AN NCCS BI-MONTHLY PUBLICATION May / June 2009

...HELPING READERS TO ACHIEVE GOOD HEALTH

Issue No. 03 • MICA (P) 207/10/2008

BRINGING PALLIATIVE MEDICINE TO THE COMMUNITY

SALUBRISMay / June 2009

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In Other Words

A/Prof Cynthia Goh shares her lonely journey of bringing relief to pain sufferers and enhancing quality of life to hospice patients.

If there’s one character trait of A/Prof Cynthia Goh that stands out, it’s her love for the terminally ill. Her compassion sets her on the path to take up what was then a less than glamorous field of medicine. Yet, selflessly she pursued her cause eventually contributing to the success of palliative medicine in the National Cancer Centre Singapore (NCCS) and the wider community.

BRINGING PALLIATIVE MEDICINE TO THE COMMUNITY

Photo courtesy of Singapore Press Holdings.

Today A/Prof Cynthia Goh is Head of the Palliative Medicine Department at NCCS, and Centre Director of the Duke-NUS Lien Centre for Palliative Care. Being a pioneer of Singapore’s hospice movement, her name has become

synonymous with words like ‘hospice care’ and ‘palliative care’.

Back in the 1970s and 1980s, people who were at the end of life’s journey were a much neglected group. Any attention given was patchy with no real focus on quality of life. It was in the mid 1980 that a group of volunteers took upon themselves to care for these people.

“I was involved in the founding of the first organisation, now known as the HCA Hospice Care, that looks after people with terminal illness when hospitals were no longer able to provide curative treatment,” recalled A/Prof Goh.

She took her first palliative care job as Medical Director of Assisi Hospice from 1994 to 1999 where she built up her clinical experience. The hospice provided in-patient hospice care. To improve its ability to provide more wholesome services, she established a home care service and day care centre.

It was not all smooth sailing in those early days. Doctors did not think that hospice was serious doctoring.

“When I was with the Assisi Hospice, I tried to establish our medical credibility by communicating with doctors in the same language as they use. So when a referral was made to us, I would feed back to the referring doctors what happened to their patients, how the pain and symptoms were controlled, and how the patient died. The doctors were pleased to know that their patients were cared for and their families were supported right until the end,” added A/Prof Goh.

By doing so, she managed to build bridges to the hospital system and help establish recognition for palliative care.

SALUBRIS May / June 2009

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In Other Words

Manpower was another issue that A/Prof Goh had to contend with. Recruiting people was a challenge. Most of those who joined were untrained foreigners.

Hence, to resolve these issues, she knew she needed a strategy to get palliative care recognised as a medical specialty.

In 1997, two years before NCCS was established, talks of including hospice care as part of NCCS were initiated. But A/Prof Goh was looking beyond a table manned by volunteers and giving out brochures. At a meeting with Prof Soo Khee Chee, then Director-designate of NCCS, she told him that if a comprehensive cancer centre was what he wanted, then NCCS should include palliative medicine as one of its clinical services. After looking at models overseas, he agreed.

There was no looking back since. A/Prof Goh was joined by another pioneer, Dr Rosalie Shaw to set up the Department of Palliative Medicine at NCCS.

It took many more years to establish hospital palliative care services, and even longer to establish palliative medicine as a specialty in order to

produce trained manpower for future palliative services. The department now offers consultative palliative care services to in-patients within the Singapore General Hospital, as well as specialist outpatient services at NCCS.

The Ministry Of Health eventually recognised palliative medicine as a sub-specialty in 2006 and its first batch of specialists graduated in March 2009.

Not many have the chance of realising their dreams. For A/Prof Goh, hers came true in the form of the Lien Centre for Palliative Care, which was established in March 2008 as a collaboration between the Lien Foundation, the Duke-NUS Graduate Medical School, NCCS and Singapore Health Services.

As a field, Palliative Medicine has expanded beyond cancer patients to include patients with other life-limiting illnesses, such as dementia, lung, kidney and heart failure.

While work often keeps A/Prof Goh up and about anywhere but home till 11pm, it is the satisfaction that she derives from “making a difference in patient’s lives” that keeps her going.

