Medical Professionals Version - National Cancer Centre Singapore

Issue No. 13 • MICA (P) 149/10/2009
AN NCCS BI-MONTHLY PUBLICATION
November / December 2010
...HELPING READERS TO ACHIEVE GOOD HEALTH
Salubris is a Latin word which means healthy, in good condition (body) and wholesome.
BREAST CANCER
AESTHETICS

PAGE A2
In Focus
SALUBRIS
November / December 2010
PERSPECTIVES ON
LUNG CANCER
NCCS Scientists and Oncologists specialising in the research
and treatment of lung cancer turned out in full force at the
Singhealth – Duke-NUS Scientific Congress to give insightful
updates about the top killer disease. VERONICA LEE reports.
Proposal to ban tobacco products
Perhaps one of the more engaging
presentations that benefited not only the
healthcare professionals but the public as
well was Prof Koong Heng Nung’s proposal
to deny the use of tobacco products for
Singapore citizens born in or after the year
2000. The Senior Consultant and Head of
NCCS Department of Surgical Oncology
enumerated the benefits and implications of
his proposal before an attentive audience.
Despite several effective campaigns and
measures that have brought down smoking
prevalence rates from 20% in 1984 to
13.6% in 2007, the number of smokers
between the ages of 12 and 18 has increased significantly. This was mirrored by the
worldwide trend where smokers picked up the habit in their teenage years and this
continued in their adult life.
Prof Koong highlighted the rite of passage that many have come to associate with
smoking, an activity seen to be connected with maturity and adulthood. Many
youngsters are under the false notion that smoking is synonymous with the coming of
age and is an accepted practice for adults.
Although such a proposal may mean limiting one’s freedom, only less
than 11% of the total population surveyed in the Singapore Lung
Cancer Awareness Study 2007 felt that the proposal impinged on
personal rights and freedom.
Current laws make it difficult for cigarette
vendors who have to do a mental
calculation of the birth rates to ascertain
whether or not the buyer is under-aged.
Given this difficulty, Prof Koong proposed
that a tobacco ban based on a fixed birth
year would be easier to enforce.
Although such a proposal may mean
limiting one’s freedom, only less
than 11% of the total population
surveyed in the Singapore Lung Cancer
Awareness Study 2007 felt that the
proposal impinged on personal rights
and freedom.
The proposal also aimed to minimise
immediate hardship to the tobacco
industry in that smokers who were of the
legal age could still continue smoking
and slowly phase out tobacco use without
a sudden ban which was impractical
given the economic repercussions of an
immediate loss of excise revenues. This
thus fulfils the industry’s assertion about
not attracting new smokers.
‘Proposal To Deny Access
To Tobacco For Those Born
From year 2000’
(A/Prof Koong Heng Nung)

PAGE A3
In Focus
SALUBRIS
November / December 2010
Integrated Signature is valid
in predicting clinical outcome
for early stage lung cancer
Traditionally, treatment for stage 1&2 Lung
Cancer is surgery. This has been effective
as the survival rate for patients after
surgery is 40-50%. However, about 30%
of survivors may suffer a relapse and die
within five years. Hence there is the need
to accurately identify patients who might
benefit from adjuvant chemotherapy.
However, Dr Patrick Tan, Principal
Investigator, Division of Cellular and
Molecular Research, who presented
'Genetic Analysis of Lung Cancer' shared that the solution may not be as straight
forward as it seemed. Findings from the CALGB 9633 trial had showed that while
there was potential survival benefit for adjuvant chemotherapy in Stage 1B Lung
Cancer, an update from the same trial showed no benefits.
Dr Tan suggested that Stage 1B Non Small-Cell Lung Cancer (NSCLC) was thus ideal
from which genomic strategies could be further researched, to classify patients with
low and high risk of recurrence, with adjuvant therapy being a treatment option for
high-risk patients.
With one of the biggest challenge of NSCLC
being chromosonal instability that contributes
to inaccuracies in predicting tumour behaviour,
Dr Tan highlighted that a prognostic signature
solely based on gene expression may not
be adequate. Rather, it is the integration of
genomics and gene expression information, or
what he called integrated signature, to derive
a survival model rooted in recurrent CNAs
associated with NSCLC that may be the best bet.
