Test helps doctors decide on cancer treatment

​Dr Raghav Sundar, Consultant, NCIS was interviewed regarding the team’s new algorithm that analysed which stomach cancer patients would not benefit from immunotherapy. The team has discovered a negative biomarker, at the epigenetic level, which signals that immunotherapy would fail. This would save patients time and money and spare them from possible side effects of such treatment. 

年轻人患癌 遗传因素大 (High possibility of hereditary reasons for cancer in young people)

Article contribution by Dr Alfred Kow, Senior Consultant, Division of Hepatobiliary & Pancreatic Surgery, NUH; Senior Consultant, NUCOT and Senior Consultant, Division of Surgical Oncology, NCIS.

He cites the case study of a 29-year-old patient whose father was diagnosed with gall bladder cancer when he was about 40 years old. Dr Kow explains that while most cancers are not related to genetics, those with a clear family history should take extra note.

Article contribution by Dr Alfred Kow, Senior Consultant, Division of Hepatobiliary & Pancreatic Surgery, NUH; Senior Consultant, NUCOT and Senior Consultant, Division of Surgical Oncology, NCIS.

He cites the case study of a 29-year-old patient whose father was diagnosed with gall bladder cancer when he was about 40 years old. Dr Kow explains that while most cancers are not related to genetics, those with a clear family history should take extra note.

Singapore approves drug to treat late-stage breast cancer in patients with inherited genetic mutation

​Olaparib, a drug that has been used to treat ovarian cancer since 2014 was approved last month by the Health Sciences Authority (HSA). This drug specifically targets cancer cells containing mutated BRCA1 and 2 genes. Associate Professor Lee Soo Chin, Head, Department of Haematology-Oncology, NCIS mentioned that a genetic test is required to determine if the drug is suitable for a patient as it specifically targets mutant BRCA genes, which greatly increase a person’s risk of breast cancer. Led by A/Prof Lee, a recent study involving 460 breast cancer patients who underwent genetic testing found that the incidence of BRCA mutation varied among ethnic groups. A/Prof Lee added that women with a family history of breast and ovarian cancer should consider genetic testing.
Ms Kwok Pui Yee, a patient at the NCIS, was diagnosed with advanced breast cancer in November 2017 and her doctors recommended that she get tested for genetic risk factors as her mother had ovarian cancer and her aunt had breast cancer. As Ms Kwok tested positive for the BRCA mutation, she was later prescribed Olaparib which kept her cancer under control for 13 months with few side effects before becoming ineffective. Ms Kwok is now on immunotherapy. 

• Straits Times Online, 17 May 2019
• Lianhe Wanbao, 17 May 2019, Pg 8
• Shin Min Daily News, 17 May 2019, Pg 10
• Lianhe Zaobao, 18 May 2019, Pg 8
  
• Channel NewsAsia, Singapore Tonight, 17 May 2019
• Channel 5, News 5, 17 May 2019 (17:19 - 19:50)
• Channel 8/Channel U, News Tonight, 17 May 2019 (10:30 - 12:46)
• Vasantham, Tamil News, 17 May 2019 (17:23 - 18:31)
  

深入敌方阵营杀灭敌人 (Brachytherapy - Targeting the enemy from within)

​A contributed piece by Dr Vicky Koh, Consultant, Department of Radiation Oncology, National University Cancer Institute, Singapore (NCIS), on brachytherapy, a form of radiation therapy, how it works and what types of cancer it can be used to treat.

Commentary: HPV, the silent virus behind cervical cancer

 A contributed piece by Dr Ida Ismail-Pratt, Consultant, Division of Gynaecologic Oncology, NCIS, on cervical cancer being one of the most commonly diagnosed cancer among women in Singapore, MOH’s HPV vaccination programme, the HPV virus, HPV vaccination and cervical cancer prevention and the importance of HPV education and awareness.

Cancer Survivorship Programmes brings cancer patients in remission back to the community for follow-ups

A news report on the Cancer Survivorship Programme at NCIS, which allows cancer patients who have been in remission for five years to do their follow-ups at affiliated family clinics or polyclinics.
 
Dr. Chan Ching Wan, Senior Consultant, Division of Surgical Oncology (Breast Surgery), NCIS, is the programme lead for the Cancer Survivorship Programme (Breast Cancer). Due to the increase in the number of cancer patients yearly, the programme helps ease the load on the hospitals. Clinic doctors are also briefed on what situations they have to look out for.  
 
Mdm Lee, a patient of Dr. Chan, who is part of the Cancer Survivorship Programme, says that going to the polyclinic for follow-up reduces her burden.

Secondary 1 female students to get free opt-in HPV vaccination against cervical cancer

On the nation-wide school-based HPV vaccination programme announced by Senior Minister of State for Health Amy Khor during the ministry’s Committee of Supply debate speech yesterday, Prof Teo Yik Ying, Dean, NUS Saw Swee Hock School of Public Health shared two reasons for the low uptake of the vaccination – low public awareness of the vaccination as well as cost.  Prof Teo added that the vaccination is most effective when administered around 11-13 years old and by the vaccination can significantly reduce the risk of cancers and genital warts from happening.

Dr Joseph Ng, Senior Consultant, Division of Gynaecologic Oncology, NCIS commented that the recommendation for the HPV vaccination is for females aged 9 – 26 years old. He emphasised that it is still important to go for regular screening even after taking the HPV vaccination. Dr Ng also mentioned that implementation of the measure of vaccination to prevent cervical cancer is an effective way to eradicate cervical cancer. 

