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COVER STORY

PHOTOGRAPHY JUSTIN LOHART DIRECTION

ALEX GOH STYLING

PHOEBE PONGHAIR & MAKE-UP ADELINECLOTHES

ROBINSONS THE HEERENTIMEPIECE

DELACOUR

ON THEFRONTLINES

OF CANCER

WORDS

QUINTELLA KOH

Instantly relatable, Dr Lim Hwee

Yong reveals why he decided to

pursue a career in oncology and how his passion

for this demanding profession

is constantly renewed. JA

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his day-to-day job. He says, “A cancer diagnosis is very severe. Once a patient gets the diagnosis, it immediately impacts everyone around him or her.” Alongside professional advice, providing assurance to both the patient and the patient’s family and friends is an integral part of his job.

He speaks with unabashed fondness when describing his patients. His candid recounting underlines the complexities of his job. “A diagnosis is not just for the patient, but also for the family and other caregivers. Everyone has to pull together as the patient has to come in so often for treatment. It could be once every two weeks or once every three weeks,” says Hwee Yong. “My patients themselves are in a very fragile position – they don’t know how their diagnoses are going to affect the rest of their lives.”

What if his patient eventually passes on? He does not flinch or try to dodge the question. “Do I think that it is a failure if my patient dies? The way I look at it, my patient needs help. It is a failure if a patient dies painfully. It is not a failure when the patient gets help to face the process with dignity.”

Deciding on OncologyAs a young medical student in the early 1990s, Hwee Yong found himself drawn to the immense scope of research in this field and the intense human interaction involved during the treatment process.

“I was greatly inspired as a young medical student while on a scholarship in the US. I was put in charge of patients – to care for them and to establish psychological relationships. Even if it is not the patient’s life that I can save, I can do something to alleviate the amount of pain that he is in. The vibrancy of the research

We are just beginning to

realise that our body has the

ability to self-regulate. It is a

balance between our genetic

constitution, the environment

and our immune system.

and the complexity of the body intrigued me.”

Hwee Yong received his medical degree from University College Dublin, National University of Ireland. His postgraduate training in Internal Medicine was across the oceans at University of Hawaii. Then came Hematology and Medical Oncology training at Huntsman Cancer Institute, University of Utah.

When he was training and working in the US, Hwee Yong realised that oncology was not just something he loved doing, but something he actually needed to do – much like the writer’s need to put pen to paper, or the runner’s need to bolt full-speed to the finish line.

“When I first went into oncology, there was a lot to learn and a large psychological strain to bear. It is known that oncologists in Singapore shoulder one of the heaviest workloads. But when I came through it, I realised that the amount I can do for a patient makes this very satisfying.

“There is continuity – a very personal relationship with the patient. It is a relationship that starts with the diagnosis and persists for many years. Several of my patients insist on having check-ups even after 10 years of reassurance.”

Hwee Yong recounts the story of a patient who was especially close to his heart. “My patient, a 29 year old young lady who was eight months pregnant at the time of diagnosis, started having difficulty walking, limping on the left leg. It was discovered that she had a tumour mass compressing upon her spinal cord. Tumour masses were also seen in the lung, the central thoracic cavity and the muscle next to the spine. The race against time commenced, and the key was establishing the

It is said that there are generally two types of people in this world: the ones who constantly wonder how their lives would have been different if they had taken a different path at any of life’s forks in the road, and those who know exactly what his or her destiny is. Dr Lim Hwee Yong belongs to the latter.

Hwee Yong does not talk about his work with a starry-eyed look or a rehearsed manner. He is not afraid to share the less than glamorous back stories; and the poignancy of what it is like to hold the hands of people grappling with the very real and sudden threat to their lives.

Seated in his consultation room, one can sense that there is nothing routine about

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COVER STORY

right diagnosis so that proper treatments could be tailored for her.

“She underwent urgent biopsy of the tumour mass in the muscle next to the spine and also required an open thorax surgery to get the proper biopsy from the lung masses. Within a few days, the diagnosis of Hodgkin’s Lymphoma was established, her eight-month old baby was delivered and she was started on life-saving chemotherapeutic treatments. She has since made a complete recovery and has gone back to normal fully functional life with a healthy and lively two-year old.”

Hwee Yong continues empathetically: “The take-home message here is that cancer can be treatable and it is possible to return to normal life routines even after a diagnosis of severe life- threatening cancer.”

Changing public perceptionHwee Yong notes that oncology is a fast-changing field and the biggest challenge for him is to constantly stay abreast with the ever-expanding corpus of knowledge. He remembers the early days, some 20 years ago, when industry practitioners were in a “desperate” situation and it was very difficult to treat most cancer patients.

“When I got into medicine back then, there was pretty much little we could do without significant severe toxicities once we got a diagnosis. But today, we can cure a large proportion of our patients.”

He feels that there is a lot more that can be done in terms of public education and removing the layman’s fear of discussing cancer. He spends a portion of his time participating in cancer support groups such as those organised by

I look forward to the day when cancer can be treated with relative ease and cured in the majority of cases.

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the Singapore Cancer Society, Nectar Care Support Groups and various community support group forums held by charitable organisations. Hwee Yong is also increasingly spending time reaching out to the general public, with the simple message: early detection, early treatment, save lives.

“Cancer is not an incurable disease. It depends on which stage you are diagnosed with. We are now able to diagnose cancer earlier. In the case of stage one cancers, the survival rate can be over 90%, for example, for breast and colon cancers. We are talking about extracting the cancer and extricating it away from your body for the rest of your life. We are even able to cure some stage four patients now.”

