salubris - november / december 2010

AN NCCS BI-MONTHLY PUBLICATION November / December 2010

...HELPING READERS TO ACHIEVE GOOD HEALTHSalubris is a Latin word which means healthy, in good condition (body) and wholesome.

Issue No. 13 • MICA (P) 149/10/2009

BREAST CANCER AESTHETICS

SALUBRISNovember / December 2010

PAGE A2

In Focus PERSPECTIVES ON LUNG CANCER

NCCS Scientists and Oncologists specialising in the research and treatment of lung cancer turned out in full force at the Singhealth – Duke-NUS Scientific Congress to give insightful updates about the top killer disease. VERONICA LEE reports.

Proposal to ban tobacco products

Perhaps one of the more engaging presentations that benefited not only the healthcare professionals but the public as well was Prof Koong Heng Nung’s proposal to deny the use of tobacco products for Singapore citizens born in or after the year 2000. The Senior Consultant and Head of NCCS Department of Surgical Oncology enumerated the benefits and implications of his proposal before an attentive audience.

Despite several effective campaigns and measures that have brought down smoking prevalence rates from 20% in 1984 to 13.6% in 2007, the number of smokers

between the ages of 12 and 18 has increased significantly. This was mirrored by the worldwide trend where smokers picked up the habit in their teenage years and this continued in their adult life.

Prof Koong highlighted the rite of passage that many have come to associate with smoking, an activity seen to be connected with maturity and adulthood. Many youngsters are under the false notion that smoking is synonymous with the coming of age and is an accepted practice for adults.

Current laws make it difficult for cigarette vendors who have to do a mental calculation of the birth rates to ascertain whether or not the buyer is under-aged. Given this difficulty, Prof Koong proposed that a tobacco ban based on a fixed birth year would be easier to enforce.

Although such a proposal may mean limiting one’s freedom, only less than 11% of the total population surveyed in the Singapore Lung Cancer Awareness Study 2007 felt that the proposal impinged on personal rights and freedom.

The proposal also aimed to minimise immediate hardship to the tobacco industry in that smokers who were of the legal age could still continue smoking and slowly phase out tobacco use without a sudden ban which was impractical given the economic repercussions of an immediate loss of excise revenues. This thus fulfils the industry’s assertion about not attracting new smokers.

‘Proposal To Deny Access To Tobacco For Those Born From year 2000’(A/Prof Koong Heng Nung)

Although such a proposal may mean limiting one’s freedom, only less than 11% of the total population surveyed in the Singapore Lung Cancer Awareness Study 2007 felt that the proposal impinged on personal rights and freedom.


PAGE A3

In Focus

Female Never-Smokers with East-Asian ethnic background have better chance of survival following chemotherapy

Increasingly it has been found that people who do not smoke also suffer from lung cancer, suggesting that there are host differences in susceptibility to lung cancer and the presence of other risk factors. About 15% of men and 53% of women who do not smoke develop lung cancer, owing to their exposure to secondhand smoke, asbestos, radon and related substances, air pollution and smoke from cooking.

However, the good news is that never-smokers with East Asian ethnicity and adenocarcinoma make-up are more likely to respond to treatment than their western counterparts. This was found in the recent clinical development of the epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs), gefitinib and erlotinib. Mutations in the EGFR kinase domain are more common and patients with these mutations have increased sensitivity to EGFR TKIs.

Integrated Signature is valid in predicting clinical outcome for early stage lung cancer

Traditionally, treatment for stage 1&2 Lung Cancer is surgery. This has been effective as the survival rate for patients after surgery is 40-50%. However, about 30% of survivors may suffer a relapse and die within five years. Hence there is the need to accurately identify patients who might benefit from adjuvant chemotherapy.

However, Dr Patrick Tan, Principal Investigator, Division of Cellular and Molecular Research, who presented

'Genetic Analysis of Lung Cancer' shared that the solution may not be as straight forward as it seemed. Findings from the CALGB 9633 trial had showed that while there was potential survival benefit for adjuvant chemotherapy in Stage 1B Lung Cancer, an update from the same trial showed no benefits.

Dr Tan suggested that Stage 1B Non Small-Cell Lung Cancer (NSCLC) was thus ideal from which genomic strategies could be further researched, to classify patients with low and high risk of recurrence, with adjuvant therapy being a treatment option for high-risk patients.

With one of the biggest challenge of NSCLC being chromosonal instability that contributes to inaccuracies in predicting tumour behaviour, Dr Tan highlighted that a prognostic signature solely based on gene expression may not be adequate. Rather, it is the integration of genomics and gene expression information, or what he called integrated signature, to derive a survival model rooted in recurrent CNAs associated with NSCLC that may be the best bet.

Dr Tan however cautioned against specific genomic abnormalities which may be present among Asians and thus render western benchmarks irrelevant. Studies have shown that non-tobacco related risk factors exist and never-smokers constitute a portion of lung cancer patients, having been exposed to cooking fumes. Different tissue behaviour was also discovered between smoker and never-smokers.

