Doc Talk

Getting off the cancer treadmill in time

I have a confession to make. I am a master of excuses when it comes to working out.

It has been a long while since I sweated it out on a treadmill. There was an occasion when a malfunction of the treadmill pushed me into a state of near panic.

After running on a fast-paced setting for some time, I started to feel fatigue. Then, horror of horrors, the treadmill controls stopped responding. The treadmill could neither be stopped nor slowed down. I was running as fast as I could just to maintain stability and avoid falling off. I was stuck.

There are occasions in my clinic when I feel like I am running on a treadmill. I run as fast as I can with my patients afflicted with advanced cancer, just to stay on the same spot.

Battling cancer is like running on a malfunctioning treadmill that automatically picks up speed with time.

Cancer growth accelerates and resistance to treatment develops.

If a patient is fortunate enough to be diagnosed when the cancer is in its early stage, I do all I can to convince the patient to jump off the treadmill while he or she still can, before it picks up speed.

In other words, bite the bullet and accept whatever treatment that is called for to eradicate the cancer permanently.

This decision is not as easy as it sounds. You see, it is rather scary to jump off a moving treadmill. What if I trip? What if I get injured? Accepting my treatment recommendations would also mean accepting the risks and discomfort associated with therapy.

All it takes is a moment of weakness, a moment of hesitation, and the opportunity to hop off would have come and gone.

Once the cancer advances into the late stages, it would be like a fast-paced treadmill.

There is no way to jump off without sustaining a fatal injury.

Two years of hesitation in getting off the cancer treadmill, on the part of Ms T, gave ample time for the cancerous tumour in her left breast to grow to the size of a big orange, bursting through the skin with purulent and bloody discharge.

Worse, an X-ray scan confirmed that the constant pain she experienced with head or arm movement over the chest bone was due to the cancer's spread. Following two months of treatment with a combination of chemotherapy and a smart drug, there was some improvement.

However, after a further two months, the tumour started to regrow. The cancer was picking up speed and moving at a pace faster than my running. We had to run faster.

I intensified Ms T's treatment and combined two smart drugs with chemotherapy. To my relief, the cancer receded once more.

Her symptoms subsided and she returned to her normal routine.

Thankfully, our running speed managed to catch up this time.

But the cancer was too advanced to be permanently eradicated. Ms T and I are stuck on the treadmill.

Mr L has widespread cancer of the colon. Despite multiple attempts to control the cancer with the latest approved therapies, his cancer continued to worsen.

We had to up our speed.

A sample of the tumour was sent to the United States for comprehensive sequencing of the cancer genome in order to identify potential weak spots in the cancer.

Special permission had to be sought from the Health Sciences Authority to use a novel method of treatment to bring the cancer to heel. Yet again, such an advanced cancer cannot be permanently eradicated. But, at least, it was stabilised and Mr L's quality of life was restored.

Once more, my patients and I had to run faster, just to stay on the same spot.

Many of my patients with advanced cancer will be stuck on the cancer treadmill. Come the near future, Ms T, Mr L and I have to run faster again, as if our lives depend on it. Because my patients' lives do depend on it.

For those diagnosed with cancer in a potentially curable stage, I implore them to pluck up the courage and get off the treadmill before it is too late. No hesitation, please.

And, did I manage to get off the malfunctioning treadmill in the gym? Yes, thankfully I did, by plucking up my courage and leaping off.

•Dr Wong is a medical director and consultant medical oncologist at The Cancer Centre, Singapore Medical Group. He has been looking after cancer patients for the past 20 years. He is also an adjunct clinician scientist in the Institute of Bioengineering & Nanotechnology at the Agency for Science, Technology and Research.

A version of this article appeared in the print edition of The Straits Times on March 01, 2016, with the headline 'Getting off the cancer treadmill in time'. Print Edition | Subscribe