Issue No. 10 • MICA (P) 149/10/2009
AN NCCS BI-MONTHLY PUBLICATION May / June 2010
...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.
BUBBLING ASPIRATIONS
CATALYST FOR THE GOOD AND BAD
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In Other Words
SALUBRIS
May / June 2010
In popular fiction, the typical plot often would portray heroes with unique abilities who can inflict a crippling blow to the antagonist. Wishfully, this thought may cross the mind if only the battle against cancer is this straightforward.
I
ndeed, working hard to make this wish come true is what Prof Kanaga Sabapathy is doing in his approach to advancing the treatment outcomes for cancer. The Principal Investigator from the Laboratory of Carcinogenesis at NCCS is studying the origins of cancer and how it develops by understanding the basic cellular mechanisms. He then introduces suitable ‘heroes’, or catalysts, to save the ailing cells. For the record, he has made inroads in his study on cancer-related proteins and how they have been responsible for promoting tumour cell growth. One of the main focus of his research is studying the master tumour suppressor protein p53, and its related form p73, to shed further light on their traits and how they can be modulated for better or for worst.
Essentially, p73 exists in two forms - TAp73 which has tumoursuppressing properties like the p53; and DNp73 which has oncogenic properties and promotes growth of cancer cells (opposite to TAp73), by inhibiting p53 and TAp73. “One could not hope for a better mentor than Prof Sabapathy. His enthusiasm and passion for research can be quite contagious...” Mr Iqbal Dullo
In his study which was documented ‘The anti-apoptotic Delta Np73 is degraded in a c-Jun-dependent manner upon genotoxic stress through the antizyme-mediated pathway’ in the Proceedings of the National Academy of Science of the United States of America (PNAS), Prof Sabapathy discovered that genotoxic insult such as exposure to chemotherapeutic drug doxorubicin, which stabilises and activates TAp73, is also able to reduce the levels of tumour-promoting DNp73 in cancer cells. Together with his team, they probed into how DNp73 levels are regulated under this scenario so as to better understand the mechanisms which can subsequently be utilised to modulate its expression in cancer cells.
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In Other Words
SALUBRIS
May / June 2010
They discovered that c-Jun, a protein that is typically induced by a variety of stress signals was a key player. Further testing provided strong evidence that c-Jun was indeed capable of inducing the degradation of DNp73 via the non-classical polyamineantizyme pathway, an outcome that was needed to reduce the proliferation and survival of cancerous cells. These findings gave a new and unexpected insight into why cancers, which have high levels of DNp73, are resistant to some chemotherapy regimes. Prof Sabapathy explained that it all boils down to knowing the abilities of cancer cells. “We seek to understand why cancer cells behave the way they do, how they work in order to know how to deal with them. We can then work with our translational research counterparts to determine how to treat them, whether it is through drug development or other treatment forms.” Although the discovery brings plenty of hope for cancer patients and research, Prof Sabapathy explained that there is still more to be done. “We will now test for compounds which will inevitably kill cancer cells through the regulation of DNp73, whether they are toxic and bring harm to normal cells. The findings will be useful to identifying bases to develop drugs.” To ensure that no efforts are spared, the team will have a strenuous task of testing hundreds of compounds each time. Although the work may be likened to looking for a needle in a haystack, Prof Sabapathy believes that it adds to the value chain for patients. “Our work is important for pharmaceutical companies as it helps them in the development of new drugs,” he said.
As a sweetener to his work, research funds are ample, though they come at no small cost. Over the years, Prof Sabapathy has been constantly soliciting for research funds through publishing scientific papers and presenting notable research work. To date, he has published more than 50 papers and the influence that comes from them helps him to secure research grants. “When a scientist publishes a paper, recognition will come when the paper contains good information for the field. Our productivity also hinges on how many papers we have published and how impactful they are.” As part of his work at NCCS, Prof Sabapathy has been mentoring a team of PhD and Masters students who are also research officers, such as Mr Iqbal Dulloo who has been working on the DNp73 project. Commenting on the calibre of his mentees, he said that their stint at NCCS has put them in good stead. “It is about sharing my knowledge and experience and guiding them. Although the standard between the PhD and Masters Students vary somewhat, I believe they are equally capable. I am also confident that the PhD students will endure in the field, even if they work in the West.” Mr Dulloo has benefited much from Prof Sabapathy’s guidance. He said: “One could not hope for a better mentor than Prof Sabapathy. His enthusiasm and passion for research can be quite contagious. His guidance and openness to discussion had undoubtedly helped me get the most out of my years in the lab as well as my PhD study. The knowledge, training and scientific achievements that I have made under his mentorship are the perfect building blocks for a career in the ever-so competitive world of medical research.”
Prof Sabapathy works with a multinational team, which he considers “a challenging yet rewarding experience for the team as they also gain cultural insights which will be valuable when they work in the US or Europe.“ With so much on his plate, it is little wonder that the father of a teenage son values the little family time he gets. He interacts with his 14-year-old during morning drives to school, going for short walks together when time permits and annual vacations.
Hence, Prof Sabapathy has no regrets in taking this arduous and rugged route.
“I have not had second thoughts about what I have done so far. I love Science and knew that there is nothing else I would do apart from research.”
By Veronica Lee
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In Focus
SALUBRIS
May / June 2010
LOOKING AHEAD… Cancer Opens My Eyes to the Beauty Around Me
To be diagnosed with breast cancer at a young age is never easy to accept. It’s even more difficult when life until then has been plain sailing. Even so, when the news broke, like a bolt out of the blue, Ms Yvonne Boon accepted her fate bravely. She cast a positive look on the future, to survive.