‘Genetic Analysis of Asian Lung Cancers’(Dr Patrick Tan)

Approximately 30-40% of NSCLC patients in Asia and 10-15% of Caucasians have EGFR mutation-positive tumours and over 70% of these patients are women in Singapore.

Prof Hui Kam Man, Head of NCCS Division of Cellular and Molecular Research, presented these findings of the study, in which gene expression profiling to measure all the mRNA in the lung tumor tissues of these patients was carried out. The team has also identified gene signatures associated with better treatment responses to chemotherapy and prolonged survival for female never-smokers patients with adenocarcinoma of different ethnic backgrounds. Further molecular evidence was also presented to demonstrate that Chinese female never-smokers with adenocarcinoma is not a homogenous population and the responses to treatment could also differ within this group of patients.

‘Is East Asian Lung Adenocarcinoma a Distinct Disease’(Prof Hui Kam Man)

Continued on page A4.


PAGE A4

In Focus

Genomics techniques is useful in unraveling drug resistance

About $1.2 million people suffer from lung cancer annually. Majority present in the advanced stage and even in those patients that undergo surgery, a significant proportion of cases eventually recur. Advanced stage lung cancer (Stage 3B and 4) is traditionally treated with chemotherapy, with response rates of approximately 20% with a median survival of six months.

For the past three decades, selection of chemotherapy regimens for the

treatment of NSCLC has largely been empirical. However, with the advent genomic technologies, there is now an improved understanding of the disease biology that has led to classifying lung cancer into molecular subtypes. Importantly, these subtypes are now amenable to targeted therapeutics, especially in the era of mechanism-based drug discovery. In the landmark IPASS study, in which NCCS was one of the participating sites, 1,217 patients were randomly allocated to either gefitinib (an EGFR tyrosine kinase inhibitor) or carboplatin-paclitaxel. In approximately two thirds of patients that harboured the EGFR mutation, response rates were 70%, and the overall median survival 22 months.

Genomics techniques have also been useful in unravelling drug resistance mechanisms – the common reason for treatment failure. Elucidating these mechanisms allow the development of rational strategies to overcome them. A critical aspect is the need for discovering and developing new biological markers – or biomarkers – that can help in directing these treatments.

However, Dr Daniel Tan, Associate Consultant, Department of Medical Oncology, NCCS warned that while identifying biomarkers that predict for drug response promise to improve cancer management, it is important that they undergo sufficient rigor to ensure their validity, reproducibility and repeatability. Indeed an inaccurate biomarker may be misleading – resulting in unnecessary patient exposure to ineffective drugs, or conversely patients wrongly deprived of useful treatments. A new generation of clinical trials is necessary to meet these evolving concepts of patient selection in targeted therapeutics.

Dr Tan also shared that such translational studies are resource-intense, requiring multidisciplinary input involving oncologists, basic scientists, radiologists, pathologists as well as other disciplines. The crucial components of such an infrastructure are already available in NCCS and the Outram Campus, and the next few years hold tremendous promise for lung cancer patients.

‘How Genomics has transformed the Therapeutic Landscape of Non Small Cell Lung Cancer’Dr Daniel Tan

Continued from page A3.

The SingHealth – Duke-NUS Scientific Congress is an annual event that promotes the exchange of medical and healthcare expertise through quality fellowship and educational activities. Held at the Suntec International Convention and Exhibition Centre, it attracted more than 2,500 healthcare professionals this year.

For the past three decades, selection of chemotherapy regimens for the treatment of non-small cell lung cancer (NSCLC) has largely been empirical. However, with the advent genomic technologies, there is now an improved understanding of the disease biology that has led to classifying lung cancer into molecular subtypes.

PERSPECTIVES ON LUNG CANCER


PAGE B1

Looking ForwardBEAT THE ODDS

Survivors of childhood cancer often find that the illness and its treatment have changed their lives in many powerful and often positive ways. Two young cancer survivors, Marianne and Benedict (names have been changed to protect patients’ identities) share their feelings, thoughts and insight on their fight against cancer. Both have emerged champions. With their outgoing personality and their thirst for life, they have much to celebrate.

S What went through your minds when the doctor told you

that you have lymphoma?

B I asked myself, “How can that be?” I am so young. How could such

a thing happen to me? I remembered my doctor telling me that the tests showed cancerous “lumps” and I needed to be given injections. I thought that it would just be one or two injections like those to cure chicken pox. But then, I realised that it was actually chemotherapy. I was going to lose my hair for sure! I really don’t want that to happen. I can’t imagine myself bald.

M I was not mentally prepared for it. It took me by surprise.

Why must it be me? Why must I be so unlucky? I wanted to escape from it all and stop the treatments.

But at the same time, I felt that the consequences could be serious if I didn’t get treated immediately.

S What were your feelings at that time?

M I had a sudden fear of death as I have so many unfulfilled dreams

and I had just started a new term in school. I cried and felt sorry for myself. The expression on my father’s face made me feel even worse. He was with me in the clinic at that time.

B I felt very nervous and scared because I have heard many things about

chemotherapy. I felt very depressed when I was told that I needed such a treatment.

S What are your feelings now a year down the line?

