condition with<br />
<strong>the</strong> current NCCS Director, Professor Soo Khee Chee, who<br />
was <strong>the</strong>n a doctor <strong>in</strong> S<strong>in</strong>gapore General Hospital. She was<br />
touched by Prof Soo’s care and his passion <strong>in</strong> help<strong>in</strong>g patients<br />
fight aga<strong>in</strong>st <strong>cancer</strong>. The <strong>cancer</strong> cause soon became part of her<br />
philanthropic endeavours.<br />
As Mdm Lee cont<strong>in</strong>ues pursu<strong>in</strong>g her love for art despite<br />
health challenges and physical limitations, she also donates<br />
her pa<strong>in</strong>t<strong>in</strong>gs to <strong>the</strong> <strong>Centre</strong> to raise funds for <strong>cancer</strong> research<br />
and for needy <strong>cancer</strong> patients. “ 在 所 有 能 力 范 围 内 , 还 是 可<br />
以 为 慈 善 尽 一 份 力 - Believe <strong>in</strong> giv<strong>in</strong>g what is with<strong>in</strong> your<br />
means and you can still help to make a difference,” she said.<br />
If you wish to jo<strong>in</strong> her <strong>in</strong> giv<strong>in</strong>g to <strong>the</strong> <strong>cancer</strong> cause, be it through purchase of her works or mak<strong>in</strong>g donations,<br />
please contact NCCS Community Partnerships at 6236 9440 or email donate@nccs.com.sg\.<br />
YEAR 2012 WAS A<br />
YEAR OF MANY<br />
FIRSTS FOR NCCS<br />
AND ITS CHARITY<br />
FUNDS, REACHING<br />
OUT TO MANY, IN<br />
OUR RELENTLESS<br />
CANCER-FIGHTING<br />
ENDEAVOURS.<br />
YOUNG HEARTS WITH<br />
VOICES OF HOPE<br />
Students and alumnus of <strong>the</strong><br />
Methodist Girls’ School (MGS)<br />
presented Voices of Hope, a CD<br />
album compris<strong>in</strong>g excellent pieces<br />
by <strong>the</strong>ir award-w<strong>in</strong>n<strong>in</strong>g perform<strong>in</strong>g<br />
arts groups – Primary and Secondary<br />
Choirs, <strong>the</strong> Secondary Hand-bell<br />
Choir, Str<strong>in</strong>g and Guitar Ensemble<br />
– and that of MGS Soloists, past and present. Of quality<br />
comparable to professionally produced albums, <strong>the</strong> CD was<br />
released <strong>in</strong> conjunction with <strong>the</strong> school’s 125th anniversary<br />
celebrations <strong>in</strong> 2012.<br />
The CD acknowledges that Life is a Battle and F<strong>in</strong>d<strong>in</strong>g Our Way<br />
<strong>in</strong> <strong>the</strong> Dark is not necessarily dismal especially when you hear<br />
<strong>the</strong> Voices of Hope and are assured <strong>the</strong>re is Love and <strong>the</strong>re are<br />
Streets of Gold and Colour everywhere. This production was<br />
made possible with <strong>the</strong> support from Trustees of <strong>the</strong> sacrificial<br />
fund of Dr Tan-Chow May L<strong>in</strong>g and Derek Tan. The late couple<br />
both battled and passed away from <strong>cancer</strong>.<br />
Proceeds from <strong>the</strong> CD sales, through <strong>the</strong> Community<br />
<strong>Cancer</strong> Fund, will provide necessary relief for needy<br />
patients as well as improve <strong>cancer</strong> care and prevention.<br />
CDs are available for <strong>in</strong>dividual and corporate purchases<br />
at $20 per album from <strong>the</strong> NCCS Retail Pharmacy (level 1)<br />
or mail orders via www.nccs.com.sg<br />
GIVING DIFFERENTLY -<br />
LEAN ON YOU (THE RACE)<br />
Forty performers aged 6 to 65, from different walks of<br />
life, crooned <strong>the</strong>ir hearts out for <strong>the</strong> <strong>cancer</strong> cause. Local<br />
musicians and artistes, <strong>cancer</strong> survivors and caregivers<br />
plus Mr Baey Yam Keng, MP for Tamp<strong>in</strong>es GRC gave <strong>the</strong>ir<br />
