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Race against time

Parkway Cancer Centre aims to deliver a diagnosis and treatment plan within 48 hours of a patient walking in.

Despite the many scientific and medical advances in the past decade, cancer, or the possibility of cancer, still strikes fear in the hearts of many.

In truth, many are curable, especially if caught at an early stage. Many others can live for years without a severe loss in quality of life.

Nonetheless, the fear of a cancer diagnosis remains – because of this, people who visit an oncologist for the first time with a suspicious lump, or painful, unexplainable bleeding, are usually extremely anxious. Uncertainty makes the process much harder to deal with.

Parkway Cancer Centre (PCC) has taken steps to address these fears and anxieties by working to treat patients quickly.

“At Parkway Cancer Centre, we are able to establish a histologic diagnosis, to determine the extent of the cancer and to come up with the treatment plan within 48 hours of seeing the patient,” said Dr Ang Peng Tiam, the Medical Director of PCC.

Dr See Hui Ti, a Senior Consultant in Medical Oncology, said: “We know that every minute counts when a loved one is diagnosed with cancer and awaiting a treatment plan. As such, a multi-disciplinary team of doctors, nurses, counsellors and other paramedical professionals will be activated immediately.”

Achieving the 48-hour goal is no easy task because it calls upon the different parts of PCC to work together as a well-oiled machine. The entire process involves many people – apart from the oncologists, it involves radiologists, radiotherapists, pathologists, perhaps even surgeons, laboratory technicians and allied health workers like nurses and counsellors.

Dr Ang likens it to an orchestra where the oncologist is the conductor. However, in an orchestra, all the musicians are in the same room, poised and waiting for their cue. This is not the case with an oncology practice where experts and equipment are scattered all over the hospital.

What helps is that PCC, over the last decade, has built up a large team of professionals with expertise in many different disciplines who work together and share the same goals, he said.

Added Dr Richard Quek, a Senior Consultant in Medical Oncology: “As a team, we strive to provide the best care a patient deserves.”

While in most cases, the speed is about providing patients with answers so that they can remove worry and uncertainty, and in some cases, working quickly is critical for combatting the cancer, said Dr Ang.

And just as important as speed is accuracy. “As such, while we work quickly, we don’t sacrifice accuracy for speed,” he said.

In 48 hours...

• A biopsy needs to be done to get an early diagnosis.
• Immunostaining needs to be done to find out the type of cancer.
• A full screening needs to be done to stage the cancer.
• Oncologists need to come up with a treatment plan.
• Oncologists, radiologists, radio-therapists, pathologists and even surgeons, laboratory technicians and allied health workers need to work together.

Why the rush?

Dr Ang Peng Tiam, Medical Director of Parkway Cancer Centre, explains the urgency.

Can you explain what the 48-hour goal is and what it involves?

We want to bring a patient from first consult to treatment plan within 48 hours.

When patients first come to us, they are worried and anxious. They want answers as quickly as possible. They want to know: Do I really have cancer? What do I need to do? What is my prognosis? What can be done?

For oncologists at Parkway Cancer Centre (PCC), it means that by the end of a 48-hour period, we can answer the questions: Do you have cancer? What type is it? Is it localised or has it spread? How can it be treated? Is it curable or are we talking about prolonging of life?

Among cancer patients, the anxiety is tremendous. That’s why for me, 48 hours is something all oncologists should strive for – to arrive at a diagnosis and come up with a treatment plan for patients.

Is 48 hours a long time or a very short time?

From a patient’s point of view, 48 hours is a very long time. For the system in most medical institutions, it’s a very short time.

To achieve this, you need to muster the full resources of the institution. When a patient walks into the room with a breast lump, you have to do many things – you examine, you want to get a biopsy, which could be done by yourself or done by a radiologist.

Once you have a specimen, a pathologist needs to quickly get an early diagnosis. He then has to put in immunostains to find out the type of cancer.

As the pathologist is doing this, the oncologist needs to mobilise a team to do a full screening in order to stage the cancer.

During this whole process, the oncologist is like a conductor of an orchestra, coordinating different parts to come in at the right moment, except that in an orchestra, all the musicians are sitting in the same place waiting for their cue. For a medical institution, all the players are scattered about, and they are working independently. They are not merely waiting for their cue to jump in. 

That’s the strength of the private sector  – we have the resources, the capacity and the willingness of the doctors to deliver care in an expeditious manner.

This is not easy to do. We must make sure that the machinery is well oiled. Everyone must appreciate the urgency of the matter.

Is there a clinical reason for moving quickly?

In all cases, being able to deliver a diagnosis and treatment plan quickly means being able to alleviate the worries of patients. However, there is usually no clinical reason to work speedily, not in most cases anyway. In some cases though, it is vital to be able to act quickly.

While we aim for speed for the mental wellbeing of patients, we do not compromise on accuracy. Accuracy is very important to us. It is far more important for us to be definitive in our diagnosis and treatment plan. As such, while we work quickly, we don’t sacrifice accuracy for speed.

What is PCC’s track record for delivering on its 48-hour goal?

We are able to achieve our goal for about 90 per cent of patients.

In some cases, such as for non-small cell lung cancer, you need to do special molecular studies and the lab time to do to the test takes a week. You need the molecular studies to come up with the definite care plan, so, for those instances, we cannot meet the 48-hour goal. However, in almost all other cases, I’m proud to say that we do meet this goal.

Written by Jimmy Yap