B Well, I thought I was pretty brave to have gone through all the ordeal

of therapies, countless injections, etc. I also consider myself lucky to be alive. Everyone should really cherish what they have…family, friends, and most importantly their health.

M I’m glad that the worst is over.

“From the time of discovery and for the balance of life, an individual diagnosed with cancer is a survivor.”

NATIONAL COALITION FOR CANCER SURVIVORSHIP

Continued on page B2.

S Anniversaries can be times of pain or joy, and sometimes a mixture of

both. There are different anniversaries for everyone: for some it is the date of diagnosis, while for others it is the last day of treatment. Some feel very anxious as the follow-up with their doctors draws closer. How do you deal with the fear of recurrence and follow-up anxiety?

M My worst worries were actually during treatment, especially during

follow-up with my doctor. What if my blood count is low? What if I have a fever? That means I can’t go for chemotherapy and the date of the final treatment is delayed.

The thought of recurrence does come to mind occasionally. It always frightens and frustrates me. I vented my frustrations on my family and that made me even unhappier. Then I decided to lead life positively. OPTIMISM IS THE MEDICINE!

I started writing in a diary during my therapy. I found it therapeutic and it soothed my emotions. Also, talk to someone who can hear you out. I suggest someone mature, as they make better listeners.

B I am very afraid of a recurrence, as my risk is much higher than any normal

person. However, I live one day at a time because no one can predict the future.

Salubris (S) How old were you when you were diagnosed?

Benedict (B) 20 years old.

Marianne (M) 19 years old.


PAGE B2

Looking Forward

S How did your family and friends react to you having cancer?

M My entire family was very supportive. My dad even stopped

working to keep me company during my treatments. Sometimes I got friends to accompany me during therapies. It is very comforting to have someone there whom I can talk to and distract me from the pain. Adversity is the true test of love and friendship.

B I realise that family and friends play an important role. But at the same

time, I don’t want them to worry too much. Friends didn’t avoid me. On the contrary, I became very close to some of them. I feel truly grateful to them for just being there when I needed them most.

S What do you think would be the most unhelpful thing a person can say

to someone with cancer?

B “Is it contagious and will it spread to me?” That would be an

inconsiderate thing to say.

M “So unlucky for you!”

S What are the helpful things a person can do or say to someone

with cancer?

M Accompany the patient when they go for treatments. One does not

need to say much. Being there is enough. Be supportive and encouraging.

B Cancer can make a person feel very lost and lonely. Just by being there for

the person is good enough.

S Some cancer survivors avoid thinking about the future because

expectations of a long, healthy life have been interrupted by cancer. Commitment to a relationship or a long-term goal may be difficult. Thinking about having children may become complicated. What are your feelings about all this? Have you considered going into a serious relationship, if you are not already in one?

BEAT THE ODDS

B Be strong. It helps to keep an open and positive mind. It doesn’t help to be

depressed all the time. The treatment will make us weak, so mentally we have to be strong to overcome the ordeal.

S What are your plans for the future?

M I would like to pursue my dreams and try to fulfill them. Keeping my body

healthy is also very important.

B To enjoy life because the future is a little uncertain now.

S What advice do you have for young cancer patients still fighting

the disease and for those who have just finished their treatment?

M Most patients feel inferior when they see friends physically fit and active.

That’s a normal reaction because as a young person we want to have fun. You can still enjoy yourself; you just need to be more careful. In fact, I still go on outings with my family, and even karaoke at the community centre where it is smoke-free and less crowded. Our immunity is low, so avoid crowded places to prevent getting an infection.

Some are upset by the hair loss, especially girls. If you have long hair, do cut it shorter before your treatment so that you do not get too upset when your hair starts to fall. It will also be easier to put on a wig when your hair is short.

Do get yourself a wig before your treatment starts. Get someone whom you can trust to go with you when choosing your wig. It is important that you are comfortable with it as you are going to wear it until you no longer need it.

After treatment is over, eat plenty of fruits and vegetables like tomatoes, apples, carrots and broccoli and exercise regularly. They have anti-cancer properties. You can find out more information from the Internet. Rest when you are tired. You need good health to keep living! Remember to smile always and keep a positive mind about the future.

B Yes, a well-balanced diet and a healthy lifestyle are important. Post

treatment follow-up is important. Lastly, trust your doctors and nurses.

Continued from page B1.

M The fear of rejection is always present. If I’m not in a

supportive relationship now, I guess I would not have this much confidence in myself. Going through happy and difficult moments together, you will realise how much your partner loves you. The bond will definitely be strengthened. Just be positive.

I understand most cancer drugs have adverse effects on fertility. Being a young female adult, I am worried about not being able to have children. But then again, I can’t predict the future. Just let nature take its course.

S In the course of your cancer journey, which would you say was

the most difficult period?

B The thought of needles, packets of chemo-drugs, hair loss definitely

put me off. I cannot imagine going through it again. Radiotherapy was more tolerable but I had to disguise all the treatment markings on my body as they are rather obvious to me.

M I agree. Chemotherapy and the side effects are unbearable.

It took me a few days to recover from each cycle.

S Who or what motivated you to press on and fight the disease?

