10 years of palliative care

Dr Kok Jaan Yang, Senior Consultant in Palliative Medicine at Parkway Cancer Centre, talks about the 10th anniversary of PCC’s Palliative Care Service.

Congratulations on the 10th anniversary of Parkway Cancer Centre’s Palliative Care Service! Can you tell us how it first started?

Dr Kok: Palliative care/medicine refers to medical care that aims to improve the quality of life for patients and their family members who are facing life-threatening illnesses such as advanced cancers. Any established cancer centre in the world will need to integrate palliative care as part of its comprehensive cancer programme.

With this in mind, I was asked to join Parkway Cancer Centre (PCC) in July 2008 to start the PCC Palliative Care Service. PCC is the first private cancer service in Singapore with a specialist palliative care service.

Today, our palliative care team of one specialist and three palliative care nurses provide consult service to our PCC patients in three Parkway hospitals – Gleneagles Hospital, Mount Elizabeth Hospital Orchard and Mount Elizabeth Hospital Novena.

Most of us would associate palliative care with end-of-life care. Are these the only patients you see?

Dr Kok: End-of-life care forms a small part of our work; most of the patients are referred by our PCC medical oncologists and haematologists for the management of difficult cancer pain. Majority of these patients are still having ongoing cancer treatment.

Cancer pain is one of the commonest and most feared symptom in patients with advanced cancer. Most of these patients have mild and moderate cancer pain, which can easily be managed by their medical oncologists or haematologists. For a small group of patients, the cancer pain is more severe and requires higher doses of opioids and combinations of pain-relieving medicines, and they often suffer from more side effects from these medicines. This latter group of patients are often referred to our team.

Our team will help to assess the cancer pain comprehensively, and to educate the patients and their caregivers on why they are suffering from the pain and how best to cope with it. Essentially, the aim is to maximise the pain relief and minimise the side effects.

Some of our patients have been seeing me for years for cancer pain management as they continue their cancer treatment in PCC.

Besides cancer pain management, what other services does the Palliative Care Service provide?

Dr Kok: For local patients, we also assist in discharge planning and home care planning.

Patients with advanced cancer may get weaker and require more than usual care at home after prolonged hospitalisation. We can evaluate a patient’s condition and determine the nursing and equipment needed for the caregiver to take care of the patient at home. We also help link them up with the appropriate services that could provide the necessary nursing care and equipment rental.

For patients who are too weak to come to see us in the clinic, we can help to engage a home care service, or arrange for home visits by our team to continue the care at home.

We can also help our patients in Advance Care Planning (ACP). This is a relatively new concept that is popular in the US and Australia. It is essentially a process to understand patients’ values in life and preferences, and what they wish their loved ones and their doctors to do for them, in the event of a disabling and life-threatening condition where they are no longer mentally capable to make decisions for themselves.

For the continuity of patient care, we are a three-in-one palliative care service which provides hospital-based consult service, outpatient-based consult service as well as home-based palliative care service for a small group of our local patients.

Do you still do end-of-life care for patients?

Dr Kok: Oh, yes. Some of our patients do deteriorate and may suffer from many symptoms in their last hours, days or weeks. These symptoms may be distressing to them and their family members. Our team helps to assess and manage their symptoms, and address their concerns. PCC’s CanHOPE counsellors also provide psychosocial support to these patients and family members if needed.

With the advances in cancer treatment in the last few years, how do you see the role of the Palliative Care Service in PCC in the next five to 10 years?  

Dr Kok: With the advances in cancer treatment, we are likely to see more patients living longer with cancer treatment and we expect PCC to continue to grow in the years to come. So for the next five to 10 years, I foresee the Service, which is an integral part of PCC, to also grow, as we work hand-in-hand with our medical oncologists, haematologists, and our multidisciplinary team of nurses and allied health staff, to provide the best care for our patients undergoing cancer treatment in PCC.



Tags: cancer caregiver, cancer counsellor, cancer pain management, cancer quality of life, CanHOPE, common side effects of cancer treatment