November/December 2012

IN THIS ISSUE: PCC’s new clinic | Walk-the-Talk outreach | 两度战胜癌症

Stories ofHOPE

Continued next page

Tan Siok Cheng, 47, has survived cancer, not once but twice. In between, she dated, married, had a child and travelled the world. She lived

life to the full, not despite the cancer, but because of it.

“Having had cancer, I take each day I am alive as a bonus,” Siok Cheng explained. “I don’t want to let this disease deprive me of life and the opportunity to be happy.”

“For instance, I have travelled to almost every country in the world. I get on roller coasters. People have asked me why I am so bold. No company would ever insure me. I have a permanent cough which can be triggered by weather changes and bad air. I have to monitor my diet. But I still travel. I won’t let cancer stop me.”

She had her first run-in with the disease in 1990 when she was just 25. While other women were crafting their careers, going on dates and thinking of marriage, Siok Cheng was facing major surgery.

“The first sign I had that something was wrong was when my body swelled. I had water retention, I felt breathless and it was especially bad at night when I could not even lie down to sleep. When I lay flat, I felt as if I was suffocating.”

She was finally admitted to Singapore General Hospital and scheduled for chest surgery. After waking from general anaesthesia, she was told that the surgeon had removed a tumour from her chest.

“They described the tumour as being like an octopus, with tentacles reaching out to my ribs and my lungs,” she said, spreading the fingers of one hand wide to show the nightmarish reach of the growth.

Tan Siok Cheng had cancer at 25, and again at 42. In between, she dated, married and became a mother. She now lives a full life, and says every day is a bonus

Part of her right lung had to be removed. The diagnosis was that she had lymphoma. Lymphoma is a cancer of the lymphocytes, a part of the body’s immune system. Removing the tumour was only the first step. Thereafter, she had to undergo 12 rounds of chemotherapy and five weeks of radiotherapy.

Her right lung was already weakened by the surgery, and was further strained by radiation treatment. She contracted pneumonia and her right lung collapsed. One result of this was that she suffered from racking cough every morning for the next 22 years.

“You really should leave,” she told her boyfriend. They had only started dating months before her diagnosis. She felt that it would be unfair of her to cling to him. What if they got married and she could not bear him children because of her condition? What if she died and left him a widower?

Her advice was sensible but Gary Neo persisted in wooing her. Ten years later, he wore her down. At 35, she said ‘yes’ to his marriage proposal. Her treatment for lymphoma had ended by this time but she was still visiting Parkway Cancer Centre oncologist Dr Ang Peng Tiam for quarterly follow-up.

She had been told that it was near to impossible to conceive. But, who knows? Siok Cheng conceived soon after she got married.

When she broke the news to Dr Ang, his response was mixed. While congratulating her, he said in the same breath: “We’ve got a lot to do.”

Siok Cheng had to be monitored by three doctors

She faced cancer twice

...and beat it

HealthNewsInspiring and informative stories for patients MICA (P) No. 021/01/2012

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Stories of Hope

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throughout the nine months of pregnancy – Dr Ang, a chest and respiratory specialist and a gynaecologist. “If complications happen,” she told her husband, “Give priority to the baby.”

After the delivery of her daughter, Zhi Qing, in December 2000, Siok Cheng felt a renewed sense of purpose in life. The following years were hectic and productive. She successfully juggled childcare with a satisfying career as a part-time administrator in a childcare centre. Years passed and she developed a false sense of security, so much so that when work pressure caused her to miss a routine check-up with Dr Ang in 2006, she did not give it a second thought.

One ordinary day in July 2007, Siok Cheng was taking a shower when she felt a three-centimetre lump under her left breast. With her history, she knew immediately what it was. “It had been so many years since I recovered from lymphoma, I thought I could take care of myself without the doctors’ help. I was wrong,” she admitted ruefully.

She not only had to endure a scolding from herself. A bigger one awaited her in the clinic. Dr Ang’s face was thunderous when she walked meekly into his office. As they had known each other for 17 years by that time, Dr Ang did not hold back. However, after scolding her for her irresponsibility towards her health, he quickly got down to business.