M My family and boyfriend.

B My parents and a few close friends were always there for

me. But most important of all it’s self-determination.

S What was the most valuable experience that you would like to

share with those affected by cancer?

M This illness has definitely given me a different perspective

to life. I have gone through and survived cancer. Not everyone would have that “chance”. I’ve become more matured than most people of my age. Maturity, that’s what I had gained.


PAGE B3

Looking ForwardCAREGIVER SURVIVAL

When our loved one falls ill, we usually get a lot of advice on how to do our job as a caregiver. Most of the advice – well meaning or not – comes from family, friends, neighbours, professionals, or anyone else who feels obliged to tell us what to do. In all of this, there seems to be some consistency. Almost everyone feels we should take care of ourselves and that is good advice.

B eing a good caregiver means taking care of yourself as enthusiastically as you can for your loved one. Take time out from your care-giving duties to find respite in some other activity. Make other arrangements for your

care receiver for a half-day or even an hour to have lunch with friends, go to a movie or the hairdresser. Do it and you will come back to your care-giving responsibilities with renewed energy.

Take relaxation breaks. When the going gets tough, stretch, walk, or practice relaxation techniques. Take time to release daily tension, especially when you are working under pressure. Tension and stress reduce productivity.

Attitudes are very powerful. They determine the way you live. Once you truly understand and accept this basic fact of human nature, you will gain control over everything you do. That includes every decision you make as a caregiver and as a human being.

Attitudes are reflection of your thoughts, feelings and actions. Thoughts are really “self-talk”. They lead to feelings. You cannot have a feeling without first having a thought. Feelings lead to actions. If you tell yourself your care receiver is wonderful, you will think your care receiver is wonderful. You will do things that make both of you feel good. And best of all, you will feel a lot better about being a caregiver and you improve your chances for survival.

Positive attitudes are self-reinforcing. They provide the motivation you need to carry out your care-giving responsibilities with ease and spontaneity. They give you a practical outlook on life and inspire you to achieve your care-giving goals and objectives. Develop a positive attitude and you will be able to acknowledge and accept your darkest feelings – anger, resentment, and fear – and know why they are there. Take control of your attitudes toward care-giving and you will experience those feelings without guilt. Share those feelings with people who care about you to get the support you need.

Maintain a positive attitude and you will nurture your self-esteem and your sense of humour. Laughter and a sense of humour provide an effective anti-depressant that does not require a prescription. And best of all it is free!

Remember that things always turn out best for people who make the best of the way things turn out.

By Flora Yong, Manager, Community Partnerships and Fund Raising, NCCS

Here is a checklist of things you can start doing right now to develop a positive care-giving attitude:

• Be flexible in dealing with people and events.

• Set realistic goals for yourself and meet them.

• Forgive yourself for mistakes and learn from them.

• Accept the things you cannot change in yourself or others and move ahead.

• Take satisfaction and pride in your accomplishments and do not dwell on your shortcomings.


PAGE B4

Tender Care LIFE AFTER TREATMENT, NOW WHAT?

You have been active in fighting your cancer and now you have made it through treatment. It looks like things are going well but this can be a scary time and often people ask themselves, “Now what?”

For some people, having to adjust to no longer being sick is uncomfortable. Cancer has become a big part of their lives while they were living with and fighting the disease. Losing that focus can take some getting used to. Often the expectation is now that treatment is over, you should be happy. Quite frequently, this is when a person can become depressed.

A llow yourself some time to move through this, but if it lingers too long, do not hesitate to seek help to get you

through this period. Others may think you should be able to get right back to your old routine. Depending on the duration and type of treatment, this could take a while.

PSYCHOLOGICAL AND PHYSICAL REACTIONSIt is likely that you are going to experience one of the various psychological or physical responses common to those of us who have recently completed cancer treatment. These responses can last from three months to a year. Many of us will fall into one of two camps: “fight or flight” or “drained and empty.”

FIGHT OR FLIGHTFor some of us, long after treatment ends, our body continues to pump out high levels of the hormone adrenaline, which is the way it responds to the sense of panic that a cancer diagnosis and treatment can invoke.

Steroids and other drugs given with chemotherapy may also impact how this and other hormones are received and processed. The fight-or-flight response may give us an almost manic sense of hyper-awareness, energy, or even euphoria.

For some of us, this emotional high leads to a highly creative, very productive time. At the same time, it can and often does impair judgment. If you recognise these symptoms in yourself, you might want to consult your doctor to make sure they are within a “normal” range.

DRAINED AND EMPTYOthers may be at the opposite end of the spectrum, completely drained of energy and finding basic tasks like childcare or housework beyond their strength or abilities.

Those of us in this camp may need to re-allocate responsibilities and take frequent naps to get through the day. Some of us will be unable to work more than part time or even to engage in hobbies we used to enjoy.

It can be hard to tell where normal post-treatment exhaustion stops and depression creeps in. That is why it is important to maintain contact with the support groups you joined during active treatment, and to talk openly about how you are feeling when you meet with your medical team for check-ups.