Her surgeon husband and two children, a son, also a trainee surgeon, and daughter who currently works in Hong Kong, give her their full support in her work. Even though each family member is busy pursuing their own career, both husband and wife will make it a point to spend some time together during weekends and on annual holidays.

For a doctor who manages only five hours of sleep, A/Prof Goh still looks her best anytime of the day. When Salubris asked for her beauty secrets, she answered laughingly: “I hardly spend any time on my appearance! Probably except the few seconds I use to put on my lipstick. But I’ve got my mother to thank as she taught me to always look decent since I was young.”

There is probably another less known secret about A/Prof Goh... she indulges in overseas retail therapy just like any other ladies.

By Carol Ang

As a field, Palliative Medicine has expanded beyond cancer patients to include patients with other life-limiting illnesses, such as dementia, lung, kidney and heart failure.

“I was involved in the founding of the first organisation, now

known as the HCA Hospice Care, that looks after people

with terminal illness when hospitals were no longer able

to provide curative treatment.”

A/Prof Cynthia Goh, a pioneer of Singapore’s hospice

movement, whose name has become synonymous with words like

‘hospice care’ and ‘palliative care’.

SALUBRISMay / June 2009

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In Focus A TELLING SIGN FOR OPTIMAL TREATMENT

Three top research scientists at the National Cancer Centre Singapore (NCCS), namely Prof Hui Kam Man, Head of the Division of Cellular and Molecular Research together with colleagues, Prof London Lucien Ooi and Wang Suk

Mei have discovered that chances of post-surgical recurrence is as high as 80 per cent within 6 to 35 months for HCC patients, if they present clinically with cirrhosis and vascular invasion (tumours in blood vessels) at point of diagnosis.

In comparison, patients who are non-cirrhotic or have vascular invasion are likely to remain disease free after surgery.

There is another group of patients with either liver cirrhosis or vascular invasion. Their risk of developing disease recurrence stands at 50 per cent. This makes clinical management for these patients a challenge as doctors are not able to determine the aggressiveness of adjuvant treatment needed to prevent recurrence which may or may not even occur. The other option is to prescribe the appropriate treatment only after HCC recurs, explained Prof Hui.

In this three-year research funded by the Biomedical Research Council, Prof Hui and

his team took the cancerous and some of the corresponding distal non-cancerous liver tissues from patients during surgery of genomic studies, in the hope of helping doctors answer that question and improve clinical management of HCC.

“We studied 44,958 genes in each patient who met the test subject criteria and identified a 57-member gene signature that could predict recurrent disease for HCC patients with either cirrhosis or vascular invasion.

“If the 57-member gene set displays a particular pattern associated with the return of the disease, we can be almost 80 per cent certain that it would return within 6 to 24 months. And doctors could give optimal clinical treatments and follow-up strategies to prevent recurrence of HCC,” said Prof Hui.

He added: “Early detection saves lives. But in this instance, the ability to predict chances of post-surgical recurrence for HCC patients is as advanced as we can get.”

Meanwhile, it is back to the lab for more work. Prof Hui and the team hope to reduce the waiting time to obtain results based on genomic studies of tissue specimens which now takes “a couple of days to merely a day” with a simple blood test.

HCC patients’ outlook can only get better.

By Carol Ang

Hepatocellular carcinoma (HCC) or liver cancer is the fifth most common cancer and the third leading cause of cancer death worldwide. A male predominance has been reported, with a male to female ratio of 2–4:1. Some of the risk factors of HCC include Hepatitis B carrier status, hepatitis C infection, alcohol abuse and liver hardening or cirrhosis.

The dismaying fact about the disease is: the majority of patients experience no symptoms when they are inflicted by liver cancer.

When detected, very often by chance as a result of an ultrasound test or CT scan for other unrelated problems, the options of a cure are limited.

Worst if left untreated, most patients do not survive beyond six months. Although, surgery is by far the best method of treatment, only 20 per cent of HCC patients can undergo liver resection as it is very much dependent on the condition of the liver. Even then there is no way of telling if HCC will recur for patients post-surgery.

