Newly-minted chief of NCCS William Hwang is optimistic about steering the centre through future challenges such as the cancer tsunami and rising treatment costs.

From heading the Department of Haematology at SGH, the Singapore Cord Blood Bank and then leading SingHealth Transplant and the SingHealth Duke-NUS Blood Cancer Centre, Associate Professor William Hwang has worn many hats before his latest one as the Medical Director of the National Cancer Centre Singapore (NCCS).

Prof Hwang, who specialises in blood cancers, took over the mantle from Professor Soo Khee Chee, the founding director of the centre, in November 2017. He shares his thoughts about the future of cancer care.  

Q: How do you feel about helming NCCS?

A: It's a great opportunity because I have always respected NCCS and its people for the good work they do. While excited about this opportunity to help lead this amazing group of people to win the fight against cancer, there is also some anxiety. NCCS is not a small institution and I have very big shoes to fill. But I am optimistic about carrying on the journey together with the many people Professor Soo has groomed over the years at NCCS as well as with its different partners.

Q: What do you think are the biggest challenges for cancer care in Singapore? What are NCCS' efforts to overcome them?

A: One big challenge we will face is the "cancer tsunami", an explosion in the number of cancer cases here due to our ageing population. At NCCS, we hope to step up prevention and screening programmes to help delay the onset of cancer and to reduce its severity when it is diagnosed.

Another challenge will be the cost of cancer care, which can be substantial. Overcoming this requires us to enhance value by eliminating waste and redundancy as well as by managing the cost of drugs. I believe we can also use robotics and artificial intelligence to temper the need for increased manpower.

The new 24-storey NCCS building, which will be ready by 2022, is part of our efforts to address these challenges. There will be more space for patient care, and for research to accelerate availability of better and cheaper drugs. Throughout the building process, we have the opportunity to get the opinions of various stakeholders to see how we can redefine cancer care on our campus and nationally.

Some patients told us they had to see many doctors before they finally had their cancer diagnosis and saw a cancer doctor. Through a more integrated care model we hope to give patients easier access to cancer doctors, so that they can have early diagnosis, treatment and faster recovery.

Q: Is there hope for the future of cancer care here?

A: Yes, of course! There are three reasons why I am hopeful.

Firstly, we have seen the progress made by cancer treatment and how cancer has become more curable over the last several decades. Sixty years ago, almost nobody was cured of cancer. Since then, we have made small improvements every decade and now, we have therapies that give as high as 90% survival rate for some subgroups of cancer patients. There are many therapies available now and more to come in future.

Then, if we view our battle with cancer as a war, I would say that we have very good intelligence of the enemy now. Through research in genomics, proteomics, immunomics and a variety of other fields, our "spies" have come back, with good knowledge of how to beat the enemy.

Lastly, the science of immunotherapy has come of age – we are now able to use the immune system to fight a number of cancers effectively. One recent example is by introducing a gene into T-cells, the policemen of the immune system, so that T-cell receptors can look out for cancer cells and kill them. Called CAR T-cell therapy (CAR stands for Chimeric Antigen Receptor), it has been given to patients with acute lymphoblastic leukemia with a good response rate. This therapy is gradually being expanded to other tumours, with ongoing trials for lymphoma, multiple myeloma and solid tumours.

Q: How about other aspects of cancer care, such as prevention?

A: We want to get the population involved in cancer prevention. Some cancers are linked to lifestyle factors, one of which is smoking. Many smokers may find it difficult to quit smoking, but if you ask them if they want to prevent their children from smoking, an overwhelming number will say yes. So, we want to put a new boost into our public education programme to get the children to be the voice and ambassadors of a tobacco-free generation.

In terms of screening, a lot of effort is already going on. But instead of having different people suggesting different types of health screenings and methods of prevention, we need a clearer message for the public, and tell them what's effective and what's not, based on clinical evidence. We at NCCS have a duty to provide that clear voice and direction.

The other challenge is to expand our palliative and supportive care department. We need a more systematic approach from the point of diagnosis, and through the different phases of cancer. This makes the transition to palliative care smoother because the patient would be supported by the same group of health professionals.

Q: Can you share your more memorable interactions with patients and what you, as a doctor, learnt from them?

A: When I was a medical officer, I had difficulty accepting the deaths of some patients. I remember treating a boy with leukaemia who had a relapse. He passed away subsequently and I felt lost and defeated. But the mother came up to me and gave me a hug and said, "Thank you for all that you had done."

I realised that while we may not always succeed in curing patients, families and patients appreciate that we care and that we have done our best for them.

“In life, it’s not about the number of days we live, but the amount of good we can do while we are alive.”

Another patient came to me as a young boy. He's doing well and working as a researcher right now. Though he is aware that he may have a relapse in future, he has been living life to the fullest every moment he can. He has done more things than I have ever done in my life - tandem skydiving, bungee jumping, running marathons.

While you never know what the future holds for patients, I find that those with the right mindset can make the best out of it. And I came to understand that in life, it's not about the number of days we live, but the amount of good we can do while we are alive.