It was Stage III breast cancer. Dr Ang prescribed mastectomy of the left breast and eight rounds of chemotherapy. All the decision-making and surgery were done within five days of discovery of the tumour.

“I cannot emphasise to other patients how important it is to be brave, face facts and act fast,” Siok Cheng said earnestly. “The tumour was invading my left lung at that point in time. Any delay and the cancer would have advanced. I already had a collapsed right lung. If my left lung was compromised, I’d have nothing left to breathe with!”

Dr Ang recalled her admirable courage. “She did not give me the impression that she was fearful, even when she was found to have cancer the second time. There was a quiet confidence that she was going to beat it the second time round.”

Having faced, and conquered, cancer twice, Siok Cheng lives as if each new day is a bonus, yet she is not fatalistic. She has dreams for herself and her daughter. For Zhi Qing, Siok Cheng hopes to cultivate her interest in music and enrol her in music courses. For herself, Siok Cheng reaches out to people who have been diagnosed with cancer.

Oftentimes, Siok Cheng found herself helping them to put their situation in perspective. “Funnily, a lot of cancer patients are most concerned about hair loss after chemotherapy. I tell them: ‘It’s only hair. Shave it off. It will grow back. Your life is more important.’”

Nowadays, Siok Cheng does not skip her follow-up, which she attends every two months. “I am a good girl now,” Siok Cheng says with a sheepish smile.

“The follow-up for each cancer is different,” Dr Ang explained. “Patients with a history of cancer tend to have a higher risk of getting a second malignancy. Continued follow-up is important even when patients have crossed their five-year cancer-free period,” he emphasised.

From cover page

在接受两次癌症治疗后，陈淑贞说：“现在我把活着的每一天当成是额外的奖励”

现年47岁的陈淑贞战胜了癌症—不是一次，而是两次。在接受完第一次癌症治疗后，陈淑贞和其他女生一样谈恋爱、结婚，还生了一名千金。在两次癌症治疗期间，她也到处周游列国，观光享乐。因为癌症让她更能领会“一寸光阴，一寸金”的道理，她不允许自己浪费活着的一分一秒。

淑贞说：“我曾经患上癌症，现在我把活着的每一天当成是额外的奖励。我不会让癌症有机会剥夺我生存的权利，也不会让它掠夺让自己开心的机会。”

“我的身体很弱，天气一出现变化或空气素质稍微差一些，我就很容易咳嗽。一开始咳，就很难好。没有保险公司愿意接受我的投保。我必须时时注意饮食。但我还是坚持继续旅行。我不会让癌症阻挠我的行程。我几乎走遍了地球上的每个国家。我还坐过过山车呢。很多人都问我是哪里来的勇气。”

1990年，当淑贞只有25岁时，她第一次发现自己患上癌症。当她的同龄少女正在冲刺事业、甜甜蜜蜜地谈情说爱，筹划着自己的结婚大计时，淑贞却得面对一项大手术。

“当我发现自己身体发肿的时候，我就已经知道健康一定出现了什么问题。这是第一个征兆。我面对水肿的困扰，喘不过气，一到晚上，问题就更加严重，严重到我想躺下来睡觉都不行。当我平躺时，我感觉自己简直就快窒息了。”

最后，她得被送入新加坡中央医院，排期动胸腔手术。在麻醉效应消去后，外科医生告诉她，已经从她的胸腔取出了一个肿瘤。

淑贞把手张到最开，展示被取出的肿瘤有多么可怕。她的拇指和小指末端已经不能离得更远了。淑贞说：“他们说我的肿瘤好像章鱼一样，触角都快申向我的排骨和肺部了。”

淑贤必须切除右肺的一部分。她患上的是淋巴瘤。淋巴瘤是原自淋巴结—身体免疫系统的一部分—的癌症。切除肿瘤只是治疗的第一步。手术后，淑贞必须接受12轮的化疗和五个星期的放疗。