For instance, he explains, in the case of the most common cancer in females – breast – the survival rate for stage one patients is close to 93%. Hwee Yong notes that in the case of a successful cure for stage one patients, it is likely that the cancerous cells will never return. “Stage two (survival rate) is at an aggregated 75 to 80% survival rate while stage three is 65 to 70%.”

Part of his public education takes the form of serving as a visiting consultant medical oncologist at the National Cancer Centre Singapore. His is also actively involved in the training of doctors, medical students and nurses. As a member of the Medical Oncology Residency Advisory Board, he is involved in reviewing and advising on the training structure for medical oncology training. This places him in the role of an examiner for the medical oncologist trainee exit exams.

Hwee Yong sees cancer as a disease that requires a high level of very specialised care,

and involves multidisciplinary care. Singapore with its high level of human, biomedical engineering and technological resources is well positioned to be the Asia-Pacific international tertiary high-level cancer treatment hub.

With cancer being increasingly prevalent, Hwee Yong has no reservations about providing free consultations to patients who may not be able to afford the charges. Every single cancer-stricken person, he believes, deserves to fully understand the options. He believes that proper cancer care can be provided at all resource levels. “If a patient is unable to afford the [proposed] treatments, we will look into how we can best help within their resource levels, such as approaching charity sources or using alternative affordable treatment options.”

It’s about moving away from the old ‘cancer equals death’ mindset and not losing hope. Even though Hwee Yong deals with desperately ill patients on a daily basis, he remains optimistic that the medical field will continue to gain deeper knowledge about the molecular, immunological and genetic basis of cancer. “I look forward to the day when cancer can be treated with relative ease and cured in most cases.”

He illustrates his point with three real-life examples. The first is of a 40-year old female patient who was diagnosed with stage one breast cancer. “Upon diagnosis, the first thing she did was to go into denial and shy away from treatment. She returned only one year later to receive treatment. By that time, the disease had spread and the cure rate for her, which was initially at more than 90%, had plummeted to zero per cent. To me, this was a very sad case of denial.”

But can one live a fulfilling

STAGE

1

93 %STAGE

275%-80%

STAGE 3

65%-70%

BREAST CANCER

SURVIVAL RATE

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COVER STORY

life knowing that there are cancer cells in your body? “Absolutely,” he replies.

He proffers the case of another patient, a 53-year old mother of two who learnt that she had contracted stage four breast cancer 20 years ago. The patient first discovered her cancer when she started having persistent back pain due to cancer spreading to her bones. Urgent surgical treatment was required to stabilise the spine. After going through the recommended treatments, she now lives the same kind of life as any other normal female.

“She works as a beautician, she is able to travel for vacations, she dresses up and goes for her hair treatments. She enjoys a good quality of life even knowing that she has cancer, not unlike people living with the knowledge that they have diabetes or high blood pressure.”

Hwee Yong’s third patient is also a 53-year old female who was diagnosed with ovarian cancer. When he first saw her, she was lying in bed with severe back pain due to kidney outflow obstruction, and so ill that she could not speak. Once they ascertained that she had ovarian cancer, Hwee Yong and his team administered the appropriate pain control intervention followed by intensive chemotherapeutic and biologic molecular treatments. “In two weeks, we discharged her well enough to shop happily at Orchard Road; she even managed to travel to the Johor Premium Outlets. She continues to be socially active and entertains guests at her home two years later.”

The message that Hwee Yong wants to spread is for people to never give up hope, to be open to treatment options and to understand that advances in technology have

dramatically increased the survival rate after treatment; and that there is hope beyond the diagnosis. “Patients who previously would have only three to six months can now go on for years with a good quality of life. People need to hear this message of hope.”

Preventing cancerHwee Yong is also actively promoting the concept of “prevention is better than cure.” He explains that the global research community is starting to gain a deeper understanding of the biology of cancer. “We are just beginning to realise that our body has the ability to self-regulate. It is a balance between our genetic constitution, the environment and our immune system.”

He emphasises the importance of the environment and the immune system in cancer evolution by highlighting that there are very few types of inherited cancers. In fact, less than five percent of the global population have hereditary cancer.

He notes that the types of food that we eat and the environment that we expose ourselves to are factors that we can control to help our body’s immune system. Hwee Yong advises staying away from consuming charred and preservative-laden foods, chugging alcohol and smoking.

He cites a research study conducted in Okinawa, Japan. “We realise that the more elderly population continue to live to a very old age while the younger population are getting diseases similar to that of the Western world. This is primarily due to the westernisation of their diet and living habits.”

Winding downIt takes stamina, compassion and commitment to pursue a career in oncology. As

rewarding as his career is, Hwee Yong is well aware of the realities of physical and emotional burnout. Regular breaks help him to unwind and refocus on his goals. He notes that burnout is all too real amongst fellow practitioners of oncology, and he is thankful that he has a very supportive network of family and friends. He describes himself as a family man who enjoys going on outings and hanging out with his family on the weekends.

He also enjoys the occasional bracing ski session, priding himself on being an expert skier who has tackled slopes at heights over 3,000m. “When I am skiing, my mind is completely free and clear – I don’t think about my schedule and cases. I am only aware of my immediate surroundings.”

He also loves running and has taken part in a few marathons. He loves trekking and running in national parks. “After a good workout, I feel energised. It is like food for the mind. And then I feel like I have a kind of renewed energy to go on for weeks.”

Patients who previously would have

had only three to six months can now go on

for years with a good quality of life. People

need to hear this message of hope.

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