Cancer is not a Curse

A contributed article by Dr Balamurugan A Vellayappan, Consultant, Department of Radiation Oncology, NCIS, about breast cancer, the risk factors of the disease as well as what can people do to prevent breast cancer. 

• Tabla!, 16 November 2018
  
• Tamil Murasu, 11 November 2018
  

National University Cancer Institute, Singapore Launches a Number of Services to Improve Quality of Care for Patients

Reports on NCIS launching a number of services to improve the quality of care, providing additional care for geriatric cancer patients and providing door-to-door care for stem cell transplant patients. 

They interviewed Mr. Yeo Wee Lee, the first patient who enrolled for the Outpatient Stem Cell Transplant + Home Monitoring. He spoke that the home care service is much more convenient because he does not need to travel, queue in the hospital and reduces risk of contracting hospital bugs. The recovery process at home is better and more comfortable, with nurses checking on him three times a week. 

NCIS will also be launching the NCIS Cancer app for in Q2 next year. Equipped with Artificial Intelligence a chatbot, it aims to provide support for cancer patients for all their cancer-related needs. It will be rolled out first for breast and colorectal cancer patients. Prof Chng Wee Joo, Director of NCIS, said that the application can follow a patient’s entire treatment process and provide information at any time through chatbot. He added, “Patients have questions now and then, and they get worried when they could not find the answers. They have to wait to ask their doctors at the next consultation which they may forget when the time comes. With the chat bot, they can now get an answer anytime anywhere.”  

NCIS also launched a Geriatric Oncology Clinic in September 2018 which will assess elder patients more accurately so that they can provide better patient care. The Acute Cancer Care Unit, which was launched in January 2018, hopes to reduce the number of cases that will require patients to be hospitalised. If a patient’s condition is not serious, the nurses would administer treatment at the Acute Cancer Care Unit for a few hours before being discharged.

These were announced at the NCIS 10^th Anniversary gala dinner yesterday. Over $700,000 was raised for the NCIS Cancer Fund which helps needy cancer patients and funds cancer research and education.  

• The Straits Times, 9 November 2018, Page B4
• The New Paper, 9 November 2018, Page 22
• Lianhe Zaobao, 9 November 2018, Page 4
• Channel 8 News, 8 November 2018
  

跨国研究：加大化疗强度血癌童治愈率提高至九成 (Multinational Research: Stronger chemotherapy raises cure rates for child leukemia by 90%)

The study, jointly conducted by NUS Yong Loo Lin School of Medicine and University of Malaysia, together with NUH, KKH and two Malaysian hospitals, was completed in 8 years and involved 346 children in both countries with high-risk acute lymphoblastic leukemia (ALL).

About 20% of children with ALL have a more than double chance of relapse due to the absence of the Ikaros gene. The team of researchers raised cure rate from 70% to more than 90% and reduced relapse rate from 30% to 13% with intensified chemotherapy treatment in this group of children.

A/Prof Allen Yeoh said “Through bone marrow tests, we identified these children who do not have the Ikaros gene, intensified their chemotherapy dose, and the results were very good.” He added, “At present, these children are receiving the highest dose of chemotherapy. The research team will continue to look for new treatment options, such as immunotherapy and other safer options… our ultimate goal is to help them recover fully.”   

• Lianhe Zaobao, 6 September 2018, Page 14
  
• Lianhe Wanbao, 5 September 2018, Page 4
  

为和会得舌癌（Tongue Cancer)

​Dr Lim Chwee Ming from NCIS shared about causes, symptoms and treatment of tongue cancer.  

临终护理温暖 最后一程写意 (Warmth of end-of-life care)

​Dr Noreen Chan from NCIS was one of the doctors interviewed on end-of-life care. She shared that the focus of our medical system is usually the patient’s ‘body’, neglecting the spiritual and emotional needs. She said many times the medication is not in the bottle but in relationships, in positive words and encouragement.” She added that many times patients do not need the many medical tests and treatments. Conversations are more important and is the beginning of providing quality care.     

照顾病患义工 益己暖人 (Patient Volunteers: Caring for others, benefiting self)

Jenny Chee (tonsil cancer survivor) and Alice Koh (main caregiver of her husband with throat cancer), both members of the NPC oneHeart Support Group at the NCIS, shared their motivations and positive experiences as volunteers with the NCIS Befrienders Programme. Dr Choo Bok Ai, Senior Consultant, Department of Radiation Oncology, NCIS shared that there are many ways which one can volunteer, from raising awareness, providing care to supporting activities for patients. Volunteers can also be part of the Dream Makers Programme launched in April, which aims to help cancer patients fulfil their dreams.

NUH volunteer Jenny Yeo, who is a former salon owner, also spoke about her experience helping patients cut their hair and NUH Volunteer Coordinator Pauline Chua explains how the hospital's volunteers engage patients in various activities, including through the Silver Connection and Night Sitter Programmes. 

US findings may help breast cancer patients here avoid chemo

​An article about how breast cancer patients in Singapore can avoid chemotherapy after surgery in some early-stage cases. Dr Andrea Wong, Consultant, Department of Haematology-Oncology, NCIS, said that the Oncotype DX, which is a test that assess the need for chemotherapy in patients, has been available in public hospitals here for six years. In Singapore, it is already routinely recommended foe eligible patients.  

Treatment Over, but the Anxiety Remains

​An article with cancer survivors on how they still have anxiety about cancer despite completing their treatment. Madam N. Pushphavalli, a cancer survivor who was treated at NCIS, mentions that when she sees a rash or lump, she will keep monitoring it for four to five days to observe if it gets bigger or skin around it gets thicker. She has to also go through various lifestyle changes and have to go for many test and check-ups.