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t age 35, Yvonne had a life that every woman wished for, namely, a loving husband, career satisfaction and three intelligent, beautiful young children. She led a fulfilling life as an active volunteer in church and spend her weekends and evenings indulging in her favourite activities like doing sports and having meals with her family. When diagnosed with her illness, the obvious came to mind: the end of life was near. She remembered her sister who succumbed to breast cancer because she failed to receive treatment. But it was different for her. She could count on her immediate family to give her the support she needed. She had her husband and three children to live for. Before long, Yvonne came to terms with her condition. She decided not to let cancer take her life away. She told herself that she had to be strong. She went through a lumpectomy and eventually mastectomy, chemotherapy and hormonal therapy. These took more than a year to complete. “It is amazing to be alive!” she gushed. “When I was healthy in the past, I took so much for granted. I used to push myself to multi-task too much, not listening to my body when I was tired. I think I’m very blessed as I have support from my husband, family and friends and I was also well covered by insurance.” For Yvonne, survival began at the point of diagnosis. It was the time when cancer patients are forced to confront their own mortality and begin to make adjustments that will be part of their immediate and long term future. “My plight opened my eyes to more important things, like family and friends. Work and material things just don’t matter as much any more and I am no longer petty about small issues. I have also become more understanding and generous towards others. I am also making changes to my priorities. Being diagnosed with cancer gives me a chance to do things better the second time round.” There were times when doubts crossed her mind and coping with them got tough. The side effects of treatment took a toll on her. “There were times when it seemed hard to move on and I wanted to give up. But when I look at my children, they reaffirmed my will to fight on and live for them. Whenever I fall into negative mode, I remind myself to look at all the positive things such as my children and my faith.” The experience has made her see life with a different purpose. “Cancer does not simply end at remission. Life will change in unexpected ways. Some have made their lives more meaningful, while others and their loved ones have responded negatively. As for me, finding meaning is one way to understand my cancer experience. It made me realise the greater purpose behind my illness and what it means for me and my family.”
Part of her greater purpose was also to help others make sense of cancer. Yvonne explained, “The fear of death that permeates most people when they are diagnosed often leads me to think about what I will leave behind and what I would like to do with the time I have left. I want to make sure I do my best while I still have the strength. I want to teach my children to be independent, to be kind and loving towards one another. Most important, I want them to support one another should the day come when I am no longer around. I want to help as many as I can to make sense of their sickness, to embrace it and to live their lives as meaningful as possible.”
On how she has made sense of the sickness herself, Yvonne has a refreshing perspective:
“Cancer has been the most beautiful experience in my life. Initially there was a reason to survive, then a purpose in helping others. It has enriched my life and made me not take life for granted. I am a survivor and can now watch my children grow and help others learn to see the beauty of life.”
OVERCOMING RADIATION SIDE EFFECTS
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Looking Forward
SALUBRIS
May / June 2010
Radiation treatment is painless though some undesirable side effects may occur over the course of treatment. Radiation side effects vary in types and severity, depending on the site of treatment, the duration of treatment and the amount of body tissues involved in the treatment volume. Most radiation side effects are specific to the areas being irradiated and they can be divided into short-term and long-term side effects. This article discusses some of the common, shortterm side effects and useful measures to delay/reduce the discomfort.
SKIN
Recommended skin care during radiation treatment:
Side effects on skin start with a darkened pigmentation (erythema), and later develop into dry and moist desquamation. Skin appears a pinkish colour and may be accompanied by a sensation of burning and itching. This usually occurs in the third week of treatment and progresses over the course of radiation treatment. It can develop into dry desquamation, which is presented with dryness, itching, scaling and flaking. A darker skin tone will also be noted. All these only occur within the treated skin. It is important to monitor the further development of the skin reaction into moist desquamation, which comes with burning, itching and tenderness. It occasionally brings about blister formation and pain. Appropriate dressing is required and it is essential to observe signs of infection such as fever, foul odour, purulent exudates, pain and swelling within and around the area.
• For facial and underarm shaving, use an electric razor to prevent cuts.
For head and neck treatment, besides erythema, hair in the facial area and particularly at the back of the head that is treated will gradually fall and become thin. For treatment to the pelvic region, pubic and abdominal hair will also gradually shed. The hair usually re-grows once radiation treatment ceases.
• Wash the affected area with lukewarm water and gently pat dry with a soft towel to avoid abrasion. If the head is treated, wash hair using lukewarm water and mild, non-medicated shampoo. Pay attention to skin folds. Keep this area clean, dry and cool.
• Only apply lotion that is prescribed by your Radiation Oncologist. Avoid petroleum jelly-based products that are poorly absorbed and difficult to remove. • Avoid rubbing the affected skin. Apply lotion with clean hands. • Aloe vera gel may be used on intact skin. Once the skin is broken with scaling, flaking and peeling, discontinue use of aloe vera. • For head and neck treatment, avoid shirts with tight collars. • Protect affected skin area from direct sunlight and excessive wind exposure. • Avoid swimming in chlorinated pools or hot tubs. These have a drying effect on skin. • Do not apply cold or heat treatment directly on the affected skin to avoid thermal injury. • Do not use adhesive tapes on the affected skin such as medicated skin patch. If dressing is required, let the radiation oncology nurse perform the dressing. • Do not use products containing perfumes or additives, alcohol and alpha hydroxy acids (AHAs). For head and neck treatment, be cautious on the choice of aftershave lotion and keep make-up to the minimum. For breast treatment, avoid deodorants and alkaline-based soap.
