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In a first in the region, KKH is sharing its expertise in the area of paediatric brain and solid tumours with doctors in our neighbouring countries through training fellowships as part of the VIVA-KKH Paediatric Brain and Solid Tumour Programme. With more doctors in Southeast Asia and the region equipped with the skillsets needed to treat these complex diseases, more children's lives can be saved every day.

Paediatric brain and solid tumours: a tricky foe

As one of the leading causes of death among children past infancy, childhood cancers are especially heartbreaking due to the patients' young age. Regionally, paediatric cancers have a high fatality rate – childhood cancer mortality rates in Southeast Asia are the third highest in the world.

"Brain and solid tumours make up over half of all childhood cancers and account for the majority of malignant deaths in children worldwide. Their treatment is complex and requires coordinated efforts from a whole team of diverse medical subspecialties," shared Dr Amos Loh, Chairman, Steering Committee, VIVA-KKH Paediatric Brain and Solid Tumour (PBST) Programme; and a Senior Consultant with the Department of Paediatric Surgery at KK Women's and Children's Hospital (KKH).

For best outcomes, patients require prompt and efficient care from many disciplines, including medical oncology, surgery, radiation oncology, diagnostic radiology, and pathology.

For some patients, not having access to one particular subspecialty can mean a world of difference in their treatment outcomes. This is where exchange of knowledge can help bridge the gap and improve multidisciplinary cooperation for better patient outcomes.

Giving our neighbours a leg up by sharing expertise

To help boost regional expertise in certain specialties, KKH started training fellowship programmes in the fields of paediatric surgery and pathology for trainees from neighbouring countries.

These training fellowships were first launched in 2018, as part of the Education and Exchange initiative under the VIVA-KKH PBST Programme – a clinical and research partnership between KKH, St. Jude Children's Research Hospital, USA, and the VIVA Foundation for Children with Cancer. Trainees can come onboard as either fellows or observers, and will return home equipped with the knowledge and skills to better treat their patients.

Dr Loh elaborated, "Through our Programme's research on childhood cancer care in Southeast Asia, we found that many regional hospitals only had oncologists but may not have other specialists with the necessary expertise to care for patients with brain and solid tumours. We realised we could benefit many other children by sharing the skills and knowledge of our experts in Singapore."

Fellows ready to lead the charge back home

Since its inception, six fellows and observers from neighbouring countries like Cambodia, China, Malaysia, Myanmar, and Pakistan have been trained in the fellowship.

Paediatric surgeon, Dr Yusran Othman, from Malaysia joined the one-year training fellowship to build his expertise in performing surgery and providing perioperative care for paediatric surgical oncology patients. 

He said, "Through this fellowship, it is also my hope that I become the first Malaysian paediatric surgeon with formal training in surgical oncology. I wish to improve the paediatric surgical oncology services in Malaysia, as well as formulate better training opportunities for other like-minded colleagues."

Another participant in the training fellowship, Dr Mary Nheb, signed up for the programme as an observer in August 2019. As a pathologist from Calmette Hospital in Phnom Penh, Cambodia, Dr Nheb had the chance to gain further experience in paediatric pathology by observing processes in the pathology laboratory and sitting in on meetings between medical professionals from different subspecialties.

She shared, "The training has inspired me to have a think about how I can train the pathology residents in Cambodia and even redesign the laboratory in our hospital to make sure it complies with certain standards such as safety standards and infection control precautions."

Mutual learning to better understand paediatric tumours in the region

Sharing of knowledge often goes both ways.

"Given the limitations they face back home, there are often unique aspects of their practice and experience that we do not encounter in Singapore. These are learning points for us too," shared Dr Loh.

At the end of the day, the battle against a tricky foe like childhood brain and solid tumours cannot be won alone.

"Childhood tumours are diverse and individual histotypes are comparatively rare. This makes it particularly challenging to study individual tumour types in clinical trials and limits the opportunities to define the effectiveness of new treatments," explained Dr Loh.

"This is exacerbated by a lack of research in Asian childhood solid tumours."

Indeed, the fellowship programmes have brought about the opportunity to gain deeper insights into Asian childhood brain and solid tumours.

As an extension of this, several online networking platforms have been set up to keep the exchange of knowledge going among hospitals in the Asia Pacific. Comprising faculty in KKH and international experts, these groups give regional doctors the chance to seek advice for challenging cases in their home countries.

All this collaboration can only mean one thing: improved outcomes for the young patients with cancer in the region. The VIVA-KKH PBST training fellowship is undoubtedly making progress in the right direction, one regional fellow at a time.

About the VIVA-KKH PBST Programme

In Singapore, the majority of paediatric brain and solid tumour cases are treated in KKH, and there has been a need for increased focus on this deadly disease. To that end, the VIVA-KKH PBST was started in 2015. This clinical and research partnership draws on the combined expertise of KKH and the world-renowned St. Jude Children's Research Hospital, USA, to advance the treatment of paediatric brain and solid tumours, with the support of the VIVA Foundation for Children with Cancer. Specifically, the programme is focused on improving clinical care, facilitating bench to bedside translational clinical research and looking into prevention, control and population-based science. Singapore has now been identified as a regional coordinating centre for the St. Jude Global Alliance of paediatric cancer centres.