Dr Tan however cautioned against specific
genomic abnormalities which may be present
among Asians and thus render western
benchmarks irrelevant. Studies have shown that
non-tobacco related risk factors exist and neversmokers
constitute a portion of lung cancer
patients, having been exposed to cooking
fumes. Different tissue behaviour was also
discovered between smoker and never-smokers.
‘Genetic Analysis of
Asian Lung Cancers’
(Dr Patrick Tan)
Female Never-Smokers with
East-Asian ethnic background
have better chance of survival
following chemotherapy
Increasingly it has been found that
people who do not smoke also suffer
from lung cancer, suggesting that there
are host differences in susceptibility to
lung cancer and the presence of other
risk factors. About 15% of men and 53%
of women who do not smoke develop
lung cancer, owing to their exposure to
secondhand smoke, asbestos, radon and
related substances, air pollution and
smoke from cooking.
However, the good news is that never-smokers with East Asian ethnicity and
adenocarcinoma make-up are more likely to respond to treatment than their
western counterparts. This was found in the recent clinical development of the
epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs),
gefitinib and erlotinib. Mutations in the EGFR kinase domain are more common
and patients with these mutations have increased sensitivity to EGFR TKIs.
Approximately 30-40% of NSCLC patients in
Asia and 10-15% of Caucasians have EGFR
mutation-positive tumours and over 70% of these
patients are women in Singapore.
Prof Hui Kam Man, Head of NCCS Division of
Cellular and Molecular Research, presented these
findings of the study, in which gene expression
profiling to measure all the mRNA in the lung
tumor tissues of these patients was carried out. The
team has also identified gene signatures associated
with better treatment responses to chemotherapy
and prolonged survival for female never-smokers
patients with adenocarcinoma of different ethnic
backgrounds. Further molecular evidence was also
presented to demonstrate that Chinese female neversmokers
with adenocarcinoma is not a homogenous
population and the responses to treatment could
also differ within this group of patients.
‘Is East Asian Lung Adenocarcinoma
a Distinct Disease’
(Prof Hui Kam Man)
Continued on page A4.

PAGE A4
In Focus
SALUBRIS
November / December 2010
PERSPECTIVES ON
LUNG CANCER
Continued from page A3.
Genomics techniques is useful
in unraveling drug resistance
About $1.2 million people suffer from
lung cancer annually. Majority present
in the advanced stage and even in
those patients that undergo surgery,
a significant proportion of cases
eventually recur. Advanced stage lung
cancer (Stage 3B and 4) is traditionally
treated with chemotherapy, with
response rates of approximately 20%
with a median survival of six months.
For the past three decades, selection
of chemotherapy regimens for the
treatment of NSCLC has largely been empirical. However, with the advent genomic
technologies, there is now an improved understanding of the disease biology that
has led to classifying lung cancer into molecular subtypes. Importantly, these
subtypes are now amenable to targeted therapeutics, especially in the era of
mechanism-based drug discovery. In the landmark IPASS study, in which NCCS
was one of the participating sites, 1,217 patients were randomly allocated to
either gefitinib (an EGFR tyrosine kinase inhibitor) or carboplatin-paclitaxel. In
approximately two thirds of patients that harboured the EGFR mutation, response
rates were 70%, and the overall median survival 22 months.
Genomics techniques have also been useful in unravelling drug resistance
mechanisms – the common reason for treatment failure. Elucidating these
mechanisms allow the development of rational strategies to overcome them.
A critical aspect is the need for discovering and developing new biological
markers – or biomarkers – that can help in directing these treatments.
However, Dr Daniel Tan, Associate Consultant, Department of Medical Oncology,
NCCS warned that while identifying biomarkers that predict for drug response
promise to improve cancer management, it is important that they undergo
sufficient rigor to ensure their validity, reproducibility and repeatability. Indeed
an inaccurate biomarker may be misleading – resulting in unnecessary patient
exposure to ineffective drugs, or conversely patients wrongly deprived of useful
treatments. A new generation of clinical trials is necessary to meet these evolving
concepts of patient selection in targeted therapeutics.
Dr Tan also shared that such translational studies are resource-intense, requiring
multidisciplinary input involving oncologists, basic scientists, radiologists,
pathologists as well as other disciplines. The crucial components of such an
infrastructure are already available in NCCS and the Outram Campus, and the
next few years hold tremendous promise for lung cancer patients.