她那在手术后已经变得脆弱的右肺在接受放疗后更加无力了。淑贞感染上肺炎，导致整个右肺垮下。这让她在接下来的22年里，每天早上都咳嗽咳得就像是要把整个肺都咳出来了一样。

二度面对癌症、再次战胜癌症

“Having had cancer, I take each day I am alive as a bonus. I don’t want to let this disease deprive me of life and the opportunity to be happy.”Siok Cheng, with her

husband Gary and their daughter Zhi

Qing (far right)

“你应该放开我的，”淑贞曾经这么告诉她当时的男朋友。他们才刚交往几个月，淑贞就被诊断出患有癌症了。淑贞认为，如果他们继续谈恋爱，对男友是很不公平的。即使他们最终结婚，如果她因为病情而无法为他开枝散叶怎么办？如果她死了，留下他守寡又怎么办？

她的考量不是没有道理的，但男友梁德明却坚持对她不离不弃。十年后，她终于没有办法再推开德明。35岁时，她答应了他的求婚。这时，她的治疗已经结束了，但她还是每三个月回去找百汇癌症中心的洪炳添医生复诊。

医生告诉她，她受孕的机率微乎及微，但人算不如天算，淑贞结婚不久后就成功怀孕了。

当她把这个好消息告知洪医生时，他的反应是矛盾的。在向淑贞贺喜的同时，她也告诉淑贞：“我们需要做的事情还很多。”

在怀胎九个月里，淑贞需要受到三个医生—洪医生、呼吸道专科医生和妇科医生—的紧密检查。她告诉丈夫：“万一出了什么并发症，一定要先保住孩子。”

2000年12月，当女儿芷晴出世后，淑贞发现自己的生命被赋予新的使命。接下来的几年过得非常地忙碌，但也很充实。 在照顾女儿的同时，她也在托儿所里出任部分时间行政人员，过得非常有意义。时间一年一年地过去，随着时间过去，淑贞不知不觉地产生一种错误的安全感。这种安全感让她连在2006年工作压力让她错过例行检查时，她也不以为意。

2007年7月的一天，淑贞在洗澡时发现自己左边的乳房下方有一个大约三公分的肿块。因为上次的经验，她马上就知道自己出现什么问题。

她充满悔意地说：“我的淋巴瘤康复已经很多年了。我还以为自己可以照顾自己，不再需要医生的帮助。事实证明我的想法是错误的。”

责备淑贞的不只是她自己。当她心虚地走进洪医

生的诊所时，看到的是一张气得暴跳如雷的熟悉面孔。毕竟洪医生和她相识已经17年了，洪医生没有必要隐藏自己的情绪。但在她对自己的不负责任进行一番斥责后，洪医生很快就进入正题。

是第三期癌症。洪医生要求淑贞切除左边乳房并接受八轮化疗。很快地，在淑贞发现肿瘤的五天内，所有的决定和手术已经完成。

淑贞中肯地说：“勇敢面对、面对现实、果断决定是重要的。这是我想告诉每个病人的话。再次发现肿瘤时，肿瘤已经侵入我的左肺。如果再拖延，癌症就可能会扩散了。我的右肺已经垮下。如果我的左肺也出问题，那我就真要断气了。”

她令人敬佩的勇气让洪医生印象深刻。洪医生说：“即使是第二次患癌，她根本就没有让我感觉到她有丝毫的害怕。她很有信心自己一定能再次战胜癌症。”

经历过两次癌症；两次，她都战胜癌症。现在，淑贞把活着的每一天都当成是额外的奖励。她一点都不消极。她对自己，对女儿都抱有很大的梦想。淑珍希望培养芷晴对音乐的兴趣，帮她报读音乐课程。她则把每一天的时间都奉献给那些被诊断出患有癌症的病人。

很多时候，淑贞发现自己需要帮病人理清事情的轻重，让他们更有能力处理自己所面对的问题。“好笑的是很多病人最担心的竟然是化疗后的脱发问题。我必须告诉他们‘那只不过是头发，把它剃掉了，它会再长出来。比起头发，你的性命更加重要。’”

