salubris oct - dec 2014

RESEARCH UNCOVERS NEW TOOLS TO HELP DIAGNOSE BREAST CANCER

AN NCCS QUARTERLY PUBLICATION October – December 2014

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

...HELPING R EADERS TO ACHIEVE GOOD HEALTH

Issue No. 31 • MICA (P) 140/03/2014

DISCOVERY OF FREQUENT GENE MUTATIONS IN BENIGN BREAST LUMPSBY 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.

2 SALUBRIS OCTOBER – DECEMBER 2014

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”.

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 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.

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.

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.

Histopathology of Fibroadenoma (higher magnification)

Histopathology of Fibroadenoma (low-power magnification)

3SALUBRIS OCTOBER – DECEMBER 2014

BREAST CANCER SURGERY IS SAFE FOR ELDERLY PATIENTSBY 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.

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.

“Surgery should always be considered

even among elderly patients and performed

expeditiously.”

DR ONG KONG WEE


PATIENT PROFILEMDM 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.

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

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.”


DOING GOOD BY WALKING DOWN MEMORY LANEBY 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.

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).

More than 20 different varieties of snacks and beverages were made available to staff.

When accuracy matters more than strength…


Grand finale to the week’s long Kampung Days Nostalgia… Everyone has their lucky draw tickets ready?

Just get me a drink…

Aim for the stars with ping pong balls. Kampung originated games: Five stones, paper balls and captehs.

* 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.

BINGO! An employee in the background in disbelief.

“Live” screening of Bingo Draw. An employee matching his Bingo card to the number. Can Buddie save the ball?


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).

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

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.

CT scan with arrow indicating kidney tumour

Nephrectomy specimen showing a renal cell carcinoma composed of a tumour mass with yellowish and hemorrhagic areas (arrow).


NATIONAL DAY AWARDS 2014

CONGRATULATIONS!

NURSES’ DAY AWARD

LONG SERVICE AWARDEFFICIENCY AWARD

MERIT AWARD

IRENE CHAN

Principal Radiation Therapist

Division of Radiation Oncology

YOONG YIM KUEN

Principal Radiation Therapist


GINA HOW

Nurse Manager

Specialist Oncology Clinic

SUKARMI BTE KATANI

Senior Executive


DR FONG KAM WENG

Head, Senior Consultant


CHUA GEK PHIN

Director

Nursing

WONG SIN HUI

Senior Staff Nurse

Infection Control Unit


CANADA

USA

UK

CHINA

INDIA THAILANDPHILIPPINES

INDONESIA

MALAYSIA

AUSTRALIA

NETHERLANDS

JAPAN

SINGAPORE

Runners from OVER 45 COUNTRIES participated in Run For Hope SG last year.Most of our supporters came from...

AREAS WE RANTo make it more accessible for the

increasing number of runners, venues were shifted over the years.

15,000 RUNNERSThis year, we hope to reach out to

Join us in paving the way for cancer cures!

The Promontory @ Marina Bay

2013 & 2014

ECP Casuarina Grove 2008

ECP Angsana Green2009 ~ 2011

The Padang 2012

SAVE THE DATE!

SIGN UP AT WWW.RUNFORHOPE.SG

THE PROMONTORY @ MARINA BAY10KM @ 7.00AM | 3.5KM @ 7.30AM

16

NOV, 2014SUN

You can also support by making an online donation via www.sggives.org/NCCRF

RUN FOR HOPE ON 16 NOV 2014 IN SUPPORT OF CANCER PATIENTS & RESEARCH!

WHO WOULD YOU RUN FOR?

National Cancer Centre Singapore co-organises Run For Hope with

Four Seasons Hotel Singapore & Regent Singapore in support

of cancer research!

It’s the 7TH YEAR

Singapore Civil Defence Force created a new record last year with

37,837 RUNNERS ran with us over the past 6 years

> 247,200KMTotal accumulative distance covered by Run For Hope runners since 2008

> 600 VOLUNTEERSsupported the event last year

106 CORPORATIONS have supported the run through staff sign-ups in the last 3 years

THE COLOURS OF HOPEOptimism & HopeResearch gives hope

Health Good health is the

foundation of success

Love & FriendshipCaregivers & Supporters are an important source of strength

Knowledge Research empowers us with knowledge

BY GILLIAN TAN, Executive, Corporate Communications

492 STAFF RUNNERS

RunForHopeSg

More details at www.runforhope.sg

> $2 MILLION raised through the run over 6 years

in aid of cancer research at NCCS


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. CEIS/PEM-BSE-2014/07

"Lying down" position

Email us: [email protected]

Report any lump, discharge or changes to your doctor or nurse immediately. Cancer Helpline: 6225 5655

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.