NEW NORMALPeople often rush to unrealistic expectations, once treatment is finished. Returning to “normal” varies for everyone; for some it happens quickly and for others it takes longer, sometimes a year or more. It is common to have varying levels of anxiety about future appointments and tests. Being seen less frequently by the doctor can trigger fear and worry. Trust that your treatment team knows what a good schedule is for your follow-up appointments.

No matter how far from normal your post-treatment life may be, it is up to you to create and embrace some sort of routine. Whether this means getting yourself out of bed at a certain time every day or taking a nap after lunch, a new routine gives you a calming sense of order and the structure to start your new life.

By Flora Yong, Manager, Community Partnerships and Fund Raising, NCCS


PAGE B5

往前看看护者的生存之道

当我们发现至亲病倒时，往往会有很多人开始向我们提

供各种建议，告诉我们应该如何扮演好看护者的角色。

无论出发点是什么，大多数的建议都来自那些认为自己

有义务教我们怎么做的人。他们可以是我们的家人、朋

友、邻居、专业人士或任何人。这些建议都有一个共同

点—几乎所有人都认为我们应该好好地照顾自己。那是

个非常恰当的建议。

保持乐观，你会发现自己的自尊心和幽默

感会日渐加强。开怀大笑和幽默感是有效

的抗抑郁药，它不需要医生的处方，随时

可得。最重要的是，它是免费的！

你也可以培养正面的看护者

心态，下面是一些你现在就可

以开始做的事情：

• 待人处事要懂得灵活变通。

• 为自己设定实际的目标，确保自

己能够达到目标。

• 原谅自己所犯的错并从中学习。

• 接受自己无法改变的人事物，并

向前迈进。

• 满足于自己的成就并以此为傲，

不要拘泥于自己的不足之处。

记得，无论好坏，只要尽力必定会看到曙光。

作者：杨宝燕

高级护士经理新加坡国立癌症中心

要当一名出色的看护者，你首先必须积极地照顾好自己，就好像照顾你的

亲人一样。无论你的看护工作有多繁重，你都应该抽出时间休息，让自己从

事其他活动。安排其他人照顾你生病的家人，让自己有时间跟朋友吃饭、看

电影、或去理个发，即使那只是半天或一个小时的空间。这么做不但有助于

减轻疲惫，当你再担起看护者的职务时，你会发现自己更有精力继续下去。

抽出时间让你的身心轻松一下。当你感觉精疲力竭时，拉拉筋、走一走、或

做一些有助于放松的技巧。尤其当你面对压力时，更应该拨时间抒发每天所

面对的紧张情绪。处于紧张的情绪和压力都会减低生产力。

你的心态具有很大的影响力。它将决定你的生活方式。一旦你了解并接受人

性的这点，一切就会在你的掌控中，这包括你所做的每个看护决定和每一个

人生决择。

心态会影响你的思考、情绪和行动。思考是自我对话的过程。它会引发情绪。

我们不可能在没有思考的情况下产生情绪。情绪则会引发行动。如果你告诉

自己受你照顾的病人是个非常好的人，你自然就会这么想。你会自然地做出

让你们都开心的举动。此外，你会更肯定自己的看护者角色。这么一来，你

生存的机会也会随之提高。

正面的心态会自我强化。这些的心态会鼓励你在履行责任的过程中更轻松

也更具自发性。这种心态会给你一个实际的人生观，也可以启发你朝自己的

看护目标迈进。培养正面的态度后，你将更能面对并接受你内心潜藏的黑

暗情绪—愤怒、怨恨和恐惧—你会知道他们为什么存在。若能掌控你的看

护心态，就算你面对这些情绪，你也不会内疚。跟那些关心你的人分享你内

心的感受，这样一来你才可以得到支持。


PAGE B6

温柔呵护完成治疗后的新生活

一直以来，你都积极地同癌症抗争，现在你

完成了治疗，战胜了癌细胞。表面上看来，

一切都好像是一帆风顺，但实际上对很多

人来说，这段时间可能很可怕。很多时候，

他们会问自己：“接下来怎么办？”