Molecular Landscape of Human Hepatocellular Carcinoma Genes

SALUBRISMay / June 2009

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Under The Microscope

Prostate cancer is the commonest non-skin cancer among males in the United States of America. Although it is not as common among Asian males, it has risen to become the third most frequent cancer among Singapore males in the latest interim cancer incidence report 2001-2005.

Hormonal or Androgen Deprivation Therapy (ADT) is used in different scenarios in the clinical management of prostate cancer (see figure 1). The growth of prostate cancer cells can be stimulated by androgens and in turn, androgen deprivation therapy can stop or slow down the growth of prostate cancer cells but it is not curative. It is the primary therapeutic modality for men with metastatic prostate cancer, and is also used in patients with locally advanced prostate cancer who are treated with external beam radiation therapy.

HORMONAL TREATMENT IN THE MANAGEMENT OF PROSTATE CANCER

By Dr Toh Chee KeongConsultant,

Dept of Medical Oncology,

NCCS

MECHANISMS OF ACTION OF ADT

The testicles produce the majority of total circulating testosterone, while the adrenal glands produce the remainder. Testosterone is converted within the prostate gland to dihydrotestosterone (DHT) which is the hormone that has the most effect on the cells. The pathway towards the production of testosterone/DHT involves the following: hypothalamus secretes gonadotropin releasing hormone (GnRH) which in turn stimulates the pituitary gland to produce luteinizing hormone (LH). LH stimulates the testicles to produce testosterone which, together with dehydroepiandrosterone (DHEA) from the adrenal glands, stimulate the prostate to produce DHT. DHT then negatively feedbacks to the hypothalamus to reduce the amount of GnRH (see figure 2). ADT can target any part in this feedback loop of testosterone/DHT production.

Continued on page C2.Figure 1. The use of androgen deprivation therapy in the treatment of prostate cancer.

CLINICALLY LOCALISED

DISEASE

CLINICALLY METASTATIC

DISEASE

Androgen Deprivation Therapy (as Adjuvant) in Combination with

Radiotherapy

Androgen Deprivation Therapy(as Primary)

Androgen Deprivation Therapy(as Primary)

PROGRESSED

SECONDARY HORMONAL THERAPY / CHEMOTHERAPY FOR ‘HORMONE REFRACTORY’ STATE

RISING PSA

PRIMARY THERAPY

WATCHFUL WAITING

PROGRESSED

CURED

LOCAL SALVAGE

SALUBRISMay / June 2009

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ESTROGEN (DES) GNRH AGONISTS/ANTAGONISTS

E.g. Goserelin, Leuprolide

HYPOTHALAMUS

ADRENAL ANDROGEN SYNTHESIS INHIBITORS

E.g. Ketoconazole

5ALPHA-REDUCTASE INHIBITORS E.g. Finasteride

ANTI-ANDROGENS E.g. Bicalutamide, Flutamide,

Nilutamide, Cyproterone

ORCHIECTOMY

PITUITARY GLAND

TESTICLES

GnRH

LHADRENAL GLANDS

TESTOSTERONE (90%)

TESTOSTERONE (10%)

5alpha-reductase

DIHYDROTESTOSTERONE

ANDROGEN RECEPTOR

Under The Microscope HORMONAL TREATMENT IN THE MANAGEMENT OF PROSTATE CANCER

METHODS OF ADT

ORCHIECTOMYADT can be accomplished by bilateral orchiectomy to remove the major source of androgens in the body. It results in an immediate reduction in the circulating testosterone, is effective, can be an outpatient procedure and is cost effective. However, this form of surgical castration is probably underused with the advent of medical castration with GnRH agonists.

DIETHYLSTILBESTROLDiethylstilbestrol (DES), a semi-synthetic estrogen compound, was previously used as one of the nonsurgical options for the management of prostate cancer. However, due to its cardiovascular and thromboembolic toxicities, its use has been quite limited. It has been shown to be as effective as orchiectomy in the treatment of advanced prostate cancer.