‘How Genomics has transformed the Therapeutic Landscape
of Non Small Cell Lung Cancer’
Dr Daniel Tan
For the past three decades, selection
of chemotherapy regimens for the
treatment of non-small cell lung
cancer (NSCLC) has largely been
empirical. However, with the advent
genomic technologies, there is
now an improved understanding
of the disease biology that has
led to classifying lung cancer into
molecular subtypes.
The SingHealth –
Duke-NUS Scientific
Congress is an annual
event that promotes
the exchange of
medical and healthcare
expertise through
quality fellowship
and educational
activities. Held at the
Suntec International
Convention and
Exhibition Centre, it
attracted more than
2,500 healthcare
professionals this year.

IMPROVING COSMETIC
OUTCOMES FOLLOWING
BREAST CANCER SURGERY
PAGE C1
Under The Microscope
SALUBRIS
November / December 2010
It is a sobering fact that Singapore has the highest rate of breast cancer in Asia.
It is the commonest cancer among women here, with about 1300 new cases
every year. Management of breast cancer remains challenging and requires a
coordinated, multidisciplinary approach. Despite the continued discovery of
newer and better pharmaceutical agents and improved delivery of radiotherapy,
surgery still remains the cornerstone of breast cancer treatment.
For most women, the diagnosis of breast cancer evokes intense feelings of
fear, anxiety and despair. In addition, the breast is also a powerful emblem
of womanhood. The thought of losing a breast accounts for much of the
reluctance for a patient in undergoing surgery. Following treatment, there is also
considerable long-term psychological impact on self-esteem and body image.
Thankfully, with better understanding of the disease as well as improved surgical
options and techniques, patients can achieve a good cosmetic outcome without
compromising the chances of cure.
By Dr Ong Kong Wee
Consultant
Department of Surgical Oncology
NCCS
Recently, a specialised field of breast cancer surgery termed oncoplastic surgery
is gaining widespread popularity. This evolving area is based on the principles of
surgical oncology as well as plastic and reconstructive surgery, and applies them to
the management of breast cancer patients. It describes a surgical approach encompassing
a wide range of surgical procedures, and not just one particular operation. The aims of
oncoplastic surgery are to achieve wide enough surgical margins to reduce local recurrence
yet optimise cosmetic outcome.
Careful pre-operative planning is the first important step in oncoplastic surgery. In
some cases, a magnetic resonance imaging (MRI) scan of the breasts may be required
to determine the extent of the disease as well as exclude occult contra lateral cancer.
Confirmation of the diagnosis by minimally invasive techniques is essential and allows the
patient to have in-depth discussion with a multidisciplinary team including the surgical
oncologist and plastic surgeon about her surgical options.
Oncoplastic techniques can generally be classified according to whether part of, or the
entire breast, is removed.
When part of the breast is removed, the resulting defect can be filled by either a
displacement or replacement flap. A displacement flap involves mobilising breast tissue
from the same breast to minimise the resultant deformity. In other instances, particularly if
the patient has small breasts, a replacement flap consisting of autologous tissue from other
parts of the body, e.g. back muscles, is fashioned to achieve the desired cosmetic outcome.
Autologous fat transfer has also been tried but is still in an early phase of development. A
key advantage of partial breast surgery using oncoplastic techniques is that larger tumours
can be resected safely compared with standard breast conservation surgery.
Whole breast reconstruction following mastectomy is much more commonly practised
locally. In this procedure, a mastectomy is carried through a small skin incision while
preserving the overlying skin and in selected cases, including the nipple-areolar complex.
The breast mound is then recreated immediately with a myocutaneous flap harvested from
the abdomen or back. Alternatively, a prosthesis may be inserted in lieu of a flap.
Although this procedure is time consuming
and technically demanding, the risks and
possible complications are minimised with
modern surgical approaches.
Current surgical techniques
for breast cancer have
improved by leaps and
bounds, particular over the
last 30 years. Achieving the
twin aims of durable cure as
well as excellent cosmetic
outcome is an established
reality with the techniques
available today.

PAGE C2
Under The Microscope
SALUBRIS
November / December 2010
NCCS TEAM BAGS BEST
POSTER AWARD
FROM EUROPEAN SOCIETY
FOR MEDICAL ONCOLOGISTS
Researchers from the
National Cancer Centre
Singapore (NCCS) receive
recognition for their work
on Nasopharyngeal Cancer
from the European Society
For Medical Oncologists
(ESMO). VERONICA LEE
finds out more about their
study on vaccines.
