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Issue No. 17 • MICA (P) 061/10/2010

AN NCCS BI-MONTHLY PUBLICATION July / August 2011

...HELPING R E A DERS TO ACHIEV E GOOD HE A LTH Salubris is a Latin word which means healthy, in good condition (body) and wholesome.

ART EXHIBITION FOR CHARITY – ELEMENTS FROM THE SOUL


PAGE A2

In Other Words

SALUBRIS

July / August 2011

NCCS DOCTORS OFFER NEW INSIGHTS ON CANCER AT ASCO MEETING

Our oncologists presented eight research abstracts at the meeting in Chicago, USA after stringent review by the committee. CHARISSA ENG reports on the highlights. Dr Richard Quek and Dr Mohd Farid at the ASCO general poster session.

O

ne of the missions of National Cancer Centre Singapore (NCCS) is to “conduct cutting-edge clinical and translational research”. It was in this frame of mind that NCCS doctors have always strived to be at the forefront of cancer research so as to improve clinical care towards their patients. These efforts paid off when teams of NCCS Medical Oncologists were selected to present their research at the ASCO Annual Meeting.

The American Society of Clinical

The ASCO meeting is a premier educational and scientific event in the oncology community with more than 30,000 cancer specialists gathered together to discuss the latest innovations in research, quality, practice and technology in cancer. The research findings presented are from eight different projects by NCCS and they span across the continuum of cancer care.

Cancer Research recognised the

In Diagnostics, Dr Ravindran Kanesvaran used a simple bedside test, a handgrip test together with comprehensive geriatric assessment tools to evaluate how the elderly cope with cancer and its treatment. This is a particularly pertinent issue and has nationwide implications given the problem of an ageing population in Singapore. In another study involving more than 500 patient samples collected from six cancer centres worldwide, Dr Iain Tan used advanced genetic techniques to accurately classify different types of stomach cancer, leading to more precise estimates of patient prognosis. This project was selected to receive the ASCO Merit Award. In Patient Outcomes Research, Dr Richard Quek and Dr Mohd Farid detailed the clinical outcomes for patients with sarcoma, a fairly uncommon form of cancer. Dr Yap Yoon Sin evaluated the use of existing targeted therapies in breast cancer patients whose disease had spread to the brain while Dr Tham Chee Kian evaluated the effect of combining chemotherapy with radiation therapy in an uncommon form of cancer that originates from the brain. Last but not least, in Novel Therapeutics and Drug Development, Dr Tan Eng Huat described an early phase clinical trial employing a unique strategy of adding a new therapeutic antibody to an established oral targeted drug to overcome drug resistance in patients with advanced lung cancer. Dr David Tai described an upcoming trial that will be the first worldwide to employ a new “targeted” drug in the treatment of stomach and colon cancer.

Oncology (ASCO) was founded in 1964 when members of the American Association of need to create a special group dedicated to clinical oncology. Since then, their aim has been to focus on conducting cancer research. ASCO holds annual meetings where they attract thousands of abstracts each year representing the latest research in areas of cancer prevention, diagnosis and treatment. The ASCO Special Awards are given to recognise individuals or organisations that have made significant contributions to ASCO, the practice of clinical oncology and cancer patients. These awards are presented during their Annual Meeting.


PAGE A3

In Other Words

SALUBRIS

July / August 2011

These presentations and the conferment of the ASCO Merit Award will indeed encourage NCCS doctors in knowing that their works are well recognised by their peers internationally. It also expanded the Centre’s international presence. A humble Dr Iain Tan, who was conferred his first Merit Award, said, “All these would not have been possible without the collective effort on multiple fronts.” A/Prof Patrick Tan, Principal Investigator of the Laboratory of Molecular Development at NCCS who supervises Dr Tan’s research, was full of praise for his young clinician researcher. Dr Iain Tan He said, "Iain is a superb candidate for the ASCO Merit Award. His work is cutting edge, clinically impactful and balances high quality clinical expertise with the latest genomic technologies. Importantly, beyond his own research, Iain is a very good collaborator and is always willing to help others in the laboratory. He is a wonderful example of a home-grown clinician scientist, doing work that is competitive on the world stage.”

