Living with cancer

Getting post-op specialists involved from the start

To get rid of a cancer on the roof of a patient's mouth, his doctors had to remove five teeth, a portion of his hard palate and part of his jaw.

After the operation, the 44-year-old, who wanted to be known only as Mr Yap, could barely speak or swallow, and had to be tube-fed.

While head and neck cancers like this are rare, their consequences can be debilitating and require many months of therapy.

POSITIVE ATTITUDE TO RECOVERY

I had water, soft foods - almost like what a baby eats. It took some time to get used to eating, and even now I can't eat hard food like nuts. You're never really prepared for something like this. But Dr Gopal gave me a very good sense of assurance, and he was always very positive about my condition.

MR YAP, CANCER PATIENT, on his recovery after a cancer was removed from his mouth.

But one team of experts at the Singapore General Hospital (SGH) is trying to improve the way such patients are cared for.

This means getting the therapists, dieticians and other specialists - who typically see patients only after they have had surgery - involved from the start.

"It's all about a pre-emptive strike," said surgeon Gopal Iyer, who heads the SingHealth Duke-NUS Head and Neck Centre. "They get to see everyone and... they're told what to expect post-op and how we will help."

This helps both patients and doctors be better prepared for what is to come. For example, patients often tell other members of the team things that they would not tell a doctor, but which have a bearing on their surgery.

Dr Gopal recalled one patient who was a former alcoholic and had assured his doctors that he had since stopped drinking.

"Then, the day before the operation the psychologist calls me and says: 'Do you know this guy drinks 10 cans of beer a day?'" he said.

"And it makes a big difference, because you can die of withdrawal."

Doctors then had to get the man on special medication, and even change the way they did the surgery.

Dr Gopal's team of around 20 - including dieticians, various therapists and different kinds of surgeons - started seeing patients before surgery in September last year. They also meet once a week to do ward rounds together.

"Previously, we used to see the patients only the day before they left the hospital," said Ms Elizabeth Roche, a senior principal speech therapist at SGH.

"Then we had to assess their swallowing... and it was all very rushed."

Nose cancer is the most common head and neck cancer here, with between 350 and 400 cases diagnosed each year.

Treatment usually involves radiotherapy and is fairly straightforward, but other cancers in the area - such as those affecting the mouth, throat and voice box - are far less so.

"Head and neck surgery... affects things that you can't take an MC (medical certificate) to solve," Dr Gopal explained.

"It affects breathing, swallowing, speech... it's absolutely critical to get this back to normal as soon as possible."

He has known lawyers, for example, who had to undergo surgery to remove half their tongues. They subsequently needed reconstructive surgery and had to learn how to speak again.

In the case of Mr Yap, he had to learn how to swallow again.

"I had water, soft foods - almost like what a baby eats," he recalled.

"It took some time to get used to eating, and even now I can't eat hard food like nuts."

He also had to get a prosthesis to replace the part of his mouth that was removed.

"You're never really prepared for something like this," he said.

"But Dr Gopal gave me a very good sense of assurance, and he was always very positive about my condition."

Linette Lai


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A version of this article appeared in the print edition of The Straits Times on September 21, 2016, with the headline 'Getting post-op specialists involved from the start'. Print Edition | Subscribe