Nasopharyngeal cancer (NPC) is
a tumor that is relatively rare
in the west, but common in
Singapore and Southeast Asia. Although
the cure rate for patients with early stage
disease is good, patients with advanced
stage disease where the cancer has spread
to other organs, are incurable and have
a poor outlook. Although Chemotherapy
remains the only option for these patients,
it seldom produces durable cancer
control and the disease starts recurring
once chemotherapy is stopped.
The challenges in managing advanced NPC
patients has prompted a team of doctors
and scientists led by Dr Toh Han Chong
and Dr John Chia from the NCCS Medical
Oncology Department to study novel ways
of targeting the disease, in an attempt to
improve outcomes for their patients.
“NPC is a very interesting
disease, in that it is driven by
the Epstein-Barr virus which
produces cancer causing
proteins that drive cancer
growth” says Dr John Chia, a
Consultant Medical Oncologist.
“Because these cancer proteins are also expressed on the surface of
cancer cells, they also make the cancer cells vulnerable to recognition
and killing by the immune system. Our project was to develop a vaccine
that would boost the immune system’s ability to recognise these viral
products on the cancer cells, and then to kill them.”
The team thus began a clinical trial to test a “Dendritic Cell” (DC) vaccine against
NPC in August 2007.
The results of the study, which was carried out on 16 patients, showed that the DC
vaccines that were administered to patients were able to potently activate and train the
patients’ own immune cells to recognise and kill cancer. However, although the results
were promising with no side effects, treatment was not sufficiently potent to cause
eradication of the tumor in most patients.
“The results seemed to indicate that our strategy in targeting the immune system is
feasible and has given us many clues as to how the immune system works in cancer.
But the treatment is not yet ready for prime time.” says Dr John Chia. “Our focus now
is to try to make the vaccine better. We are exploring ways to modify the vaccine and
explore strategies on combining the vaccine with other potent immune targeting cells.
Along this line of research, we have just completed another trial involving the transfer of
large numbers of highly active immune cells derived from patients’ own blood that have
been trained to target and kill nasopharyngeal cancer cells. We are currently analysing
the data and are encouraged by what we have seen so far”.
The study “A Phase 2 study of vaccination with Adenovirus ΔLMP1-LMP2 transduced
dendritic cells in patients with advanced metastatic nasopharyngeal carcinoma” was
a group effort by Dr John Chia, Who-Whong Wang, Dr Marissa Teo, Wai Meng Tai,
Dr Lim Wan Teck, Dr Tan Eng Huat, Dr Leong Swan Swan, Li Sun, Jian Jiun Chen,
Stephen Gottschalk and Dr Toh Han Chong. The team was conferred the Best Poster
(Head and Neck Cancers) by ESMO.

STEREOTACTIC BODY
RADIOTHERAPY
PAGE C3
Spotlight
SALUBRIS
November / December 2010
It is well recognised that radiation therapy plays a
key role in the treatment of a wide range of cancers.
It uses high-energy x-rays to kill cancer cells or keep
them from growing. Often, radiation therapy is used
to cure early stage tumours. In some cases, where the
cancer is diagnosed in the later stages and the tumor
cells have already spread to other parts of the body
such as bones, radiotherapy can still help to control
troublesome symptoms such as pain.
By Dr Anu Thiagarajan
Consultant Radiation Oncologist
NCCS
However, one of the problems of standard radiation therapy has been
collateral damage to surrounding healthy tissues. This occurs because
the area selected for treatment usually includes the whole tumour
plus a varying amount of normal tissue surrounding the tumour. This
normal tissue is treated for two main reasons:
(1) to take into account body movement from breathing and normal
movement of the organs within the body, which can change the
location of a tumour between treatments and
(2) to reduce the likelihood of tumour recurrence from cancer cells
that have spread to the normal tissue next to the tumour (called
microscopic tumour spread).
To minimise damage to neighboring healthy tissues, standard radiotherapy is generally
given in many small doses over several weeks to allow the normal tissues to recover
and regenerate. The total radiation dose administered is also kept comparatively low
in order to protect sensitive normal tissues such as the spinal cord, which, if damaged,
can have devastating consequences for patients, impacting on their daily functioning
ability and quality of life. However, this may sometimes mean that tumours receive
inadequate radiation doses and as a result, the chances of cure may be compromised.
