NCIS Year End Celebration - Seed of Hope

This year, we will be having a joint celebration with the various support groups from NCIS. There will be individual sharing, medical talks, food, presentations by cancer survivors, carnival activities and sand art performance. Please come and join us. Open to all. Free admission. Please register attendance based on the contact provided above. Thanks.

Post event comment: Here is the video for event uploaded on Youtube.

http://www.youtube.com/watch?v=b-GWATJVe7A

Head and Neck Public forum 2012

This year Head and Neck Cancer public forum was held at Tower Block Auditorium, NUH. There were 295 people who registered. The feedback comments were excellent.

Some of the wordings were like

"Best cancer forum attended so far"
"Motivational"
"Inspirational"
"Well organised. Good job"
"More of this forum - to hold every 6 months"

Below are some of the photos. A huge thank you to all the Radiotherapy Treatment Centre, Cancer Centre and ENT staffs from both NUH and TTSH. A special thank you to NCIS Corp Comm staffs who did a lot of preparatory work.

(From L-R) A/Prof Thomas Loh, Dr. Lim Chwee Ming, Dr. Ivan Tham, Dr. Lee Khai Mun, Dr. Choo Bok Ai,
Dr. Jeeve Kanagalingam, A/Prof Goh Boon Cher

(From L-R) Group Sharing. Jennifer, Dave, Carol, Richard, Robert, Yik Kwong,  Dr. Choo Bok Ai

Sharing from experiences and encouragement 

Volunteers for NPC support group- NPC OneHeart

300 people packed the auditorium and gave the forum a thumb up. "Best cancer forum attended" Keep it up

Excellence in Public Service Award 2012 - Mr. Peter Tang

Mr. Peter Tang has been the Chairperson of the NUH/TTSH NPC One Heart Support Group for the past 4 years. He was diagnosed and treated for NPC 22 years ago. Since then, he has been helping other cancer survivors and newly diagnosed NPC patients in their cancer journey towards recovery. His  passion and motivation to help other fellow survivors had won him the Excellence in Public Service Award 2012. The photo above was the prize giving ceremony at Marina Mandarin Hotel in May 2012 with Mr. Teo Chee Hean (Deputy Prime Minister of Singapore) as the guest of honour. Well done Peter! Keep up the good work.

Hearing Loss after treatment of NPC- How do we manage it?

Radiotherapy performed near the head and neck often have a common side effect – hearing impairments and other hearing/audio related problems  Several  members in our npc group  are now experiencing hearing difficulties of various degree as a result of the treatment done . 

What are the long and short term implications of this radiotherapy induced ear injuries? Are there better prevention and management measures available for members with this problem ? What about the use of hearing aids and cochlear implants? Will these help? 

What percentages of members suffer from acute middle ear infections, constant ringing in the ears (tinnitus), discharge and in some cases hearing loss? Is  the Eustachian tube damage as the result of the treatment? 

Besides hearing loss,  how about the other function of the ear – balancing.  Is a sense of transient imbalance a side effect too?

The Speaker : Dr Dr Liu Jia Ying

If any of you have concerns of the above please do not MISS this coming meeting. The details of the meeting are in the attachment above. Please email me to confirm your registration

For members who have difficulty opening up the attachment here is a brief info of the talk

Date : 12^th October ( Friday )

Topic : Hearing loss . How do We Manage It ?

Speaker : Dr Liu Jia Ying Time : 7 – 9pm

Venue : TTSH Conference Room 1

Peter Tang

Surviving Head and Neck Cancer - NCIS Public Forum 2012

It is with great pleasure this year that NCIS is  able to hold a public forum on September 16 in association with Singapore Cancer Society.

Synopsis: Public Forum in Head and Neck Cancers

September is the Head and Neck Cancer Awareness month in Singapore. Over the last few years, there has been advancement in the understanding of the causes and biology of the cancers and the effect on subsequent preventions and treatments. Viruses have been identified, as possible causes of cancers and the mechanism on how this happens will be discussed.  Modern surgical techniques with less invasive approach using robotic arm and successful restoration of voice after surgery are innovative ideas that are now in clinical practice. Alternative to surgery, newer techniques using modern radiotherapy machines and software improves precision targeting of cancer while minimizing the radiation damage to surrounding unaffected tissues. Molecular translational researches have resulted in the availability of new targeted systemic treatments besides chemotherapy in giving new hope to the management of advance head and neck cancers. NCIS believes in the holistic approach to cancer care and quality of life during and after cancer treatments. The NCIS Nasopharyngeal Cancer Support Group has been instrumental in providing supportive care from the Befrienders program that introduces cancer survivors to newly diagnosed patients. These cancer survivors and caregivers will be coming up on stage to share their cancer journeys on surviving head and neck cancers. 

