Palliative care and surgery encouraged for advanced cancer patients under new initiative

SINGAPORE – Around 1,000 advanced cancer patients will receive palliative care for their symptoms early along with routine surgical care under an initiative at the National Cancer Centre Singapore (NCCS).

The palliative programme, called Oncordance, has benefited 226 patients with advanced cancer since it was introduced in August 2025. Nearly 80 per cent of these patients received palliative care assessments before surgery.

Oncordance was officially announced on Sept 3.

With a $1 million investment from Lien Foundation, it is expected to benefit 1,000 advanced cancer patients over a two-year period.

Surgery for advanced cancer and palliative care used to exist in different spheres. The former aims to remove tumours or extend life despite high physical risks, while the latter focuses on easing pain and improving daily comfort when a cure is no longer possible.

These days, surgeons are encouraged to integrate the two, and Oncordance is helping them do just that.

Cancer is a leading cause of death in Singapore, accounting for more than one in four deaths.

There are more than 18,000 new cancer cases diagnosed each year, and the majority of patients with advanced cancer require surgery to treat cancer or its complications.

Cancer surgeon Jolene Wong said the surgeon is the first person the patient with advanced cancer meets, and “we have long been responsible for providing solutions and performing surgeries for patients, but what we often lack is effective communication with patients”.

She said that about 80 per cent of advanced cancer patients have palliative care needs, including chronic pain, depression, anxiety and other social concerns, but these needs are often unmet.

While removing tumours can prolong life, Wong said the surgery can diminish the patient’s mobility and independence.

Citing the example of a patient she named Tan, Wong said she performed an emergency operation where she had to attach a stoma bag outside his body to save his life.

“But the bag was bothering him, so we did a stoma reversal and to close the existing colostomy,” she said.

While Tan died in 2025 after five years of treatment, Wong noted: “Here we listened to the patient and tailored the surgery according to what he wanted and what’s most important to him despite it compromising his chemotherapy.”

All cancer patients deserve access to palliative care when they need it and “not as an afterthought or an add-on at the end of life”, said Shirlynn Ho, who heads the Division of Supportive and Palliative Care at NCCS.

“Rather than only taking referrals from specialists, we actually collaborate with the different teams within the cancer centre – with the medical oncology team, with our surgical teams – and within our campus, with the non-cancer specialist team like the those in cardiology and intensive care as well.

“(Oncordance) helps us put our heads together, have conversations with patients and know what they prefer, before coming to a better and more thoughtful position of treatment,” Ho said.

Wong added: “In an Asian culture, we do not really talk about our goals or fears until something major happens. So (by) having these conversations before or even after surgery and continually repeating it, we will be able to understand what is important to the patients.”

Programme director at Lien Foundation Luo Ren called it “a fundamental redesign of the delivery of surgical care that places equal emphasis on treatment and the person”.

“(This empowers) surgeons to develop deeper, more meaningful patient relationships and to ask patients what they want from the operation.

“Both sides gain clarity, so that the operation, and everything that follows, is concordant with what the patient actually wants,” she said.

Retiree Gerald William Pereira, 63, told reporters he appreciated the fact that he had had conversations with Wong.

After he was diagnosed with an aggressive cancer in his groin in April 2025, Wong recommended chemotherapy to shrink the tumour, followed by surgery to remove it.

Wong told him that the tumour had wrapped around a major vein, and removing it carried a risk of potentially losing his left leg. However, without surgery, the tumour would grow aggressively, giving him six months to a year to live.

“The conversations were valuable as they gave me time to get my personal affairs in order – my will, nominating beneficiaries to my CPF. I was able to reflect on what mattered most and plan ahead for my brother and sister-in-law,” he said.

“I was able to clearly make up my mind to proceed with the recommended treatment of chemotherapy (before the surgery).”

Source: The Straits Times © SPH Media Limited. Permission required for reproduction.