Salubris Jul - Sept 2014

COMPREHENSIVE DIAGNOSIS AND TREATMENT FOR

LIVER CANCER

AN NCCS QUARTERLY PUBLICATION July – September 2014

Issue No. 30 • MICA (P) 140/03/2014

Salubris is a Latin word which means healthy, in good condition (body) and wholesome.

...HELPING R EADERS TO ACHIEVE GOOD HEALTH

DOWN-STAGING OF LIVER CANCER TO ALLOW CURATIVE SURGERY: AN EMERGING PARADIGMBY PROF PIERCE CHOW FRCSE, PhD Co-Director, Comprehensive Liver Cancer Clinic, NCCS Senior Consultant Surgeon, Division of Surgical Oncology

Liver cancer (HCC or hepatocellular carcinoma) is the 6th most important cancer in the world and the third most important cause of cancer mortality. Unfortunately about 80% of all HCC patients are found in the Asia-Pacific region because of the high incidence of viral hepatitis here. In Singapore, it is the fourth most important cancer but the second cause of cancer death after lung cancer.

Surgical resection (and in carefully selected patients liver transplantation and radio-frequency ablation) for early stage HCC offers the opportunity of long

term cure. A patient with HCC is a potential candidate for surgical resection if the following conditions are fulfilled: firstly, the tumour is confined within the liver and with no invasion of major blood vessels. Secondly, there is good liver function; and thirdly, there will be sufficient remnant liver after resection. In addition, the patient must be in generally good health to be able to undergo a major surgery.

At the time of diagnosis, not all HCC are amendable to surgical resection because the underlying liver function may be poor as a result of chronic liver disease or the cancer may be advanced. A number of therapies have been developed over the last 10 years to successfully treat such patients to prolong lives and reduce suffering.

While surgical resection is important, it must be appreciated that not all cases that can be surgically resected are in the early stages of the cancer. Generally, long-term cure is possible only for patients with relatively early stages of HCC.

Many patients with cancers are diagnosed when the cancer is at the intermediate or locally advanced stage. A locally advanced cancer is one which is not in the early stage but has not spread beyond the confines of its organ of origin e.g. liver cancer that has not spread outside of the liver. In many common cancers (other than liver) such as breast or colorectal cancers, a standard oncology approach when doctors are confronted with a locally advanced cancer, is to down-stage the cancer to a more early stage when surgical resection can be either possible and/or can result in better long-term survival or hopefully even cure. Such down-staging can be achieved with a combination of chemotherapy or radiation therapy and the process is known as neo-adjuvant therapy.

HCC is generally a challenging cancer to treat because it is a highly complex cancer at the molecular level. Previously there have been very few reports of successful down-staging for HCC. Most of these involved combinations of chemotherapy drugs and may be relatively toxic. More importantly, the outcomes of these treatment regimens are frequently difficult to predict. Thus, while down-staging in HCC remains a very important concept, it is not frequently practised.

Recent developments in radiation therapy in HCC using focused external beam radiation therapy (EBRT) and selective internal radiation therapy (SIRT) using yttrium-90 have been reported to significantly down-stage HCC. The results with SIRT have been particularly consistent with HCC, where it has also been shown to regress HCC that has invaded the vasculature. This offers the possibility firstly, that unresectable locally advanced HCC (such as those involving major blood vessels) may become technically resectable with down-staging by SIRT. And secondly, resectable intermediate stage HCC may be down-staged to an early stage where resection potentially results in long-term survival. Prospective long-term studies are, however, required to demonstrate if such neo-adjuvant therapy should become standard of care for locally advanced or intermediate-stage HCC.

2 SALUBRIS JULY – SEPTEMBER 2014

Down-staging with Selective Internal Radiation Therapy to surgical resection

While our experience with SIRT and other treatment regimens have been generally positive1,2,3, it remains true that because of genetic variations, some patients are inherently more responsive to these therapies than others. We are currently not able to determine this before treatment. Our ongoing research into the genomics of HCC carried out in collaboration with our partners in the Genomic Institute of Singapore, A*Star, and the Bioinformatics Institute will hopefully help us unravel this important clinical challenge.

At the Comprehensive Liver Cancer Clinic (CLCC) at the National Cancer Centre Singapore, all new cases of HCC seen are formally reviewed by the multi-disciplinary group of specialists at the clinic comprising surgeons, medical oncologists, radiation oncologists, nuclear medicine physicians, interventional radiologists and pathologists. A consensus treatment plan is proposed to the patient based on the best available scientific evidence and supported by the combined clinical experience of the team. More importantly, scientific data as well as bio-samples are collected prospectively and analysed at intervals with our statistician colleagues at the Office of Clinical Sciences at Duke-NUS. These, together with the prospective clinical trials we are conducting, will hopefully help us gain better insights on how best to offer better clinical outcomes to our patients.

REFERENCES:

1. Khor AY, Toh Y, Allen JC, Ng DCE, Kao YH, Zhu GL, Choo SP, Lo RHG, Tay KH, Teo JY, Goh KP, Burgmans MC, Irani FG, Goh SW, Chow PKH. Survival and pattern of tumor progression with Yttrium-90 microsphere radioembolization in predominantly Hepatitis B Asian. Hepatology International; (2014): 1936-0541

2. Chow PKH, Poon DYH, Khin MW, Han HS, Goh ASW, Choo SP, Lai HK, Lo RHG, Tay KH, Lim TG, Gandhi M, Tan SB, Soo KC. Multicenter Phase II Study of Sequential Radioembolization-Sorafenib Therapy for Inoperable Hepatocellular Carcinoma. PLoS One, 2014. 9(3):p.e90909.