• Cornstarch, non-perfumed talc and baby powder may be used on intact skin. With moist desquamation, avoid these products as it promotes fungal and bacterial infection. Continued on page B2.
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Looking Forward
SALUBRIS
May / June 2010
OVERCOMING RADIATION SIDE EFFECTS
Continued from page B1.
THROAT AND MOUTH
JOINT MOVEMENT
For treatment to the head and neck region, your radiation oncologist will minimise the radiation reaching areas not affected by the disease. Oral Cavity is protected if it is not an intended organ of treatment. The throat and oral cavity is lined by mucous membranes that react to radiation like skin. Mucositis can occur, showing ulcers in the throat and mouth. Treatment to whole or part of the oral cavity can impact salivary and mucus production, causing stickiness in the mouth. This will further lead to dry mouth and change in taste.
Scarring can develop following breast surgery and/or radiation to the area under the upper arm. This can affect the suppleness of your joint movement resulting in stiffness in your upper arm movements. Daily exercise by lifting arm above head will reduce stiffness in the shoulder joint.
To manage these side effects, you are advised to: • Take frequent small sip of drinks. Avoid carbonated and sweetened drinks. • Gargle using non-alcohol based mouth rinses to reduce the stickiness in the mouth. • Use cough suppressants, avoid smoking and limit alcohol consumption. • Take semi-solid foods if eating becomes painful. Avoid dry food, sticky rice and spicy food. • Consume liquid food supplements or meal replacement drinks. Have smaller portions but more frequent meals. • Consult your radiation oncologist should any discomfort arise. • Use toothbrushes with soft bristle to prevent gum injury and rinse mouth with a non-alcohol based mouthwash. Lastly, apply a layer of oral moisturiser on the inner lining of oral cavity. Continue oral care post-treatment and it is important to have regular visit to dentist. Tooth extraction following radiation to the mouth is not recommended.
GENERAL WELL-BEING AND APPETITE Patients undergoing radiation treatment may experience fatigue, poor appetite, nausea and occasional vomiting. These reactions may or may not be directly linked to radiation treatment and are possibly associated with emotional burden of the diagnosis and fear of the uncertainties related to treatment. Nausea and vomiting can be effectively treated with prescribed medication. Taking short naps throughout the day can boost your energy level.
OESOPHAGUS, BOWEL, BLADDER AND RECTUM
CONCLUSION
Mucositis can develop in the membranes of oesophagus, bowel, bladder and rectum, causing irritation and dysfunctions there. Radiation treatment to the chest region can affect swallowing, causing hoarseness of voice or infection of the oesophageal and tracheal lining. Radiation to the pelvis can cause lower abdominal discomfort and a burning sensation while passing urine. You will notice an increased frequency of urination, or bowel movement
The radiation side effects presented above are generally short-term. These effects should not prevent you from working or performing your daily chores. However, a gradual reduction in physical activities mid-way through a course of radiation treatment and immediately after the completion of the treatment is advised.
To manage these side effects, you are advised to • Maintain hydration by taking frequent sips of water or other sources of fluids. • Regulate the consumption of fruits, dairy products and fibre to keep stools soft to prevent trauma or irritation during defecation. • Consult your radiation oncologist if you notice blood stains in sputum, urine or faeces, or when the side effects worsen, occurs frequently, and accompanied with vomiting or fever. • For female patients who undergo radiation treatment in the pelvis region, regular douching or washing of the vagina is recommended. This is to reduce the risk of infection and to avoid narrowing of the vagina. Your doctor can recommend the appropriate cleansing solution and device to use.
By Eric Pang
Radiation Therapist NCCS
A WELLNESS PLAN AFTER CANCER
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Tender Care
SALUBRIS
May / June 2010
After cancer treatment, many survivors want to find ways to reduce the chances of their cancer coming back. Some worry that the way they eat, the stress in their lives, or their exposure to chemicals may put them at risk. Cancer survivors also find that this is a time when they reflect on how they take care of themselves and their health. This is an important start to living a healthy life after cancer.
EATING WELL AFTER CANCER TREATMENT
EXERCISE AFTER CANCER TREATMENT Everyone knows that exercise has many health benefits such as increasing your fitness level and helping you lose weight. One benefit of exercise that is often overlooked is that it improves your mood and give you a general feeling of well being.
1 Eat a variety of healthy foods.
• Choose whole grains rather than processed (refined) grains and sugars.
Some studies have been done to find out if physical activity affects survival after cancer treatment. Many researches have shown that moderate exercise (brisk walking, swimming, cycling) for about 30 minutes every or almost every day can:
• Choose foods that help you maintain a healthy weight.
• Reduce anxiety and depression
• Limit eating red meats, especially high fat or processed meats.
• Improve mood
• Eat five or more servings of vegetables and fruits daily.
2 Maintain a healthy weight. Keep your BMI at a healthy range of between 18.5 – 22.9 (kg/m2). 3 Limit alcoholic drinks. Research shows that drinking alcohol can increase your chances of developing certain cancers e.g. liver cancer, stomach cancer, esophageal cancer.
• Boost self-esteem • Reduce symptoms of fatigue, nausea, pain and diarrhoea It is important to start an exercise programme slowly and increase activity over time. Some survivors may need to take special care when exercising. Talk to your doctor before beginning any exercise programme.