现在，淑贞再也不会错过两个月一次的复诊了。淑贞羞愧地笑说：“我现在很乖了。”

洪医生解释说：“不同的癌症需要不同的复诊安排。那些曾经患过癌症的病人较有可能再次患癌。”

他强调说：“即使病人摆脱癌症已经超过了五年，持续复诊还是很重要的。”

“我曾经患上癌症，现在我把活着的每一天当成是额外的奖励。我不会让癌症有机会剥夺我生存的权利，也不会让它掠夺让自己开心的机会。”

淑贞

希望的故事

Serving You

At six, PCC is ‘growing up nicely’Dr Ang Peng Tiam, Medical Director of Parkway Cancer Centre, talks about PCC’s plans to bring its model of patient care into the region and across the world

Now six years old, Parkway Cancer Centre (PCC) is poised to enter a new phase with the opening of the new clinic in Mount Elizabeth

Novena.The clinic in Novena opened on 6 August and has

10 sitting cubicles, a private room and two treatment beds. Two oncologists, Dr Patricia Kho and Dr Foo Kian Fong, are based at the Novena clinic.

Dr Ang Peng Tiam, Medical Director of Parkway Cancer Centre explained that the clinic in Novena allows PCC to expand and also makes it more convenient for some patients.

“Our facilities in Mount Elizabeth and Gleneagles have reached full capacity so Mount Elizabeth Novena can help us as the number of doctors and patients increase,” he said.

Some patients might also choose treatment at Novena because the clinic has a PET/MR machine, the only such machine in Asia.

“Having the doctors and equipment in one location provides convenient cancer care for patients,” he added.

Expanding within Singapore is only part of PCC’s plans for the future, though. The Centre is also mulling over plans to go public so as to raise funds for an expansion into the region.

Dr Ang, who is also one of the four original founders of PCC, said PCC is now in the process of deciding on whether to go for a public listing.

Clinics around the region would mean that patients would not need to fly into Singapore for treatment. In fact, PCC already has a licensed clinic in Myanmar to treat patients in Yangon.

He notes, however, that budget airlines now make it cost effective for patients to fly in and out of Singapore. If the Centre does decide to go ahead, the plan is to list by the end of the first quarter of next year in a reverse takeover of an existing company in Singapore.

Looking back on PCC’s six-year history, Dr Ang said his greatest satisfaction was the Centre’s quality of care, which includes a swift response time, and a sense of time which matched the urgency of patients’ demands.

While patients today have more treatment options because of a more competitive landscape, Dr Ang believes that PCC is able to more than hold its own, thanks to its high-powered team of oncologists.

Another distinguishing feature is the level of psycho-social support that PCC provides that other oncologists in private practice do not.

“More than 50 per cent of patients who see us

Above: Staff at PCC’s new clinic in Mount Elizabeth Novena celebrate its opening. Right top and bottom: Equipped with 10 sitting cubicles, a private room and two treatment beds, the clinic is part of PCC’s continual expansion.

“More than 50 per cent of patients who see us are referred to by friends or family. We must be doing something right.”

Dr Ang Peng Tiam, PCC’s Medical Director

are referred to us by friends or family,” he noted. “We must be doing something right. Word of mouth is the most important part in determining where a patient goes.

“It’s very easy for someone to say – ‘I’m the best, I can do the job’ – but really, the proof is what others think of us.”

Serving You

At six, PCC is ‘growing up nicely’

Why PCC has succeededDr Ang answers questions about the cancer centre’s journey

How has Parkway Cancer Centre changed since it was founded in 2006?Maybe we can start even before that. Dr Freddy Teo and I went into private practice in 1997. At that time, there were very few oncologists in the private sector. The perception then was that cancer was not a very treatable condition. Many patients were diagnosed to have cancer, and within months or only a few years, they died. There was only a very small pool of cancer patients who were alive and needed treatment.