3. Lau WY, Sangro B, Chen PJ, Cheng SQ, Chow P, Lee RC, Leung T, Han KH, Poon RTP. Treatment for Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis: The Emerging Role for Radioembolization Using Yttrium-90. Oncology. 2013; 84(5): 311-8.

4. Teo, Jin Yao; Goh, Brian; Cheah, Foong Koon; Allen, John; Lo, Richard; Ng, David; Goh, Anthony; Khor, Andrew; Sim, Hui Shan; Ng, Jia Jun; Chow, Pierce. Underlying Liver Disease Influences Volumetric Changes in the Spared Hemiliver after Selective Internal Radiation Therapy with Y90 in Patients with Hepatocellular Carcinoma. Journal of Digestive Diseases. (In Press)

3SALUBRIS JULY – SEPTEMBER 2014

COMPREHENSIVE LIVER CANCER CLINIC:

A ONE-STOP SERVICE FOR LIVER CANCER PATIENTS

The treatment of liver cancer is particularly complex as it is a very heterogeneous disease and requires significant medical expertise to achieve optimal clinical outcome. The best outcome with liver cancer occurs when the patient is looked after by a multi-disciplinary team of specialists each with individual expertise in the different modalities of treatment relevant to liver cancer. To achieve this, the National Cancer Centre Singapore (NCCS) recently launched its Comprehensive Liver Cancer Clinic (CLCC) on 2 June, which provides a one-stop service to patients by bringing all the different specialists together to work around the patient.

THE CLCC IS DEDICATED TO THE DIAGNOSIS AND TREATMENT OF:1. Primary liver cancer (hepatocellular,

peripheral cholangiocarcinoma)

2. Colon / rectal cancer that has spread to the liver

3. Neuroendocrine / carcinoid tumours that have spread to the liver

4. Gallbladder cancer

5. Bile duct cancer (central and distal cholangiocarcinoma)

P reviously, the management process for liver cancer may require patients to traverse between NCCS and other

hospitals like the Singapore General Hospital (SGH) for treatment. This may have resulted in a longer treatment process and created undesirable confusion between treatment venues. The opening of CLCC will reduce the need for multiple appointments as patients can be seen by one or more of the relevant specialists within the same session.

At the launching of CLCC, Prof Soo Khee Chee, Director of NCCS said: “We are continually looking into ways to improve our services for patients. With the close collaboration between NCCS and the SGH, we are able to assemble a good team from different disciplines to offer liver cancer patients the treatment they require in the most efficient way.”

DISEASE CONDITIONS SEEN AT THE CLCC INCLUDE:

All suspected or proven tumours in the liver, including those:

– without confirmed diagnosis

– previously diagnosed with liver cancer now seeking confirmation

– without previous treatments

– with previous treatment but currently seeking consultation regarding possible surgical or regional therapy

– already been given a treatment plan or already treated but seeking a multi-disciplinary second opinion

– previously treated liver tumour now with recurrence

– secondary liver tumour with a known or suspected primary tumour elsewhere (e.g. colorectal, neuro-endocrine/carcinoid, GIST) now seeking multi-disciplinary treatment with or without other surgical specialists e.g. colorectal surgeon

– suspected or proven masses or tumours related to the liver e.g. gallbladder tumours, bile duct tumours (cholangiocarcinoma), pancreatic tumours

As each case is different, the multi-disciplinary specialist team will comprehensively assess the patient’s disease and treatment needs. The team then creates a consensus or joint treatment plan tailored for the patient, based on the latest scientific evidence and the combined clinical experience of the team.

The CLCC is located at Clinic D, on Level 2 of the NCCS. It has two Co-Directors namely, Prof Pierce Chow, a Senior Consultant Surgeon at NCCS, and Dr Choo Su Pin, a Senior Consultant Medical Oncologist at NCCS.

Clinic is open daily from Mondays to Fridays, 8am to 6pm. To schedule an appointment, please contact 6436 8088 from Mondays to Fridays (8.30am – 5.30pm) and Saturdays (8.30am to 12.30pm), or fax to 6324 3548. To learn more about CLCC, visit www.nccs.com.sg/patientcare/comprehensivelivercancerclinic or email [email protected].

A multi-disciplinary board discussion creates a consensus or joint treatment plan tailored for the patient based on his/her disease and treatment needs.


Dr Richard Quek delivering a lecture on the current systemic chemotherapy landscape in soft tissue sarcomas.

A multi-disciplinary board discussion creates a consensus or joint treatment plan tailored for the patient based on his/her disease and treatment needs.

2ND SARCOMA SYMPOSIUM 2014:

EXPERTS SHARE KNOWLEDGEUpdates on the multi-disciplinary approach for the treatment of a challenging disease

Over 400 participants gained new insights about the management of sarcomas through an interactive and buoyant session of mutual learning between sarcoma experts and members of the healthcare community.

H eld on 26 and 27 April at the Academia, the 2nd Singapore Sarcoma Consortium Education and Research Meeting is an annual effort that brings together a team of sarcoma experts from orthopaedics, surgical oncology, medical oncology, radiation oncology, paediatric oncology, pathology

and radiology. Building on the success of last year’s meeting, the Singapore Sarcoma Consortium reiterated their commitment in pursuing advancement in the specialised field of Sarcoma with a second meeting this year.

