Following the video-consultation , we assisted Pauline in submitting her application to MOH for permission to come to Singapore for treatment .
On March 4 , we received confirmation from MOH that her application was not approved . Pauline was devastated . She cried on the phone and begged me to “ save her .” She reminded me that she was a young mother with four children , the youngest of whom was four .
On the next day , I submitted a letter of appeal to MOH .
In the meantime , Pauline had gone for a PET- CT scan and sent me the report together with the radiological images . After seeing the PET-CT scan , I was convinced that surgery was not the preferred option for her .
Although I ’ m not a surgeon , I knew from the scans that surgery would involve removing her tongue , floor of mouth , and lymph nodes as well as possibly the voice box . This meant that Pauline would end up being tube-fed and unable to talk for the rest of her life .
I showed her PET-CT images and report to two senior ENT surgeons , Dr Andrew Loy and Dr Goh Yau Hong , and they both kindly wrote letters of support on Pauline ’ s behalf to MOH for her to come to Singapore for treatment .
While waiting for the appeal to be reviewed , the patient was under tremendous stress because her ENT surgeon told her that she needed to be operated on immediately and wanted her consent for the surgery .
Each day , she would text and / or call me , pleading with me to help her .
The appeal to MOH was successful . Pauline arrived in Singapore on March 16 , and her treatment was started two days later .
Treatment was a combination of chemotherapy plus immunotherapy . Almost immediately after the start of treatment , Pauline noticed that the tumor was shrinking in size and no longer painful .
She has completed six weeks ( two cycles ) of treatment , and the follow-up PET-CT scan on April 28 showed that the tumor had reduced in size and activity by 70 percent .
While the results are encouraging , and I am cautiously optimistic that she will do well , the road ahead for her remains long and arduous .
As we count the deaths of the many who have succumbed to COVID-19 , let us not forget the cost of the pandemic on those who suffer from other lifethreatening conditions such as cancer . n
Dr Ang Peng Tiam is the medical director of the Parkway Cancer Centre in Singapore . He is a council member of the Singapore Cancer Society and the past president of the Singapore Society of Oncology . He held the concurrent post of Director of the Oncology Centre and Clinical Associate Professor at the Faculty of Medicine of the National University of Singapore .
GlobalHealthAsiaPacific . com JUNE 2021
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