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Dr Chin Tan Min, who joined Parkway Cancer Centre in August 2019, is thankful for the many advancements that give cancer patients more treatment options.
As a junior doctor in training, I was drawn to specialties that offered multi-disciplinary and holistic care, and these included geriatric medicine and medical oncology. Eventually, I chose medical oncology as this was an exciting and fast growing specialty with many scientific and treatment advancements.
It has been an interesting journey of learning (both being educated and educating), contributing back to society, and paying it forward to the younger generation of doctors. It can get challenging at times to keep up the enthusiasm and energy. However, the profession of doctoring is a noble and satisfying one, and ever so often, we are reminded in the daily course of our work that we can make such a significant difference to someone’s life. This has kept me going.
The fraternity in medical oncology and medicine is a close-knit and supportive one. I have been very lucky to have had great mentors and colleagues who gave me many opportunities and guided and supported me along the way. In turn, we train the younger generation, and it makes our work purposeful.
It also helps that there have been many advances in the field of medical oncology, and as such, there is never a time of boredom! One needs to keep up with the rapidly changing field to offer the best to our patients.
I suppose it was a matter of chance and timing. Lung cancer used to be one of the most common cancers in Singapore and also worldwide, and unfortunately also accounted for the most number of cancer deaths in Singapore. In a patient with late-stage lung cancer, there used to be little, other than chemotherapy, that could be offered. It was an area of great need.
In the early 2000s, when I was a young trainee in medical oncology, it became evident that certain types of lung cancer would respond very well to oral medication. It so happened then that one of my patients was a very young lady who was resistant to the idea of chemotherapy (the standard treatment for lung cancer at that time) and its side effect of hair loss. She coughed a lot, brought up mugs of phlegm every day, and could not complete her sentences.
We treated her with oral medication, and within days, she was a completely different person – much happier, not having to catch her breath, and coughing less.
To an impressionable young doctor, that was highly motivating, knowing that we could make patients feel better with oral medications that had prompt responses and minimal side effects. This patient was probably the turning point in my choice of sub-specialising in lung cancers.
We now know that this lady had a specific subtype of lung cancer that harboured certain genetic aberrations, allowing the oral medication to target the cancer. These “genetic drivers” tend to occur more commonly in Asian women and non-smokers, and likely represent a different subset of lung cancers from that in smokers.
We have come to recognise that it is important to come up with tests that will allow us to identify these “genetic drivers”, and therefore the subset of patients who would respond favourably to oral medication.
For example, we’ve come up with a local test kit that facilitates the detection of relevant genetic drivers and markers, allowing suitable patients to get the most appropriate treatment within the shortest waiting time possible.
We’ve also moved on to design blood-based “liquid biopsy” tests which are less invasive than biopsies and can be repeated easily to reflect the cancer burden at any one time. This allows doctors to personalise the subsequent treatment based on each individual patient’s tumour profile.
The field of lung cancer has moved forward in leaps and bounds, from looking for one gene and target to multiple genes and targets, and from tumour-based tests to blood-based ones. I have been so fortunate to be practising in this era of medical oncology, when there are constant and rapid discoveries. They translate to meaningful improvements and treatment options for our patients.
I typically start my day at 8am with a cup of coffee and a good breakfast to last me till the afternoon. The morning is usually spent checking in on patients in the ward, followed by seeing patients in the clinic the rest of the day. I usually take a break in the mid-afternoon, and if possible, take a quick walk out for lunch – to get some sun and exercise (or what little there is!), and to catch up with colleagues. Before I head home in the evening, I will usually review the patients again in the ward, or any scans that need to be followed up.
As medical oncologists, we are fortunate to be equipped with the necessary information to make informed, consultative discussions with patients and their families. With time, the bond formed between patients and doctors can be strong, and it does get increasingly difficult when a patient passes on. But this is inevitable.
I always say to my patients, “There is only one eventuality and certainty at birth, that is, we will all one day succumb.” It is how we make the best of the time given, and seeing that life can be short and unexpected has taught me to live every day to its best.
It also gives me comfort that regardless of the aim of treatment, we give comfort and good care to all patients.
There have been many patients who have, in their different ways, taught me how strong humans can be in the face of adversity. This is a great lesson.
I have also learnt that despite who and where one has been, in the final days of our lives, what matters most is almost universally the same – and surprisingly, simple: That one has made peace and led a happy life with little regrets.
I must admit it is a concept still elusive to me, as it really is not easy to separate work and home life cleanly. Often, work follows one home – if not physically with a lap-top, then mentally. Over the years, I have figured out what is most important is not a clean separation, but ensuring that one is fulfilled by the work one does. That way, even if work spills over, I do not mind it so much.
On the family front, my husband is a doctor, too, and we have two young kids. Having witnessed illness in our profession, we treasure health and happiness. We are therefore, free rein parents mostly, believing that our kids should spend most of their time at the playground, being happy and carefree.
We try to keep weekends for family time, and usually look forward to an easy Sunday breakfast and just spending time together – doing nature walks or trying our hands at a new dish in the kitchen.
Most people fear the cancer diagnosis, as it usually conjures images of pain, suffering and limited survival. Some of that may be true, and even though cancer treatment has come a long way, many patients still do succumb despite the best of efforts.
My hopes for cancer medicine are…
…To cure more cancer patients. This means detecting cancers earlier, which would be one of the better strategies for reducing cancer morbidity and mortality.
…To treat advanced cancers as chronic illnesses rather than as terminal illnesses, just as how we can treat chronic conditions such as diabetes and hypertension effectively. We are not quite there yet, but with new medications coming through the pipeline and cancer research going on, I am hopeful that this may be realised in the near future.
…To increase patient awareness of the many effective treatment options for cancer, so that they do not shun treatment for fear of side effects. A fair number of patients have dropped out of mainstream treatment to pursue alternative medications due to misconceptions of how bad the side effects can be. It is important for the public to know that there are now many good supportive medications to counteract the side effects, and most patients can undergo treatment without too many side effects.
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