FOLLOW-UP CARE At the first follow-up visit, ask your doctor:
• The tests and follow-up care you need, and how often you will need them. • The kinds of physical problems you may experience from the cancer treatment and what you can do to prevent, reduce or solve them. At each visit, tell your doctor about:
• Symptoms that you think may be a sign of cancer returning. • Any pain that troubles you. • Any physical problems that get in the way of your daily life or that bothers you such as fatigue, trouble sleeping, unexplained weight gain or loss. • Other health problems you have such as heart disease, diabetes or arthritis. By Flora Yong
Senior Nurse Manager Cancer Education & Information Service NCCS
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Tender Care
SALUBRIS
May / June 2010
FACING FORWARD AFTER CANCER TREATMENT
Just as cancer affects a person’s physical health, it affects the way one feels, thinks and acts. Besides having many emotions that may surprise the individual, the treatment may actually change the way the brain works. Just as the individual needs to take care of the body after treatment, the person needs to take care of his emotions.
Each person’s experience with cancer is different and unique, and the feelings, emotions and fears that he has are unique as well. The values the individual grew up with may affect how he thinks about and deal with cancer. Some people may feel they have to be strong and protect their friends and families. Others seek support from loved ones or other cancer survivors or turn to their faith to help them cope. Some find help from counsellors and others outside the family, while others do not feel comfortable with this approach. Whatever the individual decides, it is important to do what’s right for him and not compare with others.
FEAR THAT CANCER WILL COME BACK Worrying about the cancer recurring is normal, especially during the first year after treatment. This is one of the most common fears people have after cancer treatment. Even years after treatment, this fear may always be at the back of their minds. For some, the fear is so strong that they no longer enjoy life, sleep well, eat well, or even go for follow-up visits. “If I get it again, what am I going to do?” one woman said. “I never thought I’d make it through the first time.”
Of course, not everyone reacts this way. As one survivor puts it, “Cancer is just part of life, and we always have hope.” As time goes by, many survivors report that their fear of cancer recurring lessens and they find themselves thinking less often about their cancer. However, even years after treatment, some events can cause the individual to become worried about his health. These may include: • Follow-up visits • Anniversary events (like the date of diagnosis or surgery or ended treatment) • Birthdays • Illness of a family member • Symptoms similar to the ones he had when cancer was found • The death of someone who had cancer • Personal reminders. For example, one man said he used to go to a particular dessert stall after every chemotherapy treatment because the sweet potato in ginger soup they serve was the only thing he could stand to eat. After treatment he had to stop going to the stall because