GNRH AGONISTSThe GnRH agonists, two common ones being goserelin and leuprolide, are the commonly used methods for medical castration. GnRH is normally released in pulses and this leads to the pulsatile release of LH. Continuous stimulation and release of GnRH after treatment with an agonist eventually results in downregulation of the receptors in the pituitary and thus, a decrease in testosterone production. Initial treatment with GnRH

agonists can cause a surge in LH, resulting in an intial rise in testosterone level which can result in a flare phenomenon. This phenomenon can be attenuated with the concomitant use of an anti-androgen. Studies have shown no difference in efficacy between GnRH agonist versus surgical orchiectomy. The advantage of GnRH agonists is that no surgery is required, but the disadvantages are the frequent 3-monthly injections and costs.

ANTIANDROGENSThe commonly used antiandrogens are the Non-Steroidal Antiandrogens (NSAA) bicalutamide, flutamide and nilutamide. These NSAA interfere with the binding of testosterone and DHT to the androgen receptor (AR). Studies have compared the use of NSAA with castration with either orchiectomy or GnRH agonist. Although survival was not significantly different, the normalisation of Prostate Specific Antigen (PSA) was higher in the castrated group. The general consensus is that NSAA at conventional doses, is not as effective as castration and should not be used as single agents in the treatment of advanced metastatic prostate cancer. Cyprotereone is a steroidal anti-androgen that blocks the AR as well as reduce testosterone level through an anti-gonadotropic effect. It is associated with a high rate of cardiovascular complications and is not commonly used.

CLINICAL USE OF ADT

Monotherapy with either orchiectomy or GnRH agonists is the commonest form of ADT used in the treatment of advanced prostate cancer. The use of Combined Androgen Blockade (CAB) with the addition of an antiandrogen has been proposed as about 10% of testosterone still remains in a castrated patient due to peripheral conversion of adrenal androgens. However, there is no convincing evidence that CAB is better than monotherapy as the first-line hormonal treatment of choice. The main clinical indication for ADT is the first line treatment for patients with metastatic disease or biochemical relapse after local treatment. Other use of ADT is in combination with radiation therapy for the treatment of patients with intermediate/high risk locally advanced prostate cancer and in this scenario, the ADT is usually in the form of GnRH agonists and given for a period varying from six months to three years.

SIDE EFFECTS OF ADT

Although relatively well tolerated, ADT can be associated with side effects, including loss of libido, fatigue, weight gain, depression, muscle atrophy, osteopenia/osteoporosis, hot flashes, gynecomastia, loss of cognitive function, decrease in high-density lipoproteins and an increased incidence of cardiovascular disease.

CONCLUSIONS

ADT is an effective and relatively well tolerated form of treatment for advanced prostate cancer. However, the majority of patients who initially respond to ADT progress to a hormone refractory state within 18 to 24 months, with a median survival of 24 to 30 months. In the hormone-refractory state, most patients will require chemotherapy to control the disease, although some patients may still respond for a brief period to secondary hormonal manipulation with agents such as ketoconazole, antiandrogens (if they had monotherapy alone with surgical or medical castration) or corticosteroids.

Figure 2. Strategies of hormonal manipulation in the treatment of prostate cancer.

Continued from page C1.

SALUBRISMay / June 2009

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By Dr Saabry Yusof Osmany Consultant

Dr Kelvin Loke Associate Consultant

Dr David Ng Senior Consultant

Dept of Nuclear Medicine and PET Singapore General Hospital

IS PET FOR EVERYBODY? Spotlight

Positron Emission Tomography (PET) imaging is a nuclear medicine imaging modality that uses radiolabelled molecular tracers to evaluate cellular processes. Having been called the imaging technology of the year by Time magazine, demand for and the use of PET and PET/CT imaging has been steadily increasing worldwide largely for oncologic indications.

PET imaging has a wide range of applications. For the purposes of this article only the clinical oncologic aspects of PET imaging will be considered as they represent the vast majority of PET studies at most centres. Other common clinical indications include neurology and cardiology. There is much research being done with PET. Similarly while over 500 novel research PET radiotracers are being developed and used, this article will be limited to the discussion of the tracer F-18 fluorodeoxyglucose (FDG) the most commonly used radiotracer for clinical PET imaging. It is worth noting though that non-FDG tracers are entering clinical practice, such as Gallium-68 DOTA-TEC.