HERE’S A CLOSER LOOK AT SOME OF THE PROJECTS… Prognostic Factors in Leiomyosarcoma: Does Primary Site Influence Outcome? The truth about Sarcomas is that they are rare cancers. This makes Dr Mohd Farid’s study a crucial one because many may still be unclear about the disease. Research more often than not leads to greater knowledge to better fight the disease. Sarcomas are aggressive tumours that comprise one percent of all malignancies. They arise from an embryologically primitive tissue subtype known as mesoderm, and can affect a large variety of tissues and organs in the body. Leiomyosarcomas (LMS) are sarcomas of the smooth (involuntary) muscle and they comprise 25 percent of sarcomas. LMS that arise from the uterus, or uterine LMS (uLMS), comprise more than half of all LMS. LMS that arise from outside the uterus are thus known as extra-uterine LMS (euLMS). What Dr Farid aimed to find out from his study was whether there are indeed differences in clinical outcomes and treatment responses between uLMS and euLMS. Although approximately 60 percent of uLMS are diagnosed in the early stages, most patients develop disease relapse and more than two-thirds of them would have succumbed to the disease within five years of diagnosis. In advanced cases, patients would only survive for less than one year. Dr Farid started his study by reviewing data from the NCCS Sarcoma registry to evaluate the disease‘s natural history, treatment modalities and responses, and clinical outcomes. The results that he presented at the ASCO Annual Meeting showed that there is a clear difference in outcomes favouring patients treated for earlier stages of the disease, highlighting the importance of early detection and access to treatment. While some clinical differences exist between uLMS and euLMS, the evidence for differing responses to treatment remains inconclusive at this stage. The main point that Dr Farid wants to get across is that it is important to get evaluated early on in the course of the disease. Women who develop abnormal patterns of uterine bleeding, pressure or pain in the abdomen or pelvis and abnormal vaginal discharge should have these symptoms promptly evaluated.

Comparing the Classification Precision and Prognostic Performance of an Intrinsic Gastric Cancer Signature with Existing Genomic Signatures in Six Independent Datasets Currently, Gastric cancer is the third most common cancer in males in Singapore and the fifth most common cancer among females in Singapore. The rates of incidence of Gastric cancer in Asia are among the highest in the world even though there is a decreasing trend. To classify Gastric cancer and provide prognostic information, several gene expression signatures have been proposed. These signatures are largely developed from supervised approaches based on histology, peritoneal or lymph node metastases. However, there are major disadvantages of these approaches. To overcome them, Dr Iain Tan focused on a diverse panel of Gastric cancer cell lines and hypothesised that any genomic differences detected in cell lines should be by nature tumourcentric and thereby ‘intrinsic’ to the underlying biology of the Gastric cancer cell. Using more than 500 patient samples from six cancer centres worldwide and applying advanced genetic techniques, Dr Tan is able to accurately classify different types of stomach cancer. Dr Tan explained, “This work is still in early development. We seek to classify patients with stomach cancer more precisely so that we can more accurately predict their prognosis, understand the biological basis for developing each type of cancer and tailor treatment strategies to the biological characteristics of the cancer.” Continued on page A8.


PAGE A4

In Focus

SALUBRIS

July / August 2011

WHERE EAST MEETS WEST: CLINICAL TREATMENT AND RESEARCH

“I think it has filtered down to the rest of the institution both in terms of providing holistic patient care and also in conducting cutting-edge research. It is impressive to know that NCCS itself manages up to 70 per cent of the cancer population and it has a good integrated oncology care set up here that rivals the best comprehensive cancer centres in US,” he added.

The bar has been raised for the treatment of Lymphoma cancer with the return of Dr Kevin Tay from USA. VERONICA LEE speaks to the doctor about his aspirations for the sub-specialty.

A

s a medical officer while on a six-month rotation at NCCS, Dr Kevin Tay gained a deeper insight into the advances in the field. He became intrigued by the enigmatic complexities of lymphoma, a malignancy of lymphoid cells of the immune system that often astounds with the variety of its clinical presentation.

As a volunteer doctor working with hospice patients, he drew lessons from them. “They not only became my teachers in life but also left an indelible mark. Such is the strength of the human spirit, with a propensity to find joy in times of adversity which never ceases to amaze me,” he said. This experience spurred him on his journey to become an oncologist after completing his basic specialist training in internal medicine in Singapore. After completing his residency training in internal medicine at the University of Hawaii, he was appointed as Chief Resident in internal medicine. Soon he was selected to be a clinical associate at the National Cancer Institute (NCI) in Bethesda, where he completed a fellowship in medical oncology.

During that time, where he received his training in hematology and oncology, he was part of a leading multidisciplinary research group investigating new therapies for lymphoma, with a focus on understanding cell signaling and tumour microenvironment interactions in aggressive lymphomas. Describing his eight-year experience in the US, he said, “The culture of learning and research is very evident in the daily life and in the quality of their work. They work hard and also play hard, finding time for family and loved ones. One of the things that impressed me the most from those I had worked with was that they never stop wanting to learn. That in itself spurs them on.” “As cliché as it may sound, it is truly the journey rather than the destination that inspires the best in us. They do what they do day in and day out purely because they enjoy and love what they do and it is not just a job.” Since returning to Singapore and joining NCCS a year ago, he noted that the Centre has improved by leaps and bounds since its inception. “Much credit goes to Prof Soo Khee Chee and the team who has provided a clear vision of what NCCS should stand for.”