In his opening speech, organising chairperson and Senior Consultant from NCCS’s Division of Medical Oncology, Dr Richard Quek, reinforced the complexity and heterogeneity of sarcomas and underlined the need for greater integration of care within a multi-disciplinary team.

This year’s session centred on the treatment of retroperitoneal; head and neck and limb soft tissue sarcomas; Ewing’s sarcoma and gastrointestinal stromal tumours. Members of the consortium shared their wealth of knowledge and the latest state-of-the-art advancements in their respective fields. The presentations highlighted the various challenges in the diagnosis and treatment of these sarcoma subsets, in hopes of allowing the audience a better overview of the diseases.

The symposium served as an excellent learning platform and the discussions allowed for more in-depth analysis of complicated sarcoma cases. The organisers seemed buoyant at the prospect of making considerable advancement in this field. They also have high hopes that such meetings would interest more scientists to be involved in sarcoma research, where it would benefit the personnel involved in the treatment of this uncommon cancer, and ultimately, the patients as well.

The symposium provided a platform for residents and doctors to learn, discuss and exchange knowledge and expertise.

(Left to right) Orthopaedic surgeon Dr Matthew Cheng (Novena Medical Centre), medical oncologist Dr Angela Pang (NCIS), pathologist Dr Victor Lee (NUH), radiologist Dr Kwek Jin Wei (NCCS), medical oncologist Dr Richard Quek (NCCS), Director of NCCS Prof Soo Khee Chee, radiation oncologists Dr Jonathan Teh and Dr Francis Chin (NCCS), surgical oncologist Dr Melissa Teo (NCCS) and orthopaedic surgeon Dr Mark Puhaindran (NUH).


COLOURS OF HOPEBY FLORA YONG Community Partnership

It was an enchanting evening at the Ritz-Carlton, Millenia Singapore on 29th March 2014 where the National Cancer Centre Singapore (NCCS) held its biennial charity gala event. The gala was a celebratory expression of her vision and achievements as the largest one-stop cancer treatment facility in Singapore. The event received remarkable philanthropic support from individuals, corporations and foundations for cancer research as well as the new Proton Beam Treatment Programme targeted to begin serving the community in 2018 from the new NCCS building.

T he event, themed “Colours of Hope” symbolises a myriad of wishes, desires and aspirations cancer patients may hope for. The gala’s theme took inspiration from the story of Sadako Sasaki, a brave and inspiring Japanese girl who experienced the atomic bombing at the

age of two during the Second World War and was struck by leukemia ten years later. Sadako folded cranes throughout her illness. The flock hung above her bed on strings. She held on to her hope for life till her short life ended at the age of twelve. By then, Sadako had folded six hundred and forty-four cranes. According to Japanese legend, the crane lives for a thousand years, and a sick person who folds a thousand cranes will become well again.

In the same spirit, the staff of NCCS, patients, their families, caregivers, volunteers as well as the staff of the Ritz-Carlton Hotel took part in a month long project to fold paper cranes which were used to decorate the gala ballroom and dinner tables on the day of the gala. At the end of the project, close to 3,000 colourful paper cranes were completed. Each guest at the event was presented with a paper crane as a token of appreciation of their support towards the cancer cause.

The charity gala raised a total of $55.1 million, a very promising start to NCCS’ continuing fundraising efforts towards the Proton technology, its clinical research enterprise and helping needy cancer patients. The Goh Foundation made the largest gift of $50 million that evening with $40 million dedicated to supporting the setting up of the cutting-edge Proton Beam Treatment Centre and the remaining $10 million for cancer research. The donation from the Goh Foundation is by far the largest donation from an individual donor that NCCS has received since its inception close to 15 years ago.

During the dinner, three other donors presented cheques to President Tony Tan Keng Yam, who was the Guest-of-Honour. They were Kwan Im Thong Hood Cho Temple who pledged $1.5 million in support of the Proton Beam Treatment programme, the late Mrs Irene Bronsveld and an anonymous donor each donated $1 million in aid of cancer research. The generous spirit of all donors and supporters give hope for a better treatment outcome and a more productive future to cancer patients.


ABOUT THE PROTON BEAM TREATMENT PROGRAMME

Every year, about 12,000 new cancer cases are diagnosed in Singapore. With cancer as the number one killer, there is an urgent need for more effective treatments. In early 2013, NCCS received approval from the Ministry of Health to acquire the proton therapy technology. By late 2018, NCCS will set up a state-of-the-art Proton Beam Treatment Centre within its new building. This facility will be the first in Southeast Asia serving patients from Singapore and the region with one of the world’s most advanced form of radiation therapy – Proton Therapy. It destroys cancer cells using positively charged subatomic particles known as Protons instead of x-rays used in standard radiation therapy.

The proton beams can be controlled to precisely deliver high-dose cancer-killing energy directly to the tumour without any significant damage to normal tissues.

Patients can benefit from minimal radiation exposure and avoid damage to nearby healthy tissues and organs, reducing treatment-related side effects. The ability to treat tumours in difficult areas of the body, and especially in children, is significantly enhanced. Proton therapy has been used to treat cancers such as hepatocellular carcinoma (HCC), head and neck tumours including nasopharyngeal carcinoma (NPC), prostate and lung cancers, which are among the top most common cancers, affecting at least an annual average of 2,400 in Singapore. When ready, it will benefit about 1,000 patients per year. Estimated to cost about $140 million, the acquisition of the Proton Beam Therapy technology will be a major milestone in cancer care for our community and for Singapore as Asia’s leading medical hub.