it reminded him of treatment and made him “sick in the stomach”. Thinking and talking about the feelings can be hard. Some people just want to move on. They put the thought of cancer and all that goes with it out of their minds. While it is important not to let cancer “rule your life”, it may be hard to do. Work towards having a positive attitude. This means looking for what is good even in bad times and try to be hopeful instead of thinking the worst. Use positive energy to focus on wellness and do what you can to stay as healthy as possible.
By Flora Yong
Senior Nurse Manager Cancer Education & Information Service NCCS
克服放射治疗 的副作用
放射治疗是无痛的，但在整个治疗过程中，可能会出现一些副作用。这些 副作用的种类和严重性需视乎治疗部位、治疗持续的时间和治疗涉及的体 内组织数量而定。它可分为短期副作用和长期副作用，一般只会出现在受 治疗的部位。本文将讨论一些常见的短期副作用，以及延缓/减少不适的 妙方。 皮肤 皮肤上的副作用始于色素沉着（红斑），然后逐渐演变成干性和湿性脱皮。皮肤泛红部分呈 粉红或暗淡的颜色，可能还会发痒和感到灼痛。这通常会出现在整个放射治疗过程中的第 三周。它会演变成干性脱皮，伴之以干燥、发痒和皮肤剥落的现象，肤色也会偏黑。这些现 象只会出现在受治疗的皮肤上。病人须小心观察，它会进一步演变成湿性脱皮，伴之以发 痒、灼痛感和一触即痛的现象，有时还会形成水泡和疼痛。病人需要适当敷药和留意有无 受感染的迹象，例如发烧、发臭、出现化脓性分泌物、患处周围的皮肤疼痛和浮肿。 至于头部和颈项治疗，除了会出现红斑外，脸部毛发也会渐渐脱落和稀疏，后脑勺的毛发的 脱落一般更是特别严重。此外，骨盆部位、腹部和耻部的毛发也会逐渐脱落。但放射治疗结 束后，这些毛发通常都会重新长出来。 放射治疗期间的皮肤护理建议包括： • 使用电动剃刀剃除脸部和腋下毛发，以免刮伤。 • 只使用放射肿瘤科医生指定的润肤乳。避免使用吸收力低和难以抹掉的凡士林产品。 • 避免揉搓受感染的皮肤。涂抹润肤乳前要确保双手干净。 • 完好的皮肤可使用芦荟凝胶。一旦皮肤龟裂和脱落，务必停止使用芦荟护肤品。 • 至于头部和颈项治疗，避免穿紧领的衣服。 • 避免阳光直射和大风吹到受感染的皮肤。 • 避免在氯化泳池游泳或浸泡在浴缸内，以免皮肤变得干燥。 • 不要在受感染皮肤上直接使用冷或热疗法，以免灼伤皮肤。 • 不要在受感染皮肤上使用胶带，例如药用贴片。如果您须要敷药，应让放射肿瘤科护士替您 进行。 • 不要使用含有香水或添加剂、酒精和阿尔法羟基酸（AHA）的产品，它们多见于各种卫浴用 品。至于头部和颈项治疗，小心选择须后水和减少使用化妆品。至于乳房治疗，避免使用除 臭剂和碱性肥皂。 • 用温水清洗患处，然后用柔软的毛巾轻轻拍干，以免擦伤。至于头部治疗，用温水及温和的非 药用洗发剂洗头。保持皮肤皱褶清洁、干爽。 • 完好的皮肤可使用玉米粉、非香水滑石粉和婴儿爽身粉。如出现湿性脱皮，应避免使用这些 产品，因为它们会导致真菌和细菌感染。
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往前看 SALUBRIS
May / June 2010
食道、肠、膀胱和直肠 食道、肠、膀胱和直肠的粘膜层会发生粘 膜炎，其症状包括这些器官发炎和功能障 碍。胸腔放射治疗会影响吞咽功能，导致声 音沙哑或食道和气管感染。骨盆放射治疗 会导致下腹不适和小便时感到灼痛。此外， 大小便的次数也会增加。 以下建议将能协助您更好地应对这些副 作用： • 常喝水或其他液体，让身体保持充足的 水分。 • 控制水果、乳制品和各种纤维食物的摄 取，让粪便保持柔软，以避免直肠在排 便时受损或发炎。 • 如果您发现痰、尿或粪便中有血迹，或者 副作用加剧、频频发生，还会呕吐或发 烧，应咨询放射肿瘤科医生的意见。 • 接受骨盆放射治疗女病人应常冲洗或清 洗阴道，以减少感染的风险和避免阴道 变窄。您可向医生咨询适当的清洗液和 清洗方法。
关节活动 接受胸腔手术和/或上臂下方放射治疗后 往往会留下疤痕。这会影响关节活动的灵 活度，导致您的上臂活动僵硬。每天把手 臂举及头顶，有助于减少肩关节僵硬。
整体健康和食欲 接受放射治疗的病人也许会感到疲劳、食 欲不振、反胃，有时候也会呕吐。这些反应 可能与放射治疗有直接关系，但也有可能 是诊断引发的情绪负担和对治疗不确定 性的恐惧造成的。处方药可有效解决反胃 和呕吐的问题。白天小睡片刻可补充您的 体能。
喉咙和口腔 至于头部和颈项治疗，放射肿瘤科医生会尽量避免照射到不受疾病影响的范围，亦即如果 不是要治疗的器官，口腔将受到保护。和皮肤一样，喉咙和口腔布满对放射产生反应的粘 膜。您可能会发生粘膜炎，出现喉咙和口腔溃疡的症状。整个或局部口腔治疗会增加唾液和 粘液产生，使口腔内带有粘性，进而导致口干和味觉出现变化。 以下建议将能协助您更好地应对这些副作用： • 常小啜饮料，避免喝非碳酸及原味饮料。 • 使用非酒精漱口水，以减少口腔内的粘性。 • 使用止咳药，减少抽烟及喝酒。 • 如果饮食困难，应改吃流体食物，以及避免干、辣食物和糯米饭。 • 选择液体营养品或代餐饮料。应少量多餐。 • 如有任何不适，应咨询放射肿瘤科医生的意见。 • 使用软毛牙刷，以避免牙龈损伤，以及使用非酒精漱口水。最后，在口腔内侧涂上一层口腔 滋润膏。治疗结束后，继续进行口腔护理和定期光顾牙医。进行口腔放射后，不宜拔牙。
结语 一般来说，上述均属短期的放射 副作用。这些副作用不应影响您 的工作或日常生活。但是，您应 在放射治疗期间逐渐减少体力活 动，以及在治疗结束后马上减少 体力活动。 作者: Eric Pang
新加坡全国癌症中心 首席放射治疗师
PAGE B6
温柔呵护 SALUBRIS
May / June 2010
癌症治疗后的 健康计划
许多癌症幸存者往往会在治疗后寻方设法降低病 情复发的机率。有些人担心他们的饮食习惯、生 活中所面对的压力或在治疗期间所接触的化学物 质会提高癌症复发的风险。癌症幸存者也认为， 他们应该趁此机会检视照顾自己身体健康的方 式。这是罹患癌症后开始健康生活的最好时机。
癌症治疗后注重饮食习惯
1 摄取各种健康食物。
• 每天摄取五份或更多的蔬果。 • 选择全谷食品，而不是加工 精制 谷类和糖。
癌症治疗后勤做运动
后续护理
每个人都知道运动有很多益处， 例如提高体能水平和帮助减轻体 重。除此之外，您或许往往会忽 略，运动其实也可以改善您的情 绪，让您感觉美好。
在第一次复诊时，您应该咨询 医生：
研究人员针对癌症治疗后做运动 是否会影响存活率进行研究，许 多研究结果显示，每天或几乎每 天做大约30分钟的适量运动 轻 快步行、游泳、骑脚车 ，有 助于：
• 选择有助于维持正常体重的 食物。
• 减轻焦虑和忧郁
• 少吃红肉，尤其是高脂肪或加 工肉类。