• Bloody discharge from the nipple.

• A change in the nipple or areola.

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.

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.

• Mammogram Screening – once a year if you are 40-49 years old, once every 2 years if you are 50 years and above.

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.

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.


乳腺癌检测：迈出第一步洪慧慧，高级护士傅慧君，执行人员癌症教育与资讯服务

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中会经历许多变化。这些变化多数是源于我们身体的生殖激素水平的波动。这些激素水平会在排卵期，月经，怀孕和更年期时，有所改变。

要了解自己的乳房，并分辨什么变化是不正常的，最好的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。

• 乳房或腋下长有硬块或变厚，而且持久不消；

• 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；

• 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

随着年龄的增长，激素水平会逐渐下降，乳房也会经历多种变化。这些变化可能包括异常的疼痛及/或肿胀、肿块、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。


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 FIRSTWhen 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?’.

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.


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).

Continued on page 16.

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.


ALL FOR ONEAfter 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.

Continued from page 15.

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).

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.


“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.

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.

SINGAPORE YOUTH AWARD 2014 – DR IAIN TAN“Pursue your passion, pursue excellence. Do not settle, stay resilient and persistent.”

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.

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.”

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.


NCCS GP SYMPOSIUM 2014BY 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.


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?”

A/Prof Simon Ong engaging the audience on “The Art of Clinical Medicine in Oncology – Cancer Care Vignettes”

Panel Discussion and a lively dialogue between Oncologists and Family Physicians

Dr Vijay Sethi delivering an inspiring plenary lecture on “Life, Liberty and the Pursuit of Happiness”

A/Prof Koo Wen Hsin debating on “Can Cancer be Prevented? Separating Fact from Fiction”


OUTREACH – PUBLIC FORUMS & CANCERWISE WORKSHOPS

Event Date, Time, Venue Registration

Breast Cancer Awareness Month Public Forum

TOPICS:• Intra-operative radiotherapy for early Breast Cancer• Adjuvant treatment for Breast Cancer• Cancer and nutrition• Rehabilitation after Breast Cancer surgery

11 October 2014, Saturday

MANDARIN SESSION Time: 10.15am to 12.15pm (Registration: 10.00am to 10.15am)

ENGLISH SESSION Time: 1.00pm to 3.15pm (Registration: 1.00pm to 1.15pm)

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

Free Admission

Strictly No Admission for children below 12 years old. Registration is a MUST as seats are limited.

REGISTRATION IS BY PHONE ONLY

Please call: 6225 5655 Monday to Friday: 8.30am to 5.30pm

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


Session will be conducted in English.

1.00pm – Registration 1.30pm to 3.30pm – Workshop starts

Level 4 Function Room National Cancer Centre Singapore 11 Hospital Drive Singapore 169610

Free Admission




CancerWise Workshop – Lung Cancer

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

1 November 2014, Saturday

Session will be conducted in English.

1.00pm – Registration 1.30pm to 3.30pm – Workshop starts

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

Free Admission




Upcoming Event Date, Time, Venue

Breast Cancer Awareness Month Roadshow

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.


SEMINARS / FORUMS / TUMOUR BOARDS / SMC-CME ACTIVITIES

OCTOBER 2014

Date Time Event Information CME Pt Registration Contact

2, 16 5.00pm NCCS-SGH Joint Lymphoma Workgroup Meeting

@ NCCS Level 2, Clinic C, Discussion Room

1 Tan Si Xuan / Rachel Tan 6436 8280 / 6436 8172 [email protected] / [email protected]

30 5.00pm NCCS Neuro Onco Tumour Board Meeting


1 Low Peak Wah / Ang Hui Lan 6436 8165 / 6436 8174 [email protected] / [email protected]

30 7.30am Endocrine and Rare Tumor Meetings:


1 Tan Si Xuan / Rachel Tan 6436 8280 / 6436 8172 [email protected] /

[email protected]

1, 8, 15, 22, 29

1, 8, 15, 22, 29

13, 20, 27

4.30pm

5.00pm

5.00pm

NCCS Tumour Board Meetings:

Sarcoma Tumour Board Meeting

General Surgery Tumour Board Meeting

Head & Neck Tumour Board Meeting

@NCCS Level 2, Clinic C, Discussion Room

1

1

1

V. Kalai / Lim Shufen 6436 8294 / 6436 8283 [email protected] / [email protected]

Daphne 6436 8592 [email protected]