Dr Tay is part of the NCCS Lymphoma Study Group formed to advance understanding of lymphomas in the Asian setting. It comprises senior scientists and physicians from the Departments of Medical Oncology, Radiation Oncology, Pathology, Laboratory Science and Epidemiology on the Outram campus. The Group is currently studying a whole range of issues on multiple fronts. One such project involves the scientific study of T-cell lymphoma, a relatively rare subtype of lymphoma that may have a relative predilection for Asians. Using the latest molecular profiling techniques, the group is studying the genetic profiles of these lymphomas with the hope to find patterns that may lead to the identification of important “biomarkers”, substances used as indicator of biological states to determine processes involving disease or clinical responses so that clinical outcome and effectiveness can be assessed.

Dr Tay is sanguine about the future of lymphoma care and treatment in Singapore. “I am very fortunate to work every day toward a collective goal that cancer will one day not be the feared diagnosis that it is today. With advancements made in our knowledge of the mechanisms driving the development of lymphoma, I believe we are on the threshold of altering the course of this disease for our patients, young and old alike.”


NO CURE DOES NOT MEAN NO CARE

PAGE B1

Looking Forward

SALUBRIS

July / August 2011

To be admitted as a patient to an intensive care unit (ICU), one has to be really sick these days. A year ago, our surgical ICU team (in a US hospital) admitted Mrs P, an 85 year-old woman, because of breathing difficulties. A while back, she had undergone an operation for the cancer of the pancreas, but the cancer eventually spread to other organs. She was unable to eat properly because of difficulties from prior surgery. She became quite malnourished. When she was brought to the ICU, her husband of many decades understandably wanted all measures to be taken to help her get through. This included a mechanical ventilator (breathing machine) if needed, or chest compressions, shocks, and drugs in the event of her heart stopping. Her surgeon, a well-renowned expert in the field, likewise asked the ICU team to do everything possible for her. Mrs P’s immediate clinical condition improved until she was well enough to leave the intensive care unit. However, a few days later, she was readmitted with multiple other problems. By this point, she was unable to tolerate any food by mouth (or feeding tube), and feeding her through the veins was not an option. For religious beliefs and personal values, her husband found it impossible to “let go” when the time came, although their adult children felt differently. Mrs P’s husband had not changed his stance, and neither had her primary surgeon, to pull out all the stops rather than to stop pulling out all interventions. The patient was too ill to communicate her own wishes.

Close to half the participants chose the local centre even when told that this choice would carry twice the risk of operative death compared to that at the distant hospital. When this same risk was raised to six times higher, a quarter of patients still preferred to stay close to home. No matter how ‘right’ it may feel, one simply cannot assume what’s ‘best’ for patients, at least not without having learned a thing or two about them as individuals.

D

octors often take it as a professional or even personal failure when unable to offer their patients a cure. Some of the most optimistically die-die-must-try crowd amongst doctors (and this is only a personal observation, not a hard-proven fact) are surgical oncologists, i.e. surgeons who specialise in the care of cancer patients. After all, who wants a surgeon who will shy away at the slightest hint of difficulty? Times are already too frequent when cancers spread beyond any surgeon’s optimism and any surgery’s potential to cure. But if a “chance to cut” was indeed a “chance to cure”, wouldn’t everyone jump at that chance? Just as no two patients are the same, neither are their perceptions and preferences. One may assume, for example, that given the option, patients would all willingly undertake the burden of long distance travel to seek top-of-the-line specialist care. To study this assumption, US authors surveyed patients’ choices when deciding where to have a (theoretical) major surgical operation: a local medical centre versus a distant one four hours away 1.

During a typical clinic visit, gathering medical details about the patient’s diagnoses and dilemmas may leave little opportunity to recognise a person with aspirations and apprehensions. At times, be it for cultural, language or other reasons, one may even unintentionally overlook the patient to the point of having prolonged discussions with the next of kin instead. Some patients wish to remain observers in their own care and if so, this choice is to be respected. The onus is on doctors to openly uncover some fundamental insight into their cancer patients’ health-related preferences and personal beliefs before it is ‘too late’. Continued on page B2.


PAGE B2

Looking Forward

SALUBRIS

July / August 2011

NO CURE DOES NOT MEAN NO CARE

Continued from page B1.