Table 1 – The average sensitivity and specificity of FDG PET for detecting metastases

MALIGNANCY SENSITIVITY SPECIFICITY

NSCLC, mediastinal 84 93

NSCLC, distant 98 92

Colorectal cancer, hepatic mets 94 97

Colorectal cancer, extrahepatic mets 94 80

Melanoma 90 69

Lymphoma 90 93

Breast cancer, lymph nodes 88 92

Breast cancer, lymph nodes 96 98

Nasopharyngeal, distant 100 90

Adapted from Causes and Consequences of Increased Glucose Metabolism of Cancers, Gillies, RJ et al; J Nucl Med 2008; 49:24S–42S

Continued on page C4.

The left upper lobe lung tumour shows intense FDG uptake. The contralateral small right paratracheal node surprisingly also demonstrate abnormal increased FDG uptake, changing the nodal stage of the patient.

MAJOR INDICATIONS

There are many malignancies that can be imaged with FDG PET/CT. Common approved indications include lymphoma, head and neck cancers, thyroid cancer, lung cancer, esophageal cancer, colorectal cancer, melanoma and breast cancer. Patients are also imaged for malignancies of the liver, pancreas, gallbladder, stomach, pleura, uterus, uterine adnexa, cervix and soft tissue sarcomas to name but a few.

STAGING

FDG PET scans have been shown to be very accurate in staging of malignancies. Often the primary lesion is known and FDG PET helps with pre-treatment detection of nodal and distant disease. The relatively high sensitivity and specificity of FDG PET in staging various malignancies has been described in a recent article [6] with selected data presented in table 1.

SALUBRISMay / June 2009

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Spotlight IS PET FOR EVERYBODY?

Continued from page C3.

CHARACTERISATION OF INDETERMINATE LESIONS

The fusion of PET with CT has improved the quality of the PET images as well as the anatomic localisation of the metabolic information of PET. This had led to improvements in the sensitivity and specificity of PET imaging. As they can be used to detect new malignancies, FDG PET scans are used to characterise a suspicious lesion (eg. solitary pulmonary nodules) or to look for an unknown primary. The improved staging with PET has helped the selection of appropriate treatment for patients which helps reduce both patient morbidity and health care costs. For planning radiotherapy, FDG PET/CT has been shown to be useful in identifying and selecting biological target volumes (BTV).

MONITORING TREATMENT RESPONSE

Once a patient has been started on a course of treatment, it is often helpful to know if they are responding. In the evaluation of disease response to treatment, FDG PET has been shown to predict the efficacy of ongoing management in the early phase, thus allowing earlier modification if needed. This has the advantage of reducing patient morbidity, earlier initiation of effective treatment, appropriate utilisation of resources and decreased health care costs. Monitoring of treatment response can be performed both during and on completion of treatment. In post-treatment follow up, FDG PET/CT scans are very useful for detecting the presence of residual disease and for determining an end-point for treatment. For example, in diffuse large B-cell lymphoma (DLBCL) and Hodgkin’s lymphoma, a pre-treatment PET scan has been strongly recommended by recent guidelines as comparison with follow-up scans after 1 to 4 cycles of chemotherapy to predict response, while comparison with post-treatment scans is described as “essential” to assess for complete response [6]. For example in lymphoma, it is well-documented that in the presence of a negative post-treatment PET study, the risk of relapse is < 20%. FDG-PET imaging thus provides accurate clinical information regarding the prognostic outlook for the patient.

LIMITATIONS

As FDG PET scans image glucose metabolism, relying on the difference in tumoural to non-tumoural uptake to detect malignant disease, cancers with little to no increase in glucose utilisation relative to normal tissue have poor uptake of FDG and may not be well seen on FDG PET imaging. Such tumours include some of prostate carcinomas, hepatocellular carcinomas and renal cell carcinomas. Cancer subtypes with low cellular content such as mucinous subtype of gastric carcinomas may also give rise to rather low uptake.

