Less hassle, FASTER treatment

THINK of it as a package deal. In one medical centre, you have all the experts to handle the problem. It saves time in making multiple appointments and shuttling to and from the different hospitals where the specialists are located.

That’s what Mr Lim, 38, wanted when he was diagnosed with nose cancer in 2008. He wanted to be treated as quickly as possible.

But when he checked with some private doctors, he realised his treatment would be delayed because he had to coordinate with the different doctors, located at different hospitals.

Instead he visited the National University Cancer Institute Singapore (NCIS). It had introduced a system with all the specialists located under one roof. This was initially on an ad-hoc basis, but has since been institutionalised since its official launch last week.

In December 2008, the same month he was diagnosed, Mr Lim, who has stage-three nose cancer, saw his surgical oncologist, medical oncologist (handles chemotherapy) and radiation oncologist (handles radiotherapy) – all on the same day.

Mr Lim, who works in the IT sector, then began his treatment within the same month. Otherwise, he would have to wait as long as six to eight weeks after his diagnosis to be treated. (See infographics, below.)

This multi-disciplinary approach – where doctors across different specialisations work together to treat patients – is being adopted by the NCIS.

NCIS, Singapore’s newest national cancer centre, was officially opened on 9 Feb. It joins the National Cancer Centre Singapore (NCCS) in using the multi-disciplinary approach in treating cancer patients.

Mr Lim, who completed his treatment in March last year, has been in remission since. He told The New Paper: “It makes it easier to have all three doctors under one roof. It’s less of a hassle than having to consult the surgeon at one hospital and making two other appointments
to visit the medical oncologist and radiation oncologist at a different hospital.”

Mr Lim had briefly considered the usual method or the department-based approach. That involves seeing the different specialists who may be based in different hospitals. That can be the case with some private doctors and public hospitals which do not have dedicated
cancer centres.

He changed his mind because he thought it would be“too much of a hassle”.

His doctor, Associate Professor Thomas Loh, 50, told The New Paper that under the department-based approach – Mr Lim would have had to make three different appointments to see his doctors – it would take him six to eight weeks after his diagnosis before hewould receive treatment.

Under the multi-disciplinary approach, the process was reduced by three to four weeks. Dr Loh’s the senior consultant of NCIS’s division
of surgical oncology.

On average, major international cancer centres use one month as an accepted period between diagnosis and treatment, pointed out Prof
Loh.

“Taking eight weeks would be too long and frustrating for the patient, obviously the faster the treatment takes, the better it is for the patient,” he said.

The approach also leads to faster decision making, said Prof Leong.

Doctors across the different disciplines are called into a tumour board meeting, where new cancer cases are discussed.

For instance, Prof Loh, who specialises in head and neck cancer, will typically sit in on the meetings with the radiation oncologist, the medical oncologist and the pathologist (who reports on the type of cancer cells andhowaggressive the cancer is).

The doctors will then decide how best to treat the patient. Once admitted, the patient continues to be cared for via this approach by oncology nurses, the case manager, psychiatrist and medical social worker among others. They all work together to formulate a care plan for the patient.

Associate Professor Koo Wen Hsin, NCCS’s deputy director, said the multi-disciplinary approach would result in the patient “benefiting from various specialist opinions and not just an opinion that is biased towards one specialty discipline”.

He added: “This provides patients with the state-of-the art treatment that a single specialist might have dismissed if it is outside his or her area of specialisation.”

Investigations or tests like CT scans by the doctors would not be duplicated too. On average it could cost about $600 to $800 per CT scan, he estimated.

Dr Wong Seng Weng, 40, a consultant oncologist at The Cancer Centre, views the multi-disciplinary approach as “the ideal way” to treat cancer.

But he added: “This of course takes up more resources because it is intensive – there’s a lot of time commitment on the part of the doctors.”

Prof Koo said such an approach will be the way to go.“We believe when patients get the combined assessment of doctors of various specialities, they can get the best care.”