Issue No. 31 • MICA (P) 140/03/2014
AN NCCS QUARTERLY PUBLICATION October – December 2014
...HELPING R E A DER S TO ACHIEV E GOOD HE A LT H
Salubris is a Latin word which means healthy, in good condition (body) and wholesome.
RESEARCH UNCOVERS NEW TOOLS TO HELP DIAGNOSE BREAST CANCER
2
SALUBRIS OCTOBER – DECEMBER 2014
DISCOVERY OF FREQUENT GENE MUTATIONS IN BENIGN BREAST LUMPS BY DR LIM WENG KHONG Research Fellow Laboratory of Cancer Epigenome
Fibroadenomas are the most common benign breast tumours found in women of reproductive age, affecting thousands of women in Singapore and millions worldwide annually.
I
t is frequently discovered in clinical workups for breast cancer diagnosis and during routine breast cancer screening. The challenge commonly faced by clinicians is distinguishing some fibroadenomas from breast cancer. Fibroadenomas are generally benign and harmless, though these common breast tumours may exhibit indeterminate clinical and radiological features which will require further studies to differentiate them from malignant tumours.
Currently, the best way to confirm whether a patient has a fibroadenoma is to examine a tissue sample from the lesion under a microscope. While this form of examination is the gold standard in making a diagnosis, it is not always a straight forward process.
To facilitate this diagnostic question, a multi-disciplinary team of scientists from the National Cancer Centre Singapore (NCCS), Duke-NUS Graduate Medical School Singapore, and Singapore General Hospital embarked on a study and the good news is that they may have found a way to do so. The team analysed all the protein-coding genes in a panel of fibroadenomas from Singapore patients and they have successfully identified frequent mutations in a gene called MED12 over a remarkable 60% of fibroadenomas. By measuring the presence of mutated MED12 in breast lumps, clinicians would be able to more confidently make a diagnosis of fibroadenoma, avoiding additional steps. This way, patients can avoid unnecessary surgery, reducing hospitalisation costs as well as relieving patient’s anxiety knowing the tumours are benign.
The team hopes to produce a diagnostic gene test based on the research findings in the near future, and possibly a drug that targets the MED12 gene and resolves benign breast tumours.
SALUBRIS OCTOBER – DECEMBER 2014
Histopathology of Fibroadenoma (higher magnification)
Histopathology of Fibroadenoma (low-power magnification)
By measuring the presence of mutated MED12 in breast lumps, clinicians would be able to more confidently make a diagnosis of fibroadenoma, avoiding additional steps. This way, patients can avoid unnecessary surgery, reducing hospitalisation costs as well as relieving patient’s anxiety knowing the tumours are benign.
Excised Fibroadenoma
The findings have also deepened the conceptual understanding of how tumours can develop. Like most breast tumours including breast cancers, fibroadenomas consist of a mixed population of different cell types, called “epithelial cells” and “stromal cells”.
The study also shed light on the cause of uterine fibroids, another common benign tumour in women where similar MED12 mutations have been observed and may attests to a role for abnormal response to female hormones in the birth of these tumours.
However, unlike breast cancers where the genetic abnormalities arise from the epithelial cells, the scientists, using a technique called “laser capture microdissection (LCM)”, showed that the pivotal MED12 mutations in fibroadenomas are also found in the stromal cells. Targeting such stromal cells may be an important avenue for therapy in the future as fibroadenomas and possibly other tumours may actually arise from genetic lesions in the stromal cells.
The scientists are already planning on subsequent studies to explore more possibilities by investigating the role of MED12 in other categories of breast tumours and hope to develop a drug that may target the MED12 gene and cause the resolution of benign breast lumps in the near future. The study was published in Nature Genetics, August 2014.
3
4
SALUBRIS OCTOBER – DECEMBER 2014
BREAST CANCER SURGERY IS SAFE FOR ELDERLY PATIENTS BY DR ONG KONG WEE, DR VERONIQUE TAN AND DR LEE CHEE MENG Division of Surgical Oncology
Breast cancer is the top cancer among women in Singapore and an estimate of 1 in 16 Singaporean women will develop breast cancer by the age of 80. The life-time risk of women contracting breast cancer is approximately 6.5%. This incidence rate is expected to rise with increasing life expectancy and an ageing population.
“Surgery should always be considered even among elderly patients and performed expeditiously.” DR ONG KONG WEE
W
hile there are several treatment options such as radiation therapy and chemotherapy, surgery remains the best option for early and advanced breast cancer. Treatment options outside of surgery would only control the disease. The cancer cells may develop resistance to these treatments over time and when patients require a salvage surgery, it may result in even more complications with lower success rate.
With the concern on the effects of surgery on elderly women, a retrospective analysis was performed on 109 women aged 80 years and above who underwent surgery in National Cancer Centre Singapore and Singapore General Hospital from 2001 to 2010. Most patients were assessed to be fit for surgery under the American Society of Anesthesiologists (ASA) physical classification status with 75% of patients having an ASA physical status of 1 or 2 1. Although approximately 80% of patients had one to four co-existing medical problems such as hypertension, dyslipidaemia and diabetes mellitus, there were no deaths recorded following the breast surgery.
Results show that 97% of elderly patients aged above 80 years recover without major complications after surgery.
SALUBRIS OCTOBER – DECEMBER 2014
More than 60% of patients recovered without any complications, while only 3% developed major complications but recovered subsequently. The average length of stay in the hospital was three days. The results of this study are important as they dispel the misconceptions and fear among the public that surgery for elderly patients is unsafe and has a high complication rate. Surgery is the most important modality in the treatment of breast cancer. It also relieves symptoms in patients who have tumours that do not respond to other therapies. Elderly patients should not be deprived of such treatment options. Early detection and effective treatment is very important. For elderly patients such as 87 years old Mdm Tay Sai Eng who was diagnosed with stage II breast cancer, she was given surgery despite having active medical conditions, and she is now cancer-free. The team plans to conduct further studies to measure the side effects and effectiveness between surgery and other forms of treatment on elderly patients compared to younger patients. 1
American Society of Anesthesiologists (ASA) physical classification status is a universally accepted score used to assess a patient’s fitness for surgery. ASA Physical Status 1 refers to a normal healthy patient while Status 2 refers to a patient with mild systemic disease.
https://www.asahq.org/clinical/ physicalstatus.htm
PATIENT PROFILE
MDM TAY SAI ENG 87 YEARS OLD
From left to right: Mr David Cheng (caregiver and son of Mdm Tay), Mdm Tay Sai Eng, Dr Ong Kong Wee, Dr Veronique Tan, Dr Lee Chee Meng.