In the last 10 to 15 years, a lot has changed. There is a great deal more that they can do for the

cancer patient. The two of us started out as partners in 1997. By 2005, another two joined us – Dr Khoo Kei Siong, who was the head of medical oncology at National Cancer Centre, and Dr Lim Hong Liang, who was the head of medical oncology at National University Hospital.

In 2006, we finally managed to convince Parkway that it was a good idea for us to form a joint venture and to work together to form this cancer centre.

The rest is history. The number of patients we treat has almost doubled. Our revenue has doubled.

Continued next page

Above: Staff at PCC’s new clinic in Mount Elizabeth Novena celebrate its opening. Right top and bottom: Equipped with 10 sitting cubicles, a private room and two treatment beds, the clinic is part of PCC’s continual expansion.

Serving You

And the number of doctors we have has doubled. Starting from the founding four doctors, we recruited another four more. We recruited a palliative medicine physician.

We also work very closely with our radiation oncologists as part of PCC. We have also brought in a paediatric oncologist to look after the children.

By coming together, we have become much stronger. We can offer far more to the patients.

Something which I’ve always wanted to do is to always have lots of educational material like newsletters to encourage cancer patients in their fight. But as an individual, it’s very difficult to do that. By coming together, we’ve been able to do all these things.

I’ve always felt that it was important to deliver the home care element as the patient reaches closer and closer to the end, when they are too weak to come to the hospital. That is why we formed the home care service that is led by our palliative physician.

Many of these things have only been made possible because we have come together as a group.

Looking back over the last six years, what are you proud of?We see that we have achieved much. We now see doctors wanting to join us. There are already eight in the team, and there’s another one coming aboard in January 2013. We have interest from doctors in being part of the team because they feel there is something that we are doing is right for the cancer patient.

The greatest satisfaction I have is what we are able to offer patients – we are able to offer very fast diagnosis. Often within 24 to 48 hours, we are able to establish a histologic diagnosis of cancer, we are able to finish the staging to establish the extent of cancer spread, and we are able to draw up a treatment plan.

We are able to deliver that care because we work in a very comprehensive manner where we include our radiologists, our radiotherapists and our surgeons coming together in tumour boards.

In the past, surgeons were very worried – if you have breast cancer, if I don’t operate quickly, maybe if you go for the treatment first, the disease will get

From previous page worse. But by demonstrating what chemotherapy can do in terms of shrinking down the tumours before they go for surgery, these doctors are now convinced that for many patients with large tumours, chemotherapy upfront is indeed the preferred option.

And in a similar manner, in some cases where we would have deemed a patient surgically inoperable, but because we work so closely with our surgeons in these multi-disciplinary teams, we are able to see that despite the extent of the disease, surgery can contribute something to improve the chances.

The third thing I’m proud of is the psychosocial support that our cancer patients have, from our nurses, from our palliative team, from our CanHOPE counsellors.

Only last week, a patient came to me and said the only reason she decided to choose Parkway Cancer Centre is because she had heard how we support patients in the battle against the disease and the treatment side effects.

The scene today is more competitive than it was back in 2006. Why do you think patients choose Parkway Centre Centre over other oncology practices?What makes the difference? Number one, it must be the reputation of our doctors. We have brought together a team of highly-trained oncologists to form the core of Parkway Cancer Centre. That’s our main difference.

Number two, we have recruited people whom we think are the best second and third generation oncologists to form Parkway Cancer Centre.

We have tried to recruit the best nurses and we have also formed this support group called CanHOPE, which is non-existent in the other oncology practices in the private sector. CanHOPE exists not just in Singapore. We have CanHOPE offices in Bangladesh, Cambodia, Indonesia, Vietnam, Philippines, Russia, Sri Lanka and Myanmar. Patients know that we have made the effort to reach out to them to ensure that they feel comfortable. Even though they had their treatment in Singapore, when they go back to the home country, there is a point of contact, someone they can talk to in their own language and culture, who can understand their problems.