As we continued to care for Mrs P, along the way we fell into the trap of speculating what we ourselves would do, or what we would want done for us if we were in her shoes. We were reminded by a consultant that although tempting, this approach was not productive. In our estimation, efforts at prolonging life in an intensive care unit were futile, yet we were unsuccessful at relaying this effectively to our patient’s husband. We resorted to consulting our colleagues specialising in Palliative Care to help us ‘do the right thing’ for Mrs P; the right thing according to our preferences anyway. The team, made up of a combination of nurses and doctors, met with Mrs P’s family members to establish an ongoing, and importantly unbiased, channel of communication with all parties. The palliative care team epitomises the mastery of difficult communications without an “agenda”. Such specialists can provide help anytime regardless of disease or need for other therapy. Although often called upon too late, palliative care is never about the hastening of death. When indicated, for example, palliative care supports symptom-alleviating therapies such as fluids or antibiotics through veins, blood transfusions, and the like. This team aims to provide care that relieves suffering and improves quality of life, no matter how little or how long of it is left to be lived. A few days on, Mrs P’s heart gave out. According to her husband’s wishes, we performed cardiac life support. She regained a pulse and blood pressure and her husband was brought in to see her. He conceded that should this happen again, we would only continue to keep her comfortable. Mrs P died a few hours later with her family at her side. We never knew what she herself would have wanted done for (and not to) her.

When doctors see the chance of cancer cure slipping, it is a disservice to delay or disregard end-of-life discussions. Patients whose primary caregivers accept death are more likely to do so themselves. When presented with a truthful and timely picture, patients are known to be 1) more likely to grasp their prognosis -without increased distress- and to plan ahead, and 2) less likely to spend the last days of their lives in an ICU 2. At the risk of superimposing personal views, the hope is that one does not end up in an ICU at the end of a hard-fought battle with cancer because the topic was too uncomfortable for the doctor to bring up during “better” days. For Chinese translation of the article, please go to: http://www.nccs.com.sg/pbcation/salubris.htm

There is much talk in cancer literature about targeted therapy aimed at specific markers such as those on our genes. When the opportunity for a cancer cure diminishes, a chance remains for targeted therapy of a different kind: one that targets the needs of each individual patient to create a better quality of life 2. “No cure” does not and should not mean “no treatment”. Without a cure, the cancer lingers; its symptoms, be it physical or emotional, should not. The focus of therapy may shift from the disease to the symptoms, but there is always something that can be done. Wouldn’t it be sensible if this “something” were in harmony with each patient’s own wishes? Do we know what these are? REFERENCES: Finlayson S, Birkmeyer J, Tosteson A, Nease R. Patient preferences for location of care: implications for regionalization. Med Care. 1999; 37: 204-9. Peppercorn JM, Smith TJ, Helft PR, et al. American Society of Clinical Oncology Statement: Toward Individualized Care for Patients With Advanced Cancer. J Clin Oncol. 2011. DOI: 10.1200/ JCO.2010.33.1744

By Dr Shiva Sarraf-Yazdi

Associate Consultant Department of Surgical Oncology NCCS


NUMBNESS AND TINGLING (PERIPHERAL NEUROPATHY) AFTER CHEMOTHERAPY

PAGE B3

Tender Care

SALUBRIS

July / August 2011

An article dedicated to cancer patients and their caregivers

WHAT IS PERIPHERAL NEUROPATHY? Peripheral neuropathy describes damage to the peripheral nerves. Certain chemotherapy drugs can cause peripheral neuropathy such as the platinum compounds (e.g. cisplatin, oxaliplatin), the vinca alkaloids (e.g. vincristine), the taxanes (e.g. docetaxel) and the podophyllotoxins (e.g. etoposide). Some individuals are more susceptible to peripheral neuropathy associated with chemotherapy due to certain pre-existing conditions. These conditions include, but are not limited to: diabetes, alcoholism, severe malnutrition, previous chemotherapy, shingles, vitamin B-12 deficiency, autoimmune disorders, HIV and syphilis.

SYMPTOMS OF PERIPHERAL NEUROPATHY a)

Numbness, tingling (‘pins and needles’) of hands and/or feet

b)

‘Burning’ feeling of hands and/or feet

CHEMOTHERAPY DRUGS ASSOCIATED WITH PERIPHERAL NEUROPATHY

c)

Numbness around mouth or jaw pain

d)

Constipation

e)

Lack of sensation of touch

Platinum compounds (cisplatin, carboplatin, oxaliplatin)

f)

Loss of positional sense

Vincristine

g)

Weakness and leg cramping or any pain in hands and/or feet

h)

Difficulty picking things up, buttoning clothes and/or writing

Taxanes (docetaxel, paclitaxel)

i)

Clumsiness or dropping things

Epothilones (ixabepilone)

j)

Feeling a sudden, sharp ‘stabbing’, pricking or ‘electrical shock’ pain feeling

Bortezomib

Thalidomide

k)

Blurred vision, hoarseness or difficulty speaking

Peripheral neuropathy usually starts in the hands and/or feet and creeps up the arms and legs. It can manifest itself as:

Symptoms of peripheral neuropathy may occur suddenly. However, it usually increases gradually and may worsen with each additional dose of chemotherapy (‘cumulative effect’). For certain chemotherapy (e.g. paclitaxel and oxaliplatin), it can be divided into acute and chronic peripheral neuropathy. Acute peripheral neuropathy usually happens right after a dose of chemotherapy and lasts for approximately four to seven days. On the other hand, chronic peripheral neuropathy may begin when a certain cumulative dose of chemotherapy is reached. The duration of the chronic form of peripheral neuropathy is less predictable. The abnormal sensation may disappear completely, or lessen partially. If neuropathy reduces, it is a gradual process over several months. Unfortunately, in some cases it may be irreversible and never reduce in intensity. Continued on page B4.


