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A multidisciplinary panel of specialists from Parkway Cancer Centre (PCC) gathered at a seminar on Understanding Cancer: Advances in Treatment & Care to share insights on the latest advances in the field.

As doctors and allied health professionals took turns to present major developments across different disciplines over the last decade, they emphasised the importance of a multidisciplinary team approach to cancer care.

New frontiers in cancer treatment

Dr Ang Peng Tiam, Medical Director and Senior Consultant, Medical Oncology presented his keynote on new frontiers in cancer treatment.

In his presentation, he mapped out some of the major advances in cancer care over the last three decades:

• Technological advances in imaging
• Advances in pathology through immunohistochemistry and genetic profiling
• Understanding of oncogenesis and the ability to study the molecular genetics of cancer
• Multidisciplinary care and sub-specialisations in oncology
• Development of new therapeutic agents

He stressed that a multidisciplinary team approach has become increasingly pivotal with these advances. “Working together across different disciplines allows us to provide patients with holistic, patient-centric care that is tailored to their specific disease,” he elaborated.

Dr Ang explained that advances in diagnostic evaluation have allowed doctors to classify cancer more accurately. In addition, the discovery of cancer mutations and the emergence of genetic testing have become key in determining appropriate treatment tailored to the patient’s specific disease. Cancers such as HER2 breast cancer and EGFR lung cancer, for example, can be treated by targeting the mutations specific to each cancer.

“The future of cancer is in precision oncology”, summarised Dr Ang. “Cancer treatment is no longer associated with poor quality of life. It is now about achieving good control of the disease and offering patients good quality of life.”

Cellular therapies in blood cancer treatment

One of the recent developments that is significantly improving treatment outcomes for patients with complex blood cancers is cellular therapies.

Dr Colin Phipps Diong, Senior Consultant, Haematology explained in his keynote that cellular therapies involve programming living cells in our immune system to control and/or kill cancer cells.

“The recent COVID-19 vaccine is just one successful example of how our own immune system can be harnessed to produce antibodies against diseases,” Dr Colin shared.

One therapy that is taking the field by storm is Chimeric Antigen Receptor (CAR) T-cell therapy, which involves extracting T-cells from a patient’s blood, and genetically engineering them in a laboratory to express antibody receptors that can detect and destroy certain targets on cancer cells.

It has been approved for use by the U.S. Food and Drug Administration (FDA) and the Singapore Health Sciences Authority (HSA).

CAR T-cell Therapy has improved treatment and outcomes for patients with B-cell acute lymphoblastic leukaemia (ALL) and diffuse large B-cell lymphoma (DLBCL). However, Dr Colin stressed that CAR T-cell Therapy is not for everyone. First-line therapy with chemotherapy and immunotherapy remain the standard of care for patients with complex blood diseases.

Patients are only recommended CAR T-cell Therapy when their disease is chemo-resistant and have not benefited from at least two lines of standard treatment. For these patients, CAR T-cell Therapy is a revolutionary treatment that offers a significant survival advantage compared to standard treatment.

New developments in radiation medicine

Another revolutionary treatment that is hitting the shores in Singapore is Proton Beam Therapy (PBT), a type of radiation therapy that uses protons to kill cancer cells.

Dr Ivan Tham, Senior Consultant, Radiation Oncology, shared in his keynote that PBT is a powerful tool that can extend the capabilities of radiation medicine.

The use of protons in radiation medicine through PBT has emerged in the recent decade thanks to advances in technology, computing power and imaging. Compared to conventional X-rays, PBT can deliver protons to the desired depth in the body to deposit its energy, offering more precise and targeted radiation to where it is needed, while minimising exposure to healthy cells and reduced side effects.

PBT is often used to treat tumours in sensitive areas where conventional treatment may not be the best option, such as adult primary brain tumours. However, Dr Tham emphasised that PBT may not always be beneficial for all cancers, such as the case of patients with superficial tumours. Having a multidisciplinary team approach to cancer care is key to deciding how PBT can come in to ensure patients receive the most appropriate and optimal treatment for their individual disease.