A mother of five, Mdm Tay was diagnosed with stage II breast cancer in November 2012. She had noticed a lump in her right breast but only decided to consult a doctor after a six-month lapse. Surgery was suggested as a viable treatment but she declined and requested for other treatment options instead. Her main concern was the safety of breast cancer surgery in view of her having pre-existing active medical conditions of diabetes (diet controlled), hypertension, hyperlipidemia and cervical spondylosis. Mdm Tay was then treated with a drug commonly used for early stage breast cancer about six months. Unfortunately her cancer cells did not respond well and she experienced multiple discomforts and side effects throughout the treatment. She was then referred to Dr Ong and her family members were immediately counselled on the possibility of having a breast surgery. With the confidence and advice from Dr Ong, Mdm Tay went ahead with the surgery despite mixed feelings within the family. The breast surgery was carried out in May 2013. Since then she has been followed up by the NCCS medical team on her condition. Apart from experiencing minor post operation issues, such as a Seroma (the build-up of clear bodily fluids in a place on your body where tissue has been removed by surgery; common after breast surgery), Mdm Tay has recovered well from the surgery.
Life after breast cancer surgery has been fulfilling and she has resumed her painting and calligraphy sessions, watches her favourite dramas, and even finds the energy to occasionally cook some favourite dishes for her family. Mdm Tay said, “I appreciate what NCCS specialists have done for me. They gave me hope and they gave me a new life. Every day I can look forward to the future, spending time with my family and friends.”
5
6
SALUBRIS OCTOBER – DECEMBER 2014
DOING GOOD BY WALKING DOWN MEMORY LANE BY SHAWN SOH Community Partnership
NCCS has been a strong supporter of the President’s Challenge since its inception in 2004. This year, more than $17,000 was raised during a 3-month fundraising campaign in support of the SingHealth President’s Challenge 2014. The activities included pledge card donation drive, sale of heart stickers and car decals, as well as an institutional led fundraising event named “Kampung Days Nostalgia”, which was the campaign’s highlight.
More than 20 different varieties of snacks and beverages were made available to staff.
When accuracy matters more than strength…
KAMPUNG DAYS NOSTALGIA Rapid urbanisation has resulted in the demolition of many villages (kampung) to free up the land for redevelopment. The lifestyle of the early generation Singaporeans changed dramatically as they shift from a village life to the concrete high-rise residential dwelling. “Kampung Days Nostalgia” was conceived to offer NCCS staffers the opportunity to reminisce the old days while doing their part for charity. Held from 25 to 29 August, the event transported many to the days of old and a trip down memory lane for the participants through a variety of popular traditional games, snacks and beverages. It allowed them to relive kampung memories and get re-acquainted with village life in Singapore. More than 20 different varieties of biscuits, snacks and bottled drinks were made available for our staff to redeem during the event with a $10 coupon. There were also a wide variety of games available through the coupon redemption such as capteh*, five stones*, pick-up sticks*, bola tin*, etc. ‘Tikam Tikam’* was re-adapted to a game of Bingo where winners took home bountiful hampers courtesy of Candy Empire. Indeed, a very sweet reward for helping the less fortunate.
The Community Partnership team put in much effort to create these games from scratch through the use of recycled materials. The games were uniquely novel and savings from their recycling effort go straight to the beneficiaries.
Credit for the success of the NCCS fundraising effort for SingHealth President’s Challenge is of course due to the collective support of all our staff. Amidst the fun and laughter, it was the vital display of ‘Kampung Spirit’ (camaraderie) that won the day. As a bonus, the “Kampung Days Nostalgia” also gave an opportunity for everyone to improve inter-department interaction and bonding. We are grateful to our sponsor Candy Empire and all staff for their invaluable support and generosity. This year’s SingHealth President’s Challenge was held to support five beneficiaries, namely Alzheimer’s Disease Association (ADA), Autism Association (Singapore), Cerebral Palsy Alliance Singapore (CPAS), National Kidney Foundation (NKF) and SPD (formerly known as Society for the Physically Disabled).
SALUBRIS OCTOBER – DECEMBER 2014
“Live” screening of Bingo Draw. An employee matching his Bingo card to the number.
Can Buddie save the ball?
Just get me a drink…
Kampung originated games: Five stones, paper balls and captehs.
BINGO! An employee in the background in disbelief.
Aim for the stars with ping pong balls.
* Description of Old School Games Bola Tin – knocking down a pyramid of tin cans with a ball. Capteh – a traditional game that requires keeping a feathered shuttlecock in the air for as long as possible by kicking it up with the foot. Five Stones – played by two or more players, using five small stones. The objective is to complete a set of eight steps. Pick Up Sticks – 20 to 50 sticks are bunched in one hand and set vertically on a flat surface then released so that they fall in a jumble. Each player takes turn to remove one without disturbing any other. Tikam Tikam – a popular guessing game with some similarities to a lucky draw.
Grand finale to the week’s long Kampung Days Nostalgia… Everyone has their lucky draw tickets ready?
7
8
SALUBRIS OCTOBER – DECEMBER 2014
TARGETED KIDNEY CANCER THERAPY WITH BETTER OUTCOMES New molecular diagnostic kit predicts patients’ survival and response to therapy
About 250 patients in Singapore are diagnosed with kidney cancer each year. Outcomes of surgery and targeted therapy can be unpredictable, even for the most experienced doctors. This is set to change with a new molecular test kit co-developed by Singapore General Hospital (SGH), the National Cancer Centre Singapore (NCCS) and the Institute of Bioengineering and Nanotechnology (IBN).