Similarly tumours in regions of high normal uptake like the brain are difficult to assess on FDG PET. For example, in the context of nasopharyngeal carcinoma, MRI may be better in characterising involvement of the base of the skull while PET is superior for staging nodal and distant disease. Brain metastases may be obscured in some cases by normal FDG uptake in the cerebrum. While PET has a significant role in evaluating primary brain neoplasms (of largely the white matter), the presence of normal cortical FDG uptake precludes the optimal assessment of brain metastasis by PET.

There are non-malignant conditions with increased FDG uptake such as tuberculosis and other granulomatous disease that can have increased uptake on FDG PET scans leading to false positive findings in oncology scans, requiring care in interpretation. Increased FDG uptake can also be seen normally after treatment including surgery, radiotherapy and chemotherapy as part of an inflammatory process.

As with all scans, PET scans also have a minimum imaging resolution and while this can vary slightly from manufacturer to manufacturer, generally FDG PET has decreased sensitivity for lesions below 5mm in size. This can mean that while a very avid lesion will still be visible, a smaller deposit of disease uptake will not be seen within the resolution of the PET/CT scan. A good example is breast cancer where PET/CT is very good for detecting disease but cannot exclude micrometastases and is not a substitute for axillary nodal sampling.

CONCLUSIONPET scans have changed the way medicine is practiced worldwide. The most widely used clinical PET tracer is FDG and the main clinical indication is oncology. New applications for FDG and new PET tracers are being explored and are gradually being incorporated into clinical practice. Like any tool, FDG PET scans should be used appropriately and like all modalities and procedures with a good understanding of the limitations and appropriate indications. Whether they should be used for everybody is a clinical question that will have to be answered individually for each patient.

References: 1. Monitoring Cancer Treatment with PET/CT: Does It Make a Difference? Weber, W and Figlin, R; J Nucl Med 2007; 48:36S–44S

2. Causes and Consequences of Increased Glucose Metabolism of Cancers, Gillies, RJ et al; J Nucl Med 2008; 49:24S–42S

SALUBRIS May / June 2009

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CommunityCANCER PATIENTS OVERCOME ANXIETY WITH EXPRESSION OF HOPE

This project is a collaborative effort between National Cancer Centre Singapore (NCCS) and the

Bukit Panjang Government High School (BPGHS), whose student volunteers helped to design and fire the tiles. It was completed after 13 tile-making sessions involving teachers and students from BPGHS working with many healthcare professionals, researchers, volunteers and well-wishers. The tile-making sessions were held either at the Centre or the School, once a month.

Altogether, 460 tiles had been created and erected on a wall for all to see the cancer patients’ expressions of hope despite their affliction. The 2.2m high x 8.5m wide wall stands tall outside the NCCS at the Outram Campus.

The project, which culminated in the making of these tiles, has also raised $29,000 for the NCC Foundation, in support of cancer research. The work is the brainchild of Prof London Lucien Ooi, Adviser to NCCS, when in 2005 he met the then principal of BPGHS, Mrs Shirleen Ong, to talk about cancer care for patients.

The NCCS Wall of Hope Committee consisting primarily of the Department of Surgical Oncology including a few other departments then followed through and implemented the project in 2008. The project cost about $40,000 to build and implement.

Today, the Wall of Hope stands as a beautiful display of love and hope, attracting passers-by to admire the hard work that has come to fruition.

For 15 months more than 300 people comprising patients, families, and their friends toiled together to express their thoughts and feelings onto clay tiles.

MP for Hong Kah GRC, Mr Zaqy Mohamad, speaking at the unveiling ceremony said:

“Why is it important to have hope? First and foremost, it gives us something to look forward to. It gives us something to live for. It provides our lives with direction.”

“Thus, it helps to motivate us and spur us to move forward in times of difficulty. More importantly, hope helps us to climb out of what may sometimes seem to be impossible situations.”

By Sunny Wee

SALUBRISMay / June 2009

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Community HAIR SALON JOINS THE GROWING HEAD COUNT FOR CANCER RESEARCH

It’s midnight on Friday, 8th May 2009, at Orchard Road. But for an upmarket hair salon, the chief stylist and 22 models it was one show that they had waited for many months.