In recent years, the emergence of a new and exciting technology called stereotactic
body radiation therapy (SBRT) has allowed radiation to be delivered with pinpoint
accuracy. Because of the high-precision nature of this treatment, one of the key
requirements to ensure success is mimimal body movement of patients during treatment.
For this reason, during the radiotherapy planning session (also known as simulation), an
immobilisation device is made to help patients remain still during radiation treatment.
While many immobilisation devices are
available, one of the more commonly
used devices is called a BodyFIX bag. It
consists of a bean bag that forms a cushion
under the body, and a plastic sheet that
covers the top of the body. The beanbag
and top sheet are very loose at first, then
tighten as a vacuum removes all the air,
creating a stable and precise body mold.
Once made, this mold is stored and used
every time for treatment. When treatment
is about to begin, a radiation therapist
positions the patient on the treatment
machine in the immobilisation device.
Several images including CT scan images
are taken to ensure that the patient is
positioned accurately and adjustments
are made if needed. The machine that
delivers the radiation then moves around
directing radiation to the body from
several angles. With SBRT, the physician
can even take into account movement of
a tumour based on a patient’s breathing
pattern. Such advancement in accuracy
of radiation treatments means that much
smaller margins of normal tissue are
included in the area of treatment, thereby
allowing much higher doses of radiation
to be delivered, potentially improving the
likelihood of killing the cancer cells of a
tumour and increasing the chances of cure.
Continued on page C4.

PAGE C4
Spotlight
SALUBRIS
November / December 2010
Continued from page C3.
At present, in NCCS, this treatment technique is primarily
offered to patients with early stage lung cancer who
are inoperable owing to poor medical health or those
who refuse surgery. Normally, these patients are offered
a 6-week course of conventional radiation treatment.
However, outcomes have not been ideal with this approach,
with tumour control achieved in only about 30-40% of
patients and more than half of all patients dying from
progressive disease within two years.
Another benefit to the improved accuracy is that treatments can be completed in a short
period of time. Traditional radiation therapy typically requires daily hospital visits, 5 days
a week for five to six weeks. On the other hand, SBRT usually only requires one to five
treatments over one to two weeks. This is of tremendous benefit particularly for patients who
are working full-time, those with young families, those who have long distances to travel to
get to hospital, as well as elderly patients who need assistance to get to and from hospital.
This abbreviated course of radiation reduces the number of trips to the hospital and helps
patients as well as care-givers resume their day-to-day lives as quickly as possible.
As with any type of radiation, side effects may occur with SBRT. Specific
side effects depend on the site being treated and can vary in severity
from patient to patient. These side effects are usually minor, transient
and resolve in the weeks following completion of radiation. Concerns
about worse side effects because of the higher radiation doses used have
fortunately not been seen with multiple trials consistently demonstrating
that treatment-related toxicities were within the acceptable range.
In NCCS, SBRT is delivered using one of two high-end state-of-the-art machines
(Trilogy, or Tomotherapy). Both systems offer CT scanning capabilities, allowing
radiation oncologists to confirm the precise location of tumours with CT scans prior to
each treatment, make necessary adjustments, and administer radiation, all on the same
machine. This gives the treating oncologist greater confidence that radiation is being
delivered exactly as planned. However, the implementation of such complex treatment
does come at a cost. It relies on modern, expensive equipment. It is labour-intensive,
requiring specialised training and coordinated effort between radiation oncologists,
medical physicists, and radiation therapists. Another factor that is key to the success
and safe delivery of this technique is the development and implementation of rigorous
quality assurance procedures. As such, stereotactic body radiation therapy is currently
more expensive than conventional radiation treatment.
At present, in NCCS, this treatment
technique is primarily offered to
patients with early stage lung cancer
who are inoperable owing to poor
medical health or those who refuse
surgery. Normally, these patients
are offered a 6-week course of
conventional radiation treatment.
However, outcomes have not been
ideal with this approach, with tumour
control achieved in only about 30-40%
of patients and more than half of all
patients dying from progressive disease
within two years. With stereotactic
radiation therapy on the other hand,
the preliminary results have been far
superior with long-term tumour control
rates in excess of 70%. In spite of these
promising results, SBRT is still in its
infancy and longer follow-up of patients
is needed to confirm these positive
early results.