PAGE B4

Tender Care

SALUBRIS

July / August 2011

NUMBNESS AND TINGLING (PERIPHERAL NEUROPATHY) AFTER CHEMOTHERAPY An article dedicated to cancer patients and their caregivers

Continued from page B3.

WHAT CAN I DO ABOUT NUMBNESS AND TINGLING? If you experience any of the abovementioned symptoms of peripheral neuropathy, please discuss them with your healthcare professional.

HOW IS PERIPHERAL NEUROPATHY MANAGED? Your doctor may prescribe certain medications for your peripheral neuropathy, e.g. vitamins, particularly those in the B-complex family. For painful neuropathy, your doctor may also prescribe pain relievers (e.g. paracetamol), antidepressants (e.g. amitriptyline) or antiseizure medications (e.g. gabapentin). Please be assured that antidepressants are used in this setting for nerve-related pain, not because you are actually diagnosed with depression. For milder pain, certain topical creams (e.g. capsaicin) may also be used. To date, many drugs have been studied in order to find a cure for peripheral neuropathy. However, no trial has successfully proven that any pharmacological agent is effective in preventing or reducing the severity of peripheral neuropathy. Certain non-medication approaches have been reported to help people with numbness. These include:

To date, many drugs have been studied in order to find cure for peripheral neuropathy. However, no trial has successfully proven that any pharmacological agent is effective in preventing or reducing the severity of peripheral neuropathy.

a)

Deep breathing, relaxation

b)

Acupuncture

c)

Physical therapy to strengthen weak muscles

d)

Exercise (especially swimming and walking)

e)

Occupational therapy to assist with daily activities

f)

Massages to relax and decrease pain

Please discuss with your doctor before starting any therapy for your peripheral neuropathy.

WHAT ARE THE SAFETY CONCERNS IF I AM EXPERIENCING PERIPHERAL NEUROPATHY? The lack or loss of sensation and general weakness that results from peripheral neuropathy will make you more prone to self-injuries. There are some precautions that you may adopt to avoid injury. These include:


PAGE B5

Tender Care

SALUBRIS

July / August 2011

a)

Maintaining sufficient lighting at home, especially the walkways

b)

Clearing rugs and clutter in walkways

c)

Installing non-slip flooring

d)

Installing handrails on the sides of stairways and grab bars in the shower and toilet area

e)

f)

Avoiding burns by lowering water temperature. You may use a thermometer to check that the water in the bath or shower is below 40째Celcius Avoiding sudden chilling, such as reaching into a freezer or refrigerator, drinking ice-cold drinks or other cold foods and cold shower

g)

When driving, making sure you can feel the gas and brake pedals and the steering wheels

h)

Using a cane or walker if you are limping or have difficulty in walking

i)

Inspecting your skin (especially toes and soles) daily for abrasions, burns and cuts

j)

Strengthening weak muscles through physiotherapy

REFERENCES Albers JW et al. Cochrane Database Syst Rev. 2011 Feb; 2: CD005228 [Abstract] Argyriou AA et al. Critical Rev in Oncol/ Hematol 2008; 66:218-28 Barbara A et al. CIPN in cancer survivors. www.cancernetwork.com/display/ article/10165/1523565 Caveletti et al. Curr Treatm Opt in Neurol 2011; 13:180-90 Cersosimo RJ. Ann Pharmacother 2005 Jan; 39:128-35 Griffith KA et al. J Peripher Nerv Syst 2010 Dec; 15(4):314-25 [Abstract] http://cancerinfo.cancer.iu.edu/cancerportal/ public/symptoms/numbnessandtingling.php http://www.chemocare.com/managing/ numbness__tingling.asp [Available online: accessed on 14/05/2011] http://www.chemotherapy.com/side_effects/ other_side_effects/numbness_tingling.html [Available online: accessed on 14/05/2011] Kristen W et al. Nursing Management of CIPN. www.oncolink.org/resources/article. cfm?c=16&s=59&ss=224&id=1010

IF YOU ARE A CAREGIVER OF A CANCER PATIENT WITH PERIPHERAL NEUROPATHY, YOU CAN HELP BY:

Kyung KB et al. Cancer Res Treat. 2010; 42(4): 185-90

a)

Preparing meals

Sioka C et al. Cancer Chemother Pharmacol 2009; 63: 761-67

b)

Helping with daily household chores

c)