time and voices for a fresh remix of <strong>the</strong> “Lean On You (The<br />
Race)”. This was specially recorded to rally support from<br />
friends and <strong>the</strong> public to spread hope and optimism for <strong>the</strong><br />
fight aga<strong>in</strong>st <strong>cancer</strong>.<br />
The orig<strong>in</strong>al song, about how everyone is <strong>in</strong> <strong>the</strong><br />
fight aga<strong>in</strong>st <strong>cancer</strong> and toge<strong>the</strong>r this fight will<br />
and shall be won, had music composed by Melissa<br />
Poon and lyrics by Jerry Hoh. It brea<strong>the</strong>d new<br />
life through 2012’s stronger cast, new vocal and<br />
musical arrangements by Peng Chi Sheng, Aaron<br />
Lim and S<strong>in</strong> Sek Jhia from Intune Music.<br />
The music video (directed & produced by Rick Choy of<br />
Yang Films) on http://youtu.be/cXvR03Li1xA has achieved<br />
close to 7,000 views s<strong>in</strong>ce its release <strong>in</strong> late October.<br />
All resources <strong>in</strong>volved were generously volunteered.<br />
Cont<strong>in</strong>ued on page 16.
16 SALUBRIS JANUARY – MARCH 2013 SALUBRIS JANUARY – MARCH 2013 17<br />
Cont<strong>in</strong>ued from page 15.<br />
10,000 RUNNING<br />
FOR HOPE<br />
On 18 November 2012, for <strong>the</strong> first time, <strong>the</strong> Run For Hope<br />
(RFH) co-organised by NCCS and <strong>the</strong> Four Seasons Hotel<br />
S<strong>in</strong>gapore and Regent S<strong>in</strong>gapore, had its largest turnout of<br />
10,000 runners <strong>in</strong> its history of runn<strong>in</strong>g for <strong>cancer</strong> research.<br />
Its first ever city-run at <strong>the</strong> Padang was officiated by <strong>the</strong><br />
M<strong>in</strong>ister of Health, Mr Gan Kim Yong, who also participated<br />
<strong>in</strong> <strong>the</strong> 3.5km family fun run/walk.<br />
In addition to memorable moments from support<strong>in</strong>g <strong>the</strong><br />
worthy cause, runners enjoyed <strong>the</strong> scenic view of Mar<strong>in</strong>a<br />
Bay as <strong>the</strong>y ran for hope, pass<strong>in</strong>g by iconic landmarks such<br />
as <strong>the</strong> Esplanade, Mar<strong>in</strong>a Barrage, and Gardens by <strong>the</strong> Bay<br />
(for <strong>the</strong> 10 km runn<strong>in</strong>g route). They were also enterta<strong>in</strong>ed<br />
by emcee-volunteers Neil Humphrey, L<strong>in</strong>da Black, Simon<br />
Wong, Steve Lai, Sharda Max<strong>in</strong>e Harission and comedians<br />
Rishi Budhrani and Sharul Channa. Some lucky runners also<br />
went home with fabulous hotel-sponsored w<strong>in</strong>s.<br />
Donations to <strong>the</strong> cause cont<strong>in</strong>ued via <strong>the</strong> website<br />
and pledges after <strong>the</strong> run. $433,668.28 was raised to<br />
date for NCC Research Fund, break<strong>in</strong>g previous years’<br />
RFH records, <strong>in</strong> aid of streng<strong>the</strong>n<strong>in</strong>g NCCS research<br />
capabilities and accelerat<strong>in</strong>g <strong>the</strong> speed of research to<br />
benefit patients earlier.<br />
More than 600 student volunteers from Temasek Polytechnic and<br />
Republic Polytechnic were <strong>in</strong>volved and contributed to <strong>the</strong> smooth<br />
execution of <strong>the</strong> event.<br />
More than 10 senior management executives from large corporations stepped up to RFH’s new Executive Challenge,<br />
tak<strong>in</strong>g <strong>the</strong> lead to support RFH.<br />
“It’s such a refresh<strong>in</strong>g change from our<br />
previous years - <strong>the</strong> atmosphere, scenic<br />
