One-stop cancer centre for elderly patients

Multi-disciplinary geriatric clinic planned for National Cancer Centre's new home in 2020

The National Cancer Centre plans to formalise a new "multi-disciplinary" approach to tackling the disease among elderly patients when its new building opens in 2020.

In an interview with The Straits Times, Dr Ravindran Kanesvaran, a consultant at the medical oncology division of National Cancer Centre Singapore (NCCS), said such patients often suffer a host of other conditions like high cholesterol, stroke and heart disease.

As a result, their conditions require a range of medical professionals such as pharmacists, geriatricians and physiotherapists.

Tackling all their problems together in one go is a model practised in countries such as South Korea, Australia and the United States.

It is one the NCCS wants to follow when it moves to its new building in Outram as part of the multibillion- dollar plan to re-develop the Singapore General Hospital campus.

Dr Ravindran Kanesvaran and clinical coordinator Ong Zi Ling testing an elderly cancer patient's grip strength at the National Cancer Centre Singapore.
Dr Ravindran Kanesvaran and clinical coordinator Ong Zi Ling testing an elderly cancer patient's grip strength at the National Cancer Centre Singapore. PHOTO: NCCS

"By 2020, we want to sit everyone in one room - patients and their families, together with the cancer specialists, surgeons, physiotherapists, dieticians, geriatricians, pharmacists," said Dr Kanesvaran. "We will look at their case files and decide the best approach to take, what kind of care they need."

Currently, elderly cancer patients complete a questionnaire about their lifestyles and other medical conditions. If they need other forms of attention such as physiotherapy, dietician or geriatrician care, they have to be separately referred to Singapore General Hospital. However, not all patients may follow up on this.

"We are working towards a true multi-disciplinary geriatric clinic," said Dr Kanesvaran, adding that Singapore will be the first country in South-east Asia to have such a geriatric cancer programme.

There will be four consulting rooms built for the multi-disciplinary programme and discussions have been held about a rehabilitation centre with exercise machines and physiotherapists on hand to build up the patients' strength.

From this year on, Dr Kanesvaran hopes to start the new approach on a smaller scale by getting the specialists and other allied healthcare workers together for weekly meetings, using patient case files to map out a holistic plan.

For instance, a pharmacist could ensure there is no interaction between cancer drugs and medicines taken for other conditions, thus lessening the risk of toxicity for the patients.

Such an approach has also led to doctors adjusting treatment plans to suit the patients, given the more comprehensive assessment.

"We think it will help their survival chances because their fitness levels are improved, toxicity is lessened, and treatment decisions are changed leading to better outcomes. Prolonging survival is our ultimate aim,"said Dr Kanesvaran.

The NCCS sees almost 70 per cent of all cancer patients in public-sector institutions. Of these patients, about 40 per cent are aged above 70.

However, doctors in private practice - who practise in a more ad hoc manner - say there are challenges to such a model.

Dr Wong Seng Weng, medical director and consultant medical oncologist at The Cancer Centre, believes the system would be efficient, but "cost is an issue, as all the doctors will charge. It also takes up too much of their time as they all attend the session".

A version of this article appeared in the print edition of The Straits Times on January 01, 2016, with the headline 'One-stop cancer centre for elderly patients'. Print Edition | Subscribe