Huddled together under the glare of spotlights and a huge tent at the Civic Plaza outside the Ngee Ann City, Action Hair Salon staged the Charity Hair Show in support of National Cancer Centre Research Fund.

Held against a packed audience of young and not-so-young, it was not the first time that the hair salon had done fund raising for a good cause but for NCCRF it was certainly a breakthrough to get the support from the hair fashion industry.

Besides big corporations and philanthropic foundations, to date NCCRF can count on support from the aesthetics, artistic and professional groups among its supporters.

By Sunny Wee

Two hair demonstrations were put up by Vinn Wong, the salon’s artistic director, in a flamboyant display of his creative talents and making heads turn. Mr Sonnie Tan, the Salon’s executive director, said:

“It is important that we don’t forget the less fortunate who suffer from cancer. Through research our doctors can be better equipped to improve the treatment for the patients and lighten their suffering.”

SALUBRIS May / June 2009

PAGE A7

PeopleIN RECOGNITION OF THEIR GOOD WORK

PROMOTIONS

Prof London Lucien Ooi

Advisor, National Cancer Centre Singapore

Dr Koo Wen Hsin

Deputy Director, National Cancer Centre Singapore

Dr Toh Han Chong

Head and Senior Consultant, Medical Oncology

Dr Tan Hiang Khoon

Senior Consultant, Surgical Oncology

Dr Yeo Ming Chert Richard

Consultant, Radiation Oncology

WELCOME

Dr Khoo Tan Hoon Seng

Senior Consultant, Radiation Oncology

Dr Meera Rajasekaran

Consultant, Palliative Medicine

Dr Teo Tze Hern Patrick

Associate Consultant, Oncologic Imaging

Dr Ho Shirlynn

Registrar, Palliative Medicine

Dr Kam Kuinn Haur

Registrar, Surgical Oncology

Five people stood out when National Cancer Centre Singapore held its Staff Recognition Award Ceremony at the NCCS lecture theatre on 11th February. The event was part of the Centre’s continuous effort to motivate, recognise and reward staff for providing excellent service and excelling in their work.

Each of them received the 10TH YEAR COMMEMORATIVE AWARD for their dedication, passion, drive and mentorship. The recipients were Prof Soo Khee Chee, Director of NCCS, together with Dr Chua Eu Jin, NCCS

Deputy Director, Dr Kon Oi Lian (Head, Division of Medical Sciences), A/Prof Cynthia Goh (Head, Department of Palliative Medicine) and Prof Hui Kam Man (Head, Division of Cellular and Molecular Research).

For the CARE EXCELLENCE AWARD, after a stringent selection process, eight staff were selected. The award which was first given out in 2002 was to those who demonstrated Courtesy, Attentiveness, Respect, and Excellence in their course of work. This year’s recipients are: Dr Lalit Kumar Radha Krishna (Department of Palliative Medicine) • Gilbert Fan (Department of Psychosocial Oncology) • Tan Cheng Khim (Operating Theatre) • Brenda Lee (Ambulatory Treatment Unit) • Sarojah Veerappan (Specialist Oncology Clinic) • Angeline Hoi (NIP) • Winson Tan (Operations) • Prudence Lim (Lab Services)

This year’s EXCELLENT SERVICE AWARD (EXSA), a national award managed by SPRING Singapore, to individuals who delivered outstanding services, are: Dr Wong Nan Soon (Department of Medical Oncology) • Dr Darren Lim (Department of Medical Oncology) • Dr Yong Wei Sean (Department of Surgical Oncology) • Kalaichelvi Veerappan (Department of Surgical Oncology) • Dr Alethea Yee (Department of Palliative Medicine) • Tay Beng Choo (Department of Palliative Medicine) • Tan Cheng Khim (Operating Theatre) • Ling Bee Chuan (Operating Theatre) • Gwendoline Kok (Operating Theatre) • Georgina Tan (Ambulatory Treatment Unit) • Connie Ong (Specialist Oncology Clinic) • Carol Lee (Specialist Oncology Clinic) • Janet Fernandez (Specialist Oncology Clinic) • Rossnani Bte Abdullah (Specialist Oncology Clinic) • Rashidah Bte Ibrahim (Specialist Oncology Clinic) • Richard Tay (Specialist Oncology Clinic) • Laura Chin (Specialist Oncology Clinic)