 Come and join the forum. It is free. Refreshment and goodie bags to be given out. 

For more information and registration, please email npconeheart@gmail.com 

Thanks.

Dr. Choo Bok Ai

Organiser of the 2012 

NCIS Head and Neck Public Forum

Medical Adviser of the NPC One Heart Support Group

Is there a right diet to prevent cancer or recurrence of cancer?

Diet and nutrition are frequent topics that cancer survivors are concerned about. When doctors offer treatments in the form of chemotherapy or radiotherapy or surgery and in fact other medications to treat cancer, patients are often left with little choices what they themselves can do to fight the cancer. Leave it to the doctors - they are the experts. But, patients want to be involved in their cancer fight. Surely, they can do something more, something that can help fight the cancer or prevent the cancer recurrence. In medical term, this is called autonomy - to have power to make ones own choice for their own health.

It is therefore not a surprise that diet is the most common form of autonomy. There was a TV program a few years ago focussing that one is in control of their own health and this is strongly reflected to their own attitude of eating. In that program, volunteers underwent a whole body MRI to calculate their body fat in relation to their body mass and muscles. It was no surprise that they chose the overweight volunteers and journeyed through their eating habits over a few months to see whether they could undergo any transformation (not just slimming down to look good) but measuring their own activity endurance, energy level and biochemistry of their blood testing. One can apparently measure your body age as compared to your chronological age. You maybe 30 years of age, but the body MRI, fat to skeletal muscle composition, blood tests and endurance tests showed you are actually 40 years old, besides looking like 40 years old when you are actually 30 years of age.

So, when one member of the NPC support group email list asked whether one should only eat fruits and vegetables and omit any form of meat; as accordingly to her friend, the meat can feed the cancer, it generated a few feedbacks. So far, the feedbacks are saying this is not true, no scientific basic, eating a normal and balance diet is important, eating fresh food is good and one must balance it according to their own pleasure of eating/liking and almost all said - "You can eat everything, but in moderation". This statement is also the most common statement used if you asked any doctor what you can and cannot eat after the diagnosis of cancer.

The question whether eating fruits and vegetables prevent cancers and reduce the risk of recurrence and to totally omit meat can have the same effect is a age old question.

While the Western doctors have always advise that you can eat anything you want but in good proportion of protein (from lean meat and vegetables), carbohydrates, fruits and fibers and reduce processed food like tin food, preserved food and fast food with lots of fat and BBQ meat and to reduce sugar intake and salt intake, this is too general.

The NPC support group organized a talk on Eating Organic Vegetables and Fruits (Eating to Starve Cancer) and part of the talk involve watching a TED presentation by Dr. William Li, the President of Angiogenesis foundation. His video presentation can be found on this link:

http://www.ted.com/talks/william_li.html

Angiogenesis is the growth of new blood vessels in the body. Cancer starts as a cluster of a few mutated cells, but can only develop into something larger with the aid of new blood vessels that support it. One can culture cancer cells on in a laboratory plate, but without being able to get new blood supply; the cancer cells will not grow and eventually outlive its own nutrients and die. Dr Li proposed that natural food products can inhibit and regulates angiogenesis and hence by eating these fruits and vegetables based products, one can starve the cancer by stopping the process of angiogenesis. He provided a list of such products, mainly berries, green vegetables, green tea and red wine. Note that none of the meat product is on the list.

Berries (Strawberries, Blueberries, Blackberries and Raspberries), Red grapes and Red Wine, Turmeric, Citrus fruits (Orange, Lemon), Grapefruits and grape seeds, Pineapples, Cherries, Tomato

Vegetables like Artichoke, Lavender, Pumpkin, Pak Choy, Parsley, Soy and Soy extract

Others like Ginseng, Nutmeg, Garlic, Green Tea (includes Earl Gray, Jasmine), Olive Oil, and Dark Chocolate

Rather than saying we should stop eating meat because it feeds the cancer, let say that eating fruits and vegetables with high anti-oxidant, natural and organic has shown some benefits in medical research that it can potentially reduces the risks of getting cancer. Certainly for bowel cancer, which is the No 1 cancer in Singapore, eating a high fiber diet and low in saturated fat reduces the risk. Eating a highly preserved meal and BBQ charred grilled meat also increases risks of stomach cancer. Eating salted fish had been linked to development of Nasopharyngeal cancer.

Final word – cancer development is a complex process. Angiogenesis is just one of the crucial mechanisms but did not explain the whole process. Judah Folkman discovered angiogenesis in 1971 and he was the youngest professor at Harvard Medical School. Despite availability of synthetic drugs that can block angiogenesis, these drugs do not work in all cancers and still not possible to cure cancer.  Hence, eating natural food products that regulate angiogenesis rather than blocking it is a good theory.

