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Launch of ACCESS Programme

4,000 breast cancer patients will benefit from a holistic network of after-care supportive services in the community, which provides integrated medical, para-medical, psycho-social and educational components of care to optimise their recovery. The new model of care is to be piloted for two years under the Temasek Foundation ACCESS (Accessible Cancer Care to Enable Support for Survivors) programme, a partnership between Temasek Foundation and the National Cancer Centre Singapore (NCCS).The programme was launched on the 30th of November by Dr Amy Khor, Senior Minister of State (Health and the Environment and Water Resources) today at the inaugural Best of MASCC (Multinational Association of Supportive Care in Cancer) Meeting on Supportive and Survivorship Care. 

Cancer remains a top cause of mortality with the number of new cancer cases diagnosed increasing from 57,243 in 2008 to 2012, to 71,265 in 2013 to 2017 1. Physical, psycho-emotional, social and spiritual problems can occur at any time during a patient’s cancer journey. Supportive and survivorship care in collaboration with community partners is not only essential for managing supportive care needs of survivors in the community, but also offers preventive and proactive management of the disease long term.


Ms Tan Yee Pin (second from left) Head of Psychosocial Oncology presenting “A Patient’s Journey” to (from right to left) Guest of Honour, Senior Minister of State Dr Amy Khor; Mr Richard Magnus, Chairman, Temasek Foundation Cares and Professor William Hwang, Medical Director, NCCS.

 
From left to right: Ms Woon Saet Nyoon, Chief Executive, Temasek Foundation Cares; Professor William Hwang, Medical Director, NCCS; Guest of Honour, Senior Minister of State Dr Amy Khor; Mr Richard Magnus, Chairman Temasek Foundation; Dr Patricia Neo, Head and Senior Consultant, Division of Supportive and Palliative Care, NCCS

While cancer survival rates have been increasing with improvements to treatment, post-treatment care for patients remains a gap in holistic cancer care. In a 2018 article published in the Journal of Global Oncology 2, the team observed that while there have been increasing efforts to transition care from tertiary institutes to the community, there is a lack of training to allow primary health care providers to develop skill sets in cancer survivorship. Furthermore, oncology practitioners may not be equipped with the appropriate skills and knowledge to identify and manage some of the lesser known supportive and survivorship care issues. A multidisciplinary approach that encompasses other health care disciplines such as rehabilitation, nursing, and allied health should be involved as part of the care team, but the involvement of these specialty care providers was done in an ad hoc manner. 

To address these issues, the Temasek Foundation ACCESS programme will introduce integrated after-care case management and care coordination from acute care treatment to care in the community. The programme also aims to build a network of after-care supportive services. Temasek Foundation has committed $2.1 million to support the programme.

Mr Richard Magnus, Chairman, Temasek Foundation Cares, said: “Now, there is inadequate psychological, emotional and social follow-up support for cancer patients who have successfully undergone treatment. The Temasek Foundation ACCESS programme is a cancer survivorship initiative that test beds a continuum of care from the acute setting into the community. The programme addresses the medical and non-medical needs of cancer survivors, starting with breast cancer patients, both during treatment as well as in post-recovery. We are hopeful that this will give better care outcomes, as well as quality of life for survivors.” 

Prof William Hwang, Medical Director, NCCS said: “1 in 4 Singaporeans are likely to develop cancer in his or her lifetime 3. Cancer cases have been rising over the years. This trend has a far-reaching impact on families and our society.  While there are many cancer treatments that give good survival and cure rates, patients often suffer from potential side effects and issues related to the disease. With this supportive care programme, we want to give cancer survivors the support they need to cope with their illness and improve their overall quality of life. I would like to thank Temasek Foundation for their generous contribution which will support the ACCESS programme.

“We aim to reach out and positively impact the care for approximately 4,000 breast cancer patients at NCCS during this two year pilot programme. In the future, we hope to be able to extend this programme to every NCCS cancer patient and their family,” said Dr Patricia Neo, Head and Senior Consultant, Division of Supportive and Palliative Care, NCCS.

What is the Temasek Foundation ACCESS Programme?

By consolidating a network of community resources, assets and services to provide the necessary after-care services for cancer survivors, the Temasek Foundation ACCESS programme aims to bridge the gap in the current clinical care landscape for patients who need long term supportive care to achieve better recovery outcomes. The programme comprises three components:

A) A holistic after-care model

The holistic after-care model will facilitate the recovery of cancer survivors. Patients will be screened at their initial and subsequent medical visits at NCCS with a holistic screening tool to assess their distress levels and identify any physical, psychological, social, or spiritual concerns. With the oncologists, a multi-disciplinary supportive care team will monitor the patients’ level of distress, assess the type of support needed and refer patient to relevant supportive care services.

B) Building a community network of after-care supportive services

A community network of after-care support in key non-medical services such as therapy, rehabilitation, counselling, dietetics and education will be built to meet the needs of cancer survivors as they transit to the community. This will bring together various community partners such as general practitioners, social workers and rehabilitation therapists in the community who can offer psycho-social care services, counselling, rehabilitation and palliative care services.  

C) Upskilling community partners

A structured training programme by NCCS to upskill community partners will address topics such as managing physical symptoms and psychosocial problems in cancer survivors and provide evidence-based post-treatment care. Processes will also be developed to enable the community partners to reach out to the NCCS multidisciplinary care team should they require assistance in managing the case. 


References
Singapore Cancer Registry 50th Anniversary Monograph (1968 – 2017), Table 5.1.1: Incidence Number and Rate (Per 100,000 Population) For Cancer By Gender And Five Year Period, 1968-2017)

https://www.nrdo.gov.sg/docs/librariesprovider3/default-document-library/thespore-cancerregistry_commerativebook_-1.pdf?sfvrsn=231fce6e_0

Cancer Supportive and Survivorship Care in Singapore: Current Challenges and Future Outlook, published in Journal of Global Oncology, 2018. https://ascopubs.org/doi/10.1200/JGO.17.00117

3 Singapore Cancer Registry 50th Anniversary Monograph - Appendices, Appendix D: Lifetime risk for ten most frequent cancers in males & females by ethnicity and five-year period, 1968 – 2017 https://www.nrdo.gov.sg/docs/librariesprovider3/default-document-library/thespore-cancerregistry_commerativebook_-2.pdf?sfvrsn=711bf71a_0