views, smooth execution and all.<br />
Positive feedback echoed <strong>in</strong> my ears<br />
after <strong>the</strong> run and without any doubt,<br />
many from runn<strong>in</strong>g enthusiasts to firsttime<br />
runners and walkers are look<strong>in</strong>g<br />
forward to sign-up for RFH 2013!” said<br />
<strong>cancer</strong> survivor and RFH ambassador,<br />
Ezzy Wang.<br />
Manag<strong>in</strong>g Director of Towers Watson S<strong>in</strong>gapore,<br />
Mr Robert Wilkes came <strong>in</strong> first, followed closely by<br />
SCDF Commissioner Eric Yap and CEO of Superbrands,<br />
Mr Mark Po<strong>in</strong>ter <strong>in</strong> <strong>the</strong> Executive Challenge.<br />
Missed sign<strong>in</strong>g up last year? Save <strong>the</strong> date and sign up<br />
early for 17 Nov 2013! Visit www.runforhopes<strong>in</strong>gapore.<br />
org.sg or fb.com/RunForHopeSG for more.<br />
BUDDIE THE BADGER JOINS<br />
YOU IN FIGHTING CANCER<br />
At <strong>the</strong> RFH, NCCS also <strong>in</strong>troduced a new team member –<br />
Buddie <strong>the</strong> Badger, <strong>the</strong> NCCS mascot that represents tenacity<br />
and fearlessness – to cheer society on <strong>in</strong> <strong>the</strong> fight for a<br />
<strong>cancer</strong>-free tomorrow.<br />
In a recent qualitative study with close to 50 <strong>cancer</strong> survivors,<br />
caregivers and members of <strong>the</strong> public, <strong>the</strong> importance of collective<br />
fight<strong>in</strong>g spirits and hav<strong>in</strong>g a never-give-up attitude was evident.<br />
Amongst <strong>the</strong> creative concepts presented to boost optimism and<br />
public concern <strong>in</strong> <strong>the</strong> <strong>cancer</strong> cause, <strong>the</strong> idea of a dist<strong>in</strong>ctive mascot<br />
that represented positivity and tenacity was warmly welcomed<br />
especially by survivors and caregivers.<br />
Known to be one of <strong>the</strong> most tenacious and fearless animal, <strong>the</strong><br />
small-sized honey badger that takes on fights with larger predators<br />
such as lions and bears, symbolises <strong>the</strong> key attitudes essential<br />
<strong>in</strong> overcom<strong>in</strong>g <strong>the</strong> dreaded big C. Its family-oriented nature also<br />
highlights <strong>the</strong> realistic need for family and community support.<br />
All ready to pick a fight with <strong>cancer</strong>, Buddie <strong>the</strong> Badger will be<br />
cheer<strong>in</strong>g on NCCS team and all <strong>cancer</strong>-fighters through various<br />
staff and community outreach activities from 2013.<br />
We also look forward to<br />
partner<strong>in</strong>g family-oriented groups<br />
and corporations, and schools,<br />
who are keen to help! Contact us<br />
today at marcomm@nccs.com.sg<br />
Toge<strong>the</strong>r, for a <strong>cancer</strong> free tomorrow.<br />
BY ADELINE TEO<br />
Support<strong>in</strong>g <strong>the</strong><br />
worthy cause can<br />
also be <strong>in</strong> <strong>the</strong> form<br />
of shar<strong>in</strong>g your<br />
expertise and time.<br />
Special thanks to:<br />
Creative hotshop, Arcade, for<br />
giv<strong>in</strong>g time and develop<strong>in</strong>g ideas<br />
(<strong>in</strong>clud<strong>in</strong>g <strong>the</strong> creation of NCCS<br />
mascot) with us to promote<br />
community engagement <strong>in</strong> aid<br />
of <strong>the</strong> <strong>cancer</strong> cause.<br />
All <strong>in</strong>dividuals and organisations<br />
<strong>in</strong>volved with <strong>the</strong> Voices of<br />
Hope, Lean On You and Run For<br />
Hope projects.