Efforts are also currently underway to
expand the usage of SBRT to include
selected patients with spine and liver
tumours. While SBRT is not suitable
for every patient, its potential to be an
effective and convenient alternative to
conventional radiation therapy in the
near future is immense.

PREETI’S LOVE
TRANSCENDS BORDERS
PAGE A5
Community
SALUBRIS
November / December 2010
One concert every six months is what 17-year-old Preeti
Varathan has been doing since 2007. But one particular
concert holds a very special place in the heart of the carnatic
violinist – the concert that took place in New York City this July.
Preeti raised $40,000 for the National Cancer Centre Singapore
in support of cancer research. CHUA HWEE LENG reports.
A
young and bright lass,who glows
with positive energy, Preeti is no
stranger to cancer. The disease
took her mother away from her life when
she was only six years old. Her late
mother, Madam Hema Devanathan was
only 36 years old.
Despite having witnessed her mother’s
two-year-long struggle with lung cancer,
Preeti did not allow the experience to
wane her. Instead, she was determined
to be stronger each day, refusing to
allow the negative experience to occupy
her thoughts.
Withholding tears, she recounted how
strong her mother was in her fight against
cancer and how the tragic episode had
then affected her.
“Before she was diagnosed with cancer,
I would read to her when I came home
from school. After she was diagnosed
with cancer, she started losing her hair
and put on a lot of weight due to the
treatment she received.
“During later stages, she stayed in her
room most of the time. But in spite of
that, whenever I got home, she would
still let me read to her. It was the kind of
consistency; the little things that touched
me. She wouldn’t allow her illness to
change our routine. I think that was what I
really respected in her,” said Preeti.
Now, Preeti lives with this philosophy,
“I am not the only person to face
tragedy – almost everyone in the world
does as well. But we must not let that
deter us. We have to move on and
pursue what we want for ourselves.”.
Although Preeti was of a young age
then, she understood that her mother
was suffering from pain. However,
Madam Devanathan never showed
her weakness in front of the children.
On her mother’s last gift to her, she
said, “I think strength is what she has
given me.”
After her mother passed away and
was cremated, Preeti and her sister
accompanied their father to the Bay
of Bengal in India to scatter her ashes.
That was when she got exposed to the
carnatic style of playing the violin. To
fill the void in her life, she decided
to go under the tutelage of famous
Carnatic violinist Sri Vittal Ramamurthy.
She learnt well and put her talent to
good use – hosting concerts that raised
funds for healthcare causes. This year
marked her first solo concert outside
India. It was also her first fund-raising
concert for the cancer cause. She
single-handedly booked the concert
hall, printed invitations and posters,
and invited two renowned artistes
– Neyveli R. Narayanan and Samir
Chatterjee – to be her accompanists.
At the concert, which did not come at any
ticket price, Preeti gave a presentation
on cancer research to her audience. They
were strangers to the National Cancer
Centre Singapore (NCCS). Preeti won their
hearts with her touching presentation and
her performance. The nearly 250-member
audience donated close to $40,000 for
cancer research.
Preeti was not surprised by the warm response
despite the almost 10,000 miles separating
the beneficiary and the donors, as “this is a
universal cause because almost everyone would
know someone who is affected by cancer.”
On why she chose NCCS as the beneficiary,
Preeti said matter-of-factly, “I have been living
here for nearly five years. As an individual
in the community, I think the most important
thing is to help the community around me.”
Preeti, a permanent
resident of Singapore
and a US Citizen, has
set her sights on going to
the US for further studies
and may well hold
another fund-raising
concert in Singapore
which will again name
NCCS as the beneficiary.

PAGE A6
People
CHARITY: HER WAY OF LIFE
SALUBRIS
November / December 2010
From Nurse to Administrator and now a
Fund Raiser, that’s the span of job scope that
Flora Yong has embraced since she joined
the National Cancer Centre Singapore.
The newly-appointed Manager at the NCCS Foundation,
shares her thoughts with VERONICA LEE.