Certainly, I have patients who are vegetarians from birth and they still develop various types of cancer, just like non-vegetarian patients. And if they stir fry their vegetables, cook them in curry and BBQ their red pepper, onion, sweet-corn, snack on chocolates and potato chips and drink coke during their meals, their diet is still worse off than a sensible well balanced meat eater. There are certain amino acids from meat proteins that are absent from vegetables proteins.

I would therefore recommend eating more fruits and vegetables as provided from the list of Dr. Li recommendation (these are done in a scientific manner) and maintain a normal diet that COULD consist of lean meat in the correct proportion.  Thus, the TV program called “You are what you eat”  is true in some degree.

Of course eating all these healthy things also reduces the risk of high cholesterol, which leads to heart attack and stroke, which are the next most common cause of death besides cancer. Angiogenesis also plays a part in the development of these conditions as well.


So, if you do ask me in the clinic what diet you should be eating, my answer would be:


Eat more fresh fruits and vegetables that are high in anti-oxidant. Cut down on food with fat. Eat lean meat. Eat a portion of vegetable, fruit, lean meat and carbohydrate in each meal. Make sure you drink enough water. Do not eat tin food if possible. Cut down on fast and processed food. The best food is always the fresh one. Do not overcook your food. If you are not eating a healthy diet, supplement with multi-vitamins tablet. Eat food with high Omega-3 such as fish and consider a Omega-3 supplement if you seldom or don't eat fish at all. Exercise 15-20 minutes a day. Walking and doing house hold chores or walking upstairs to your flat are considered exercise.


The Lancet medical journal published a research by Taiwan doctors showing that light to moderate exercise by only  15 minutes a day can cut down the risk of dying by 14% and extend life expectancy by 3 years. The study involves 400,000 participants from different age groups. Further exercises beyond 15 minutes further reduces the risks. Moderate exercise includes walking upstairs or prolonged leisure walking. Contrary to popular belief that a good exercise has to increase the heart rates to beyond 100 and with sweating, simple exercise is now defined as simple housework such as vacuuming, walking up stairs, gardening and dancing aerobics at home. This equates to any activities that burn 3-6 times more calories than when at rest watching TV. So, if you can, walk upstairs, walk your dog, do simple aerobics at home, cycle at gym or a park, take your children to a park for 30 minutes, do some housework, wash your car manually, swim and go window shopping and get your groceries. Don’t just sit down to surf the internet, facebook and watch TV. Go and get some exercise and stay healthy.


(taken from http://serembancardiology.wordpress.com) - my brother who is a Cardiologist in Malaysia wrote the above in his blog. 


Reduce stress in life - choose  a hobby to reduce stress. Apart from everything mention above, the most important is to "Live your life being happy and fulfilled". If your happiness and satisfaction is to sometimes indulge in a Chilly crab (Warning - total calorie 1128 kcal)  - please do so without guilt. Likewise, some will say that "I must as well die if you stop me eating my Hainan Chicken Rice". So, be it. Eat your Hainan Chicken Rice (Warning - total calorie per plate is 607 kcal) everyday but supplement with steam Kai Lan vegetables without Oyster sauce and or cherry tomatoes and eat 1 portion of apple or orange. This is a balance diet remembering that I would prefer you to eat white rice with chicken alone occasionally as this has a lower calorie. Stop taking any soft drinks like Coke - this is pure sugar water only with no nutrition value - it is better to drink tea or soya bean (remember the angiogenesis theory) and make sure it has reduced sugar content.


So, if you ask me what you can eat or cannot eat or whether you should stop eating meat, I will never say - "Eat anything you want but in moderation". It is far more complex than this. 

Dr. Choo Bok Ai

Medical Adviser to NPC support group

NPC Talk May 2012

There are common questions that I get asked every week in my oncology clinic.  Can Traditional Chinese Medicine be used safely with chemotherapy or radiotherapy? What kind of food that I should eat to boost my energy and immune system to cope with the side effects of chemotherapy or radiotherapy? It is therefore my privilege to introduce Professor Teo Eng Kiat who will be giving a talk on TCM this week at NUH. He has vast experiences in Traditional Chinese Medicine and is a practicing TCM physician with a specialist interest in Oncology at the Singapore Chung Hwa Medical Institution.  He has a PhD from the China Academy of TCM and a visiting Professor to the Guangzhou University of Chinese Medicine. He was formerly the Principal of the Singapore College of Traditional Chinese Medicine for more than 10 years (till 2008).

Come and join us.

Dr. Choo Bok Ai
Consultant in Radiation Oncologist