From Left to Right: Dr Tan Eng Liang (Director, Goh Foundation), Mr Goh Cheng Liang (Chairman, Goh Foundation), President Tony Tan and Professor Soo Khee Chee (Director, NCCS)

Pontiac Land Singapore, owner of the Ritz-Carlton hotel had generously sponsored the gala dinner and the guests were entertained by the students of the National Junior College String Ensemble, the lively performance of Vocaluptous, Singapore’s premier acapella group and by well-known vocal coach, Ms Babes Conde.

The spirit of philanthropy rode high that evening and touched many hearts through the inspiring speech by Professor Soo Khee Chee. He explained the importance of continually investing in our resources to strengthen our healthcare infrastructure as well as the reasons for working with the public and private sectors, leveraging on philanthropy to meet funding needs to bring NCCS closer to its aims to deliver the best cancer care to the Singapore community.

For more information about supporting cancer research or the Proton Beam Treatment Programme, please visit www.nccs.com.sg/giving or email: [email protected].

From Left to Right: Ms Jacqueline Cho, Mrs Barbara Cusick, Ms Lanabel Cho, President Tony Tan and Professor Soo Khee Chee (Director, NCCS)

From Left to Right: Dr Tan Choon Kim, (Chairman Kwan Im Thong Hood Cho Temple), President Tony Tan and Professor Soo Khee Chee (Director, NCCS)


NCCS QUALITY WEEK 2014:

AFFIRMING OUR COMMITMENT TO QUALITY, PATIENT SAFETY AND SERVICE EXCELLENCEBY SITI ZAWIYAH Executive Corporate Communications

While the objective of last year’s Quality Week was to encourage staff to work as a team in order to achieve success together as an institution of excellence, this year, more than 400 staff came together over three days in May to uphold their commitment to provide quality service, ensure patient safety, and deliver excellent service in NCCS.

Dr Terence Tan (left) presenting a token of appreciation to guest speaker, Mr Daniel Tan.

G uest speaker, Mr Daniel Tan Kuan Wei, Assistant Vice-President in the Enterprise-wide Risk Management

(ERM) Office with MediaCorp Pte Ltd was invited to speak on the first day of Quality Week 2014. He shared with NCCS staff on the implementation of ERM at MediaCorp, which included spearheading the ERM programme, developing its ‘Risk Academy’, as well as formulating threat scenario action plans.

Patient safety was the topic for the second day, with NCCS Chief Quality Officer for Clinical and Governance, Dr Terence Tan Wee Kiat sharing on how healthcare could be improved through Root Cause Analysis (RCA). Staff had an increased understanding of the principles of RCA, its common tools and how they can be used to help identify root causes.

The seminar was made more exciting when five teams representing their respective divisions, namely Division of Radiation Oncology (DRO), Division of Oncologic Imaging (DOI),

Pharmacy, Nursing, and Division of Clinical Trials & Epidemiological Sciences (CTE), participated in an enriching RCA game. The teams were asked a series of challenging questions on root causes and how problems could have been avoided. It was a close fight, with DRO emerging as the winning team! Also related to safety, the Operations team had prepared RACES – short for Rescue, Alarm, Call, Extinguish and Shut, to show staff the procedures to follow should a fire break out in the building.

On the final day of Quality Week, staff participated in discussions on how to deliver excellent service to patients. “It is not enough to just be good. We must be excellent because patients will remember that. Our behavior can make a difference between a good and an excellent service when we show we care”, shared Dr Terence Tan. Important takeaways on this day included knowing that service excellence is more than just being friendly and helpful. Going beyond just performing tasks, it means touching the hearts of patients, showing genuine care and concern, looking out for and responding to signs of fear or anxiety, and helping patients preserve their sense of hope.


For her paper on “Role of surveillance imaging in the management of T-cell lymphomas”.

2014 Conquer Cancer Foundation of American Society of Clinical Oncology (ASCO) Merit Award

DR TIFFANY TANG

Associate Consultant

Division of Medical Oncology

CONGRATULATIONS!

DISTINGUISHED CHAMPION OF CHANGE LEADERDR TAN HIANG KHOON

Head, SingHealth / Duke-NUS Dept of Head & Neck Surgery

Academic Vice Chair, ACP Surgery

Director, Division of Community Outreach & Philanthropy, NCCS

Senior Consultant, Division of Surgical Oncology, NCCS

OUTSTANDING CLINICIAN RESEARCHER AWARDDR THNG CHOON HUA

Deputy Head / Senior Consultant

Division of Oncologic Imaging

OUTSTANDING ADMINISTRATIVE STAFF AWARDMS CHAN CHIN FERN

Assistant Manager

Department of Nursing Administration

NATIONAL MEDICAL RESEARCH COUNCIL (NMRC) AWARDS 2014The NMRC awards are presented to clinician scientists and researchers to carry out translational and clinical research in Singapore, turning their research ideas into improvements for patient care.

ASSOCIATE PROFESSOR DARREN LIM WAN TECK

Senior Consultant


ASSISTANT PROFESSOR GOPAL IYER

Senior Consultant

Division of Surgical Oncology

DR JOANNE NGEOW YUEN YIE

Consultant


TRANSITION AWARD

SingHealth Excellence Awards 2014

SingHealth GCEO Excellence Awards 2014

For being elected as a member of the ASCI for his outstanding records of scholarly achievement in biomedical research.