• 提高自信心
2 保持正常体重。你的身体质量指
数尽量维持在18.5至22.9 公斤/ 米2 之间。 3 少喝酒。研究显示，喝酒会提高
您罹患某些癌症的机率，例如肝 癌、胃癌和食道癌。
• 改善情绪
• 减少疲劳、反胃、疼痛和腹 泻等症状 癌症幸存者应该慢慢地展开锻炼 计划，逐步增加运动量。有些人 可能在运动时也需要特别小心。 因此，您最好在开始任何锻炼计 划前咨询医生的意见。
• 您需要进行的检查和后续护 理，以及进行的次数和频率。 • 癌症治疗后可能会出现的健康 问题，以及预防、减少或解决 这些问题的方法。 每次复诊时，告诉您的医生： • 您认为可能是癌症复发的 症状。 • 任何令您困扰的疼痛。 • 影响您的日常生活或给您带来 困扰的健康问题，例如疲劳、 失眠、体重无故增加或减少。 • 其他健康问题，例如心脏病、 糖尿病或关节炎。 作者: 杨宝燕 高级护士经理 癌症教育与资信服务部 新加坡国立癌症中心
癌症治疗后的 心理调适
PAGE B7
温柔呵护 SALUBRIS
May / June 2010
癌症会影响一个人的健康状 况，也会影响一个人感觉、思 考和做喜欢的事情的方式。在 整个治疗的过程中，病人除了 会产生许多意想不到的情绪 变化外，脑部的运作方式可能 也会有所改变。因此，病人在 治疗后不只要照顾身体，还要 关注情绪上的变化。
每个人应对癌症的经验都不尽相同， 所面对的感觉、情绪变化和恐惧也因 人而异。病人成长的价值观也会影响 他对癌症的看法和应对方式。有些人 会觉得他们必须坚强和保护家人及朋 友，有些人则需要亲人或其他癌症幸 存者的支持，或者从信仰中获得应对 癌症的力量。有些人会寻求辅导员和 外人的协助，也有些人对这种方式感 到不自在。不管是哪一种方式，病人 最重要的是选择适合自己的方法，不 要和他人作比较。
当然，不是每个人都有同样的反应。也有一位癌症幸存者这 么说：“癌症是生活的一部分，我们总会有希望的。” 很多幸存者都表示，他们担心癌症复发的恐惧会逐渐转弱。他们也发现自己想起 癌症的次数会越来越少。但是，即使是多年以后，他们也可能会因为某些情况而 担心自己的健康状况，其中包括： • 复诊 • 特定事件的周年日，例如确诊、动手术或疗程结束 • 生日 • 家庭成员患病
担心癌症复发 担心癌症复发是正常的反应，尤其 是在治疗后的第一年内。这是病人治 疗后最常见的忧虑之一。即使是多年 以后，病人还是会有可能心有余悸。 有些人还会因此而无法好好地吃饭、 睡觉、享受生活，甚至对复诊也感到 恐惧。 有位女病患问：“如果癌症复发，我 该怎么办？我从来没有想过我可以熬 过第一次。”
• 出现类似他/她患癌症时的症状 • 有人因癌症去世 • 唤起个人回忆的事物。例如，一位男幸存者说，他每次进行化疗后总会光顾 某个甜品摊，因为那里的姜汁番薯糖水是他唯一吃得下的食物。疗程结束 后，他就不再光顾那个甜品摊，因为这会让他想起疗程和觉得“反胃”。 回想和提及这种感觉总让人难受。有些人只想向前看，把一切有关癌症的想法抛诸 脑后。虽然你不可以让癌症“操控你的生活”，但这绝对不是一件轻而易举的事。 你必须要有正面、积极的态度，也就是说，即使在艰难的时刻，你也要往好的方 面想，尽量抱有希望。你必须凭靠这股正面、积极的力量，专注于身体状况，并 且尽量做一些可以保持健康的事情。 作者: 杨宝燕 高级护士经理 癌症教育与资信服务部 新加坡国立癌症中心
PAGE B8
Outreach
SALUBRIS
May / June 2010
UPCOMING PUBLIC EDUCATION ACTIVITIES / PROGRAMMES
Event Name
Date, Time, Venue
Registration Details
CancerWise Workshop –
24 July 2010, Saturday
Admission fee: $5
HEALTHY EATING FOR DISEASE PREVENTION
Session will be conducted in English.
To register, please call: 6225 5655 or register online: www.nccs.com.sg.
TOPICS:
1pm – Registration 1.30pm to 4pm – Workshop
a. Meal Planning & Healthy Cooking b. Cooking A Healthy Peranakan Meal (Cooking Demonstration)
Function Room, Level 4 National Cancer Centre Singapore 11 Hospital Drive, Singapore 169610
CancerWise Workshop –
31 July 2010, Saturday
Admission fee: $5
UNDERSTANDING SKIN CANCER
Session will be conducted in English.
To register, please call: 6225 5655 or register online: www.nccs.com.sg.
TOPICS:
1pm – Registration 1.30pm to 4pm – Workshop
a. Common Skin Problems b. What is Skin Cancer? c. Risks, Signs & Symptoms d. Early Detection & Prevention
Function Room, Level 4 National Cancer Centre Singapore 11 Hospital Drive, Singapore 169610
e. Diagnosis & Treatment Options
FOR MORE INFORMATION ABOUT CANCER Cancer Helpline Tel: 6225 5655 Email: cancerhelpline@nccs.com.sg Monday to Friday: 8.30am to 5.30pm Saturday, Sunday & Public Holiday: Closed
欲了解更多有关癌症的资讯癌症援助热线 电话: 6225 5655 电邮: cancerhelpline@nccs.com.sg 星期一至星期五: 上午8点半至下午5点半 星期六, 星期天及公共假期: 休息
LOOK FEAR IN THE FACE
PAGE A5
Community
SALUBRIS
May / June 2010
Eleanor Roosevelt, known famously for her involvement in human rights issues, once said: “You gain strength, courage, and confidence by every experience in which you really stop to look fear in the face. You are able to say to yourself, ‘I have lived through this horror. I can take the next thing that comes along.’... You must do the thing you think you cannot do.”