CT scan with arrow indicating kidney tumour
Some members of the research team (clockwise from bottom left): IBN Postdoctoral Fellows Dr Yukti Choudhury and Dr Xiaona Wei, SGH Senior Consultant Prof Tan Puay Hoon, NCCS Consultant Dr Ravindran Kanesvaran, IBN Team Leader and Principal Research Scientist Dr Min-Han Tan.
T
he landmark kit is able to predict treatment and survival outcomes in kidney cancer patients based on their tumour profiles. This is invaluable in deciding the type of treatment the patient should undergo to shrink or slow the growth of the cancer. Said Dr Tan Min-Han, IBN Team Leader, Principal Research Scientist and a visiting consultant at NCCS, “As a practising oncologist, I have cared for many patients with kidney cancer. I see the high costs of cancer care, the unpredictable outcomes and occasional futility of even the best available drugs. “Some patients can be observed for years on end, some benefit from immediate treatment including surgery or targeted therapy, and for some patients, treatment can be futile. Experience is required in making the right judgment for patients. We hope our assay will play a role in helping that judgment.” The researchers started an investigation to discover reliable biomarkers that could improve the prognosis, and identify patients who would likely benefit from one type of treatment. The study was conducted retrospectively with close to 280 tissue samples from SGH Pathology’s tissue archive of patients with clear cell renal cell carcinoma (ccRCC), the most common type of kidney cancer.
Dr Tan explained: “Our diagnostic assay successfully classified ccRCC into groups correlating to different survival and treatment outcomes. This allows patients and doctors to make more educated choices in their treatment options. “Additionally, the development of such assays in Singapore demonstrates the highest levels of research, care and expertise that are available to our patients here.”
The kit has since been validated at SGH and NCCS, and reported in European Urology, the world’s top urology journal. Article first published in Tomorrow’s Medicine Issue 11, August 2014. www.tomorrowsmed.com
Nephrectomy specimen showing a renal cell carcinoma composed of a tumour mass with yellowish and hemorrhagic areas (arrow).
SALUBRIS OCTOBER – DECEMBER 2014
CONGRATULATIONS! NURSES’ DAY AWARD MERIT AWARD
WONG SIN HUI Senior Staff Nurse Infection Control Unit
NATIONAL DAY AWARDS 2014 EFFICIENCY AWARD
GINA HOW
LONG SERVICE AWARD
Nurse Manager
DR FONG KAM WENG
Specialist Oncology Clinic
Head, Senior Consultant Division of Radiation Oncology
CHUA GEK PHIN Director Nursing
YOONG YIM KUEN Principal Radiation Therapist Division of Radiation Oncology
IRENE CHAN Principal Radiation Therapist Division of Radiation Oncology
SUKARMI BTE KATANI Senior Executive Division of Radiation Oncology
9
10
SALUBRIS OCTOBER – DECEMBER 2014
WHO WOULD YOU RUN FOR? RUN FOR HOPE ON 16 NOV 2014 IN SUPPORT OF CANCER PATIENTS & RESEARCH! BY GILLIAN TAN, Executive, Corporate Communications
It’s the 7TH YEAR National Cancer Centre Singapore co-organises Run For Hope with Four Seasons Hotel Singapore & Regent Singapore in support of cancer research!
106 CORPORATIONS have supported the run through staff sign-ups in the last 3 years
37,837 RUNNERS ran with us over the past 6 years
> 247,200KM Total accumulative distance covered by Run For Hope runners since 2008
Singapore Civil Defence Force created a new record last year with
492 STAFF RUNNERS
> $2 MILLION raised through the run over 6 years in aid of cancer research at NCCS
> 600 VOLUNTEERS supported the event last year
THE COLOURS OF HOPE Optimism & Hope Research gives hope
Health
Good health is the foundation of success
Love & Friendship Caregivers & Supporters are an important source of strength
Knowledge Research empowers us with knowledge
SALUBRIS OCTOBER – DECEMBER 2014
Runners from OVER 45 COUNTRIES participated in Run For Hope SG last year. Most of our supporters came from...
CANADA UK NETHERLANDS USA
JAPAN
CHINA
THAILAND INDIA PHILIPPINES MALAYSIA SINGAPORE INDONESIA AUSTRALIA
AREAS WE RAN To make it more accessible for the increasing number of runners, venues were shifted over the years.
NOV, 2014 SUN
The Padang 2012
The Promontory @ Marina Bay 2013 & 2014
SAVE THE DATE!
ECP Casuarina Grove 2008 ECP Angsana Green 2009 ~ 2011
16
THE PROMONTORY @ MARINA BAY 10KM @ 7.00AM | 3.5KM @ 7.30AM
SIGN UP AT WWW.RUNFORHOPE.SG This year, we hope to reach out to
15,000 RUNNERS Join us in paving the way for cancer cures!
RunForHopeSg You can also support by making an online donation via www.sggives.org/NCCRF More details at www.runforhope.sg
11
12
SALUBRIS OCTOBER – DECEMBER 2014
BREAST CANCER DETECTION: TAKING THE FIRST STEP BY VIVIEN ANG, Senior Staff Nurse and CHARLENE PHA, Executive Cancer Education & Information Service
As a woman you are at risk of getting breast cancer and this risk increases with age. A woman’s breasts go through many changes during a lifetime. Most of these changes are quite normal and are due to the fluctuating levels of reproductive hormones in the body. These hormone levels alter during ovulation, menstruation, pregnancy and menopause.
T
he best way to distinguish whether the changes are normal or abnormal is to regularly examine your breasts. Women who practise breast self-examination (BSE) every month will soon become familiar with the normal look and feel of their breasts. They are then able to spot any unusual changes quite easily. Here are some of the changes to look out for during breast self-examination:
• Persistent lump or thickening in the breast or under armpits. • Change in the size or shape of the breast. • Change in colour or appearance of the skin of the breast.
