Biostatistics and Epidemiology Unit

Biostatistics Unit

The Biostatistics and Epidemiology Unit primarily provides statistical and epidemiological support for clinical trials and other studies conducted at the National Cancer Centre Singapore. This is in the form of consultations, collaborations as well as teaching. We also initiate and engage in relevant areas of applied biostatistics and epidemiology research.

The conduct of good biomedical research requires the appropriate disease expertise and rigorous research methodology combined with strong quantitative analyses. The added value of statistical techniques to biomedical research is well recognised. In biomedical studies the correct design, analysis and interpretation of the study all require the development and application of good statistical methods. While many such techniques have already been developed, only a relatively small number of these are routinely used in practice. A key reason for this is that many of these methods have not made the transition from the ‘statistical lab’ to the clinic. However, these methods may potentially help improve all aspects of the biomedical research process, ultimately resulting in more accurate conclusions being drawn e.g. regarding the usefulness of new treatments. This has important ethical implications as patients consent to have their data used for biomedical research with the expectation that the information that they provide will be used in the most optimal way to provide benefits for future patients and potentially themselves as well. Research thus needs to be carried out to test and bring better biostatistical and clinical research methodologies into clinical practice.

Moreover, there are many problems in biomedical research for which better (albeit less well known) statistical methods could be employed, to allow for a better analysis and interpretation of the data. This can be achieved through the conduct of applied biostatistics research and teaching.
Some of the projects currently engaged include prognostic modeling, clinical trial methodology, applications of Bayesian statistics in medicine and applications of statistics in genetics. The Biostatistics Unit also provides expert biostatistics support for all clinical trials and related studies conducted at the National Cancer Centre Singapore.

Selected publications:

1. Ng M, Chen S, Ong WS, Balachander A, Seet A, Yeong J, Sutiman N, Lim TKH, Lee B, Guo YA, Leong WF, Lee SS, Lam J, Choo SP, Skanderup AJ, Biswas SK, Tai D, Chowbay B. A phase 1b study of OXIRI in pancreatic adenocarcinoma patients and its immunomodulatory effects. Int J Cancer. 2022 Apr 12. Epub ahead of print. 
2. Tan AC, Tan SH, Zhou S, Peters S, Curigliano G, Tan DSW. Efficacy of targeted therapies for oncogene-driven lung cancer in early single-arm versus late phase randomized clinical trials: A comparative analysis. Cancer Treat Rev. 2022 Mar;104:102354. 
3. Tan RSYC, Ong WS, Lee KH, Lim AH, Park S, Park YH, Lin CH, Lu YS, Ono M, Ueno T, Naito Y, Onishi T, Lim GH, Tan SM, Lee HB, Ryu HS, Han W, Tan VKM, Wong FY, Im SA, Tan PH, Chan JY, Yap YS. HER2 expression, copy number variation and survival outcomes in HER2-low non-metastatic breast cancer: an international multicentre cohort study and TCGA-METABRIC analysis. BMC Med. 2022 Mar 17;20(1):105. 
4. Tai D, Loke K, Gogna A, Kaya NA, Tan SH, Hennedige T, Ng D, Irani F, Lee J, Lim JQ, Too CW, Ng MCH, Tham CK, Lam J, Koo SL, Chong HS, Goh GB, Huang HL, Venkatanarasimha N, Lo R, Chow PKH, Goh BKP, Chung A, Toh HC, Thng CH, Lim TKH, Yeong J, Zhai W, Chan CY, Choo SP. Radioembolisation with Y90-resin microspheres followed by nivolumab for advanced hepatocellular carcinoma (CA 209-678): a single arm, single centre, phase 2 trial. Lancet Gastroenterol Hepatol. 2021 Dec;6(12):1025-1035. 
5. Saw SPL, Zhou S, Chen J, Lai G, Ang MK, Chua K, Kanesvaran R, Ng QS, Jain A, Tan WL, Rajasekaran T, Lim DWT, Tan A, Fong KW, Takano A, Cheng XM, Lim KH, Koh T, Ong BH, Tan EH, Toh CK, Skanderup AJ, Tan SH, Tan DSW. Association of Clinicopathologic and Molecular Tumor Features With Recurrence in Resected Early-Stage Epidermal Growth Factor Receptor-Positive Non-Small Cell Lung Cancer. JAMA Network Open. 2021 Nov 1;4(11):e2131892. 
6. Yang GM, Zhou S, Xu Z, Goh SS, Zhu X, Chong DQ, Tan DS, Kanesvaran R, Yee AC, Neo PS, Cheung YB. Comparing the effect of a consult model versus an integrated palliative care and medical oncology co-rounding model on health care utilization in an acute hospital - an open-label stepped-wedge cluster-randomized trial. Palliat Med. 2021 Sep;35(8):1578-1589. 
7. Wong FY, Wong RX, Zhou S, Ong WS, Pek PP, Yap YS, Tan BKT, Ngeow JYY, Tan VKM, Sim Y, Tan SM, Lim SH, Madhukumar P, Tan TJY, Loh KW, Ong MEH, Wong TH; Joint Breast Cancer Registry collaborators.Effects of housing value and medical subsidy on treatment and outcomes of breast cancer patients in Singapore: A retrospective cohort study. Lancet Reg Health West Pac. 2020 Dec 8;6:100065.

Epidemiology Unit

The primary objective of the Epidemiology Unit is to conduct clinical translational research to investigate the risk factors for cancer and the patterns of disease in the wider population at large. This provides a platform for the development of studies to investigate possible interventions to increase survival and reduce the incidence of cancer or the stage at which the disease is diagnosed. As new technology becomes available, such as the ability to detect molecular biomarkers, better treatment outcomes for patients will also become available. The design and conduct of scientifically sound epidemiological studies is important in ensuring quality results for the future benefit of all patients. The conduct and provision of epidemiological research is able to provide direct clinical applications for patient care.

Almost all aspects of medical research require the use of statistical and epidemiological techniques at some point of the research process. Inefficient or erroneous methodology could have severe consequences on the interpretations of the research findings. This could eventually result in patients having less than optimal or worse still, inappropriate treatment.

The unit applies principles of evidence-based medicine when designing studies to ensure that the most feasible study has been conducted. A variety of studies are currently being investigated including studies in genetic epidemiology, screening and cancer risk factors. With collaborations both locally and internationally, the unit aims to investigate population risk factors for cancer.

Selected publications:

1. Yong SK, Ha TC, Yeo MC, Gaborieau V, McKay JD, Wee J. Associations of lifestyle and diet with the risk of nasopharyngeal carcinoma in Singapore: a case-control study. Chin J Cancer. 2017 Jan 7;36(1):3. doi: 10.1186/s40880-016-0174-3.
2. Ha TC, Yong SK, Yeoh KW, Kamberakis K, Yeo RM, Koh GC. The effect of test kit provision, and individual and family education on the uptake rates of fecal occult blood test in an Asian population: a randomized controlled trial. Cancer Causes Control. 2014 Nov;25(11):1473-88.