Doc Talk

Rewarding to help kids overcome spectre of cancer

You know it is the school holidays when the usually busy morning commute to work goes smoothly.

The drive to work is stress-free, which in itself is slightly unnerving.

Most clinics are also quieter as many doctors and nurses take time off to be with their families.

The only clinics which are busier during this time are the children's clinics, such as mine in the Viva-University Children's Cancer Centre. It is at the National University Cancer Institute, Singapore in the National University Hospital (NUH).

But school holidays are my favourite time of the year, not just because of the smooth traffic.

It is also the time when my clinics are packed with survivors of childhood cancer, coming for their annual check-ups.

Treatments for childhood cancer have improved over the last 30 years. Seven in 10 children diagnosed with cancer survive.

Not only are more children cured of cancer, but contemporary treatment also has fewer long-term side effects.


ST ILLUSTRATION: ADAM LEE

Since the early 1990s, brain radiation has been replaced with chemotherapy to eradicate leukaemia cells hiding in the brain.

Now, the survivors reach their full potential in school, doing as well as their siblings in their studies.

Since 2005, research funding from the Health Biomedical Sciences initiative has allowed us to devise biomarkers that can accurately predict a leukaemia patient's risk of relapse.

And we can adjust his or her chemotherapy doses to minimise side effects while maximising the chance of a cure.

Some 85 per cent of patients with childhood acute lymphoblastic leukaemia, the most common form of childhood cancer, are cured.

Its treatment typically lasts over two long and stressful years. Inevitably, the patients and families build close bonds with the medical team, including doctors and nurses.

Even the patient service associates at the registration counter play a part in the patient's journey. Many of them form good relationships with patients and their families.

For these patients and families, the hospital is like their second home, where their children spend two years leading a highly structured, clean and isolated lifestyle.

BRAVE NEW WORLD

Initially, it can be daunting for families of survivors to take the first steps alone into a brave new world without chemotherapy or frequent hospital visits.

Apprehensive parents often want their child to continue his or her chemotherapy a little longer. They make their children wear face masks as a kind of security blanket, and continue to ensure that their children avoid raw food, such as salad or sushi.

To them, it is akin to emerging from a dark tunnel and into the light where the brightness is blinding.

Slowly, but surely, they adapt.

I am particularly proud of three patients - a teacher and two students.

Mr A, a teacher in his 30s, has survived cancer for more than 25 years. He is as fit as a fiddle, good in sports and has a nice healthy tan.

When the two students were diagnosed with cancer, I called upon Mr A to help speak to their families.

Seeing him survive childhood cancer and growing up normally is more reassuring than any words of comfort I could offer.

M was diagnosed with leukaemia in Primary 6. Six years on, he has completed his O levels and is studying in a junior college.

He has grown from a fair, skinny boy into a tall, fit kayak rower. He does kayaking with his schoolmates a few times a week.

Contemporary chemotherapy for childhood cancer minimises the use of drugs that can damage the heart.

Therefore, most survivors can enjoy sports and an active lifestyle.

Another patient, C, joined the National Police Cadet Corps as his extracurricular activity soon after he completed chemotherapy.

A bit stocky like his father, he is always cheerful and helpful. He had high-risk stage 4 lymphoma and benefited from a new monoclonal antibody that was added to his treatment regimen.

Every time I ask him for help, he will jokingly say: "I am your guinea pig again!"

But he happily rolls up his sleeves to donate blood for research. He also speaks to distraught families who have received news that their children have lymphoma.

Survivors of childhood cancer like M and C will not only have normal life expectancies but, in some ways, they may also be healthier in the long run.

This is because medical staff would counsel them to lead healthy lifestyles, to avoid smoking or getting drunk, and to stay active.

I am also on a constant lookout for any late effects. This may include the patients lagging behind in school, compared with their siblings or peers.

If we can pick up these problems early, we can manage them so that they no longer pose any problems to the patient.

Not all cancer therapies have no long-term side effects.

Some types of cancer still have poor cure rates. For these, patients may have to tolerate side effects from the disease or the treatment.

Unlike actress Angelina Jolie who inherited a gene that puts her at risk of breast and ovarian cancer, childhood cancers are mostly genetic accidents. Cancer survivors face a low 1 per cent risk of passing it to the next generation.

Although I have long exhausting clinic sessions during the school holidays, it is always heartwarming and fulfilling for me.

Looking at how my patients grow up into normal adults is highly rewarding.

•Associate Professor Allen Yeoh runs the multi-centre Malaysia-Singapore leukaemia studies involving NUH, KK Women's and Children's Hospital and Malaysian centres.

A version of this article appeared in the print edition of The Straits Times on November 03, 2015, with the headline 'Rewarding to help kids overcome spectre of cancer'. Print Edition | Subscribe