"Lying down" position Report any lump, discharge or changes to your doctor or nurse immediately. Cancer Helpline: 6225 5655
Email us: cancerhelpline@nccs.com.sg
CEIS/PEM-BSE-2014/07
It is a good practice to ask your doctor to examine your breasts regularly on a yearly basis. Mammograms (breast x-rays) and breast ultra-sound are also possible alternatives to discuss with your doctor. Mammography is a special x-ray of the breast, which uses low doses of radiation. It can be used to check healthy women for early signs of breast cancer before the woman herself is aware of any change or before a lump can be felt. Recommended breast screening practices include: • Breast self-examination (BSE) – once a month about 7 to 10 days from the first day of your menses. • Clinical breast examination – once every year if you are 40 years and above.
• A change in the nipple or areola.
• Mammogram Screening – once a year if you are 40-49 years old, once every 2 years if you are 50 years and above.
For a woman, the hormone level decreases gradually with age and one may experience various changes in the breasts. These may include unusual pain and/or swelling, a lump or general ‘lumpiness’, nipple retraction, or even a discharge from the nipple. Although most of these changes are benign (non-cancerous), they can make you very anxious and concerned. It is very important that these changes are thoroughly checked by a doctor.
In conjunction with the Breast Cancer Awareness Month 2014, a bilingual public forum on Breast Cancer will be held at the National Cancer Centre Singapore on Saturday, 11th Oct 2014. The forum at the NCCS Auditorium is from 9.15am to 10.30am (Mandarin) and 11.15am to 12.30pm (English). To register for the forum, please call 6225 5655 between 8.30pm and 6pm, Monday to Friday.
• Bloody discharge from the nipple.
There will also be a roadshow at the Woodlands Civic Centre atrium on Saturday, 18th Oct 2014, from 10am to 6pm. Do visit our roadshow and take part in our activities. Tokens of appreciation will be given to participants who beat the BSE counter challenge.
SALUBRIS OCTOBER – DECEMBER 2014
乳腺癌检测： 迈出第一步
要了解自己的乳房，并分辨什么变化是不正常的，最好的
洪慧慧，高级护士 傅慧君，执行人员 癌症教育与资讯服务
• 乳房或腋下长有硬块或变厚，而且持久不消；
方法是定期做自我乳房检查。每个月都定期自我乳房检 查的妇女，就会熟悉自己乳房正常的外观和感觉。因此她 们能轻易地发现任何异常的变化。
• 乳房大小或形状起变化； • 乳房皮肤变色或变样，例如红斑、皱纹或凹陷；
身为一名女性使我们处于患乳腺癌 的风险。而随着年龄的增长，风险也 跟着提高。我们的乳房在我们一生
• 乳头出血； • 乳头或乳晕起变化，例如呈鳞状、皮疹持久不 消，或乳头内陷
中会经历许多变化。这些变化多数
随着年龄的增长，激素水平会逐渐下降，乳房也会经历
是源于我们身体的生殖激素水平的
多种变化。这些变化可能包括异常的疼痛及/或肿胀、肿
波动。这些激素水平会在排卵期，月 经，怀孕和更年期时，有所改变。
块、乳头凹陷或甚至乳头出现分泌物。虽然这些变化大多 数是良性的（非癌性），但会令我们感到焦虑与不安。出 现以上体征和症状时，让医生彻底检查是非常重要的。 医生建议您每年定期进行乳房检查。您也可以与医生讨论 其他乳房检测的方法如乳房X光检查及乳房超声波扫描。 乳房X光检查 (Mammography) 是利用低剂量的放射线， 为乳房进行特别的X光检验。乳房X光检查可帮助健康的妇 女在发现乳房有任何变化或感觉到有肿块之前，检测出初 期的乳癌症状。医生提倡以下乳房检查的良好习惯： • 乳房自我检查 (BSE) – 每月一次，从月经开始约第
7 至10 天。 • 临床乳房检查 – 如果您是 40 岁以上，每年一次。 • 乳房X光检查 – 如果您是 40 ~ 49 岁，每年一次。如 果您是 50 岁以上，每两年一次。 在乳腺癌宣传月份，新加坡国立癌症中心将于10 月 11 日，星期六当天举办《乳癌》双语公众讲座。讲座将在新 加坡国立癌症中 4 楼的礼堂举行。华语讲座将从上午 9 点
15 分至 10 点 30 分；英语讲座则将从上午 11点 15 分至下 午 12 点 30 分。请在星期一至星期五，上午 8 点 30 分至下 午 6 点之间致电于癌症援助热线 6225 5655 报名讲座。
新加坡国立癌症中心也将在 10月18 日，星期六举行乳腺癌意识月路演，地点是位于兀兰民事服务中心 (Woodlands Civic Centre) 的中庭。路演将从上午10 点至下午 6点举行。欢迎您踊跃的参与和支持我们的抗癌活动。
13
14
SALUBRIS OCTOBER – DECEMBER 2014
You have multiple medical conditions. You are seeking help from Medifund to pay for your bills, incurred at SGH and various centres on Campus. At each centre, you are assessed by a Medical Social Worker (MSW). Sometimes, you qualify for a different level of funds. You wondered why and felt frustrated by the tedious, repeated interviews and requests for documents.
ONE ASSESSMENT FOR ALL MEDICAL NEEDS In a massive action and major change from earlier efforts SingHealth MSWs pulled together and came up with one standardised assessment for the institutions to use for all patients.
S
ince November last year, such patients are assessed only once to qualify for aid at SingHealth institutions, within a six-month period. The change will benefit more than 2000 patients, the number who underwent multiple assessments for Medifund in 2013.
In their quest, the MSWs were supported by the Office for Service Transformation (OST), which facilitated and lent impetus to the project as a Cluster-wide initiative. It also brought in resources to make the wide-reaching changes possible. The push for this project and the setting up of OST signal determination to bring about similar, radical transformations to focus on patients’ needs. It’s the right time to make changes to the way we work, as One SingHealth, in a significant way.
STAND FIRST When GCEO Prof Ivy Ng first floated the idea of a standardised Medifund assessment in SingHealth, concerns over fundamental differences in processes and governance threatened to overwhelm the project before it even began. Today, we are the first healthcare cluster to achieve One Medifund Assessment (OMA).