American Society of Clinical Investigation (ASCI)

CLINICIAN SCIENTIST AWARD (INVESTIGATOR CATEGORY)

PROFESSOR TEH BIN TEAN M.D., PH.D

Director and Principal Investigator Laboratory of Cancer Epigenome

Division of Medical Sciences


WRITING FOR CHARITYTo raise funds for cancer research and the less fortunate cancer patients, Dr Chua Eu Tiong, Senior Consultant in the Radiation Oncology Division of the National Cancer Centre Singapore first presented his new book, Sang Nila Utama, at the NCCS

“Colours of Hope” Charity Gala in March. A distinguished philatelist, writer and artist, Dr Chua illustrates his version of the legend with inspiration and creativity. He shares with GILLIAN TAN the motivation behind his book.

Please share with us briefly what your book is about.

The story is about Sang Nila Utama’s sighting of the Singa. It tells of this adventure, with love, hate, intrigue, revenge, good and evil all thrown in. It also sets the story for future adventures.

What inspired you to retell the story of Sang Nila Utama?

I was reading the Iliad again, you know, the story of Achilles by Homer. Of course, there was Helen of Troy, the Trojan horse and King Agamemnon, all in prose. Then, I decided to read the story in rhyme. It was an epic and I was captivated by that story in rhyme. So, why not create an epic of our local legend in rhyme?

Where did your ideas come from?

The ideas, oh well, off the cuff of my head, I presume! Well, actually as the story developed, I added and subtracted as I went along. Then, I was corresponding with a good friend in Kuala Lumpur and it was like Scheherazade trying to send a story, in this case, a chapter a day.

Dr Chua Eu Tiong with his paintings.


However, therein too lies the fun, because you can see the story and tension built up in each chapter as I attempted to leave each chapter with a problem to be solved in the next.

How much time was taken to write this book?

The story took about four months to write. It started with isolated poems but as the story flowed, it became easier, and having got the hang of writing a narrative poem, keeping the suspense with each chapter became second nature.

The pictures took about two months to conceptualise, but it took another six to eight months to get all together. Altogether, it took more than a year, from the time I started writing, to getting it printed.

Why did you decide to write this book to raise funds for cancer care and research at NCCS?

I did not start off by writing a book to raise funds. I decided to convert it into a book with pictures to raise funds only later, when I saw the story and book being developed. I thought the Arts scene should be engaged and involved with raising funds for a cause that is not often on people’s mind. Cancer seems to be a taboo word and I feel people don’t often give to cancer-related funds because it does not tug at their heartstrings. However, it is such a devastating disease for patients and relatives alike, so funds to help them, both patients and caregivers, are very, very useful.

Besides sharing your book with the Gala attendees, how are you reaching out to readers for philanthropic support through your book?

The book is a convenient way to raise the subject of contributions and donations. Some people have asked me why I wanted to write the book, and as this conversation proceeds, the subject of supporting cancer research and cancer patients is broached. Currently made available outside the NCCS library, the book will also be promoted online to reach out to the community.

It is hoped, too, that the book can reach out to the Arts and Literary circle to get them interested in Cancer as a worthy cause to donate to.

We understand that you are an avid artist and the goldfishes featured on the book cover were painted by you. Does the painting have a significant meaning to the story?

Yes, the goldfishes in this story were a calming medicine for the heroine, but in the future stories, they will play a bigger part and form part of the poems and rhymes. The goldfish will be a link to all the stories from Sang Nila Utama to the prequel, Sri Vijaya, the future – Malacca, Singapura, First World War, Second World War, and so on.

What kind of writing were you doing before this book?

Prior to writing this book, I was focused on articles on philately – stamps and the history of the postal services in Singapore and Malaya. I was also writing poems but, you know, poems depend very much on the period of your work. As one ages, poems become more introspective, or sometimes, more appreciative of the world around us.

What is the hardest thing about writing this book?

The hardest thing about writing this book was that it is a narrative poem. Narrative poems require me to tell a story, so I could not, as one says, “go all over the place” like writing a descriptive, emotional or reflective subject. I had to keep the tension in the story and to ensure its continuity. Sometimes, words would rhyme but did not fit the flow of the story at all, not even as imagery.

What do you wish to convey to your readers and the general public?

There are several points. From the artistic viewpoint, sometimes one should create for fun rather than always try to make a statement, social or political. Art need not be restricted to the dark emotions but can be illuminated by joy and happiness – it is not a bad thing to be joyous!

The other reason for this book was to engage the arts circle in raising funds for cancer research and cancer patients. As I mentioned in the author’s note, it is hoped that someday, a literary or art giant in our society will bequeath his or her work to the Centre to continually raise funds for this cause.

This Sang Nila Utama book is available free outside the Staff Library at NCCS, Level 4 (11 Hospital Drive). Dr Chua hopes that individuals who appreciate the book can make direct donations to the NCC Research Fund and/or Community Cancer Fund.

If you wish to give to the cancer cause by making a donation and/or volunteering, kindly contact NCCS Community Partnership at 6236 9440 or email [email protected].