Helping with dressing and shopping

Soussain C et al. The Lancet 2009 Nov. 374(9701): 1639- 51

d)

Getting objects off the floor

e)

Helping to take the temperature of water in sinks and tubs

f)

Installing brighter light bulbs and making sure that all pathways are well lit

g)

Helping with transportation

WHERE CAN I GET MORE INFORMATION? a)

Contact your healthcare provider

b)

Cancer Helpline: 62255655 (Singapore)

c)

National Cancer Institute: http://cancer.gove/cancerinfo. Click on coping with cancer

d)

Cancer symptoms: http://cancersymptoms.org

e)

Chemocare: http://chemocare.com. Click on managing side effects

NeuPSIG. Mayo Clin Proc. 2010; 85(3) (suppl):S3-S14 Shilpa A. Annals Pharmacother 2008 Oct; 42:1481-5

Subblefield MD et al. Clin Oncol (R Coll Radiol) 2005 Jun; 17(4):271-6 [Abstract] Verstappen CVP et al. Drugs 2003; 63(15): 1549-63 Wickham R. Clin J Oncol Nursing 2006. 11(3): 361-76

By Yeoh Ting Ting

Senior Pharmacist Oncology Pharmacy NCCS


PAGE B6

SALUBRIS

July / August 2011

a) b) c) d) e) f) g) h) i) j) k)


PAGE B7

SALUBRIS

July / August 2011

a) b) c) d) e) f) g)

a) b) c) d) e)

a) b) 62255655 c) http://cancer.gove/cancerinfo

f) d) e)

a) b) c) d) e) f) g) h) i) j)

http:// cancersymptoms.org http://chemocare.com

B5


PAGE B8

SALUBRIS

July / August 2011

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PAGE B9

SALUBRIS

July / August 2011

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PAGE B10

Outreach

SALUBRIS

July / August 2011

UPCOMING PUBLIC EDUCATION ACTIVITIES / PROGRAMMES

Event Name

Date, Time, Venue

Registration Details

CancerWise Workshop – Understanding Colorectal Cancer

23 July 2011, Saturday

Admission fee: $5

Session will be in English.

To register, please call: 6225 5655 or register online: www.nccs.com.sg (click events).

TOPICS: a. Anatomy & Functions of the Colon and Rectum b. Common Bowel Problems c. What is Colorectal Cancer? d. Risk factors, Signs & Symptoms e. Early Detection & Prevention f. Screening & Diagnostic Procedures g. Treatment Options h. Advances in Treatment

1pm – Registration 1.30pm to 4pm – Workshop Function Room, Level 4 National Cancer Centre Singapore 11 Hospital Drive

CancerWise Workshop – Managing Gastrointestinal System Side-Effects During & After Chemotherapy

27 August 2011, Saturday

Admission fee: $5

Session will be in English.

To register, please call: 6225 5655 or register online: www.nccs.com.sg (click events).

TOPICS: a. Overview of GI System b. What is Chemotherapy? c. Common GI Side Effects During & After Chemotherapy & Management (I) d. Common GI Side Effects During & After Chemotherapy & Management (II) e. Questions & Answers

Function Room, Level 4 National Cancer Centre Singapore 11 Hospital Drive

Beat Liver Cancer Campaign 2011

17 September 2011, Saturday

1pm – Registration 1.30pm to 4pm – Workshop

Fun-filled programme with games for all ages, lucky draws and goodie bags. 1pm to 5pm IMM Building Garden Plaza, Level 3 Jurong East Street 21 (5 minutes from Jurong East MRT)

Free Admission


DIPLOMATS HOST ART EXHIBITION TO SUPPORT NCCS RESEARCH PROJECTS

PAGE A5

Community

SALUBRIS

July / August 2011

Peru’s artist Alfredo Alcalde donates a painting for research fund

“Cultural Exchange and Art Exhibition of Alfredo Alcalde: Elements From The Soul” – A Charity Art Exhibition in aid of NCC Research Fund, 25 April to 2 May 2011

I

t was certainly heart warming for the National Cancer Centre Singapore when two foreign ambassadors decided to work together to host an art exhibition to support our cancer research programme.

The exhibition of works by renowned Peruvian artist Alfredo Alcalde, held from 25 April-2 May 2011, was certainly a good start. The opening night drew some 200 guests including members of several diplomatic corps from Peru, Mexico, Bolivia, Venezuela, South Africa and Rwanda. Held at the Singapore Chinese Chamber of Commerce and Industry, the exhibition “Cultural Exchange and Art Exhibition of Alfredo Alcalde: Elements From The Soul” was organised by the International Culture Centre. Peru’s Ambassador to Singapore, Mr Armando Raul Patiño, and Mexico’s Ambassador to Singapore, Mr Antonio Villegas, made the welcome speeches and shared with the audience the objectives of the event. NCCS Director Prof Soo Khee Chee also spoke briefly, emphasising the need for continuing support from the local and international community to advance the cause of cancer research as part of the global efforts to improve current treatment protocols and eventually to get a cure for this disease. When artist Alfredo Alcalde offered to donate one of his paintings to the NCC Research Fund, it received thunderous applause from the audience and set the tone for the evening’s event.