2, 9, 16, 30 Lung Tumour Board Combine SGH-NCCS Meeting

@ SGH Blk 2 Level 1, Radiology Conference Room

1 Christina Lee Siok Cheng 6326 6095 [email protected]

1, 8, 15, 22, 29 1.00pm Hepatobiliary Conference

@ NCCS Level 4, Lecture Hall

1 Lim Shufen / V Kalai 6436 8283 / 6436 8294 [email protected] / [email protected]

17 1.00pm Journal Club

Topic: To be advised

@ NCCS Level 1, Mammo Suite Discussion Room

1 Phua Chay Sin 6436 8043 [email protected]

24 1.00pm Teaching Session






NOVEMBER 2014



@ NCCS Level 2, Clinic C, Discussion Room 1

Tan Si Xuan / Rachel Tan 6436 8280 / 6436 8172 [email protected] / [email protected]



Low Peak Wah / Ang Hui Lan 6436 8165 / 6436 8174 [email protected] / [email protected]

27 7.30pm Endocrine and Rare Tumour Meeting


Tan Si Xuan / Rachel Tan 6436 8280 / 6436 8172 [email protected] / [email protected]

5, 12, 19, 26

5, 12, 19, 26

3, 10, 17, 24

4.30pm

5.00pm

5.00pm






1

1

1

V Kalai / Lim Shufen 6436 8294 / 6436 8283 [email protected] / [email protected]


6, 13, 20, 27 11.30am Lung Tumour Board Combine SGH-NCCS Meeting



5, 12, 19, 26 1.00pm Hepatobiliary Conference


1 V Kalai / Lim Shufen 6436 8294 / 6436 8283 [email protected] / [email protected]

21 1.00pm Journal Club




28 1.00pm Teaching Session






DECEMBER 2014







1 Low Peak Wah / Ang Hui Lan 6436 8165 / 6436 8174 [email protected] / [email protected]

18 7.30am Endocrine and Rare Tumour Meeting



3, 10, 17, 31

3, 10, 17, 31

1, 8, 15, 22, 29

4.30pm

5.00pm

5.00pm






1 V. Kalai / Lim Shufen 6436 8294 / 6436 8283 [email protected] / [email protected]


4, 11, 18 11.30am Lung Tumour Board Combine SGH-NCCS Meeting



3, 10, 17, 31 1.00pm Hepatobiliary Conference


1 Lim Shufen / V Kalai 6436 8283 / 6436 8294 [email protected] / nsokal @nccs.com.sg



JANUARY 2015


7, 14, 21, 28 1.00 pm Hepatobiliary Conference


1 Lim Shufen / V Kalai 6436 8283 / 6436 8294 [email protected] / [email protected]

7, 14, 21, 28

7, 14, 21, 28

5, 12, 19, 26

4.30 pm

5.00 pm

5.00 pm






1

1

1

1

V. Kalai / Lim Shufen 6436 8294 / 6436 8283 [email protected] / [email protected]


8, 15, 22, 29 11.30am Lung Tumour Board Combine SGH-NCCS Meeting



8, 22 5.00 pm NCCS-SGH Joint Lymphoma Workgroup Meeting


1 Jennie Tan 6436 8280 [email protected]

16 1.00 pm Journal Club




27 5.00 pm NCCS Neuro Onco Tumour Board Meeting


1 Saratha / Ang Hui Lan 6436 8165 / 6436 8174 [email protected] / [email protected]

23 1.00 pm Teaching Session




29 7.30 am Endocrine and Rare Tumour Meeting


1 Jennie Tan 6436 8280 [email protected]


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 www.facebook.com/NationalCancerCentreSingapore www.linkedin.com/company/NationalCancerCentreSingapore

Editorial Advisors

Prof Kon Oi Lian Prof Soo Khee Chee Dr Tan Hiang Khoon

Editorial Consultant

Mr Sunny Wee

Medical Editor

Dr Richard Yeo

Executive Editors

Ms Adeline Teo Ms Rachel Tan Ms Siti Zawiyah Mr Edwin Yong Ms Gillian Tan Ms Hazlin Hepbun

Members, Editorial Board

Ms Lita Chew Dr Mohd Farid Ms Sharon Leow Ms Jenna Teo Dr Melissa Teo Dr Teo Tze Hern Dr Deborah Watkinson

salubris oct - dec 2014

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