PALLIATIVE CARE DOCTOR Q&A

What is palliative care? Is it only for the terminally ill?

With an ageing population, and advancements in cancer detection and treatments, an increasing number of cancer survivors and patients with advanced cancers are now living longer than in the past. These patients may face a myriad of physical, emotional, and psychosocial issues related to the cancer itself and its treatment, which can potentially compromise their quality of life, if not addressed.

Ask Asst Prof Grace Yang, Senior Consultant, Division of Supportive and Palliative Care at National Cancer Centre Singapore (NCCS), and Dr Loo Yu Xian, the Head of Service & Consultant of the Department of Post-Acute and Continuing Care (PACC) at Outram Community Hospital (OCH), both members of the SingHealth group, all about the facts and myths surrounding cancer survivorship, supportive and palliative care.

Posted by G****

Dear Dr Grace Yang, my father has stage 2 lung cancer (he’s been a heavy smoker all his life).

  • What is the survival rate?
  • I hear the term ‘palliative care’ being mentioned frequently these days, what exactly does it entail? Is it only for the patient or does it also include family members?

Answered by Dr Yang:

Dear G****,

Sorry to hear that your father has lung cancer – must be a stressful time for the whole family. There is a good chance of cure for stage 2 lung cancer if he is able to get through the treatment. You will be able to find various 5-year survival rates online but these are just estimates and it is best to talk to your doctor about your individual situation.

“Palliative care” is an approach that focuses on quality of life for patients with serious illnesses such as cancer, and for their families. Palliative care includes checking and treating for symptom problems such as pain, breathlessness and nausea. It also includes providing a listening ear and journeying with patients. Some general palliative care is provided by your cancer doctors and nurses. There is also specialist palliative care for those with more complex problems, and these specialist palliative care services may be based in the hospital, community or hospices. You can read more at https://singaporehospice.org.sg/

Posted by T**

Dear Dr Yang,

I’m an only child and my parents are in their mid and late seventies. No serious condition with their health so far, thankfully. But we all know, no one stays in perfect health forever. So to prepare myself for that day, is palliative care beneficial for me and my family?

If it is, how do you suggest I go about broaching the idea to my parents (they’re old-fashioned)? Or is it more applicable only when they’re approaching end of life?

Answered by Dr Yang:

Palliative care is for patients with serious life-threatening illnesses and their families. Nonetheless, it is good to be prepared. You can start by having conversations. Conversations about their life story, about what is important to them, about what they look forward to in life. Then go ahead and make time for things that matter. There are some events for the month of October in various public libraries around Singapore. You can also check out https://singaporehospice.org.sg/events/ Going together to an exhibition or talk near you could be one way of broaching the idea.

Posted by A*******

Hi Dr Yang,

How are you? Low white blood cell count does it indicate the probability of breast cancer relapses is higher? Currently patient is thinking to commit suicide. Please advise any solutions.

Answered by Dr Yang:

Dear A*******,

There is no evidence that low white blood cell counts indicate a higher breast cancer relapse rate.

I am sorry to hear that the patient is thinking of committing suicide. I am unable to give specific medical advice – please consult the patient’s doctor as soon as possible. You mean read more about how to help someone who expresses suicidal thoughts here https://www.sos.org.sg/get-help/helping-someone-in-crisis. One of the best ways you can help is providing a listening ear and being available.

Posted by N*******

Dear Dr,

I had NPC in 1992, followed by 34 doses of radio therapy on the throat, nose, left and right side under the ear.

I suffered from progressive side effects after the radiation.

I do not need Chemotherapy as mine is 1st stage.

About 12 years ago, my throat started to give problems. My voice started to deteriorate.

In 2016 Jan, I could not eat and drink. My doctor from NTFGH (Dr. Soon Yu) opened a hole in my tummy and inserted a tube so that I could feed milk.

The problem did not end here, my windpipe could not close, thus saliva enters and I always cough very hard to remove it.

Is there anything that can be done to alleviate the sufferings?

Answered by Dr Yang:

Dear N*******,

I am sorry to hear about the problems and suffering that you have. Indeed, cancer treatment is really tough and can have long term effects on quality of life. Joining a support group may help – there is an NPC support group for cancer patients and survivors and caregivers. You may find more information about this here: https://www.healthxchange.sg/forums/support-groups/nose-cancer/Pages/nose-cancer-support.aspx We may be able to help with some of the symptom problems that you are experiencing – if you would like specific medical advice, do call 6436 8000 to make appointment with a Palliative Medicine doctor.

Posted by K*****

NSCLC ,Stage III A patient

66 yrs, F, non-smoker

Successful Treatment =

  1. Pre-op Chemotherapy (carboplatin + Pemetrexide)
  2. Lobectomy + removal of lymph nodes near tumor
  3. Post-op chemotherapy (carboplatin + Anzatax) + RT
EGFR +ALK + PDL 1 are all negative.

The present X-ray, CT shows normal and no metastasis.

Blood tumor marker test shows with normal.