The guests networked and mingled with NCCS staff to learn more about NCCS work and share their interest to support its cause. Two paintings were sold that evening and the sale proceeds went to the NCC Research Fund.

NCCS is grateful to the organisers, the Embassy of the United Mexican States and the Embassy of the Republic of Peru for their support, and also to Mr Alfredo Alcalde for generously donating one of his prized paintings. Companies or individuals who would like to support NCCS research initiatives through fund-raising projects can write to communitypartnership@nccs.com.sg. We will be pleased to work with you.

By Evangeline Goh

Executive, Community Partnership Division of Community Outreach & Philanthropy NCCS


PAGE A6

People

SALUBRIS

July / August 2011

SERVICE TO PATIENTS: MY UNDYING PASSION

It’s more than a decade of good work that Dr Chua Eu Jin has put in at the National Cancer Centre Singapore. Not surprisingly, when he reached his compulsory retirement age in April this year, the Centre decided to confer on him the title of Emeritus Consultant. CHARISSA ENG speaks to Dr Chua on his life and his passion in medicine.

D

r Chua’s contributions to NCCS date back to 1999 when he was appointed the Head of Radiation Oncology. Swiftly, he moved up the ranks and held appointments as chairman of the Medical Board as well as the Head of Medical Affairs and Deputy Director of NCCS. During this time, he was the catalyst who introduced many changes that vastly improved the workflow in NCCS, most important of which was to bring in the technology to facilitate in the treatment of cancer patients. Between 1996 and 1998, he was tasked with planning the establishment of NCCS.

It was a responsibility that enabled him to draw on his experience as the former head of the department of Therapeutic Radiology (TRD) in Singapore General Hospital (SGH) to give NCCS a good head start. When NCCS was operational in 1999, Dr Chua helped to obtain new equipment and a new CT stimulator, the first ever in Singapore. He had the foresight to make NCCS the best equipped centre for the treatment of cancer. He then quickly embarked on the move from 2-D to 3-D planning and also on planning for IMRT. The rest is history as NCCS moved on to even newer treatment modalities. Despite his illustrious career, Dr Chua humbly maintains that the milestones achieved under his leadership would not have been possible without his team’s effort. Credit for NCCS’s recognition as a leading cancer centre goes to its capable managers, department heads and staffs.


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People

SALUBRIS

July / August 2011

The Emeritus Consultant title is awarded to a retiring doctor in recognition of his distinguished services to National Cancer Centre Singapore (NCCS). To be eligible, he has to serve a minimum of 10 years of service as Senior Consultant or Head of Clinical Department, and have made significant contributions to the specialty, department and Centre including taking on headship appointment(s). He demonstrates the desired values of the profession, serving as an exemplary role model for the younger doctors, as well as exhibiting leadership qualities in rallying his fellow doctors together for the benefit of patients and the hospital, among other eligibility criteria.

As Head of Medical Affairs, Dr Chua saw to the establishment of clinical quality and service quality under Clinical Affairs in 2001. He set up the infection control unit in 2002, which stood the test well during the SARS epidemic in 2003.

In times like these, you really know who the committed and loyal staffs are”, said the soft-spoken and bespectacled doctor, who is recognisable as one of the few in the profession who sports a bow-tie as he goes about his duties unassumingly.

The 2003 SARS epidemic was one of the most unforgettable crises. Dr Chua was at the frontline where he witnessed the best and worst in human behaviour. However, what gave him hope were the many unsung heroes who fought hard to maintain the efficient deployment of medical services. These heroes were self-sacrificial and provided excellent care to the patients, such that none of NCCS’s patients was afflicted with the virus.

Another problem the team had to contend with was to make the best use of outmoded equipment while they constantly source for new replacements. Through the creative sourcing and use of limited funding, Dr Chua and the team developed in-house techniques for treatments. Most importantly, as he recalled, was that the staff at NCCS never gave up. Dr Chua explained, “There was no lack of trying. Ultimately, I believe everyone must take ownership of the processes and efforts to make NCCS a truly safe and courteous place to work.”

For NCCS to get to where it is today, it was not all plain sailing. Challenges that confronted Dr Chua and his team include for example, the acute manpower shortage which required the staffs to perform multiple roles. In the words of Dr Chua, those were the days of the “long march experience”. Instead of succumbing to the pressures, the team persevered. “Many of my staff worked tirelessly to see us through.

Dr Chua believes in using his influence to help patients, not just medically, but in other aspects as well. For example, he called for the alteration of public policies regarding Medisave claims for radiotherapy patients to keep treatment affordable. He has always been attracted by NCCS’s passion to serve and its dedicated, committed and loyal staff.