18 SALUBRIS JANUARY – MARCH 2013 SALUBRIS JANUARY – MARCH 2013 19<br />
LET’S GO FLY KITE!<br />
– BREAST CANCER<br />
AWARENESS MONTH<br />
2012<br />
BY WINSTON TAY<br />
Executive<br />
Surgical Oncology, NCCS<br />
An eventful day for all <strong>the</strong> participants who came for <strong>the</strong> event.<br />
The <strong>National</strong> <strong>Cancer</strong> <strong>Centre</strong><br />
S<strong>in</strong>gapore (NCCS) organised an<br />
outdoor kite cum picnic event for<br />
Breast <strong>Cancer</strong> Awareness Month<br />
(BCAM) 2012 at <strong>the</strong> Mar<strong>in</strong>a Barrage<br />
on 3 November.<br />
Kites, a symbol of freedom and emancipation, were<br />
used to convey <strong>the</strong> message of freedom from<br />
breast <strong>cancer</strong> through early detection and prompt<br />
treatment. This specially designed concept for <strong>the</strong><br />
P<strong>in</strong>k Ribbon Kite is a shock<strong>in</strong>g p<strong>in</strong>k loop on <strong>the</strong> kite (600cm<br />
long x 550cm wide) with two-metre long p<strong>in</strong>k tails stitched<br />
to <strong>the</strong> sides.<br />
The commemorative T-shirts depicted a family runn<strong>in</strong>g on<br />
<strong>the</strong> grass and fly<strong>in</strong>g <strong>the</strong> p<strong>in</strong>k ribbon kite, as a symbol of <strong>the</strong><br />
liberation from fear and despair and <strong>the</strong> joy, happ<strong>in</strong>ess and<br />
hope that families give to breast <strong>cancer</strong> survivors.<br />
The event was supported by The Layangman and his<br />
team of “Layang Kakis”, <strong>the</strong> band SEYRA and <strong>the</strong> 501st<br />
Legion S<strong>in</strong>gapore Garrison who came to do <strong>the</strong>ir part to<br />
bless <strong>the</strong> participants.<br />
Participants enjoyed <strong>the</strong> picnic and music amidst<br />
breathtak<strong>in</strong>g views of S<strong>in</strong>gapore city.<br />
The event was well attended by some 360 adults and<br />
children despite <strong>the</strong> <strong>in</strong>clement wea<strong>the</strong>r, to celebrate <strong>the</strong><br />
triumphs of breast <strong>cancer</strong> survivors and to reflect on those<br />
who have lost <strong>the</strong>ir battle to <strong>the</strong> disease.<br />
The band SEYRA.<br />
501st Legion S<strong>in</strong>gapore Garrison.<br />
Kites, a symbol of freedom and<br />
emancipation, were used to convey<br />
<strong>the</strong> message of freedom from breast<br />
<strong>cancer</strong> through early detection and<br />
prompt treatment.
