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Giving patients a better treatment

Dr Ivan Tham tells why he is excited to be in the field of radiotherapy, where technological developments have improved the delivery of radiation treatment.

Why did you choose to be a radiation oncologist?

When we were medical students, we often interacted with patients as we learnt the ropes of medical practice. I had the chance to talk to many patients with cancer, and I could see first-hand what these people were going through.

Many had no previous medical conditions, so the diagnosis of a life-threatening disease was often very difficult to deal with. Some described their struggle with the big “C” as the “fight of their lives”.

This moved me at several levels. I could see that cancer was a multi-faceted and challenging disease. At the same time, I could also see that cancer affected not just physical health, but often also the psychological and social well-being of these patients.

After graduation, I felt that a career in cancer treatment would be fulfilling. At that time, the field of radiation oncology was also evolving rapidly because of new technology.

When I was in medical school in the late 1990s, a lot of the radiation treatment planning was manual. Radiation oncologists often used a transparency sheet, ruler and a chinagraph (wax) pencil to plan which areas to give radiation to, and which areas to shield.

While this technique could deliver radiation to the tumour to treat it, it could also cause significant side effects because the radiation beams to the normal organs often could not be blocked.

However, all that was changing because of the rapid improvement of computing power and imaging technology. This helped radiation oncologists to see the cancer clearer, and to deliver treatment more accurately. I wanted to be a part of this exciting development.

By the time I finished my specialist training, many of our treatments were planned by computers and we were more effective in shielding normal structures from radiation.

We could also show that these treatments were benefiting patients by reducing their side effects without compromising their chance of cure.

How long have you been doing this? What keeps you going?

I graduated from the National University of Singapore in 2000 and became a radiation oncologist in 2006. I trained in both the National Cancer Centre Singapore and Guy’s and St Thomas’ NHS Foundation Trust, London, UK.

Prior to joining the Parkway Group, I was working at the National University Health System (NUHS) as head of department.

I enjoyed working in all these hospitals. I feel that the time I spent in the UK was especially instructive because I had the opportunity to work in a very different healthcare system.

Nevertheless, what is common across these hospitals is the trust that patients place on us to do our best for them. I feel privileged that I am able to help these patients go through a particularly rough patch in their lives.

Can you tell us more about your area of special interest or subspecialty?

Medical specialties have become very complex, and to be a good educator or researcher at an academic centre, one often has to concentrate on only certain areas within the specialty.

While I was at NUHS, I mainly treated patients with head and neck cancer, lung cancer, or haematological cancer. I was also in the team developing and using stereotactic body radiation therapy (SBRT).

I developed an interest in head and neck cancer during my six-month rotation to Ear, Nose and Throat surgery as a junior doctor. Over the years, I also had opportunities to conduct some research in nasopharyngeal cancer (NPC), a type of head and neck cancer.

NPC is quite common in this region, making it an important research priority. It can be difficult to treat because its location is deep within the head, at the back of the nose. This means that the tumour is surrounded by important normal structures. The base of the skull and brain are just behind the tumour; the parotid salivary glands are at the sides; and the mouth is just in front. Our research group published some reports showing good treatment outcomes with modern radiotherapy techniques (Intensity modulated radiation therapy).

I am also interested in SBRT treatment. Recent technological developments have now enabled higher doses of radiation to be safely delivered using this technique. Many of us are excited by this technology, which can be very effective in selected patients.

What does your typical day at Parkway Cancer Centre look like?

I spend most of my time in the outpatient clinic and the radiation treatment planning room.

Treatment planning is a critical step of the radiation therapy process, where we localise the tumour and work with our physicists to decide the best possible way to deliver the treatment so as to achieve the treatment goals while minimising the potential side effects.

I refuel in the middle of the day with lots of coffee.

Doctors can establish close bonds with some of their patients, and losing patients along the way are inevitable. What is your experience?

Our radiation therapists and I do get to know our patients quite well, especially since many come daily for radiation treatment over a few weeks.

Losing patients is never easy, and it has not become any easier for me. Often, we can be busy looking after patients, but I find that it is also important to make time to look after my own emotional health to avoid burnout.

Young patients with cancer often leave a deep impression on me. It is difficult for anyone to cope with a diagnosis of cancer, but even more challenging for a young person with a lifetime ahead of him or her.

How do you balance work and family? What do you do in your free time?

I am married with three children, aged 17, 14 and 10. To maintain work-life balance, I try not to talk about work at home. At the end of the day, if time permits, I enjoy watching a good streaming TV series.

In my free time, I enjoy travelling and bird-watching. Despite Singapore’s very urban landscape, there are still many species of birds that can be seen (or heard) on our shores!

What are your hopes for the future of cancer treatment?

Our technology is becoming very good at delivering a precise amount of radiation exactly where we want it. However, different people and different tumours can respond differently to the same dose of radiation.

In the next decade, I hope for advances in radiobiology to help us predict the individual’s response to radiation treatment, and allow us to tailor just the right amount of radiation to cure with minimal side effects.

What advice would you give people?

Some cancers can be prevented or picked up at an earlier stage. For example, cervical cancer risk can drop significantly if a person is vaccinated against the HPV virus.

However, many Singaporeans do not like to go for vaccinations or cancer screening. These simple procedures can potentially save your life!