Cancer no longer a death sentence

Following the keynote presentations, Dr Colin, Dr Tham, Dr Richard Quek, as well as Senior Dietitian Chloe Ong and Principal Counsellor Tan Hui Ping, led a panel discussion on treatment advances.

Dr Quek began the discussion by reemphasising the importance of a multidisciplinary team approach to treatment.

“Even before a patient comes in, we know who our partners are going to be and what is needed to give the patient the care they need,” explained Dr Quek. “Dietitians and counsellors also come into the picture if we assess that the patient has certain nutritional or psychological needs.”

Chloe explained that dietitians work closely with doctors to ensure that patients are receiving enough nutrition and energy to help them get through treatment.

Hui Ping added that one of the roles of a counsellor is to assess and observe a patient’s mental health, and alert doctors if a patient’s psychological well-being is adversely affected for prolonged periods of time so that any adjustments to medication or psychiatric intervention can be arranged.

Using prostate cancer as an example, Dr Tham explained it is important to paint a full picture of the different treatment approaches and possible side effects for the patient. Through a multidisciplinary team approach, doctors are better able to put the treatment journey into context for the patient so that patients can decide on the best treatment for themselves.

With so many new advances in the mix, Dr Quek explained that cancer is no longer a death sentence. “Over the last decade, we are curing more patients, even those with advanced stage cancers,” shared Dr Quek. “Today, we are focusing more on improving treatment outcomes and giving patients better quality of life.”

Raising awareness on female cancers

Medical oncologists Dr Khoo Kei Siong, Dr See Hui Ti and Dr Wong Chiung Ing discussed the importance of early detection in a breakout session on female cancers.

Dr Wong shared about three common female cancers—breast, gynaecological and cervical cancers—and highlighted some common symptoms and risk factors associated with them.

She stressed that some cancers do not show signs and symptoms in early stages. However, they can be detected early with regular screening.

Women who have had sexual intercourse should get a pap smear to screen for cervical cancer at age 25, or within three years of their first sexual activity—whichever happens first.

Women should also screen for breast cancer by conducting regular breast self-examination (BSE) monthly, and going for annual mammograms from age 40.

Dr Wong then shared the different treatment options for patients with female cancers. She highlighted that the future of treatment for female cancers is personalised, tailored treatments that will enhance patients’ treatment response while reducing risk and toxicity.

“As the field constantly evolves, early detection and prevention remain the key to cure”, Dr Wong explained. “The earlier the diagnosis, the greater the probability of recovery.”

Caring for your wellbeing

In a breakout session on caring for your wellbeing, Senior Counsellor Chia Hui Erl, Counsellor Jaime Yeo and Senior Dietitian Gerard Wong discussed the importance of holistic care.

Hui Erl explained that cancer can have a significant impact on patients’ mental health and psychological growth. Cancer patients are generally confronted with a number of challenges that can result in long-lasting negative psychological outcomes and disruption to daily life.

She stressed however, that a cancer diagnosis may not always lead to negative psychological outcomes. Temporary distress related to cancer may also lead to positive psychological growth through two pathways, namely resilience and post-traumatic growth.

Jamie shared that patients who require professional help to manage their mental wellbeing may turn to counselling to facilitate and support their psychological growth. She clarified that counselling is not a quick fix solution to problems, but a therapeutic and collaborative client-counsellor relationship that provides patients with a safe holding space for their experiences.

Holistic care is not complete without caring for patients’ nutritional needs. In his presentation, Gerard debunked common myths about anti-cancer and anti-inflammatory properties in superfoods.

“Cancer is a complex disease, and to say that any one food or diet has the power to eradicate or prevent cancer is often an oversimplification,” said Gerard.

He shared some broad guidelines for cancer prevention, such as maintaining a healthy weight, partaking in regular physical activity, and reducing intake of energy dense foods, meat and alcohol.

He added that while superfoods can be viewed as an additional means to help reduce risk of disease, improve our nutrient profile, and promote good health, moderation is still key.

“The most important strategy to achieve good health and prevent certain diseases is to keep everything in balance and live an overall healthy lifestyle.”