20 SALUBRIS OCTOBER – DECEMBER 2012<br />
NCCS STUDIES NEW<br />
TECHNOLOGY TO<br />
TREAT CANCERS<br />
NEW APPOINTMENTS<br />
The <strong>National</strong> <strong>Cancer</strong> <strong>Centre</strong> S<strong>in</strong>gapore will be conduct<strong>in</strong>g<br />
studies to develop a new technology that can help to treat<br />
<strong>cancer</strong> cells that may be left beh<strong>in</strong>d after an operation.<br />
There is always a post-surgery risk that tumour cell residues may rema<strong>in</strong> <strong>in</strong><br />
<strong>the</strong> abdom<strong>in</strong>al l<strong>in</strong><strong>in</strong>g when remov<strong>in</strong>g abdom<strong>in</strong>al tumours.<br />
The focus for <strong>the</strong> research will be on abdom<strong>in</strong>al <strong>cancer</strong>s, start<strong>in</strong>g with<br />
advanced ovarian <strong>cancer</strong>. Prof Soo Khee Chee, NCCS director, said:<br />
“Besides <strong>the</strong> abdom<strong>in</strong>al cavity, <strong>the</strong>re are also o<strong>the</strong>r areas <strong>in</strong> <strong>the</strong> body<br />
which are difficult to target with conventional <strong>the</strong>rapies such as ovarian,<br />
gastro<strong>in</strong>test<strong>in</strong>al and hepatobiliary <strong>cancer</strong>s.<br />
“Instead of high-dose chemo treatments, if we can significantly kill off<br />
microscopic residual tumors us<strong>in</strong>g this approach, survival rates would<br />
improve and recurrence would be lessened,” said Prof Soo when speak<strong>in</strong>g<br />
to <strong>the</strong> media at <strong>the</strong> new cl<strong>in</strong>ical and laboratory facility under construction at<br />
S<strong>in</strong>gapore General Hospital. The facility will be equipped to move directly<br />
from precl<strong>in</strong>ical to Phase I work with <strong>the</strong> same research team.<br />
The Master Research Collaboration Agreement was signed between S<strong>in</strong>ghealth’s<br />
S<strong>in</strong>gapore General Hospital, <strong>National</strong> <strong>Cancer</strong> <strong>Centre</strong> S<strong>in</strong>gapore and Australia’s<br />
Sirtex Medical Pte Ltd to explore <strong>the</strong> potential of a new technology called<br />
Carbon Cage Nanoparticles. It was signed on 5 December.<br />
DR RICHARD YEO<br />
(Senior Consultant)<br />
Department of<br />
Radiation Oncology<br />
DR JEFFREY TUAN<br />
(Consultant)<br />
Department of<br />
Radiation Oncology<br />
DR FRANCIS CHIN<br />
(Senior Consultant)<br />
Department of<br />
Radiation Oncology<br />
DR PATRICIA NEO<br />
(Consultant)<br />
Department of<br />
Palliative Medic<strong>in</strong>e<br />
(From left) Mr Kev<strong>in</strong> Lai, Director, Biomedical Sciences, S<strong>in</strong>gapore<br />
Economic Development Board, Professor Ross Stephens, Research<br />
School of Physics & Eng<strong>in</strong>eer<strong>in</strong>g, Australian <strong>National</strong> University, Ms<br />
Enny Kiesworo, Director, Office of Research, S<strong>in</strong>gHealth, Professor Soo<br />
Khee Chee, Deputy Group CEO (Education & Research), S<strong>in</strong>gHealth,<br />
and Director of NCCS, Mr Gilman Wong, CEO, Sirtex, Dr Steve Jones,<br />
Global Head of Research & Development, Sirtex.<br />
DR TAN NGIAN CHYE<br />
(Senior Consultant)<br />
Department of<br />
Surgical Oncology<br />
DR LEE SER YEE<br />
(Consultant)<br />
Department of<br />
Surgical Oncology<br />
Editorial Advisors<br />
Prof Kon Oi Lian<br />
Prof Soo Khee Chee<br />
Dr Tan Hiang Khoon<br />
Editorial Consultant<br />
Mr Sunny Wee<br />
Medical Editor<br />
Dr Richard Yeo<br />
Executive Editors<br />
Ms Charissa Eng<br />
Ms Veronica Lee<br />
Ms Rachel Tan<br />
Members, Editorial Board<br />
Ms Lita Chew<br />
Dr Mohd Farid<br />
Mr Mark Ko<br />
Ms Sharon Leow<br />
Ms Jenna Teo<br />
Dr Melissa Teo<br />
Dr Teo Tze Hern<br />
Dr Deborah Watk<strong>in</strong>son<br />
is produced with you <strong>in</strong> m<strong>in</strong>d.<br />
SALUBRIS If <strong>the</strong>re are o<strong>the</strong>r topics related<br />
to <strong>cancer</strong> that you would like to read about or if you would<br />
like to provide some feedback on <strong>the</strong> articles covered,<br />
please email to salubris@nccs.com.sg.<br />
NATIONAL CANCER CENTRE SINGAPORE<br />
Reg No 199801562Z<br />
11 Hospital Drive S<strong>in</strong>gapore 169610<br />
Tel: (65) 6436 8000 Fax: (65) 6225 6283<br />
www.nccs.com.sg