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Bringing the Spotlight to Geriatric Oncology

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As a recipient of the Professorship in Geriatric Oncology, Associate Professor Ravindran Kanesvaran has received the highest honour given by Duke-NUS to faculty members. This award not only recognises his outstanding achievements in academic medicine, but also seeks to support him in his quest to improve cancer survival rates in elderly patients through research discovery and educating the next generation of specialists.

Even though the practice of Geriatric Oncology (GO) has been in Singapore for almost two decades, it is still not a field that is widely known among the general public, and even to members within the medical fraternity.

For Assoc Prof Ravindran Kanesvaran, who is a Senior Consultant at the Oncology Academic Clinic Programme and National Cancer Centre Singapore specialising in urological cancers, however, GO is something that sits close to his heart. 

His entry into the world of geriatric oncology
The story about how A/Prof Kanesvaran became involved with GO is an interesting one that involves several plotlines converging.

He shares that he was just about to begin his specialty training and was thinking hard about which area he should go into. He says: “There were several areas I was considering. At first, I was interested in gastroenterology, but then my mum got diagnosed with breast cancer. This led me to look more intently into the area of oncology.

At the same time, he also heard about GO for the first time from his senior, Dr Donald Poon in 2007. “He had just come back from a training stint at the Moffitt Cancer Centre in Florida and started the first GO programme at the National Cancer Centre Singapore. The idea that elderly cancer patients should be treated based on factors specific to their stage in life, such as their physical and social condition, was something that was new and very interesting to me.”

“Somehow all of these factors just sort of came together at the right time. There was this field that not many people were involved in, and there was still so much that we could do to help improve patient care. That was when I decided to let Donald know that I was interested and wanted to be part of his programme.”

Campaigning for elderly cancer patients
A/Prof Kanesvaran explains that as part of the GO treatment process in Singapore, cancer patients over the age of 70 will undergo a comprehensive geriatric assessment (CGA) to determine if they meet the criteria for treatment as a geriatric cancer patient. This involves an assessment of their physical state, such as whether they suffer from common elderly conditions such as prostate, bladder and kidney disease; their mental state, such as dementia and memory issues; and their social state, such as whether they are experiencing social isolation.

“This CGA undoubtedly takes up resources like time and manpower, and as such, many doctors find it challenging to implement in the clinic. Very often, a lack of awareness and understanding is a factor as well, as older patients are perceived to be less fit and suitable for active treatment due to their age.”

To overcome these challenges, A/Prof Kanesvaran has been leveraging his many hats at SingHealth Duke-NUS Academic Medical Centre (AMC) to try and change the mindset of both medical professionals and the public.

“As an educator, I get to influence young minds. From an early stage, we want our trainee doctors to see the value of treating elderly cancer patients differently. We also want to raise awareness that older patients are in better physical condition than before, and that it is not time for them to be written off yet.”

Furthermore, in his hats as a clinician and a researcher, A/Prof Kanesvaran is also able to act as a bridge to bring clinical trials to older cancer patients. “Not only am I able to work with the development of new cancer drugs, but I am also directly involved with observing how these trial drugs perform on my actual urology patients.”
In addition, he also appreciates how research helps him to answer questions that he comes across in his clinical practice, especially with regards to the cases involving older cancer patients that have not been recruited into trials.
Grooming the next generation of GO specialists
Identifying manpower as the main limiting factor for the advancement of GO in Singapore, A/Prof Kanesvaran is keen for the next generation of medical professionals, be it medical oncologists or therapists or pharmacists, to step up and pave the way for a future where GO is no longer just a treatment option, but a standard part of cancer care.

He says that for this to happen, everyone will need to get on board, from the policymakers to the multi-disciplinary departments right down to the patients and their families.

“I think that the Professorship being conferred by SingHealth Duke-NUS AMC is certainly a step in the right direction. I am ecstatic to have been conferred the Distinguished Professorship for Geriatric Oncology. Not because it recognises my personal achievements, but because it is a great way to show the world that GO is an important field, especially with the rapidly ageing populations seen in Singapore and many parts of the developed world.

With this increased recognition of GO, I hope that more people will see the value in older patients getting assessed and treated appropriately, and then hopefully more doctors will want to be part of an exciting area where they can make real inroads into improving outcomes for older cancer patients.”