If you’ve seen Flora Yong all dressed to
the nines don’t be surprised. For her
new role in the NCCS Foundation,
that’s what she needs to do to meet up
with corporate chiefs, business tycoons,
donors and well-wishers. Perhaps some
may still remember her as the woman
with that rich and melodious voice
making the public announcements
twice a day at the Centre during the
outbreak of the H1N1 flu some two years
ago. Certainly with her demure and
confident personality, good vocal chords
and a sound knowledge about cancer,
Flora is set to open more doors for
the Foundation.
With her new appointment as
Manager of Community Partnership
and Fundraising, she has a mammoth
task ahead of her. Together with the
Foundation’s Director Dr Tan Hiang
Khoon, she will be building a new
team for the fund-raising arm of NCCS.
No longer is she worried about patient
clinical issues. Instead she has to set
her sights on how to help raise the
millions that are required to support the
many cutting-edge research projects
undertaken by the clinicians and
researchers at the NCCS laboratories.
While she may not have worked in the
laboratories, Flora is certainly familiar
with medicines and their roles in saving
lives. She was trained as a Staff Nurse
before rising to Nurse Manager in
the Singapore General Hospital. She
joined NCCS in May, 1999 and started
the Cancer Education and Information
Service (CEIS), whose role was to
provide public education on cancer and
also to answer public inquiries on the
Cancer Helpline.
Under her watch, CEIS introduced
many cancer awareness programmes for
patients and the public and produced
the inaugural issue of a newsletter that
has an audience of 22,000 readers. The
Cancer Helpline also took off successfully
since it was launched in September 2000
attracting more than 90 calls on the first
day of its operations.
The helpline now gets an average of 350
contacts per month. Here she learnt to
understand the demands and anxieties
of the patients, and despite the heavy
workload she had the satisfaction of being
able to offer a listening ear and knowing
that a few helpful words had calmed the
nerves of the callers.
Indeed, the love of sharing and offering
her time for charitable causes was
imbued in her since her growing up years
in Batu Pahat, Johor. She would take part
in fund-raising activities like Flag Day or
sell cookies, cakes and candies baked by
her mother, to support charitable causes.
During the Christmas season, she would
join a youth group of carolers to make
their rounds to raise funds for the needy.
As a Girl Guide in school, she visited
old folks’ homes to help clean up their
premises and bring cheer to them.

PAGE A7
People
SALUBRIS
November / December 2010
“It’s not only about giving money. It’s
also about giving kindness in words
and in deeds and that helps a lot
especially to those who are faced
with life-threatening illnesses. They
need kind words and hands to hold
on to for strength as they go through
their arduous cancer journey.”
Flora Yong
Flora (second from left) with the former
President Wee Kim Wee.
Looking back at her childhood, she
surmised that her love for charity just
blossomed from there. “Helping did not
mean much to me as a child. I just knew
I had to be a good little girl and help
whenever it was needed. Giving help
holds a much deeper meaning to me
now as an adult.
“It’s not only about giving money. It’s also
about giving kindness in words and in
deeds and that helps a lot especially to
those who are faced with life-threatening
illnesses. They need kind words and
hands to hold on to for strength as they go
through their arduous cancer journey,” said
Flora who is someone who walks the talk.
She has offered her paintings for sale at a
recent art exhibition in a bid to raise funds
for patient support programmes. With her
new role at NCCS Foundation, she feels she
has come full circle and is all set for the
greatest challenge – to raise funds for cancer
research. Barely weeks into her job, she was
thrown “into the deep end” and was roped
into the working committee for the Run for
Hope which was held on 21 Nov. The Run
drew a record 7,000 participants and was
organised jointly with the Four Seasons
Hotel and the Regent Hotel.
She tapped on her network and worked
with Borders Bookstore for convenience
of registering prospective participants
at the bookstore in Orchard Road. In
December, she arranged for teams of
volunteers to do gift wrapping at the
bookstore. In return, NCCS Foundation
will sell the gift cards to raise money for
cancer research.
When asked why she felt charity was
so important to her, she replied, “I have
received many acts of kindness in my
life. Although they were not monetary in
value, each of them taught me valuable
lessons on being generous and kind to
others. So I want to keep this flame alive
and pass it on to others. Everything comes
full circle, I believe what I give now will
be returned at a time when I least expect
it and when I most need it.”
