In Singapore, the future is bright for cancer cure

Perhaps there is no other word more feared in the world than the one that starts with the big C. Being told that one has cancer almost seems tantamount to being handed a death sentence. But this need not be. Not anymore.

The important thing to remember is that cancer can be cured. This, Dr. Quek Swee Chong, clinical director of the preinvasive disease services unit at the KK Women’s and Children’s Hospital in Singapore, points out. The preinvasive disease service is focused on prevention — managing and dealing with the pre-cancer condition.

Here are some statistics. Cervical cancer is the second commonest cancer and the number one killer of women worldwide. There are about 500,000 new cases a year, resulting in 230,000 deaths a year. Sixty percent occurs in Asia. And yet, cervical cancer is almost 100 percent preventable, says Dr. Quek. Greater education and greater provision of health service lead to reduced incidence of the disease. The treatment for pre-cancer stage is almost 100 percent effective. A majority of cancers pass through the pre-cancer stage, which may last for up to 10 years. This can be detected by Pap smears. Colposcopy, a common gynecology follow-up for abnormal Pap smears, plays a central role in the cervical screening. The KK Colposcopy Suites has set up the first digital colposcopy network in Asia. Each colposcopy room has a data and image archival terminal (MediScan), which is connected by a local network. An additional terminal at the patient reception allows pre-registration and input of patient demographic data.

"The main focus of our medical service is the patient," says Dr. Quek.

The patient is at the heart of the practice. They call it "patient-centric services."

They also practice the team approach and hold multidisciplinary tumor board meetings wherein expert oncologists in the hospital discuss every case and best management treatment to provide the best evidence-based treatment for the patients. New research is taken into consideration as well as updated guidelines and protocol. KK Hospital played a significant part that led to the approval of the world’s first cervical cancer vaccine launched in 2002. The vaccine is effective in providing protection against the human papilloma virus (HPV) which accounts for over 70 percent of all cervical cancers.

In October 2006, Singapore ’s largest hospital for women, the KK Women’s and Children’s Hospital, officially opened the KK Breast Centre, a one-stop center fully dedicated to looking after breast health. It is the first and only one in Singapore to house a state-of-the-art breast imaging technology, side by side with consultation and day treatment facilities.

"This set-up enables women to have their mammography, breast ultrasonography, surgical consultation, minimally invasive biopsies and procedures all under one roof, and with quick turnaround time," says Dr. Esther Chuwa, associate consultant of the KK Breast Unit. Daily clinics are managed by a multi-disciplinary team of breast surgeons, reconstructive surgeons, radiologists, medical oncologists, nurse clinicians, and physiotherapists. 

Breast cancer is said to be the new epidemic of the modern world. One in 20 women above the age of 40 will be diagnosed with breast cancer. More than 1,100 women are diagnosed in Singapore every year. In the Philippines, studies show that breast cancer is the second largest leading cause of death among women, and the Philippines has the most number of breast cancer cases in Asia.   

"Early detection is key to the treatment of breast cancer," Dr. Chuwa notes. The KK Breast Centre is the first in the world to use the first FDA-approved Computed Radiography technology for mammography, combined with CAD. Digital mammography is significantly more accurate in detecting cancer in women younger than 50 years old, women with dense or extremely dense breasts, and premenopausal and perimenopausal women.   

The KK Women’s and Children’s Hospital, a government hospital, which had its beginnings in 1858 (in a district that used to be a buffalo enclosure, which is what Kandang Kerbau or KK stands for), started as a general hospital. In 1924, it became an obstetric and gynecology hospital serving only women. Later, KK expanded its women services to pediatrics up to 16 years old and young girls up to 18 to 20 years old. In 1966, KK made it to the Guinness world records for having the largest number of births in a single maternity facility that year (39,835), a record it held for 10 years. In 1997, as part of its expansion, it moved to its new building which was built in the shape of a ship. Its Children’s Cancer Centre, with its Day Therapy facility treats 70 percent of all Singaporean children with cancer and manages a number of children with cancer in the region.

"Childhood cancer is treatable, with good cure rates," says Dr. Chui Chan Hon, head of the Department of Pediatric Surgery at the KK Women’s and Children’s Hospital. Better outcome results because of earlier diagnosis, improved diagnostic techniques, a better understanding of molecular biology, multimodal approach to treatment, and translational research. Information is shared worldwide. At the Children’s Cancer Centre in KK, the cure rate for acute lymphoblastic leukemia, which is the most common childhood cancer, is as high as 80 percent.

"One in every 500 children will develop cancer before their 18th birthday," says Dr. Anselm Chi-Wai Lee, consultant pediatric hematologist-oncologist at the Parkway Children’s Hematology and Cancer Centre at the East Shore Hospital, one of three premier private healthcare providers in Singapore (together with Gleneagles Hospital and Mount Elizabeth Hospital), owned by Parkway Hospitals Singapore. "However, with effective treatment, 70 percent of children diagnosed with cancer can be cured." This can be done with disease directing techniques or the best combination of treatment with chemotherapy, surgery, radio therapy, and biological agents.

Other aspects are also considered such as pain management, nutritional management, play therapy, as well as parent empowering therapy. "We can beat cancer with contemporary medicine," Dr. Lee says. "There is hope for the future."