CANCER HELPLINE – LISTENING WITH OUR HEARTSBY TEO LAY CHOO Nurse Counselor Cancer Helpline

The Cancer Helpline was officially launched on 28th September 1999 with the aim to provide cancer information, counseling and support on cancer and related issues to the community. The helpline is manned by trained nurses to provide up-to-date information on the signs and symptoms, early detection and treatment for cancer as well as management of treatment side effects. The Cancer Helpline offers emotional and psychological support to anyone who is affected by cancer. Support is provided to cancer patients and their families through phone calls, emails as well as face-to-face counseling. This requires good listening skills with sensitivity and tact.

When being diagnosed with cancer, patients and their families often face intense fear and anxiety. They will need some form of help, support and information during their journey with cancer.

The Cancer Helpline is a telephone counseling and information service maintaining privacy and confidentiality of the caller.

Services include providing reliable cancer information, counseling as well as emotional and psychological support in coping with cancer.

T he nurse counselor is equipped with good listening skills to meet the challenges of communicating over the phone, gaining the

trust and confidence of the caller. One of the attributes of the nurse counselor is sensitivity toward the different needs when communicating with people from various belief systems and cultural backgrounds. The counselor also demonstrates patience while interacting. She has to be calm, non-judgmental and give her attention to the conversation, offering empathy and support throughout the call.

The Cancer Helpline aims to empower the public with the right knowledge and information to take charge of their own health and others through their cancer journey. The helpline is not only a telephone enquiry service like most people perceive it to be, but is a vital link to related agencies for relevant support in their fight against cancer. Privacy and confidentiality is assured as there is no caller ID installed on this line. Callers are not required to reveal their identities. The focus is on the caller’s concerns and the issues they face, regardless of who they are, what they do or where they are from.

In Singapore, patients are often hesitant to ask questions during consultation with their doctor for fear that they may be taking up the doctors’ time. Sometimes, they may not be sure of what questions to ask their doctor. A selection of questions is offered to them to help them clarify their doubts and concerns when seeing the doctor at follow-up appointments.

By maintaining anonymity and confidentiality, the service aims to reach out to people who, in our Asian society are not comfortable to discuss about their condition openly. The helpline allows them to express concerns, fear and doubts to someone who can listen to and understand their experience.

The Cancer Helpline is accessible by telephone, face-to-face visits (by appointment) and email. This allows the caller to reach the nurse counselors by channels which they feel most comfortable with. The helpline has also received calls and email enquiries from both locally as well as countries such as Bangladesh, China, Indonesia, Myanmar, Philippines, Sri Lanka and Vietnam.

When patients are being diagnosed with cancer, support and information with regards to their condition is significant to help them cope better in their battle with cancer. With the Cancer Helpline, callers have the opportunity to speak their mind about their worries, and be assured that their queries will be attended to by compassionate nurse counselors in confidentiality.

To speak to a nurse counselor, please call the Cancer Helpline at 6225 5655 from Monday to Friday, between 8:30am and 5:30pm.


癌症援助热线 −用心聆听作者：张丽珠护士辅导员癌症援助热线

癌症援助热线于1999年9月28日正式成立，它的宗旨是为病人与公众提供癌症讯息，辅导以及癌症和相关事项的支持服务。该热线是由受过专业训练的护士负责接听，针对癌症的征兆与症状、提早发现和治疗，以及如何减轻治疗过程中的副作用提供最新资讯。此外，癌症援助热线也为所有受癌症影响的人提供情绪与心理上的支持。癌症患者以及病人的家属可以通过电话、电邮以及面对面的方式接受辅导。这些都需要良好的聆听技术，以及感同身受的态度与妥善的应对方法。

被诊断患上癌症时，许多病人和他们的家人都会感到极大的焦虑和恐慌。在应付癌症的问题上，每个人都有不同的需求。因此，在接下来的抗癌路途中，将会需要一些帮助、支持和必要的资讯。

癌症援助热线是一项注重个人隐私，并能为来电者保密的电话辅导以及资讯服务。服务项目包括提供可靠的癌症资讯、辅导以及情绪与心理上的支持，以帮助病人能更好地应对癌症。热线的目的是协助病人面对癌症的经历。

热线的护士辅导员均具备上述技能。她们能够应对电话沟通所带来的挑战，取得来电者的信任及信赖。这些护士辅导员必备的特质之一，就是当她们与不同信仰、不同文化背景的人交流时，能够敏锐地察觉到他们不同的需求。她们也能在跟病人交谈的过程中表现出无比的耐心。她们以淡定、客观的方式，与致电癌症援助热线的人士沟通。使致电人士在倾谈中感受到护士辅导员对他们的关怀，支持与鼓励。

此外，癌症援助热线也为社会大众提供相关的知识与资讯，让他们懂得如何照顾自己的身体，如何为正在与癌症抗斗的亲人或朋友提供协助。它不是一般的电话资讯服务，它是联系相关机构的重要联结点，可以在病人的抗癌过程中为他们提供相关的咨询与所需的服务。癌症援助热线没有设置来电显示的功能，因此能确保来电者的隐私受到保密。拨打该热线时，无须透露自己的身份。无论来电者是谁，从事什么职业，来自哪一个国家，热线关注的焦点只会是他们所挂虑和面临的问题。

在新加坡，很多病人在看病时都不太会向医生提问，因为害怕耽误医生的时间或不确定该问哪些问题。因此，癌症援助热线也替他们列出一份问题清单，好让他们在复诊时能与医生讨论，从而消除内心的疑问和顾虑。