“The greatest satisfaction I have is what we are able to offer patients – very fast diagnosis. Often with 24 to 48 hours, we are able to establish a histologic diagnosis of cancer, we are able to finish the staging to establish the extent of cancer spread, and we are able to draw up a treatment plan.”

Dr Ang

Community Outreach

The truth about salted fishHeld at the newly-built Mount Elizabeth Novena Hospital, 938LIVE and Parkway Cancer Centre brought together a team of medical experts for a seminar on The Truth And Myths Behind Ear, Nose And Throat Cancers, in September.

The doctors tackled a range of topics from diet, lifestyle and risk factors to treatment of Singapore’s seventh most common cancer among males – nasopharyngeal cancer (NPC).

Dr Patricia Kho, Senior Consultant of Medical Oncology, Dr Lee Kuo Ann, Consultant of Radiation Oncology, Dr Mark Khoo, Senior Consultant ENT Head and Neck Surgeon and Dr Samuel Yeak, Senior Consultant ENT Head and Neck Surgeon were among those who spoke at the public forum, which drew about 100 people.

One of them was 54-year-old Kevin Goh. It was through the talk that the private investor became aware of how NPC can be prevented. Mr Goh said: “I would want to add more fruits and vegetables to my diet. I think this is important to keep the cancer at bay.”

Amidst the crowd, 25-year-old Lionel Lee stood out as one of the younger participants. The civil servant, whose mother has NPC, said he plans to lead a healthier lifestyle and monitor himself closely for symptoms.

Mr Lee said: “It’s good to hear from the experts so you won’t miss out on important points that can save your life.”

Dr Samuel Yeak (left) and Dr Patricia Kho share their expertise on cancers of the ear, nose and throat with the audience.

Dr Mark Khoo (top) and Dr Lee Kuo Ann giving one-to-one attention to participants after the session.

Community Outreach

Early detection for better outcomes

To raise awareness on colorectal cancer – the most common cancer in Singapore – Parkway Cancer Centre (PCC) organised another series

of its Walk-the-Talk outreach at Mount Elizabeth Novena Hospital in September.

Launched in July, the campaign saw well-known MediaCorp artistes Edmund Chen and Xiang Yun undergoing their first colonoscopy. At the latest outreach, Walk-the-Talk extended its invitation to nine NTUC U Live Health Ambassadors to participate in colorectal screening and share their own experiences about early detection through colon screening.

In his opening speech, Dr Ang Peng Tiam, Medical Director of PCC, stressed the importance of getting screened for early detection. He noted that there are 1,500 new cases of colorectal cancer every year, of which most of them are diagnosed in their advanced stage. A polyp takes at least five years to develop into a cancerous tumour, he said, so preventive measures are key in limiting the risk of developing cancer.

His simple advice: “Opt for early detection.” One of the health ambassadors who shared his

experience of undergoing a colonoscopy was 80-year-old Mr Lee Choon Kim. His parents, he said, were the reason for his decision to undergo the procedure.

“They both had stomach cancer and we didn’t know they had it until it was too late; I don’t want to be in that situation,” he said. “I’m on a mission to encourage my friends to go for this too.”

Another ambassador was Madam Susan Teo. The bubbly 57-year-old is no stranger to cancer, having been diagnosed with ovarian cancer in 2005. Madam Teo went through chemotherapy and a hysterectomy, and has been in remission for six years. She credited early colorectal screening as the reason for her survival. “Because of the early colorectal screening, I went for an MRI scan only to find out that I had Stage I ovarian cancer. If I hadn’t gone for it, things would be different,” she said.

Asked what it was like to undergo the screening again, she said she felt more reassured than anxious. She said: “The oncologists and staff here are really taking care of us – there isn’t anything for us to worry about. Besides, prevention is always better than cure, so I hope others will take time to go for this as it’s best to get to the problem early.”

Madam Susan Teo (top, with Dr Ang Peng Tiam) and Mr Lee Choon Kim (left) share their experience on screening.

Health ambassadors stress importance of screening at Walk-the-Talk outreach