心理和生理反应

刚完成癌症治疗的人一般可

能会面对一些心理和生理的

反应。这样的状态可能会持

续三个月到一年。多数人会

陷入“战或逃”或“精疲力竭

和空虚”的心理状态中。

战或逃

当得知自己患上癌症或在接受治疗时，我们会感到惊慌。排放肾上腺素是身体面对惊

慌时的自然反应。但完成治疗后，一些人的身体可能还会继续排出大量的肾上腺素。

化疗过程中所施与的类固醇和其它药物可能影响这类和其它激素的接收和处理方

式。“战或逃”的身体反应可能会让我们处于高度警惕、能量过剩或甚至极度愉快的

疯狂状态。

对一些人来说，这样高涨的情绪可能激发创意并提高生产力。但与此同时，它也可能使

我们的判断出现误差。如果你发现自己有这样的状态，你可向你的医生咨询，确保它们

处于“正常”范围。

对一些人来说，要重新适应不再生病的日子过程可能不太好受。

在和病魔共处、互相搏斗的日子里，癌症占据了它们生活的一大

部分。现在失去这个重心，他们需要一些时间适应。很多人往往

会先入为主地认为，疗程结束了，应该开心才对。但更常见的情

况是，这是他们陷入抑郁的时候。

给自己一些时间，让自己适应这个过渡期。如果过渡期太长，不

要犹豫向其他人寻求援助，帮自己更容易渡过这段时日。其他人

可能以为你可以马上回到以前的生活。但每个病人所接受的治疗

不同，治疗期也不同，要重新适应可能需要一段时间。


PAGE B7

温柔呵护

精疲力竭和空虚

其他人可能处于截然不同的状态，他们完全精疲力竭，就连照料孩子和家务这类

基本的日常琐事都无能为力。

那些属于这一阵营的人可能需要别人帮他分担责任，一天也可能要小睡几次。一

些人也可能需要减轻工作量，只在部分时间工作，有的甚至无法再从事以往喜欢

做的活动。

治疗后所引起的疲倦和抑郁之间界限可能很模糊，前者几时结束、后者几时开始

可能难以分辨。所以继续跟互助小组保持联系非常重要。此外，当你复诊时也可

以向医护团队坦白自己的心情。

新的常态

一旦治疗完毕，多数人都会马上对

新的常态设定很多不切实际的期

望。实际上，回复到“常态”的路程

因人而异；对一些人而言过程可能

很短，对另一些人而言可能要一年

或更长的时间。如果你对跟进复诊

的预约和所需接受的检测感到焦虑，

这是正常的。复诊的次数减少也可

能让你感到恐慌和担忧。相信你的

治疗团队，他们知道你什么时候需

要复诊。

无论你完成治疗后的生活离正常

生活作息多远，你必须为自己设定

并遵循一套日常作息。这可以以任

何形式呈现—可以是每天早上在一

定的时间起床、在午饭后小休片刻

等—拥有新的一套生活作息可以为

你的新生活注入一份安定和次序。

作者：杨宝燕

高级护士经理新加坡国立癌症中心

刚完成癌症治疗的人一般可

能会面对一些心理和生理的

反应。这样的状态可能会持

续三个月到一年。多数人会

陷入“战或逃”或“精疲力竭

和空虚”的心理状态中。


PAGE B8

Outreach UPCOMING PUBLIC EDUCATION ACTIVITIES / PROGRAMMES

Event Name

ADVANCES IN BREAST SURGERY

Care for breast cancer patients has evolved tremendously and many treatment options are now available for patients. Get a comprehensive update on oncologic treatment and breast reconstruction by experts from National Cancer Centre Singapore and Singapore General Hospital about the advances in breast imaging, oncologic surgery, systemic therapy and radiotherapy and the variety of options for breast reconstructive surgery.

T his engaging meeting aims to provide participants with the optimal care and treatment strategies for breast cancer from clinical experts who will deliver cutting-edge knowledge from their individual perspectives.

Topics for the meeting include Breast Cancer in Singapore, Breast Imaging, Diagnostic Procedures, Breast Cancer Treatment, Breast Conserving Surgery, Sentinel Lymph Node Biopsy, Principles of Breast Reconstruction, TRAM Flap, Fascia-Sparing TRAM Flap, DIEP Flap, Implant Breast Reconstruction, LD Flap, Surgery for Upper Limb Lymphedema, Surgery for LABC, Chest Wall Reconstruction, Systemic Therapy for Breast Cancer, Radiotherapy, Prophylactic Mastectomy, Bilateral Breast Reconstruction and Use of Alloderm in Breast Reconstruction.

There will also be a workshop where participants can experience hands-on Ultrasound-guided Core Needle Breast Biopsy.

Date, Time, Venue

15 January 2011, Saturday, 8.30am – 2.30pm

Peter & Mary Fu Auditorium Level 4 National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610

Registration Details

To register for this meeting, please make a cheque ($150) payable to ‘National Cancer Centre’ and submit your particulars via www.keepabreast.com.sg.

For more information, please contact Post Graduate Education Unit at (65) 6236 9425/9423.


PAGE A5

CommunityPREETI’S LOVE TRANSCENDS BORDERS

One concert every six months is what 17-year-old Preeti Varathan has been doing since 2007. But one particular concert holds a very special place in the heart of the carnatic violinist – the concert that took place in New York City this July. Preeti raised $40,000 for the National Cancer Centre Singapore in support of cancer research. CHUA HWEE LENG reports.

A young and bright lass,who glows with positive energy, Preeti is no stranger to cancer. The disease

took her mother away from her life when she was only six years old. Her late mother, Madam Hema Devanathan was only 36 years old.

Despite having witnessed her mother’s two-year-long struggle with lung cancer, Preeti did not allow the experience to wane her. Instead, she was determined to be stronger each day, refusing to allow the negative experience to occupy her thoughts.

Withholding tears, she recounted how strong her mother was in her fight against cancer and how the tragic episode had then affected her.

“Before she was diagnosed with cancer, I would read to her when I came home from school. After she was diagnosed with cancer, she started losing her hair and put on a lot of weight due to the treatment she received.