Although she was at first apprehensive about
her role in fund raising, Flora decided to
take on the challenge as she believes she
can help the Foundation to move on to its
next phase given her background knowledge
of NCCS. She sees it as an opportunity to
push boundaries and see how far she can
go. Speaking before audiences is something
she does with confidence, having been
the founding President of the SingHealth
Toastmasters Club in 2004.
But it is still early days as Flora confesses.
The team is new and her immediate task
is to help the team members learn the
ropes. Believing that each of her team
members have their own talents, she
hopes they will contribute effectively and
work cohesively towards the long term
goals of raising funds and maintaining
lasting relationships with donors.

PAGE A8
NCC Foundation
SALUBRIS
November / December 2010
NCCS CANCER CAUSES
GET A STRONG BOOST
FROM THE COMMUNITY
As a finale to the year, NCCS saw another
successful Run for Hope, an annual charity
run in support of cancer research. Jointly
organised by the Regent Singapore, Four
Seasons Hotels & Resort, the event saw
7,000 runners this year, a huge surge in the
number of runners compared to last year’s
6,000 signed up. One school of thought
is that this increase may be indicative of
the increasing number of people who are
beginning to see the value in cancer research
and in helping others who are less fortunate.
A sum of $320,000 was raised from this run.
The desire to help cancer patients and
give them the hope to overcome their
ordeal has won many kind hearts to
support the cause promoted by NCCS.
The NCCS cause is that for every dollar
that is spent on research, the benefit to
the community will be more far reaching
than a dollar given to just one patient. A
breakthrough in medical research will save
more lives than monetary handouts to the
patients. Without a cure, the outcomes for
the patients will be a forgone conclusion.
In the last quarter of 2010 NCCS, through
various activities carried out by its
Foundation, the fund-raising arm for cancer
research as well as patient welfare, the
support has been very encouraging.
A good example is the effort undertaken by
the Methodist Girls’ School teachers and
students, together with their parents.
The students from both the primary and
secondary cohorts of the school, which is
located at Blackmore Drive, presented
another charity concert – for the second year.
Entitled Sounds of Hope, the charity
concerts were the brainchild of Mrs Shirleen
Ong, Principal of the school, who wanted
to support the cancer cause by expending
her students’ artistic talents. Through sales
of concert tickets, food items, MGS
souvenirs and soliciting of donations
from the parents, the school has raised
close to $128,000 during the two years.
This year also saw the students expending
their efforts beyond fund raising. The
students had embarked on several
educational projects such as the creation
of cancer blogs and the production of
a storybook that was titled “Safaree”
to illustrate the value of friendship and
acceptance of one another.
Prof Soo Khee Chee, Director of NCCS
felt comforted by the response and
generous donations from participants
and well-meaning organisations. “We
are very heartened by the overwhelming
participation this year. It goes to show that
many people understand the importance
of cancer research…This will definitely
encourage us at NCCS to put in even
greater effort as we continue with our
research work to find a cure for cancer.”
The Run for Hope also continues to see its
regular supporters from all communities in
Singapore including expatriates, who apart
from taking part in the run, also helped out
for the event. More than 500 volunteers from
Temasek Polytechnic, Hwa Chong Institution
and Canadian International School came
forward to help with race pack collection,
marshaling and snacks distribution.
NCCS researchers and doctors have not
disappointed the donors. They have been
making in-roads and more patients are
getting better outcomes from their treatment.
By Veronica Lee
Editorial Advisors
Dr Kon Oi Lian
Prof Soo Khee Chee
Executive Editors
Ms Chua Hwee Leng
Ms Veronica Lee
Mr Sunny Wee
Contributing Editor
Dr Wong Nan Soon
Members, Editorial Board
Ms Sharon Leow
Mr Joshua Tan
Ms Flora Yong
Medical Editor
Dr Richard Yeo
Members, Medical Editorial Board
Ms Lita Chew
Dr Mohd Farid
Dr Melissa Teo
Dr Teo Tze Hern
Dr Deborah Watkinson
is produced with you
SALUBRIS in mind. If there are other
topics related to cancer that you would like to read about
or if you would like to provide some feedback on the
articles covered, please email to salubris@nccs.com.sg.
NATIONAL CANCER CENTRE SINGAPORE
Reg No 199801562Z
11 Hospital Drive Singapore 169610
Tel: (65) 6436 8000 Fax: (65) 6225 6283
www.nccs.com.sg