I
ndeed, cancer survivors must be applauded for having walked the long and arduous journey bravely. Family members and caregivers who have accompanied their love ones through cancer treatment would know that they did not have it easy.
So what happens after beating cancer into remission? “Physical, emotional, and financial hardships often persist for most of them years after diagnosis and treatment. They may also face challenges such as employment problems, psychological struggles and the strain on personal relationships and, not to mention, the fear of recurrence,” shared Dr Yap Swee Peng, acting Director for Public Education and Patient Support Unit of National Cancer Centre Singapore (NCCS). “Hence, family support and seeking timely professional help from counsellors, medical social workers, among others, are essential in helping patients get back on their feet.”
Despite the many challenges cancer survivors have to face, a majority of them live a fulfilling life and is a source of inspiration for those around them. One such brave individual is Mr Ezzy Wang, the epitome of survivorship. Despite losing his right lower limb to cancer, he endured in his exercise regime, which includes cycling 50km around Singapore. To honour all who have fought a hard battle with cancer, the NCCS will host a day of fun and adventure for more than 400 cancer survivors, including their families, friends and the healthcare providers at the Singapore Zoo on Saturday, 26th June 2010 from 8.30am to 1pm. The event not only serves as an opportunity for cancer survivors to meet and spur each other to live better but also to equip them with the knowledge of doing so. Participants can partake in an exciting Zoomanji Adventure or visit the carnival game stalls and snack booths when hunger strikes. Mr Wang will also be there to share some tips on challenging negative thoughts.
After all, surviving cancer boils down to three key elements - knowledge, hope and inspiration!
By Carol Ang
PAGE A6
People
SALUBRIS
May / June 2010
NCCS ON TRACK IN ITS FOCUS ON CUTTING-EDGE CANCER RESEARCH
Singapore is laying a strong foundation for its cancer research programme with the growing number of doctors returning from overseas training stint to put their knowledge to good use by conducting research and conducting clinical trials. Veronica Lee reports.
A
s clinical trials are fundamental to cancer research, the expertise of these doctors may see more translational research that would contribute to the development of a strong cancer research base at the National Cancer Centre Singapore. Two doctors who recently returned to join the talent pool at the NCCS are Dr Daniel Tan and Dr Iain Tan, both of whom are Registrars from the Department of Medical Oncology. While at the UK’s Royal Marsden Hospital on a National Medical Research Council (NMRC) fellowship, Dr Daniel Tan was the primary fellow in charge of a trial that tested for the safety and toxicity of a novel agent used for the first time in human bodies. He supervised the administration of the trial and monitored a maiden group of patients in the UK receiving these drugs and coordinated multiple investigations that were indicators of intended efficacy. The trial was selected for oral presentation in the Developmental Therapeutics session at the recent American Society of Clinical Oncology (ASCO) annual meeting, and Dr Tan was conferred a Merit Award by ASCO for his efforts.
The trial was to determine a safe and tolerable dose of the new agent targeting the mTOR pathway - a promising therapeutic pathway in cancer, as well as find the best techniques of administering it to patients. The drug in question is an improved design compared to the mTORC1 inhibitors currently used in clinical practice. In these early studies, it is reassuring that some of the biomarker analyses suggest that the agent was hitting its intended target within the schedules explored. On what contributed to the success of the trial, Dr Daniel Tan said, “Phase 1 trials are typically challenging. They require tremendous coordination of clinical care, logistics and administration. I am thankful for the dedication of the trial team.” He also expressed gratitude to Professor Stan Kaye and Dr Johann De Bono from the Royal Marsden Hospital, both leaders in the field of drug development who have provided “invaluable guidance and mentorship.”
Traditionally, the attrition rate is high with many compounds from the drug development pipeline failing to make it past a Phase 1, 2 and 3 Trial. However, the odds are now improving with an increasing incorporation of biomarkers that determine the best way to use the drug. In the case of this trial, it exhibited encouraging results when the agent showed that it was hitting its intended target, with some patients actually responding well to the agent. Dr Daniel Tan attributed this to a paradigm shift in drug development. “As majority of modern drugs are created and modelled purposefully rather than through serendipitous findings, early phase trials are now expanding from dose titration safety studies to include more information that can provide potential insights to drug effect, resistance and even disease biology. We see an increasing number of patients reap benefits even at an early stage, as evidenced in recent Phase 1 trial findings on PARP and BRAF inhibitors published in the New England Journal of Medicine.” “The positive outcomes from such early trials certainly help in the development of specific novel therapeutics, and determine a suitable patient base. Most importantly, it will accelerate the approval of useful drugs so that patients can benefit’, Dr Tan added.
PAGE A7
People
SALUBRIS
May / June 2010
It was also found that the two intrinsic subtypes of gastric cancers respond differently to drugs that are presently being used in the treatment of gastric cancer. They also displayed strikingly different patterns of genetic aberrations that provided a reason for further development of subtype-specific targeted therapies. The findings were recently presented at the American Association of Cancer Research annual meeting, where he was awarded the meritorious scholarin-training award. Dr Iain Tan (far left) and Dr Daniel Tan (left).