SOMETHING’S BREWING “How?” “All the institutions have our own processes and governance. How to align them?” Esther Lim, Head of SGH Medical Social Services (MSS), recalled when GCEO first raised the matter in Jan 2013. Away at an overseas conference, she followed the flurry of email exchanges with other heads of MSS and the Group Allied Health office. Many were resistant and doubtful citing the many differences and the huge undertaking it would be to consolidate the workflow. But GCEO was not letting up. “It was clear something big and serious was brewing. I quickly set up a meeting to discuss this further with the SGH Chief Financial Officer (CFO).”
FROM WHY TO WHY NOT? We already have some standardisation, the MSWs told GCEO at the first major meeting involving all the institutions’ CFOs and Heads of MSS. For straight-forward cases that had to meet only the income criteria, we could honour each other’s Financial Assistance Memo which is already shared in the Group, they suggested. “Go all the way” with the complex cases too, countered GCEO. She urged the MSWs to look at the value this project can create and do for the patients despite the existing obstacles. She challenged the MSWs to change their mind set – instead of asking ‘Why’, ask ‘Why not?’.
SALUBRIS OCTOBER – DECEMBER 2014
MSS heads having fun preparing desserts for MSW day (from left to right): Priscilla Lim (SNEC), Genevieve Wong (NHCS), Gilbert Fan (NCCS) and Esther Lim (SGH).
It was clear and undeniable to the MSWs that the project would bring a huge improvement to patients. Encouraged by the show of strong support from top leadership, they committed to a radical change in thinking – even though they could not see any solutions then.
NO LETTING UP At a management retreat in June, GCEO checked in on the progress. Esther reported that her team gave themselves at least three months to fully understand the different perspectives of the institutions and bring about a radical integrated structure across Campus. She was almost floored when GCEO jokingly quipped “How about three weeks?” Addressing the retreat participants later, GCEO acknowledged that the One Medifund Assessment project would take time, but urged the team to be persistent and keep up its efforts.
DEMOLITION AND CONSTRUCTION WORKS “It was like a plot of land with many buildings in place. Now, we have to erect a new big building and demolish the rest,” said Esther.
Three main workstreams were set up to tackle the key areas that had to be aligned: Workflow and Systems, Assessment & Training and Approval Guidelines. The greatest challenge was to fit the OMA into each institution’s workflows. Besides MSS, processes in billing and the interfacing IT systems had to be enhanced. Pharmacists’ processes were also reviewed as the charges for non-standard drugs were affected. There was a lot of negotiation as each institution passionately put forth its case for holding on to certain processes. Working in small groups, the MSWs gathered input from colleagues from the other areas. They would then discuss ways to weave the requirements into the new workflow. The group working on developing common assessment criteria was able to fall back on an SGH operating guideline which had previously been shared with the other centres. The assessment criteria were refined and a norm took shape after much brainstorming. Alignment was achieved when every MSW was put through a structured training on the refined guidelines. “In addition to challenging our own comfort zones, the MSWs had to face the difficulty of challenging others’ comfort zones as well,” shared MSW Lim Ching Yee from SingHealth Polyclinics. Continued on page 16.
15
16
SALUBRIS OCTOBER – DECEMBER 2014
Continued from page 15.
ALL FOR ONE After four months of unceasing, gruelling hard work, OMA was rolled out in November 2013. Esther named three key components as the secret to success. “When the project structure was set up, with the three main work groups, everything fell in place. Next was the clarity of the key issues and coming up with clear tracks to work on.” “Most important of all was the engagement of stakeholders. Listening to the feedback and ideas of partner departments such as pharmacy was very important. Mutual respect is the foundation for the collaborative relationship that both departments share today.” MSW Lim Si Min from NHCS noted, “Job satisfaction is higher now as we have more time to spend with patients, with fewer Medifund assessments. Our patients are more satisfied and less frustrated, making them more willing to comply with treatment.”
Today the MSWs are a close-knit community, having gained new perspectives from each other. What helped the most was having the patients in mind. “We argued sometimes, but it never got ugly. When we really listened to each other, it became clear we were actually on the same page – we were all ‘fighting’ to do this for our patients,” said MSW Tin Yin Mei from SNEC.
WITH SPECIAL THANKS TO: Esther Lim Li Ping and Constance Thong, SGH; Lim Si Min, NHCS; Tin Yin Mei, SNEC; Esther Lim Ching Yee, SHP. Article first published on LIFE@SGH Campus, May 2014.
To provide momentum to initial efforts, GCEO set up a One Medifund Assessment Taskforce in August 2013, co-chaired by A/P Celia Tan, Group Director of Allied Health, and Ms Lee Chen Ee, Director of the Office for Service Transformation. The taskforce was to galvanise MSWs, regardless of institution, to create a single Medifund Assessment for our patients. The workgroup was co-led by Ms Esther Lim and Ms Genevieve Wong, Head of Medical Social Services at SGH and NHCS respectively, and included representatives from the various institutions. KKH was the only institution not included for now because after looking at the small number of shared patients, and that enhancements to KKH’s IT systems would require a significant amount of money as KKH was on a different IT system, it was proposed that the IT enhancements to KKH’s system wait till the national eMSW system is completed (in around 2015).
SALUBRIS OCTOBER – DECEMBER 2014
SINGAPORE YOUTH AWARD 2014 – DR IAIN TAN “Pursue your passion, pursue excellence. Do not settle, stay resilient and persistent.”
His research has been recognised with various awards and grants such as the American Society of Clinical Oncology (ASCO) Young Investigator Award in 2010, Terry Fox Foundation grant in 2013, and National Medical Research Council (NMRC) Individual Research Grant in 2014.
Humbled by his latest award, he added, “I am fortunate to have achieved success and contributed to society in two disciplines I care deeply about – clinical medicine and scientific research, especially when cancer is a growing public health concern and the leading cause of death in Singapore.”
“Commitment, excellence and collaboration – by honing our craft, engaging and communicating with partners across disciplines, and being committed to the mission of using science to advance human health, we have the opportunity to truly make a difference”. – DR IAIN TAN
C
onsultant Medical Oncologist Dr Iain Tan has been recognised for his contributions as a specialist doctor and research scientist in the field of cancer and his efforts to cultivate an environment conducive for clinical research.
