@Jackie San

Cancer is a word that strikes fear into the hearts of many.

In Singapore, where one in four residents is expected to confront this diagnosis at some point, the concern isn’t just about health outcomes but also the financial toll.

While the Singapore Government has been actively working to ease the burden, there is always room for other potential solutions that could help alleviate these concerns.

A prime example: Precision medicine, an approach that dovetails perfectly with Singapore’s emerging focus on preventive health.

Traditionally, cancer treatment has been a complex and costly endeavour, marred by fragmented care, a deluge of information for clinicians, and non-standardised medical technology infrastructures.

These challenges could lead to compromised treatment plans that come with no guarantee of success.

The same treatment that proves effective for one patient might not work for another, leading to wasted resources and, more tragically, lost time.

Time is of the essence in cancer care; delays can result in a decreased effectiveness of treatment and an increase in the cost of care.

Add to this the prevailing notion among patients and caregivers that the most complicated and expensive treatments are the best, and you’ve got a recipe for skyrocketing costs.

This is why precision medicine is poised to be a game changer in cancer care, offering not just personalised treatments but also a more streamlined pathway to care.

This innovative approach tailors treatments to individual patients by using their genetic makeup, lifestyle, and environmental factors as a blueprint, accelerating the journey from diagnosis to treatment.

Diagnostics imaging, a key contributor of the acceleration of the journey, spans the whole process of the cancer care continuum, not just for screening and early detection, but also through diagnosis, therapy and survivorship.

The molecular-level imaging has allowed for more accurate decision-making through each stage and complements the precision medicine process.

By leveraging the power of machine learning and the burgeoning field of panomics (the combined analysis of multi-dimensional data), precision medicine can analyse massive sets of data and turn them into actionable decision-support tools, providing healthcare providers with the insights they need to create highly personalised treatment plans.

This is particularly relevant for cancer care because of the disease’s inherent complexity and the multitude of types, each requiring different treatment modalities.

Precision medicine promises to not only produce better outcomes but could also lower the costs of cancer treatment in a number of important ways.

The first is in the realm of cancer screening.

Traditional screenings can be costly and uncomfortable, leading some to avoid them unless symptoms appear.

Precision medicine can more accurately identify those most at risk for specific cancers, making screenings more targeted and, by extension, more cost-effective.

Early detection often leads to less invasive and less expensive treatments.

But it’s not just about early detection; it’s also about smarter detection.

Precision medicine leverages a wide array of data, from genomics to lifestyle, which in turn sharpens diagnostic accuracy.

Armed with this knowledge, doctors can identify the most effective treatments, side-stepping unnecessary and costly procedures and medications.

Precision medicine’s cost-cutting benefits may apply most significantly to complex cancer cases.

By integrating a wide variety of data, ranging from the specific type of cancer involved to the patient’s genetic makeup and family history, treatments can be highly tailored to each individual case, making them far more effective and efficient.

But knowing the potential of precision medicine is one thing; implementing it is another.

The reality is that most cancer treatments are still rooted in a one-size-fits-all approach, often boiling down to surgery, radiation or chemotherapy.

This is largely due to systemic constraints.

Our current healthcare systems are not yet equipped to handle the data-intensive nature of precision medicine.

There’s also a lack of flexibility in treatment decision-making, a crucial component in individualised care.

Singapore is uniquely poised to overcome these challenges.

The creation of specialised cancer care centres of excellence offers a promising avenue for addressing obstacles such as fragmented care and technology gaps.

These centres would offer integrated, multimodal cancer care, harnessing advancements in diagnostics, genomics, robotic surgery, and radiotherapy.

These flagship establishments combine facilities, equipment and specialists under one roof to share precision cancer care resources among wider healthcare networks, increasing efficiency and reducing the costs of implementing large-scale precision medicine.

Singapore’s National Cancer Centre building, which recently opened new facilities and is five times larger than its previous premises, is perfectly positioned to serve this purpose as a hub for precision medicine approaches across the country’s healthcare system.

Public-private collaborations are another way to realise this route towards the wider adoption of precision medicine.

Singapore is also well ahead of the curve in terms of digitising healthcare data thanks to its smart health initiatives, with platforms like HealthHub and genetic studies like SG100K setting the stage for the data-centric needs of precision medicine.

The kind of highly customised cancer treatment plans that are the ultimate promise of personalised medicine require groups known as molecular tumour boards, in which healthcare professionals from a variety of disciplines come together and use molecular and clinical data to ensure that treatment decisions are properly optimised for each individual patient’s unique case.

In the past, such groups would have been difficult to convene, but the normalisation of remote consultations and virtual meetings in the post-Covid-19 pandemic era has made them a far more practical option.

So, as we grapple with the rising tide of healthcare costs and cancer cases, we need to ask ourselves: Can we afford to ignore the potential of precision medicine any longer?

It’s time for a radical rethinking of how we allocate healthcare resources, perhaps even considering outcome-based payment systems as a way to encourage more effective, less costly care.








@Jackie San

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