This year, the American Association for Cancer Research (AACR) organised a special conference in July 2020 focused on the presentation of emerging data in basic, clinical, epidemiologic research related to COVID-19 and cancer care.
Prof Lim Soon Thye, Deputy Medical Director (Clinical), National Cancer Centre Singapore (NCCS) was first lecturer at the conference. He shared with participants on ‘Continuity of Cancer Care’ in Singapore during the Pandemic. We speak to Prof Lim to find out how COVID-19 altered NCCS’ approach to caring for patients with cancer.
What are the challenges in delivering cancer care during the pandemic?
A patient’s cancer journey often involves multiple touchpoints, and this can increase the risk of virus transmission. At the onset of the pandemic, NCCS implemented many precautions to ensure the safety of our patients, their caregivers and staff.
For instance, all patients and accompanying persons who arrive at NCCS are screened and triaged at counters located outside the entrance of NCCS. Those with suspected symptoms are not permitted to enter NCCS and are channelled to the fever clinic, a temporary outpatient facility that we set up outside the NCCS building. These patients are seen by NCCS doctors who attend to them in full personal protective equipment (PPE). Patients who require further investigation are transferred from the fever clinic to the Singapore General Hospital for admission.
Within NCCS, we have also implemented strict safe distancing and precautionary measures to protect all patients and staff. The measures have made our patients and staff feel reassured and safe. However, implemented these measures also requires additional resources in terms of infrastructure, manpower and medical supplies, this is something we have had to address quite quickly.
- Fever clinic outside the NCCS building
What did we learn SARS in 2003 that helped us manage COVID-19 in 2020?
The 2003 SARS outbreak was a wake-up call to remind us not to let our guards down when it comes to infectious diseases. Since then, Singapore has made advances in many areas and we were thus better equipped to battle COVID-19.
There has been significant improvement to Singapore’s infrastructure for outbreak management since SARS. The ability to quickly convert wards to isolation facilities in public hospital hospitals has been ramped up and we now have a national infectious disease facility with integrated clinical, laboratory and epidemiologic functions.
At the national level, there are adequate medical supplies to last up to six months, with trained manpower in outbreak response and enhanced public engagement and education. Most importantly, the Disease Outbreak Response System Condition (DORSCON) framework was established for the nation to effectively respond to any outbreak.
DORSCON framework
Can you elaborate on the Disease Outbreak Response System Condition (DORSCON) National strategy?
The Disease Outbreak Response System Condition is a colour coded framework that shows the current disease situation. The four-colour alert system progresses from Green to Yellow and Orange to Red.
Appropriate precautionary health measures are put in place to contain the spread of the disease at each level of the alert system. Some of these measures include implementing social distancing, infection control, temperature screening, contact tracing, Home Quarantine Orders, travel advisories and public health advisories.
At the end of the day, the Disease Outbreak Response System aims to achieve three outcomes – 1) reduce morbidity and mortality by providing healthcare and early treatment of infected cases, 2) slow and limit the spread of disease to reduce the surge on the healthcare system, 3) maintain essential services in Singapore and limit community disruptions.
What is NCCS strategy in handling COVID-19?
As Singapore is a densely populated city-state of 5.7 million and a global travel hub, we were one of the first countries to report imported cases early in 2020.
Following the first case of COVID-19 in Singapore, the NCCS Disease Outbreak Response (DORS) taskforce was immediately set up. A multi-disciplinary team was put in place to coordinate the institutional response and communication. Daily huddles are DORSCON framework held to proactively identify and solve operational problems and we also had meetings with heads of departments. We met with the SingHealth DORS taskforce to coordinate the response across our academic health system in close collaboration with the Ministry of Health.
Apart from implementing screening, triage and the use of PPE as mentioned earlier, we also re-engineered the patient’s journey to reduce contact time at the clinics. We have since implemented tele-consultation (where patients consult their doctor or healthcare professional remotely), the drop and go initiative (where patients can leave right after their appointment and have their bill and next appointment scheduled via a SMS text sent to them) and medication home delivery service (where arrangements are made for the patient’s prescription to be filled and for the medication to be sent to their home). These initiatives not only offer patients and their caregivers convenience and time savings, but also reduce their contact time in the centre, which is what we want to do to reduce their risk of infection.
In terms of measures at the workplace, we have started work from home for staff as much as possible, and reconfigured offices and rest areas to ensure safe distancing at all times.
What do you think the new normal for cancer care will look like post COVID-19
This pandemic has given us the opportunity to re-imagine and transform the way we deliver cancer care to patients. I believe we can build on the positive operational changes brought about by the crisis and discard inefficient and old ways of doing things.
I would imagine the new normal to be one that allows patient to be cared for as much as possible from the comfort of their home. This will reduce the risk of exposure to diseases in the community or in healthcare facilities as patients avoid commuting and dwell time are reduced.
Professor Lim Soon Thye Deputy Medical Director (Clinical) National Cancer Centre Singapore
The American Association for Cancer Research (AACR) is the first and largest cancer research organization dedicated to accelerating the conquest of cancer. AARC gives several annual awards for significant contributions to the field of cancer research. In 2018, Prof Lim and his team were awarded the AACR Team Science Award for research in Asian cancers. It was the first time an Asian team of cancer researchers won the prestigious award.
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