His latest achievement is being named winner in the prestigious Singapore Youth Awards 2014.
Besides being a consultant oncologist leading the colorectal cancer service in the Division of Medical Oncology at National Cancer Centre Singapore (NCCS), he is concurrently a clinician scientist at the Genome Institute of Singapore (GIS), A*STAR, where his research focuses on new ways in the early detection and diagnosis of colorectal cancers.
Explaining his passion as a clinician scientist, “As a scientist, I can combine clinical and scientific insights to identify specific opportunities where translational research can take advancements in science and technology into discoveries that can improve treatment outcomes for patients.” He emphasises that translational bench-to-bedside research is a “team sport”. With the strong support from both NCCS and GIS, he is able to work closely with fellow clinicians and scientists towards a common goal of translating scientific advances into potential clinical applications. His expertise in both fields also offers him an opportunity to provide meaningful mentorship to his students and apprentices from both disciplines. Established in 1975, the Singapore Youth Award is the highest accolade for youths aged under 35 and honours exceptional young people who enrich the hearts and souls of the community and bring distinction to the nation.
17
18
SALUBRIS OCTOBER – DECEMBER 2014
NCCS GP SYMPOSIUM 2014 BY DR FARID HARUNAL RASHID Consultant Division of Medical Oncology
The second annual National Cancer Centre Singapore (NCCS) symposium for general practitioners was held on 19 July 2014 at The Academia on Outram Campus.
T
his year’s symposium centred around the theme of cancer survivorship. With the significant advances in diagnostics, supportive care and therapeutics of cancer in the last decade, a greater proportion of patients are living meaningful, functional lives many years following their diagnosis. This rapidly changing demographic presents many new challenges and opportunities for cancer care that we are only beginning to grapple with systematically. The family physician will undoubtedly be a critical member of the team in the axis of care for cancer survivors. It was our aim to provide a substantive platform of knowledge and resources for the shared care of these patients.
The symposium was well attended, with more than 400 participants, including over 150 family physicians, and 200 nurses from various institutions. Following an inspiring and often humorous plenary lecture by Dr Vijay Sethi on the multifaceted aspects of cancer survivorship, participants broke up to attend one of four concurrent sessions covering the topics of cancer prevention, updates in cancer therapy, clinical case studies in cancer and common medical devices used by cancer patients.
Dr Mohamad Farid, Organising Chairman, opening the symposium on “Cancer Survivorship and Primary Care”
These sessions were each conducted twice, allowing participants to choose the two (out of four) sessions that best suited their interests and needs. The sessions were conducted in smaller groups to create opportunities for dialogue and interaction. The symposium concluded with a lively sharing and dialogue session. Dr Rose Fok, a general practitioner who has been running cancer survivorship clinics and attending educational activities at NCCS for the past two years, shared her insightful thoughts and observations on the cancer care continuum from the perspective of a family physician. A panel discussion followed, where many pertinent and fascinating issues were vigorously discussed, including strategies to improve access to cancer therapy, the burgeoning cost of cancer care, and the many challenges in enhancing the involvement of primary care practitioners in cancer care delivery.
There is no doubt that optimal community based care will be critical to improving the outcome of cancer patients; the contribution of family physicians in this endeavour is thus absolutely critical. We aim to build upon the success of this year’s symposium in the coming years to further this synergy between primary and tertiary care. This will likely include a greater frequency and depth of educational and training events, and the establishment of enhanced communication channels between oncologists and general practitioners. It is hoped that these initiatives can realise our common goal of seamless, world class, and cost effective cancer care in Singapore.
SALUBRIS OCTOBER – DECEMBER 2014
More than 400 participants, including more than 150 family physicians, and 200 nurses from various institutions
A/Prof Toh Han Chong updates on “Cancer Treatment 2014 – What’s New?”
Dr Vijay Sethi delivering an inspiring plenary lecture on “Life, Liberty and the Pursuit of Happiness”
A/Prof Simon Ong engaging the audience on “The Art of Clinical Medicine in Oncology – Cancer Care Vignettes”
A/Prof Koo Wen Hsin debating on “Can Cancer be Prevented? Separating Fact from Fiction”
Panel Discussion and a lively dialogue between Oncologists and Family Physicians
19
20
SALUBRIS OCTOBER – DECEMBER 2014
OUTREACH – PUBLIC FORUMS & CANCERWISE WORKSHOPS
Event
Date, Time, Venue
Registration
Breast Cancer Awareness Month Public Forum
11 October 2014, Saturday
Free Admission
MANDARIN SESSION Time: 10.15am to 12.15pm (Registration: 10.00am to 10.15am)
Strictly No Admission for children below 12 years old. Registration is a MUST as seats are limited.
ENGLISH SESSION Time: 1.00pm to 3.15pm (Registration: 1.00pm to 1.15pm)
REGISTRATION IS BY PHONE ONLY
TOPICS: • Intra-operative radiotherapy for early Breast Cancer • Adjuvant treatment for Breast Cancer • Cancer and nutrition • Rehabilitation after Breast Cancer surgery
Peter & Mary Fu Auditorium National Cancer Centre Singapore 11 Hospital Drive Singapore 169610
CancerWise Workshop – Sexual & Body Image Concerns in Breast Cancer (for ladies only) TOPICS: • Impact of Breast Cancer and treatment on body image • Physical impact • Psychological concern • Achieving a healthy body image • Adjusting to changes in body image and sexuality • Support needs related to body image and sexuality
Please call: 6225 5655 Monday to Friday: 8.30am to 5.30pm
11 October 2014, Saturday
Free Admission
Session will be conducted in English.
Strictly No Admission for children below 12 years old. Registration is a MUST as seats are limited.