My Questions are:

  1. Is it necessary immunotherapy (anti-PDL 1) with negative PDL1 result?

  2. What are the best further managements for no recurrence and no metastasis?

Answered by Dr Yang:

Dear K*****,

Well done for completing the treatment. It’s not easy to get through all that, and you have now given yourself the best chance of no recurrence and no metastasis. The best thing you can do now is eat healthily and stay active. Importantly, live well – do things that you enjoy, do things that are important to you.

If the PDL1 result is negative, we do not give PDL1-inhibitors (a form of immunotherapy).


Posted by L*****
Hi Dr,
I have been diagnosed with stage 4 colon cancer as it has spread to my liver. 
I have been informed that I will be on palliative care. So I am not sure what exactly it means.
I want to find out more and how to prepare myself for my end days. Do I need to talk to somebody or join some group?

Answered by Dr Loo:
Dear L*****,
Thanks for your questions! I think they are great and would encourage you to also share with the healthcare team caring for you.

Palliative care can be described as a way to care for persons with life-threatening illnesses that aims to improve the quality of life for them and their loved ones.　

Anything that is important to you at this time and in the future (e.g. being free of discomfort; being able to do what matters most to you) will therefore be something that palliative healthcare providers would like to help you achieve. This can be done through a variety of ways, e.g. medical treatments, social and financial help, or even just being there to lend a listening ear.　

I think it is worth discussing with your doctors to help them understand what is important to you, and discuss whether a referral to the palliative care team can be helpful for you.

I would also like to share some helpful resources with you.

Singapore Hospice Council is our national body that advocates for palliative care and helps to share information to the public.

(1) Answers to some frequently asked questions about palliative care:
https://library.singaporehospice.org.sg/?docs=faqs-palliative-care

(2) Further resources and tools that you might find helpful:
https://library.singaporehospice.org.sg/?doc_category=patients-general-public

(3)My Legacy is a government website that contains useful information about various end of life matters.
Information about how to start planning, record your healthcare preferences, and how to get palliative care:
https://mylegacy.life.gov.sg/end-of-life-planning/

(4) A place where people can login with their Singpass to plan, store and share legal, healthcare and estate matters with a trusted group of people:
https://mylegacy.life.gov.sg/vault/

Please reach out again if you have further questions!


Posted by W***
Hi Dr,
My dad had a transient stroke recently, and he has difficulty remembering his most recent activities, like losing his sense of time, feeling dizzy and losing his balance, not remembering what he ate for lunch, and forgetting his insulin injection. 

How can I help him to live more comfortably? I have to manage a full-time job, what are the options if I cannot be around all the time to watch over him?

It is the beginning of my journey of being a caregiver and I am feeling lost. Any course that you could recommend me to take.

Answered by Dr Loo:
Dear W***,
Thank you for your questions!
Firstly, palliative care traditionally refers to a way to care for persons with life-threatening illnesses that aims to improve the quality of life for them and their loved ones.　

As your dad’s stroke was transient, I am uncertain whether it qualifies as life-threatening, though I can certainly sense the distress his condition is causing both him and you. I would encourage you to alert these concerns to the doctors looking after your dad so that they are aware and can think of practical ways to manage the difficulties that your dad is experiencing.　

Secondly, I would like to point you towards some resources that might be helpful for you as a caregiver.

(1) Singapore National Stroke Association (SNSA) is a national association that supports stroke survivors and caregivers. They have support group networks for both stroke survivors and caregivers that might be worth looking at for your situation:
https://snsa.org.sg/activities/stroke-support-groups-ssgs/

(2) HealthHub is a government website that lists down various community support groups. You can consider those which may be relevant to you:
https://www.healthhub.sg/a-z/support-groups-and-others/3/caregiver_support_groups

(3) Agency of Integrated Care (AIC) is a very helpful resource for caregivers that offers practical information on various aspects of caregiving:
https://www.aic.sg/caregiving

Your role as a caregiver for your dad is a very important one, so I applaud you for your efforts, but also do remember to take care of yourself in the process!


About Asst Prof Grace Yang

Asst Prof Grace Yang graduated from University of Cambridge in 2005 and obtained MRCP (UK) in 2008. She completed her specialist training in Palliative Medicine in National Cancer Centre Singapore (NCCS) in January 2014 and joined NCCS, where she is now a Senior Consultant. She is a Fellow of the Academy of Medicine, Singapore.

Alongside clinical work, Asst Prof Yang is also actively pursuing research and is currently involved in projects on spirituality, quality of life and health services research. 

ABOUT DR LOO YU XIAN

Dr Loo Yu Xian is the Head of Service & Consultant of the Department of Post-Acute and Continuing Care (PACC) at Outram Community Hospital (OCH), and the Director of SingHealth Community Hospitals (SCH) Supportive and Palliative Care Service.

In his current roles, Dr Loo supports the planning and development of PACC services in OCH to provide a seamless and complete care plan for patients and caregivers, and contributes meaningfully to the delivery of thoughtful and compassionate end-of-life care for palliative patients.

He is also currently the Inpatient Hospice Palliative Care Service (IHPCS) lead in SCH, and the Co-Director for the Community Partnership domain within SingHealth Duke-NUS Supportive and Palliative Care Centre.