通过采取匿名拨打及身份保密的形式，这项服务得以解决亚洲人对于不习惯坦率讨论自己的病情所带来的不便。病人因此能够向愿意聆听和了解自己的经历的人，说出内心的担忧、恐惧和疑虑。

癌症援助热线以电话、面对面交流（需要预约）及电邮等方式接受询问。这样一来，病人就可以选择他们觉得最自在的方式与护士辅导员沟通。除了本地人士，该热线也经常接到或收到来自孟加拉国、中国、印尼、缅甸、菲律宾、斯里兰卡和越南的电话及电邮。

病人被确诊患上癌症后的这段期间，热线能针对他们的病情提供必要的支持和资讯，使他们更有信心与癌症抗斗。通过癌症援助热线，来电者能在保有隐私的情况下从容地向热心的护士辅导员倾诉内心的担忧。

如果您想与护士辅导员交谈，请在星期一至星期五早上8点30分至下午 5点30分，拨打6225 5655联系癌症援助热线。


JULY

Event Date, Time, Venue Registration

Public Forum – Common Cancers Affecting Men

TOPICS:• Common cancers affecting

Singaporean men• What are the risks, signs & symptoms?• What screening tests should you do to

detect cancer early?• What are the treatment options available?

5 July 2014, Saturday

MANDARIN SESSIONTime: 9.15am to 10.30am Registration: 9.00am to 9.15am

ENGLISH SESSION Time: 11.15am to 12.30pm Registration: 11.00am to 11.15am

Peter & Mary Fu Auditorium National Cancer Centre Singapore 11 Hospital Drive Singapore 169610

Free Admission

Strictly No Admission for children below 12 years old. Registration is a MUST as seats are limited.

REGISTRATION IS BY PHONE ONLY

Please call: 6225 5655 Monday to Friday: 8.30am to 5.30pm

CancerWise Workshop – Coping Tips for Caregivers

TOPICS:• Who is a caregiver?• Caregiver’s challenges across cancer trajectory• Factors affecting caregiver’s stress• Taking Care by Letting Go, Letting Go

by Taking Care• Tips for caregiving• Resources for caregiver• Questions and Answers


Session will be conducted in English.

Registration : 1pm Workshop : 1.30pm to 3.30pm


Free Admission




CancerWise Workshop –Pain Management (Nurses Only)

TOPICS:• What is a pain?• How does pain occur?• Why does cancer cause pain? • Pain assessment• Management of pain• Other options for pain




Level 4 Function Room National Cancer Centre Singapore 11 Hospital Drive Singapore 169610

Free Admission




OUTREACH – PUBLIC FORUMS & CANCERWISE WORKSHOP

The information is correct at press time. NCCS reserves the right to change programmes or speaker without prior notice.


AUGUST


CancerWise Workshop – Is There a Link between Hepatitis B and Liver Cancer?

TOPICS:

• What is Hepatitis?

• Types of Hepatitis

• Causes of Hepatitis B

• Signs & symptoms of Hepatitis B

• The link between Hepatitis B and Liver Cancer

• Treatment & prevention of Hepatitis B

• Living with Hepatitis B

• Questions & Answers

2 August 2014, Saturday




Free Admission

Strictly No Admission for Children below 12 years old. Registration is a MUST as seats are limited.



CancerWise Workshop –Management of Hypersensitivity Reactions to Chemotherapy (Nurses Only)

TOPICS:

• What are hypersensitivity reactions?

• When are hypersensitivity reactions likely to occur?

• Signs and symptoms of hypersensitivity reactions

• Management of hypersensitivity reactions

• Can hypersensitivity reactions be prevented?


23 August 2014, Saturday




Free Admission

Strictly No Admission for Children below 12 years old. Registration is a MUST as seats are limited.



OUTREACH – CANCERWISE WORKSHOP



OUTREACH – PUBLIC FORUMS & CANCERWISE WORKSHOPS

SEPTEMBER


What You Need to Know About Gastrointestinal Cancers

TOPICS:

The Gastrointestinal System• Anatomy & functions• Cancers of the gastrointestinal system:

Stomach, Liver, Pancreas• Risk factors, Signs & Symptoms• Early detection & prevention • Screening & treatment procedures• Questions & Answers

13 September 2014, Saturday

MANDARIN SESSIONTime: 9.15am to 10.30am Registration: 9.00am to 9.15am

ENGLISH SESSION Time: 11.15am to 12.30pm Registration: 11.00am to 11.15am


Free Admission




CancerWise Workshop –Oncologic Emergencies (Nurses Only)

TOPICS:

• Definition, pathophysiology & management of:– Neutropenic sepsis – Tumor lysis syndrome– Hypercalcemia– Spinal cord compression– Increased intracranial pressure– Superior vena cava obstruction– Anaphylaxis


13 September 2014, Saturday


Registration: 1pm Workshop:1.30pm to 3.30pm


Free Admission





Upcoming Event Date, Time, Venue

Cancer Awareness Roadshow ACTIVITIES: Cancer Information poster exhibits, Breast Self-Examination education counter, Cancer Information booklets sign-ups, Upcoming events registration, and Game booths (tokens of participation will be given out!)