1.00pm – Registration 1.30pm to 3.30pm – Workshop starts Level 4 Function Room National Cancer Centre Singapore 11 Hospital Drive Singapore 169610
REGISTRATION IS BY PHONE ONLY Please call: 6225 5655 Monday to Friday: 8.30am to 5.30pm
CancerWise Workshop – Lung Cancer
1 November 2014, Saturday
Free Admission
TOPICS: • What is Lung Cancer? • What are the risks, signs and symptoms? • Prevention • What diagnostic tests to detect Lung Cancer? • What are the treatments available? • New development in Lung Cancer • Targeted therapy
Session will be conducted in English.
Strictly No Admission for children below 12 years old. Registration is a MUST as seats are limited.
1.00pm – Registration 1.30pm to 3.30pm – Workshop starts Peter & Mary Fu Auditorium National Cancer Centre Singapore 11 Hospital Drive Singapore 169610
REGISTRATION IS BY PHONE ONLY Please call: 6225 5655 Monday to Friday: 8.30am to 5.30pm
Upcoming Event
Date, Time, Venue
Breast Cancer Awareness Month Roadshow
18 October 2014, Saturday
ACTIVITIES: Cancer information poster exhibits, breast self-examination counter, mammogram screening information, interactive game booths, upcoming events and cancer information publications subscriptions. (Tokens of participation will be given out!)
10.00am to 6.00pm Woodlands Civic Centre Atrium
The information is correct at press time. NCCS reserves the right to change programmes or speaker without prior notice.
SALUBRIS OCTOBER – DECEMBER 2014
SEMINARS / FORUMS / TUMOUR BOARDS / SMC-CME ACTIVITIES
OCTOBER 2014 Date
Time
Event Information
2, 16
5.00pm
NCCS-SGH Joint Lymphoma Workgroup Meeting
CME Pt
Registration Contact
1
Tan Si Xuan / Rachel Tan 6436 8280 / 6436 8172 nmogyy@nccs.com.sg / nmotsk@nccs.com.sg
1
Low Peak Wah / Ang Hui Lan 6436 8165 / 6436 8174 nmolpw@nccs.com.sg / dmoahl@nccs.com.sg
1
Tan Si Xuan / Rachel Tan 6436 8280 / 6436 8172 nmogyy@nccs.com.sg /
@ NCCS Level 2, Clinic C, Discussion Room
30
5.00pm
NCCS Neuro Onco Tumour Board Meeting @ NCCS Level 2, Clinic C, Discussion Room
30
7.30am
Endocrine and Rare Tumor Meetings: @ NCCS Level 2, Clinic C, Discussion Room
nmotsk@nccs.com.sg NCCS Tumour Board Meetings:
V. Kalai / Lim Shufen 6436 8294 / 6436 8283 nsokal@nccs.com.sg / dsolsf@nccs.com.sg
1, 8, 15, 22, 29
4.30pm
Sarcoma Tumour Board Meeting
1
1, 8, 15, 22, 29
5.00pm
General Surgery Tumour Board Meeting
1
13, 20, 27
5.00pm
Head & Neck Tumour Board Meeting
1
Daphne 6436 8592 pakiam.marie.daphne@nccs.com.sg
1
Christina Lee Siok Cheng 6326 6095 christina.lee.s.c@nhc.com.sg
1
Lim Shufen / V Kalai 6436 8283 / 6436 8294 dsolsf@nccs.com.sg / nsokal@nccs.com.sg
1
Phua Chay Sin 6436 8043 ddipcs@nccs.com.sg
1
Phua Chay Sin 6436 8043 ddipcs@nccs.com.sg
@NCCS Level 2, Clinic C, Discussion Room
Lung Tumour Board Combine SGH-NCCS Meeting
2, 9, 16, 30
@ SGH Blk 2 Level 1, Radiology Conference Room
1, 8, 15, 22, 29
1.00pm
Hepatobiliary Conference @ NCCS Level 4, Lecture Hall
17
1.00pm
Journal Club Topic: To be advised @ NCCS Level 1, Mammo Suite Discussion Room
24
1.00pm
Teaching Session Topic: To be advised @ NCCS Level 1, Mammo Suite Discussion Room
21
22
SALUBRIS OCTOBER – DECEMBER 2014
SEMINARS / FORUMS / TUMOUR BOARDS / SMC-CME ACTIVITIES
NOVEMBER 2014 Date
Time
Event Information
6, 20
5.00pm
NCCS-SGH Joint Lymphoma Workgroup Meeting @ NCCS Level 2, Clinic C, Discussion Room
27
5.00pm
7.30pm
Registration Contact
1
Tan Si Xuan / Rachel Tan 6436 8280 / 6436 8172 nmogyy@nccs.com.sg / nmotsk@nccs.com.sg
1
Low Peak Wah / Ang Hui Lan 6436 8165 / 6436 8174 nmolpw@nccs.com.sg / dmoahl@nccs.com.sg
1
Tan Si Xuan / Rachel Tan 6436 8280 / 6436 8172 nmogyy@nccs.com.sg / nmotsk@nccs.com.sg V Kalai / Lim Shufen 6436 8294 / 6436 8283 nsokal@nccs.com.sg / dsolsf@nccs.com.sg
NCCS Neuro Onco Tumour Board Meeting @ NCCS Level 2, Clinic C, Discussion Room
27
CME Pt
Endocrine and Rare Tumour Meeting @ NCCS Level 2, Clinic C, Discussion Room
NCCS Tumour Board Meetings: 5, 12, 19, 26
4.30pm
Sarcoma Tumour Board Meeting
1
5, 12, 19, 26
5.00pm
General Surgery Tumour Board Meeting
1
3, 10, 17, 24
5.00pm
Head & Neck Tumour Board Meeting
1
Daphne 6436 8592 pakiam.marie.daphne@nccs.com.sg
1
Christina Lee Siok Cheng 6326 6095 christina.lee.s.c@nhc.com.sg
1
