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Staying in good shape reduces the risks of chronic diseases and increases life expectancy
 A “SINGAPORE” approach to seeking a better treatment has led to a new, gentler regimen for dealing with the most common form of children’s cancer here. Patients with acute lymphoblastic leukaemia also spend less time in hospital and incur lower bills. The ailment affects three of every 10 young people diagnosed with cancer here each year. The procedure studied closely a standard treatment method in Western countries and, in Singapore fashion, streamlined and adapted it for use here.
The regimen was developed by doctors from the National University Hospital (NUH), KK Women’s and Children’s Hospital and two centres in Malaysia, who studied 556 patients aged under 18 from 2003 to 2009. They found that by closely tracking patients’ disease levels, they could tailor treatment more effectively. More importantly, patients can be treated equally well, if not better, with a smaller and less toxic combination of drugs.
Children with leukaemia usually get a combination of four drugs in the crucial first five weeks of treatment. One of the drugs, daunorubicin, is more toxic, causing severe side effects like fever and ulcers. But the majority of patients studied by the doctors could do without this drug, said principal investigator Allen Yeoh, senior consultant in paediatric haematology- oncology at NUH. The findings were published in the Journal of Clinical Oncology, a top cancer journal, last month. Patients put on the regimen are screened for leukaemia levels after the first week of treatment. Only those deemed to be responding poorly go on to be treated with the four drugs.
The rest – about 87 per cent in the study – are treated with three drugs. In the fifth week, the patients are screened again with a test specially adapted by the doctors. If patients have less then one leukaemia cell in 10,000 cells, they get further reduced treatment. The new procedure means patients now spend about a week in hospital, instead of a month, and face less risk of complications, said Associate Professor Yeoh. Previously, patients spent about $15,000 after subsidy for five weeks of treatment with the four drugs. That has since been shaved to $5,000 to $7,000.
The study achieved a cure rate of 80.6 per cent in its patients, just slightly less than top cancer centres – such as St Jude Children’s Research Hospital in the United States – which still use the four-drug treatment. Prof Yeoh, noting that doctors used to overtreat, said: “It’s finding the correct, optimal therapy for every child that is more critical, (as) you can cure without the huge side effects we see (now).” The new procedure won over lecturer Joshua Liew and his wife Amy, who are in their 40s, when daughter Victoria was diagnosed with leukaemia five years ago. She spent 11/2 months in hospital out of 21/2 years of treatment. Now cured, she is a happy pupil at St Anthony’s Canossian Primary School.
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