Many patients with advanced stage cancer at diagnosis had predominantly been the targeted group for trials. These patients are ideal candidates for clinical trial as they are usually at the end of their journey for a cure. One such group is patients suffering from gastric cancer. Gastric Cancer is the second leading cause of global cancer mortality and is particularly common in Asia. It is a difficult cancer to treat as symptoms appear late. At diagnosis, many patients already have stage four cancer for which surgery is no longer possible. Among patients who do undergo surgery upon early detection, the disease can recur. There are several effective palliative treatment options available and whilst these are unable to completely eradicate the disease, they can control the cancer, prolong survival and most importantly, provide much needed symptom relief for patients. Patients can however experience varied responses to the available treatment regimens. Hence, choosing the right regimen for each patient is important because achieving initial control of the cancer leads to an improved clinical outcome and many patients will be unfit for subsequent attempts at treatment if their cancer degenerates early.
The lack of reliable tests to select the most appropriate treatment regimen for individual patients has been the impetus behind Dr Iain Tan’s research into understanding the biology of gastric cancer. Working under the supervision of his clinical Head of Department, Dr Toh Han Chong and his scientific supervisor, A/P Patrick Tan from DukeNUS Graduate Medical School, Dr Iain Tan studied more than 400 cancer samples derived from patients in four countries. The study revealed that whilst there was indeed substantial molecular complexity and heterogeneity at a fundamental level, each gastric cancer conformed to one of two major molecular patterns which the team termed as ‘intrinsic signatures’.
After demonstrating effectiveness in predicting treatment responses in the controlled laboratory environment, the next step was to evaluate if it could be translated to the clinic. Dr Iain Tan then developed a research proposal to leverage upon cutting edge genomic tools to correlate tumor genetic profiles with patient treatment outcomes so as to rapidly and efficiently obtain a timely answer to his scientific enquiry. For conceiving this cutting-edge approach with the potential of providing direct benefit to patients, Dr Iain Tan received the ASCO Young Investigator Award and was the only recipient from an institution outside of North America to receive the award. Predicting good outcomes with specific chemotherapeutics had been the driving force to Dr Iain Tan’s research. With an aim to be a physician scientist in gastrointestinal cancer, the field will be given a boost and will definitely become one of the major pillars of clinical expertise at NCCS.
The achievements of NCCS oncologists, winning worldwide recognition for their work, is another step in the right direction for NCCS to achieve its mission to become the leading global cancer centre.
ARE YOU HAPPY?
PAGE A8
NCC Foundation
SALUBRIS
May / June 2010
If there is such a thing as the secret to happiness, it is this: Happiness comes from within.
L
ast year, Singapore was placed in an unremarkable 49th out of 140 countries in The Happy Planet Index. As a materially wealthy nation, the results unleashed much soul-searching about the way Singaporeans truly view life and happiness. The common connotation is that the stresses of living in a society that focused on materialism have made Singaporeans less happy than their peers in many other countries. Concerned with the rising levels of stress in Singapore, Philip Merry - founder of the Philip Merry Consulting Group, organised the 1st Asian Happiness and Well-Being Conference that led the search for Singapore’s happiest person last year in 2009. “If you have people who love you, good health, food on the table and a stable job, you are already happier than nine in 10 people on earth,” he said. “Essentially, happiness comes from having meaning (contributing to something outside of yourself), authenticity (being your true self) and connection (having friends and family) in our life.” Philip is currently planning the 2nd Happiness Conference, this time focusing on Resilience & Courage. This year’s theme is linked to the economic downturn and centred on how resilience skills can help people thrive in difficult times. National Cancer Centre Singapore (NCCS) is the healthcare partner for this year’s conference.
Editorial Advisors Dr Kon Oi Lian Prof Soo Khee Chee Executive Editors Ms Carol Ang Ms Veronica Lee Mr Sunny Wee
Resilience is the positive behaviour we show when facing adversity that allows us to bounce back, and courage is our ability to confront our fears and problems. When things go wrong – such as the loss of health, relationships, jobs, savings or hope in a better future, resilience can be another opportunity for learning effective coping strategies. When asked for the reason behind NCCS partnering this meaningful conference, Eugene Sng, Programme Director of NCC Foundation, NCCS shared: “Cancer patients and caregivers face difficulties with resilience every day. NCCS is happy to be the healthcare partner of Resilience & Courage as we believe resilience skills will add a huge value to the lives of our patients, caregivers and staff.”
Contributing Editor Dr Wong Nan Soon
Medical Editor Dr Richard Yeo
Members, Editorial Board Ms Audrey-Anne Oei Ms Sharon Leow Ms Flora Yong
Members, Medical Editorial Board Ms Lita Chew Dr Mohd Farid Dr Melissa Teo Dr Teo Tze Hern Dr Deborah Watkinson
In enabling our healthcare practitioners to benefit from this talk, two lunch seminars were held at Singhealth, where Philip shared his secrets to building resilience in life and at work. Resilience & Courage is a community outreach effort that will help bring out the true meaning of resilience, and help people recognise that resilience is already within us. A search for Singapore’s resilient heroes will also be conducted later this year.
As Philip says, “If this conference can make just one person’s life better and happier, we will be happy,”
For more information about Resilience & Courage, please visit www.simply-happy.com
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.
NATIONAL CANCER CENTRE SINGAPORE Reg No 199801562Z
11 Hospital Drive Singapore 169610 Tel: (65) 6436 8000 Fax: (65) 6225 6283 www.nccs.com.sg