Recommended reading: Analysis of Prognostic Factors of Comprehensive Geriatric Assessment and Development of a Clinical Scoring System in Elderly Asian Patients with Cancer, published in the Journal of Clinical Oncology in 2011)
5. Some elderly cancer patients in Singapore visit TCM doctors because they are convinced that TCM medications can alleviate some symptoms caused by chemotherapy. Do you think TCM is a good alternative?
The use of TCM is very common in the local population due to centuries of belief in its benefit. TCM may become a good alternative only when there is more research done regarding its benefit and side effects. Till we have that evidence, I only agree to use it when all known evidence-based treatments have failed.
6. The aging population in this modern era leads to increasing need in geriatricians in the coming decades. Yet, there is only about 70 certified geriatricians and no registered geriatric oncologists in Singapore. What approach would you suggest to encourage people to join the workforce in this field?
I think the latest geriatrician numbers have increased to 90, and yes, there are no registered geriatric oncologists in Singapore as there is no registry for such specialists. I was fortunate to have received specialized geriatric oncology training at the Duke University Medical Centre, US in 2011 and am the second person in Singapore to have such training. The first was Dr Donald Poon who received his training at the Moffit Cancer Centre, US. Dr Poon is now in private practice at the Raffles Cancer Centre.
I think the key now is to train every oncologist on the principles of geriatric oncology so that they can apply some of the basic principles of GO on their patient population. This alone can improve the care of the elderly cancer patient population substantially. Should a handful of them be keen to do more and receive more comprehensive training, I will be happy to have them come for attachments at NCCS. Over the years I have taken on nurses and medical students on such attachments with great success.
7. How can we ensure early diagnosis and early treatment of cancer disease among elderly? What actions are Singapore government taking right now (and also other countries)?
There are 2 ways to do this. The first is to have evidence-based screening programs. It is known that screening for certain cancers can help improve survival as patients are diagnosed at an early curable stage. Examples of these cancers include colorectal and cervical cancer.
The other method is to educate the public about the common cancers and how to identify the symptoms early and seek the necessary medical attention. Education on lifestyle changes is also essential in teaching the population on how these changes can help prevent the cancers in the first place.
The Health Promotion Board of Singapore has played an important role in both areas described above i.e. in screening and lifestyle change (prevention). Other regional countries have similar authorities doing the same as well.
8. What can the young people nowadays do to reduce the risk of getting cancer as they age?
The key to reducing their risk of cancer is to inculcate good lifestyle habits as early as they can. These habits include having a healthy diet, exercising regularly, having good work-life balance and staying away from bad habits like smoking, use of recreational drugs and excessive alcohol consumption.
9. What drives your passion for oncology especially in the field of genitourinary and geriatrics?
Very early in my career I had an opportunity to get involved in a society that promoted healthy ageing. This exposure made me realise the numerous challenges that the elderly in the region faced. This made me more sensitive to their needs as well as got me interested in trying to come up with better ways to improve their lot. As such, it was only natural for me to get involved in geriatric oncology research when I became an oncologist. Many of the genitourinary patients that I see are coincidentally in the elderly category as well. Hence I am able to use the geriatric oncology tools to optimise treatment for this special group of patients.
10. As the National Representative for Singapore in SIOG, what role do you play?
As the National Representative, my main role is to promote geriatric oncology in Singapore. In essence, I hope to expose as many healthcare practitioners in Singapore as possible to the numerous benefits of practicing the principles of geriatric oncology in treating elderly cancer patients in the country. In line with this, Singapore Society of Oncology (SSO) organise workshops for family physicians, nurses, allied health professionals and medical students regularly.
11. How do you juggle with various positions/roles simultaneously?
I am fortunate to have a group of like-minded people working together with me in organising the geriatric oncology workshops. With regards to SSO, I have the full support of the capable executive committee members in running the society. We also have a full time secretariat that helps run the day to day activities of the society.
12. As an educator, what would you advise or recommend students who are interested in taking the medical path? Is Singapore a good place to take on such a path?
As I looked back at what made me decide to do medicine, the first thing that came to mind was having a keen desire to help others. This, along with a passion to provide comfort and care to those in need, are key elements in making a good doctor. Also, a student should have an interest in science and have an inquisitive mind with a constant desire to learn as medicine involves life-long learning.
Yes, Singapore is a great place to train in medicine. We have 3 well known medical schools. Two of these schools (Yong Loo Lin School of Medicine, National University of Singapore and Lee Kong Chian School of Medicine, Nanyang Technological University) are undergraduate schools with an excellent 5-year program.
The third school is a collaborative effort between the National University of Singapore and Duke University Medical School. The Duke-NUS Medical School is a unique program that caters to graduate students who are keen to pursue a career in medicine. I am currently a faculty at Duke- NUS and adjunct clinical lecturer at YLL School of Medicine, NUS.
About the Interviewee
Dr. Ravindran Kanesvaran is a Consultant in the Department of Medical Oncology of the National Cancer Centre Singapore. He is also an Assistant Professor at Duke-NUS Graduate Medical School and clinical senior lecturer at the Yong Loo Lin School of Medicine, National University of Singapore. He is actively involved in graduate medical education and is a core faculty member of the Medical Oncology Senior Residency Program and the Singhealth Internal Medicine Residency Program.
He completed his medical oncology speciality training in the National Cancer Centre Singapore. After completion of that training he followed up with a fellowship in genitourinary oncology (GU) and geriatric oncology in Duke Cancer Institute in North Carolina, USA on a Healthcare Manpower Development Program (HMDP) scholarship awarded by the Ministry of Health Singapore. His research interests include GU oncology and geriatric oncology. He has published in a number of well-known peer reviewed journals including Journal of Clinical Oncology and Lancet Oncology.
He has also been awarded a number of awards including the American Society of Clinical Oncology (ASCO GU) Merit Award 2009, American Association for Cancer Research (AACR) scholar-in-training Award 2010 and European Society of Medical Oncology (ESMO) fellowship award 2012. He is currently the President of the Singapore Society of Oncology (SSO) and the Singapore Geriatric Oncology Society. He has been appointed as European Society of Medical Oncology (ESMO) Faculty 2015-2016. He is on the Scientific and Education Committee and the National Representative for Singapore in the International Society of Geriatric Oncology (SIOG). He was recently awarded National Representative of the Year SIOG 2014 award.