27 APRIL 2015

Relieving pain, improving quality of life

Contributed by: Dr Kok Jaan Yang

Dr Kok Jaan Yang, a Senior Consultant in Palliative Medicine at Parkway Cancer Centre explains the what and whys of palliative care.

What is palliative medicine?
Palliative medicine is the branch of medicine in palliative care, which aims to relieve suffering and improve the quality of life of patients who are facing life-threatening illnesses such as advanced cancers.

Is palliative care the same as  terminal care or hospice care? No, although terminal care or hospice care (which generally implies the medical care in the last few days or months of life) is an important part in palliative care; palliative care is more than terminal care/hospice care. Palliative Care Services may be involved with patients who are still receiving active cancer treatment such as chemotherapy or radiation therapy, and are not necessarily in their last days or months of life. Many of these patients are seen by Palliative Care Services for pain management. With better pain management, the patients are able to cope better with their cancer treatment.

Tell us about Parkway Cancer Centre’s Palliative Care Services. The Palliative Care Services in Parkway Cancer Centre (PCC) was set up in July 2008, as part of the centre’s push to provide comprehensive cancer care programme for all our patients. It is the first palliative care service in the private healthcare sector with full-time specialists in palliative medicine. The Palliative Care Services here is unique in that we are really a three-in-one service. We function as a hospital-based specialist palliative medicine service, we run a palliative medicine clinic in PCC and we also provide home care palliative care services to our patients who choose to remain with us when they are too weak to travel to our clinics. Since 2013, for our efforts to integrate palliative care successfully into our cancer management in PCC, it has earned us the prestigious accreditation as an European Society for Medical Oncology (ESMO) Designated Centre of Integrated Oncology and Palliative Care. PCC joins more than 160 cancer centres worldwide which have been awarded this title.

Can you explain broadly what the services are that Palliative Care Services provide in Parkway Cancer Centre? We provide four main categories of services: Cancer Pain Management, Discharge and Home Care Planning, Advance Care Planning, and End-of-Life Care.

Cancer Pain Management About a quarter of patients with advanced cancers suffer from severe cancer pain.  The cancer pain may be complex as it may be caused by tumour expansion, bone involvement, nerve compression, and so forth. Sometimes pain-relieving medications may cause a lot of side effects. After a comprehensive pain assessment, we will provide a pain education and pain management plan for our patients to cope better with their cancer pain.

Discharge and Home Care Planning Discharge and Home Care Planning is aimed at patients with advanced cancers who are getting weaker and who require more than the usual care at home. We evaluate the patient’s condition and determine the nursing and equipment needs at home. We will also link up with appropriate services to provide the necessary nursing care and equipment rental or purchase.

Advance Care Planning Advance Care Planning is a new concept to help the patient to plan and document his wishes/preferences regarding his medical treatment in advance and to appoint a substitute decision maker in the event that he loses the mental capacity to do so later.

End-of-Life Care End-Of-Life Care addresses the many symptoms that patients experience in their last hours, days or weeks of life. We help to assess and address these symptoms so that patients can be more comfortable in the place of care.

How did you become interested in palliative care/palliative medicine? My first encounter with palliative care was in 1988. At the time, I was a second-year medical student and my mother was dying of cancer. In her last days, she was one of the earlier patients enrolled in the then new Hospice at Home programme. Inspired by what they were able to do for her, I joined the Hospice Care Association as a volunteer doctor in 1992. In 2000, I decided to join Dover Park Hospice to pursue my interest in palliative medicine though it was still in infancy stage in Singapore. I completed a distance learning post-graduate diploma course from Cardiff, UK, in palliative medicine in 2002. In 2004, I spent a year at the St Vincent’s Hospital in Melbourne at the Department of Palliative Care Medicine under a scholarship from the Ministry of Health. Since 2007, I was appointed by the Specialists Accreditation Board, Ministry of Health, as one of the pioneer members of the Specialist Training Committee in Palliative Medicine to oversee the specialist training in Singapore. Palliative medicine was formally recognised as a medical specialty in Singapore in 2010.

What are your other works? I am very involved in teaching and training in palliative medicine. I have been teaching medical students in palliative medicine since 2002; I hold the appointment of a Clinical Senior Lecturer in Yong Loo Lin School of Medicine, National University of Singapore. I am also involved in teaching graduate doctors in palliative medicine – I am the Programme Director of the Graduate Diploma in Palliative Medicine Course (GDPM) offered by the Division of Graduate Medical Studies (DGMS) at the National University of Singapore. I am still involved in the training of specialists in palliative medicine and have been serving as one of the examiners in the Exit Examinations for the Advanced Specialist Training in Palliative Medicine.

What is it like working in palliative medicine? Caring for the dying is both physically and emotionally draining but a career in palliative care is not depressing. I find joy in helping patients and their family members to cope with cancer treatment better, especially in terms of pain management so that they could have a better quality of life while undergoing cancer treatment. For patients who are dying and in the last days of life, I also find satisfaction in helping the patients to be more comfortable and to support them and their families step by step, through this difficult journey.

By Jimmy Yap
POSTED IN Palliative Care
TAGS cancer pain management, cancer quality of life