Certainly, he was motivated and impressed by “the camaraderie, collegiality, common purpose, team spirit, a desire to make a difference to the work, the department and the institution”. His advice for his younger colleagues is: “Always pursue your passion and believe in a cause bigger than yourself. Always be committed, be loyal and never forget your patients who are the reason for your calling.”

On his wish for the future of NCCS, he said, “I hope that NCCS will achieve its vision to be the best and continue to develop its staff and provide opportunities for them to grow and contribute. I also hope that we all can build an institution that everyone is proud of and that at the end of the day we can say ‘Yes I was there, I did the best I could for the good of all who passed through its gates’.”


NCCS DOCTORS OFFER NEW INSIGHTS ON CANCER AT ASCO MEETING

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In Other Words

SALUBRIS

July / August 2011

Continued from page A3.

Mucocutaneous Angiosarcoma (MC-AS) Versus Non-MC-AS: Clinicopathologic Features and Treatment Outcomes in 44 Patients Mucocutaneous Angiosarcoma (MC-AS) is sarcoma that arise from the superficial regions of the body, primarily the skin. The majority of MC-AS occurs in the scalp or head and neck region, and usually affects elderly males. Non MC-AS can occur in the breasts, solid organs or deep soft tissues in different parts of the body. In NCCS, the majority of patients who have this type of cancer develop MC-AS. The prognosis of Angiosarcoma is usually poor and patients diagnosed with Angiosarcoma have a reported five-year survival of about 35 percent. In advanced stages of the disease, average survival is less than one year. To improve prognosis, Dr Richard Quek aimed to compare the clinical presentation and treatment outcomes of patients with MC-AS versus non MC-AS seen in NCCS. What Dr Quek found out has far-reaching implications for the medical community. His results also highlighted the limitations of standard clinical staging tools in stratifying patients for survival within the MC-AS subgroup of patients.

An Analysis of the Prognostic Value of Handgrip Strength and its Incorporation into the Comprehensive Geriatric Assessment (CGA) in Elderly Asian Patients with Cancer From studies done earlier, it has been noted that tell-tale signs of one’s mortality has something to do with one’s handgrip strength. The studies in Britain pointed out that poorer grip strength has been associated with increased mortality from all causes including cancer. This is significant for Singapore with our ageing population. Dr Ravi Kanesvaran’s study aimed to assess how handgrip strength can determine clinical outcomes for older cancer patients in an Asian context. He used the Cox proportional hazard method to identify prognostic factors within comprehensive geriatric assessment to analyse the relationship between handgrip strength and overall survival for patients. About 249 newly diagnosed patients aged 70 years and above, taking into account their age, ECOG performance status, gender, body mass index and the DETERMINE nutritional assessment index, took part in the study.

Dr Ravi Kanesvaran

Editorial Advisors

Contributing Editor

Medical Editor

Dr Kon Oi Lian Prof Soo Khee Chee

Dr Wong Nan Soon

Dr Richard Yeo

Members, Editorial Board

Members, Medical Editorial Board

Mr Mark Ko Ms Sharon Leow Dr Shiva Sarraf-Yazdi Ms Flora Yong

Ms Lita Chew Dr Mohd Farid Dr Melissa Teo Dr Teo Tze Hern Dr Deborah Watkinson

Ms Charissa Eng Ms Veronica Lee Mr Sunny Wee

Based on the positive findings of phase three trials in glioblastoma multiforme, concurrent temozolomide (TMZ) and radiation is often used as an initial treatment for anaplastic glioma, an uncommon form of cancer that originates from the brain.

However, there is no prospective randomised data currently to prove the efficacy of combining both TMZ and radiation in the treatment for anaplastic glioma. To investigate this, Dr Tham Chee Kian launched a study to find out if the addition of TMZ to radiation is better than radiation alone for the initial treatment of anaplastic glioma. Dr Tham reviewed patients with anaplastic astrocytoma or oligoastrocytomas treated at NCCS between the years 2000 to 2010. Only patients who received upfront radiation or concurrent TMZ and radiation were included in this study.

The study revealed that handgrip strength is an important prognostic factor in elderly patients and was useful in the comprehensive geriatric assessment of such patients. They include the DETERMINE nutritional index, ECOG performance status and advanced stage as prognostic factors with the CGA.

Executive Editors

Concurrent Temozolomide and Radiation as the Initial Treatment for Anaplastic Glioma

His study revealed that there is not any significant benefit of TMZ with radiation compared to just radiation alone as the initial treatment of anaplastic glioma. Prospective randomised trials will be needed to evaluate the optimal treatment for this disease.

SALUBRIS

is produced with you 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.

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NCCS Salubris Issue No. 17 (Public Edition)