6 & 7 September 2014, Saturday & Sunday

10am – 6pm

Downtown East (1 Pasir Ris Close)


SEMINARS / FORUMS / TUMOUR BOARDS / SMC-CME ACTIVITIES

JULY 2014Date Time Event Information CME Pt Registration Contact

3, 10, 17, 24, 31 11.30am Lung Tumour Board Combine SGH-NCCS Meeting

@ SGH Blk 2 Level 1, Radiology Conference Room

1 Christina Lee Siok Cheng 6326 6095 [email protected]

3, 17 5.00pm NCCS-SGH Joint Lymphoma Workgroup Meeting

@ NCCS Level 2, Clinic C, Discussion Room

1 Tan Si Xuan / Rachel Tan 6436 8280 / 6436 8172 [email protected]/ [email protected]

2, 9, 16, 23, 30

2, 9, 16, 23, 30

7, 14, 21

4.30pm

5.00pm

5.00pm

NCCS Tumour Board Meetings:

Sarcoma Tumour Board Meeting

General Surgery Tumour Board Meeting

Head & Neck Tumour Board Meeting @ NCCS Level 2, Clinic C, Discussion Room

1 V. Kalai / Lim Shufen 6436 8294 / 6436 8283 [email protected] / [email protected]

Daphne 6436 8592 [email protected]

2, 9, 16, 23, 30 1.00pm Hepatobiliary Conference

@ NCCS Level 4, Peter & Mary Fu Auditorium

1 Lim Shufen / V Kalai 64368283 / 8294 [email protected] / nsokal @nccs.com.sg

24 5.00pm NCCS Neuro Onco Tumour Board Meeting


1 Low Peak Wah / Ang Hui Lan 6436 8165 / 6436 8174 [email protected]/ [email protected]

31 7.30am Endocrine and Rare Tumour Meeting



18 1.00pm Journal Club

Topic: To be advised

Speaker:

@ NCCS Level 1, Mammo Suite Discussion Room

1 Phua Chay Sin 6436 8043 [email protected]

25 1.00pm Teaching Session


Speaker:




mailto:[email protected]



AUGUST 2014Date Time Event Information CME Pt Registration Contact

7, 14, 21, 28 11.30am Lung Tumour Board Combine SGH-NCCS Meeting






6, 13, 20, 27

6, 13, 20, 27

4, 11, 18, 25

4.30pm

5.00pm

5.00pm







6, 13, 20, 27 1.00pm Hepatobiliary Conference

@ NCCS Level 4, Peter & Mary Fu Auditorium


28 5.00 pm NCCS Neuro Onco Tumour Board Meeting








Speaker:





Speaker:







SEPTEMBER 2014Date Time Event Information CME Pt Registration Contact




25 5.00pm NCCS Neuro Onco Tumour Board Meeting






3, 10, 17, 24

3, 10, 17, 24

1, 8, 15, 22, 29

4.30pm

5.00pm

5.00pm







4, 11, 18, 25 11.30am Lung Tumour Board Combine SGH-NCCS Meeting



3, 10, 17, 24 1.00pm Hepatobiliary Conference

@ NCCS Level 4, Lecture Hall








@ NCCS Level 1 Mammo Suite Discussion Room





CANSURVIVE 2014:

A CELEBRATION OF COURAGE AND TENACITYBY SITI ZAWIYAH

On a pleasant 7 June evening, 200 cancer survivors from the National Cancer Centre Singapore (NCCS) together with their family members marked Cancer Survivors Day by gathering on board a stewords riverboat at Marina South Pier.

T he three-hour celebration known as CanSurvive, saw guests posing at the instant photo booth, and

participating in activities such as fridge tile magnets painting, and shrink art. Right after a scrumptious buffet dinner, laughter and applause filled the boat decks as guests participated in stage games, and were awed by a magic show by Jeremy Tan and performances by Donna Daniels.

“This analogy of steering through challenging waterways represents the cancer survivors in their journey to fight cancer. The path to recovery for every cancer patient is never an easy one.” added Dr. Yap.

CanSurvive not only celebrated the survivors’ courage and tenacity in the fight against cancer, but it was also an opportunity for them to appreciate their family, friends and caregivers for their unconditional support in journeying with them.

Ms Mandy Lim, a cancer patient said, “This is my first time attending a CanSurvive event, and I would definitely come back for the next one. It is heartwarming to see cancer survivors and patients coming together, and seeing their family members show their support and having a good time.” Ms Lim attended CanSurvive 2014 with her family members, with one member walking away with the grand lucky draw prize, a Samsung Tablet LTE 7.0.

Highlighting the significance of the ship in celebrating cancer survivorship, the organising chairman of CanSurvive 2014, Dr. Yap Yoon Sim, said, “We hope that our survivors, caregivers and families have the buoyancy like a ship, and to have the resilience to move forward in life. This stewords riverboat is perfect for this celebration as it is modelled after the historic steamers that steered through the challenging waterways of the Mississippi River in the 1800’s.”


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 [email protected].

NATIONAL CANCER CENTRE SINGAPOREReg No 199801562Z

11 Hospital Drive Singapore 169610 Tel: (65) 6436 8000 Fax: (65) 6225 6283www.nccs.com.sg www.facebook.com/NationalCancerCentreSingapore www.linkedin.com/company/NationalCancerCentreSingapore

Editorial Advisors

Prof Kon Oi Lian Prof Soo Khee Chee Dr Tan Hiang Khoon

Editorial Consultant

Mr Sunny Wee

Medical Editor

Dr Richard Yeo

Executive Editors

Ms Rachel Tan Ms Siti Zawiyah Mr Edwin Yong

Members, Editorial Board

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

Documents

Salubris Jul - Sept 2014