V Kalai / Lim Shufen 6436 8294 / 6436 8283 nsokal@nccs.com.sg / dsolsf@nccs.com.sg
1
Phua Chay Sin 6436 8043 ddipcs@nccs.com.sg
1
Phua Chay Sin 6436 8043 ddipcs@nccs.com.sg
@ NCCS Level 2, Clinic C, Discussion Room
6, 13, 20, 27
11.30am
Lung Tumour Board Combine SGH-NCCS Meeting @ SGH Blk 2 Level 1, Radiology Conference Room
5, 12, 19, 26
1.00pm
Hepatobiliary Conference @ NCCS Level 4, Lecture Hall
21
1.00pm
Journal Club Topic: To be advised @ NCCS Level 1, Mammo Suite Discussion Room
28
1.00pm
Teaching Session Topic: To be advised @ NCCS Level 1, Mammo Suite Discussion Room
SALUBRIS OCTOBER – DECEMBER 2014
SEMINARS / FORUMS / TUMOUR BOARDS / SMC-CME ACTIVITIES
DECEMBER 2014 Date
Time
Event Information
4, 18
5.00pm
NCCS-SGH Joint Lymphoma Workgroup Meeting
CME Pt
Registration Contact
1
Tan Si Xuan / Rachel Tan 6436 8280 / 6436 8172 nmogyy@nccs.com.sg / nmotsk@nccs.com.sg
1
Low Peak Wah / Ang Hui Lan 6436 8165 / 6436 8174 nmolpw@nccs.com.sg / dmoahl@nccs.com.sg
1
Tan Si Xuan / Rachel Tan 6436 8280 / 6436 8172 nmogyy@nccs.com.sg / nmotsk@nccs.com.sg
1
V. Kalai / Lim Shufen 6436 8294 / 6436 8283 nsokal@nccs.com.sg / dsolsf@nccs.com.sg
@ NCCS Level 2, Clinic C, Discussion Room
18
5.00pm
NCCS Neuro Onco Tumour Board Meeting @ NCCS Level 2, Clinic C, Discussion Room
18
7.30am
Endocrine and Rare Tumour Meeting @ NCCS Level 2, Clinic C, Discussion Room
NCCS Tumour Board Meetings: 3, 10, 17, 31
4.30pm
Sarcoma Tumour Board Meeting
3, 10, 17, 31
5.00pm
General Surgery Tumour Board Meeting
1, 8, 15, 22, 29
5.00pm
Head & Neck Tumour Board Meeting
Daphne 6436 8592 pakiam.marie.daphne@nccs.com.sg
@ NCCS Level 2, Clinic C, Discussion Room
4, 11, 18
11.30am
Lung Tumour Board Combine SGH-NCCS Meeting
1
Christina Lee Siok Cheng 6326 6095 christina.lee.s.c@nhc.com.sg
1
Lim Shufen / V Kalai 6436 8283 / 6436 8294 dsolsf@nccs.com.sg / nsokal @nccs.com.sg
@ SGH Blk 2 Level 1, Radiology Conference Room
3, 10, 17, 31
1.00pm
Hepatobiliary Conference @ NCCS Level 4, Lecture Hall
23
24
SALUBRIS OCTOBER – DECEMBER 2014
SEMINARS / FORUMS / TUMOUR BOARDS / SMC-CME ACTIVITIES
JANUARY 2015 Date
Time
Event Information
7, 14, 21, 28
1.00 pm
Hepatobiliary Conference
CME Pt
Registration Contact
1
Lim Shufen / V Kalai 6436 8283 / 6436 8294 dsolsf@nccs.com.sg / nsokal@nccs.com.sg
@ NCCS Level 4, Lecture Hall
NCCS Tumour Board Meetings:
V. Kalai / Lim Shufen 6436 8294 / 6436 8283 nsokal@nccs.com.sg / dsolsf@nccs.com.sg
7, 14, 21, 28
4.30 pm
Sarcoma Tumour Board Meeting
1
7, 14, 21, 28
5.00 pm
General Surgery Tumour Board Meeting
1
5, 12, 19, 26
5.00 pm
Head & Neck Tumour Board Meeting
1
@ NCCS Level 2, Clinic C, Discussion Room
1
Lung Tumour Board Combine SGH-NCCS Meeting
1
Christina Lee Siok Cheng 6326 6095 christina.lee.s.c@nhc.com.sg
1
Jennie Tan 6436 8280 jennie.tan.l.k@nccs.com.sg
1
Phua Chay Sin 6704 2037 ddipcs@nccs.com.sg
1
Saratha / Ang Hui Lan 6436 8165 / 6436 8174 saratha.v.gopal@nccs.com.sg / dmoahl@nccs.com.sg
1
Phua Chay Sin 6704 2037 ddipcs@nccs.com.sg
1
Jennie Tan 6436 8280 jennie.tan.l.k@nccs.com.sg
8, 15, 22, 29
11.30am
@ SGH Blk 2 Level 1, Radiology Conference Room 8, 22
5.00 pm
NCCS-SGH Joint Lymphoma Workgroup Meeting @ NCCS Level 2, Clinic C, Discussion Room
16
1.00 pm
Journal Club Topic: To be advised @ NCCS Level 1, Mammo Suite Discussion Room
27
5.00 pm
NCCS Neuro Onco Tumour Board Meeting @ NCCS Level 2, Clinic C, Discussion Room
23
1.00 pm
Teaching Session Topic: To be advised @ NCCS Level 1, Mammo Suite Discussion Room
29
7.30 am
Endocrine and Rare Tumour Meeting @ NCCS Level 2, Clinic C, Discussion Room
Editorial Advisors
Executive Editors
Members, Editorial Board
Prof Kon Oi Lian Prof Soo Khee Chee Dr Tan Hiang Khoon
Ms Adeline Teo Ms Rachel Tan Ms Siti Zawiyah Mr Edwin Yong Ms Gillian Tan Ms Hazlin Hepbun
Ms Lita Chew Dr Mohd Farid Ms Sharon Leow Ms Jenna Teo Dr Melissa Teo Dr Teo Tze Hern Dr Deborah Watkinson
Editorial Consultant Mr Sunny Wee Medical Editor Dr Richard Yeo
Daphne 6436 8592 pakiam.marie.daphne@nccs.com.sg
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 corporate@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 www.facebook.com/NationalCancerCentreSingapore www.linkedin.com/company/NationalCancerCentreSingapore