The evolution of supportive and palliative care in Singapore

In Good Health speaks to Assistant Professor Grace Yang, Senior Consultant, Division of Supportive & Palliative Care, National Cancer Centre Singapore (NCCS) to debunk these misconceptions and explain why supportive care is essential from day one of the cancer journey.

The terms “supportive care” and “palliative care” have different origins, but both have similar goals of improving the quality of life for persons with serious illnesses such as cancer.

“Supportive care” is defined by the Multinational Association of Supportive Care in Cancer (MASCC) as the prevention and management of cancer and cancer-related adverse effects. This includes physical and psychological symptoms and side effects that occur throughout the cancer journey from diagnosis through treatment to post-treatment care. Supportive care was initiated to address cancer treatment’s toxicity and has since expanded to deliver person-centred care such as complementary medicine, nutrition, exercise and other survivorship issues. 

“Palliative care” is defined by the World Health Organization as “relieving serious health-related suffering, be it physical, psychological, social, or spiritual”. Although the development of palliative care was motivated by a desire to improve care of the dying, particularly in healthcare institutions, it has since extended its reach to include those with serious illnesses not yet at the end of life. For example, studies in the last decade have shown improved quality of life, less symptom burden and possibly even longer survival when palliative care is provided to persons with advanced cancer.

The terms “supportive care” and “palliative care” are used interchangeably at NCCS. It depends on which term carries less stigma for the patient. In view of palliative care having roots in providing care for the dying, a patient with cancer may misperceive a referral to palliative care services as giving up hope with no chance of treatment. These misconceptions of palliative care may form a barrier for patients to access palliative care. In fact, a cancer centre in the United States substituted “palliative care” to “supportive care” in their service’s name in 2008 and found that the change was associated with earlier referrals. 

In NCCS, the term “supportive care” has been weaved into our new initiatives so that we can reach out and help more patients. For example, the ‘Accessible Cancer Care to Enable Support for Cancer Survivors’ (ACCESS) programme, supported by Temasek Foundation, aims to provide physical and psychosocial support at all stages of patients’ cancer. It is led by supportive care nurses who work with a multi-disciplinary team. Patients who have more complex medical issues, such as complex pain, may benefit more from a “palliative care” consult which is led by a specialist palliative care doctor.

As we continue to develop supportive care, our approach to patient support should shift. Instead of the current reactionary approach, we need to shift towards a proactive health-wellness approach that is integrated early in the patient’s illness journey. We need to continue to improve how we equip patients and families with effective coping strategies to manage the wide spectrum of challenges associated with having serious illness. By empowering individuals before acute distress and symptoms occur, patients and families are able to better mitigate and avoid crises.

Singapore’s population is ageing, with a rising incidence and prevalence of serious life-limiting illnesses such as cancer. Besides receiving medical treatment for these diseases, patients with serious illnesses and their families can also benefit from supportive and palliative care. However, in Singapore, many patients with advanced serious illnesses do not access supportive and palliative care and those who do so receive palliative care very late in their illness journey. Merely upscaling current models of care is not enough to meet the rising demands for supportive and palliative care, innovation is also vital to meet the evolving needs of patients and families. 

The INnovation in Supportive and Palliative CaRE (INSPiRE) programme will specifically drive innovation in three areas, namely - health coaching, grief and bereavement and setting up a data-driven learning system. These will bring about a transformative change in the way supportive and palliative care is provided in Singapore, and improve the quality of life of patients with serious illnesses and of their families.

2. https://www.duke-nus.edu.sg/docs/librariesprovider3/research-policy-brief-docs/the-signs-study---i-report.pdf