“During later stages, she stayed in her room most of the time. But in spite of that, whenever I got home, she would still let me read to her. It was the kind of consistency; the little things that touched me. She wouldn’t allow her illness to change our routine. I think that was what I really respected in her,” said Preeti.

Now, Preeti lives with this philosophy, “I am not the only person to face tragedy – almost everyone in the world does as well. But we must not let that deter us. We have to move on and pursue what we want for ourselves.”.

Although Preeti was of a young age then, she understood that her mother was suffering from pain. However, Madam Devanathan never showed her weakness in front of the children.

On her mother’s last gift to her, she said, “I think strength is what she has given me.”

After her mother passed away and was cremated, Preeti and her sister accompanied their father to the Bay of Bengal in India to scatter her ashes. That was when she got exposed to the carnatic style of playing the violin. To fill the void in her life, she decided to go under the tutelage of famous Carnatic violinist Sri Vittal Ramamurthy.

She learnt well and put her talent to good use – hosting concerts that raised funds for healthcare causes. This year marked her first solo concert outside India. It was also her first fund-raising concert for the cancer cause. She single-handedly booked the concert hall, printed invitations and posters, and invited two renowned artistes – Neyveli R. Narayanan and Samir Chatterjee – to be her accompanists.

At the concert, which did not come at any ticket price, Preeti gave a presentation on cancer research to her audience. They were strangers to the National Cancer Centre Singapore (NCCS). Preeti won their hearts with her touching presentation and her performance. The nearly 250-member audience donated close to $40,000 for cancer research.

Preeti was not surprised by the warm response despite the almost 10,000 miles separating the beneficiary and the donors, as “this is a universal cause because almost everyone would know someone who is affected by cancer.”

On why she chose NCCS as the beneficiary, Preeti said matter-of-factly, “I have been living here for nearly five years. As an individual in the community, I think the most important thing is to help the community around me.”

Preeti, a permanent resident of Singapore and a US Citizen, has set her sights on going to the US for further studies and may well hold another fund-raising concert in Singapore which will again name NCCS as the beneficiary.


PAGE A6

People CHARITY: HER WAY OF LIFE

I f you’ve seen Flora Yong all dressed to the nines don’t be surprised. For her new role in the NCCS Foundation,

that’s what she needs to do to meet up with corporate chiefs, business tycoons, donors and well-wishers. Perhaps some may still remember her as the woman with that rich and melodious voice making the public announcements twice a day at the Centre during the outbreak of the H1N1 flu some two years ago. Certainly with her demure and confident personality, good vocal chords and a sound knowledge about cancer, Flora is set to open more doors for the Foundation.

With her new appointment as Manager of Community Partnership and Fundraising, she has a mammoth task ahead of her. Together with the Foundation’s Director Dr Tan Hiang Khoon, she will be building a new team for the fund-raising arm of NCCS. No longer is she worried about patient clinical issues. Instead she has to set her sights on how to help raise the millions that are required to support the many cutting-edge research projects undertaken by the clinicians and researchers at the NCCS laboratories.

From Nurse to Administrator and now a Fund Raiser, that’s the span of job scope that Flora Yong has embraced since she joined the National Cancer Centre Singapore.

The newly-appointed Manager at the NCCS Foundation, shares her thoughts with VERONICA LEE.

While she may not have worked in the laboratories, Flora is certainly familiar with medicines and their roles in saving lives. She was trained as a Staff Nurse before rising to Nurse Manager in the Singapore General Hospital. She joined NCCS in May, 1999 and started the Cancer Education and Information Service (CEIS), whose role was to provide public education on cancer and also to answer public inquiries on the Cancer Helpline.

Under her watch, CEIS introduced many cancer awareness programmes for patients and the public and produced the inaugural issue of a newsletter that has an audience of 22,000 readers. The Cancer Helpline also took off successfully since it was launched in September 2000 attracting more than 90 calls on the first day of its operations.

The helpline now gets an average of 350 contacts per month. Here she learnt to understand the demands and anxieties of the patients, and despite the heavy workload she had the satisfaction of being able to offer a listening ear and knowing that a few helpful words had calmed the nerves of the callers.

Indeed, the love of sharing and offering her time for charitable causes was imbued in her since her growing up years in Batu Pahat, Johor. She would take part in fund-raising activities like Flag Day or sell cookies, cakes and candies baked by her mother, to support charitable causes. During the Christmas season, she would join a youth group of carolers to make their rounds to raise funds for the needy. As a Girl Guide in school, she visited old folks’ homes to help clean up their premises and bring cheer to them.


PAGE A7

People

Looking back at her childhood, she surmised that her love for charity just blossomed from there. “Helping did not mean much to me as a child. I just knew I had to be a good little girl and help whenever it was needed. Giving help holds a much deeper meaning to me now as an adult.

“It’s not only about giving money. It’s also about giving kindness in words and in deeds and that helps a lot especially to those who are faced with life-threatening illnesses. They need kind words and hands to hold on to for strength as they go through their arduous cancer journey,” said Flora who is someone who walks the talk.