TomoTherapy, an image-guided radiation therapy, is a new, revolutionary way to treat cancer. "With TomoTherapy, radiation oncologists can check the location of the patient’s tumor before each treatment, then deliver painless and precise radiation therapy based on a carefully customized plan," Dr. Lee Kim Shang, consultant radiation oncologist of Parkways Hospitals Singapore, explains.

TomoTherapy combines precise 3-D imaging from computerized tomography (CT scanning) with highly targeted precise radiation beams. "Thus, the highest probability of cure can be attained with the least side effects," says Dr. Lee.  There is lower radiation exposure to healthy tissue surrounding the tumor because of targeted radiation and precise image guided positioning. The Mount Elizabeth Oncology Centre at the Mount Elizabeth Hospital is the first in Southeast Asia to offer TomoTherapy. The first patient was treated using this technology on March 1, 2006 .

"Advances in targeted chemotherapy increase the survival median," says Dr. Khoo Kei Siong, senior consultant, medical oncologist, physician and deputy medical director at the Parkway Cancer Center . There is less nausea and vomiting and only one half of patients undergoing treatment experience hair loss. Minimal invasive surgery has replaced conventional surgery. Great strides have also been made in clinical research such as the outstanding work being done in the research and development of stem cell transplant programs as well as cord blood banking by Dr. Teo Cheng Peng, senior consultant haemato-oncologist and physician at the Parkway Cancer Center at the Gleneagles Hospital . The stem cell modality offers extra benefit beyond five years, unlike conventional chemotherapy, and relapse is low after three years. It is not a 100 percent cure but it may prolong survival.

Rani Kaur, senior executive at the International Business Development Unit of the National Healthcare (NHG) Group points to the advantages for patients in the region seeking treatment in Singapore. Besides the medical expertise and world-class facilities, Singapore is safe, accessible, multi-lingual, a melting pot, with an efficient transportation system, and strong medical and legal standards. "The incidence of malpractice is low," she says.   

More than 300,000 international patients come to Singapore each year to seek quality medical care. The International Patient Liaison Centre at the National University Hospital is a one-stop medical concierge that provides assistance and supports the needs of international patients and their family members. "It is like a travel agency," NHG assistant manager, Joyce Lim explains, "where our friendly and professional staff provide assistance, from airport pick-up and transportation to accommodation, direct admission arrangement, billing and financial enquiries, medical referrals, translation, flight reservation and confirmation, and many other services upon request." 

"Research is an important aspect of treatment," says Dr. Allen Yeoh Eng Juh, senior consultant at the department of pediatrics, National University Hospital, and assistant professor at the National University of Singapore. There is no pre-conceived idea of the patient. "We always ask, how can we do it better?" Dr. Yeoh notes. Technology and research are used to be able to treat the next patient better. Doctors from the region also receive training through a series of workshops and fellowship programs. Dr. Mae Dolendo, pediatric oncologist at the Davao Medical Center — the biggest government hospital in the Philippines outside of Metro Manila — and president of the Davao Children’s Cancer Fund, was the recipient of a three-year fellowship from the Singapore NUH. There are about 150 reported cases of children stricken with cancer in Davao City every year, and almost 80 percent are admitted at the Davao Medical Center. In collaboration with the Singapore NUH, the Davao Medical Center launched a training program with the St. Jude Children’s Research Hospital in the US (renowned as the premier cancer center for children in the world), under its international outreach program, among a team of doctors and nurses to improve the survival rates of children with cancer in Mindanao.

Dr. Suresh Nathan, consultant and assistant professor at the NUH, National University of Singapore, has experimented with novel approaches to limb salvage surgery and bone transplant surgery in musculoskeletal oncology. He presented Pham Quoe Huy, a five-year-old boy from Vietnam whose tumor he had removed from the boy’s right arm. "He is one of our youngest patients," Dr. Nathan notes.

In 2000, the Johns Hopkins Singapore International Medical Centre was opened as a state-of-the-art oncology unit and private hospital within the National University Hospital. It is the first clinical healthcare facility established outside the US by Johns Hopkins in Baltimore, one of the largest teaching hospitals in the US. The clinical staff is from the faculty in Baltimore, with four doctors and a clinical research arm. In 2005, it moved to its new premises at Tan Tock Seng Hospital, with 30 beds and an out-patient clinic for chemotherapy treatment.

At The West Clinic Excellence Cancer Center, no major surgery is done, only chemotherapy treatment. Since it opened in October 2006, it has received 200 patients. It is the first international center for the Memphis-based The West Clinic in tandem with Singapore’s Excellence Healthcare. With leading US medical oncologist Dr. Steven Tucker as medical director, it aims to provide world-class US-based cancer treatment and management to patients in Southeast Asia by US oncologists and oncology nurses.

The West Clinic Excellence Cancer Center is the first international center outside North America to implement the PACE (Patient Assessment, Care and Education) System. "This is a revolutionary information technology designed to enhance patient care," Nancy Miles Bailey, director of Oncology Nursing and Clinic Operations, explains. "It utilizes wireless, touch screen, electronic tablets or e-tablets, which is presented to the patient upon arrival at the center."

"Cancer is a chronic disease. People don’t die of cancer. They die with cancer," remarks Dr. Tucker.

And so, it is said, "Hope can spread faster than cancer."