SPECIAL AWARDS were presented to Dr Chua Eu Tiong (Head, Department of Radiation Oncology), Dr Rosalie Jean Shaw (Consultant, Department of Palliative Medicine) and Anna Tan (Senior Pharmacy Technician) for going beyond the call of duty.

SALUBRISMay / June 2009

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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.

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

NATIONAL CANCER CENTRE SINGAPORE Reg No 199801562Z

11 Hospital Drive Singapore 169610 | Tel: (65) 6436 8000 | Fax: (65) 6225 6283 | www.nccs.com.sg

Editorial Advisors

Dr Kon Oi LianProf Soo Khee Chee

Executive Editors

Ms Carol Ang Ms Veronica Lee Mr Sunny Wee

Contributing Editors

Dr Lim Soon Thye Dr Wong Nan Soon

Members, Editorial Board

Ms Audrey-Anne Oei Ms Sharon Leow Ms Flora Yong

NCC FoundationNCC Foundation 2009: THE WORST OF TIMES, THE BEST OF TIMES

In an uncertain economic climate, raising funds for cancer research and patient outreach might be an increasingly uphill task; however, the causes advocated by the NCC Foundation have never been more relevant and urgent at the same time.

The phrase brings to mind the story of a tree growing through the seasons: biding its time in spring, blooming in summer, shedding in autumn and remaining stoic in the harsh winter. Through it all, its roots sink deeper drawing nutrients from the good earth so that its canopy may develop and reach higher to the skies. There is much wisdom one can learn from a tree; may NCCS and its research endeavors be as resilient as a tree – to continue growing and exploring despite the tough climate beyond.

By Eugene SngProgramme Director, NCC FoundationNCCFoundation@nccs.com.sg Contact: 6236 - 9430 / -9440 / -9454

O ur researchers are probably aware that there will be impending changes in the

National Medical Research Council’s (NMRC) block grant scheme. In the face of a radical policy shift, NCCS will thus need to be self-reliant to a greater degree in sustaining a vibrant and innovative research environment. Funding is the lifeblood of research work; the NCC Research Fund will need to be bolstered sufficiently to bridge our institution during this transitional stage in the funding landscape. Since its inception, the NCC Research Fund had received a significant majority of its contributions from grateful patients and public goodwill. We are certainly gaining momentum and receiving strong support from major corporations (i.e. BNP Paribas, The Four Seasons Group and Pontiac Land Group) and philanthropists alike. Charting forward we hope that our fellow colleagues may take on a greater stewardship role in harnessing resources and shoring support for the NCC Research Fund. Every form of contribution counts, from volunteering in our activities, to donating a small sum on a regular basis, to referring donors to our programme.

The Foundation will be having two flagship events this year. There will be a Charity Gala in September where a significant proportion of funds raised will go towards a soon-to-be launched patient outreach programme.

We plan to give out education bursaries and scholarships to the children of our cancer patients, so as to alleviate their financial burden in times of hardship. The bursaries and scholarships will range from the primary to the tertiary level. The objective of supporting education and investing in the future of our children is well aligned with our primary mandate of supporting research and investing in a breakthrough for cancer treatment. These local awards provide a nice complement to the Regional Fellowship Grant, which BNP Paribas had donated to NCCS in bringing Vietnamese clinicians and researchers to be trained at NCCS.

This year, fundraising for research will continue to take the form of our national event Run For Hope 2009, which is slated for November. We will be working together with The Regent hotel (part of the Four Seasons Group) in delivering this family carnival -themed run / walk to a higher level of community engagement.

Before closing, I would like to share with the reader a Latin phrase which is the motto of my alma mater, the University of Toronto –

Velut arbor aevo:As a tree in the passage of time.