New programme empowers surgeons to initiate palliative care for patients at National Cancer Centre Singapore

In partnership with Lien Foundation, the Oncordance programme integrates general palliative care into routine surgical care to improve the quality of life of patients with advanced cancer

Singapore, 3 September 2026 - Cancer is one of Singapore’s leading causes of death, accounting for more than one in four deaths, with more than 18,000 new cases each year¹. Around 80% of advanced cancer patients (stage three or four) have palliative care needs, including chronic pain, depression, anxiety and other social concerns². The majority of patients with advanced cancer require surgery to treat cancer or its complications. While removing tumours can prolong life, surgery can diminish the patient’s mobility and independence. Surgery can be highly stressful for patients and their families as they face the uncertainty of the operation and a demanding recovery.

Recognising the need to better support this group of patients and their families through their surgical journey, the Lien Foundation and National Cancer Centre Singapore (NCCS) launched Oncordance - a new programme that integrates general palliative care into routine surgical care for patients with advanced cancer at the Division of Surgery & Surgical Oncology (DSSO). With Lien Foundation’s investment of $1 million, the programme is expected to benefit 1,000 advanced cancer patients over a two-year period to assess its impact for potential future extension.

"This is a fundamental redesign of the delivery of surgical care that places equal emphasis on treatment and the person. Surgeons are central to their patients’ care, so Oncordance provides them the necessary support and structure to meet needs the operation itself cannot. Surgery is an opportunity to introduce cancer patients to palliative care, empowering surgeons to develop deeper, more meaningful patient relationships and to ask patients what they want from the operation. Both sides gain clarity, so that the operation, and everything that follows, is concordant with what the patient actually wants, " said Luo Ren, Programme Director, Lien Foundation.

Role of surgeons in advanced cancer care

At NCCS and Singapore General Hospital (SGH), 21% of major surgeries are performed for patients with advanced cancer, which can be a prolonged illness ranging from months to years in which tumours recur and spread. For such patients, the surgeon is often the first touch point and the doctor they see most. Surgeons frequently shoulder the burden of breaking bad news upon cancer diagnosis and they may perform multiple surgeries over time. Between operations, they also form long-term relationships with their patients as they come back to the same clinic for follow-up.

As such, surgeons are well placed to recognise patients’ palliative symptoms as well as conduct serious illness conversations, which involve understanding what matters to each patient - their individual goals, concerns, and priorities - and help them decide whether surgery and subsequent treatment is suitable for them.

Yet these conversations are not consistently taking place. While palliative care is relatively established in cancer care, a gap exists with surgeons, largely due to a lack of palliative care training and time constraints in surgical practice. At NCCS and SGH, fewer than 5% of patients with life-limiting illness are estimated to have serious illness conversations with their surgeon or receive advance care planning before major surgery.

In 2021, NCCS piloted training selected surgeons in general palliative care, which enabled an increase of documented serious illness conversations among patients cared for by these surgeons. Patients and families also reported better preparedness for surgery and less psychological distress.

Oncordance seeks to build on this foundation and accelerate impact at scale so that more patients in need of palliative care can benefit. To date, 226 patients across seven surgical departments in DSSO have benefitted from the programme. Of these, 79% received serious illness conversations and palliative care screening before surgery.

“Surgeons develop close and long-standing relationships with our patients and their families. When cancer progresses, patients look to us to explain what surgery is technically possible, and whether it is the right treatment for them. Integrating general palliative care into surgical care does not mean that we stop treating the cancer – it equips our surgeons with the additional skills to understand what matters to our patients, manage their symptoms and concerns, and make treatment decisions together with them. Through Oncordance, our goal is for patients to have a better quality of life alongside active treatment, not instead of it,” said Associate Professor Toh Song Tar, Chairman, DSSO, NCCS & SGH.

A new model of care integrating general palliative care into routine surgical care

Oncordance introduces a surgical team-led care model, supported by palliative care specialists, so palliative care can be initiated earlier in the cancer journey. Surgeons and surgical nurses are trained through a palliative care course tailored for surgical teams, jointly developed by Lien Centre for Palliative Care and DSSO in 2024. This enables them to identify and relieve symptoms for example by providing medications for pain or nausea; address psychosocial concerns; and to hold serious illness conversations to ensure that treatment decisions are aligned to patients’ goals and values.

The programme builds structure into a busy practice. All advanced cancer surgical patients are systematically screened for palliative care needs at key points in their cancer trajectory. Serious illness conversations are delivered as a team with surgeons opening the conversation at the clinic and care coaches and surgical nurses continuing the discussion throughout the surgical journey. Complex cases are co-managed at regular multidisciplinary meetings or referred early to specialist palliative care, ensuring that patients receive timely and appropriate support. A designated palliative care specialist and advanced practice nurses guide the teams throughout.

Dedicated care coaches free up the surgical team by taking on the continuity of patient support from pre-surgery through recovery and beyond. They run screenings, monitor symptoms and emotional wellbeing, surface emerging needs to the clinical team early, and coach patients on how to navigate hard conversations, such as raising concerns with their families. As the disease progresses and care preferences shift, care coaches facilitate ongoing serious illness conversations between patients and surgeons.

Enabling culture change

At DSSO, 20 surgeon champions across surgical departments managing different types of cancers have been identified to co-drive the programme. Aside from practicing palliative care within their own practice, these champions will support their colleagues, embed the new practices into routine surgical workflows and build a wider community of surgeons committed to person-centred care. Beyond these champions, to-date, more than 100 surgeons, nurses and care coaches have undergone training.

The longer-term vision is to make general palliative care a core competency of surgical practice - so that conversations about symptoms, goals, values and future care become just as routine as conversations about scans, treatment options and surgery.

More details about the Oncordance programme can be found at https://lienfoundation.org/project/oncordance/.

¹Singapore Cancer Registry Annual Report 2023 | National Registry of Diseases Office

²Long-term Changes in Pain, Depression, Function and Informal Caregiving after Major Elective Surgeries Among Seriously Ill Older Adults - PubMed

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For media enquiries, please contact:

Jewel Ng
jewel.ng@tateanzur.com

Lo Sok Wan
lo.sok.wan@nccs.com.sg

About Lien Foundation

The Lien Foundation is a Singapore philanthropic house noted for its model of radical philanthropy. It breaks new ground by investing in innovative models of care, convening strategic partnerships and catalysing action at the intersection of health and social care. The Foundation's focus areas include palliative care, eldercare, rehab and maternal & child health. For more information, visit www.lienfoundation.org.

About the National Cancer Centre Singapore

The National Cancer Centre Singapore (NCCS) is a leading national and regional tertiary cancer centre dedicated to advancing cancer care, research and education. With a comprehensive suite of specialties and services, NCCS treats all cancers and offers personalised and multidisciplinary care to ensure that patients receive holistic, compassionate care and support. Advanced and innovative treatments such as proton therapy at the Goh Cheng Liang Proton Therapy Centre, immunotherapy, and cell therapy are available at NCCS to give patients the best treatment outcomes.

Ranked among the top cancer centres in Asia, NCCS is globally recognised for its research expertise, with clinicians and scientists collaborating with local and international partners to conduct cutting-edge clinical and translational research that makes a real impact and offers hope of a cancer-free tomorrow. As an academic healthcare institution, NCCS is committed to nurturing future generations by delivering specialised training to local and overseas oncology healthcare professionals. For more information, please visit www.nccs.com.sg.