She has offered her paintings for sale at a recent art exhibition in a bid to raise funds for patient support programmes. With her new role at NCCS Foundation, she feels she has come full circle and is all set for the greatest challenge – to raise funds for cancer research. Barely weeks into her job, she was thrown “into the deep end” and was roped into the working committee for the Run for Hope which was held on 21 Nov. The Run drew a record 7,000 participants and was organised jointly with the Four Seasons Hotel and the Regent Hotel.

She tapped on her network and worked with Borders Bookstore for convenience of registering prospective participants at the bookstore in Orchard Road. In December, she arranged for teams of volunteers to do gift wrapping at the bookstore. In return, NCCS Foundation will sell the gift cards to raise money for cancer research.

When asked why she felt charity was so important to her, she replied, “I have received many acts of kindness in my life. Although they were not monetary in value, each of them taught me valuable lessons on being generous and kind to others. So I want to keep this flame alive and pass it on to others. Everything comes full circle, I believe what I give now will be returned at a time when I least expect it and when I most need it.”

“It’s not only about giving money. It’s also about giving kindness in words and in deeds and that helps a lot especially to those who are faced with life-threatening illnesses. They need kind words and hands to hold on to for strength as they go through their arduous cancer journey.”

Flora Yong

Flora (second from left) with the former President Wee Kim Wee.

Although she was at first apprehensive about her role in fund raising, Flora decided to take on the challenge as she believes she can help the Foundation to move on to its next phase given her background knowledge of NCCS. She sees it as an opportunity to push boundaries and see how far she can go. Speaking before audiences is something she does with confidence, having been the founding President of the SingHealth Toastmasters Club in 2004.

But it is still early days as Flora confesses. The team is new and her immediate task is to help the team members learn the ropes. Believing that each of her team members have their own talents, she hopes they will contribute effectively and work cohesively towards the long term goals of raising funds and maintaining lasting relationships with donors.


PAGE A8

SALUBRIS is produced with you in mind. If there are other

topics related to cancer that you would like to read about or if you would like to provide some feedback on the articles covered, please email to [email protected].

NATIONAL CANCER CENTRE SINGAPOREReg No 199801562Z

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

Editorial Advisors Dr Kon Oi Lian Prof Soo Khee Chee

Executive Editors Ms Chua Hwee Leng Ms Veronica LeeMr Sunny Wee

Contributing Editor Dr Wong Nan Soon

Members, Editorial Board Ms Sharon Leow Mr Joshua TanMs Flora Yong

Medical Editor Dr Richard Yeo

Members, Medical Editorial Board Ms Lita Chew Dr Mohd Farid Dr Melissa Teo Dr Teo Tze Hern Dr Deborah Watkinson

NCC Foundation NCCS CANCER CAUSES GET A STRONG BOOST FROM THE COMMUNITY

The desire to help cancer patients and give them the hope to overcome their ordeal has won many kind hearts to

support the cause promoted by NCCS.

The NCCS cause is that for every dollar that is spent on research, the benefit to the community will be more far reaching than a dollar given to just one patient. A breakthrough in medical research will save more lives than monetary handouts to the patients. Without a cure, the outcomes for the patients will be a forgone conclusion.

In the last quarter of 2010 NCCS, through various activities carried out by its Foundation, the fund-raising arm for cancer research as well as patient welfare, the support has been very encouraging.

A good example is the effort undertaken by the Methodist Girls’ School teachers and students, together with their parents.

As a finale to the year, NCCS saw another successful Run for Hope, an annual charity run in support of cancer research. Jointly organised by the Regent Singapore, Four Seasons Hotels & Resort, the event saw 7,000 runners this year, a huge surge in the number of runners compared to last year’s 6,000 signed up. One school of thought is that this increase may be indicative of the increasing number of people who are beginning to see the value in cancer research and in helping others who are less fortunate. A sum of $320,000 was raised from this run.

Prof Soo Khee Chee, Director of NCCS felt comforted by the response and generous donations from participants and well-meaning organisations. “We are very heartened by the overwhelming participation this year. It goes to show that many people understand the importance of cancer research…This will definitely encourage us at NCCS to put in even greater effort as we continue with our research work to find a cure for cancer.”

The Run for Hope also continues to see its regular supporters from all communities in Singapore including expatriates, who apart from taking part in the run, also helped out for the event. More than 500 volunteers from Temasek Polytechnic, Hwa Chong Institution and Canadian International School came forward to help with race pack collection, marshaling and snacks distribution.

NCCS researchers and doctors have not disappointed the donors. They have been making in-roads and more patients are getting better outcomes from their treatment.

By Veronica Lee

The students from both the primary and secondary cohorts of the school, which is located at Blackmore Drive, presented another charity concert – for the second year.

Entitled Sounds of Hope, the charity concerts were the brainchild of Mrs Shirleen Ong, Principal of the school, who wanted to support the cancer cause by expending her students’ artistic talents. Through sales of concert tickets, food items, MGS souvenirs and soliciting of donations from the parents, the school has raised close to $128,000 during the two years.

This year also saw the students expending their efforts beyond fund raising. The students had embarked on several educational projects such as the creation of cancer blogs and the production of a storybook that was titled “Safaree” to illustrate the value of friendship and acceptance of one another.

salubris - november / december 2010

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