Sand bunkers are dreaded hazards that threaten to disrupt every golfer’s game, much the same way cancer can do to our lives. In this edition of ‘Stories of Hope’, we learn how Joe Ng overcomes his cancer “bunker shot” with the help of advanced cancer technology and the skilled and attentive care of his medical team.

The Diagnosis

Joe’s nose started to bleed unexpectedly when he was asleep one night. This was the second nosebleed which he had experienced over a span of 2 weeks. Around the same time, he also experienced neckaches, but brushed it aside thinking it was due to his poor sleeping posture. That episode prompted him to visit a general practitioner who did not find anything amiss. It was only three weeks later, upon further referral to an ENT specialist that Joe found out that he had late stage nose cancer.

A Father’s Heart

“I never imagined that cancer would strike me one day,” Joe said. But when it did, he got busy. “I didn’t have much time to think about it,” he said. As the breadwinner of the family, he had to arrange, inform and settle all his work related matters. Being an associate director of a life insurance agency, the financial anxieties of his clients which he was all too familiar with, became real. Joe explained, “The worries of unemployment and being gainfully employed after cancer are real. Planning for contingencies isn’t just about getting our medical expenses reimbursed.” As a father, Joe asserted, “Fighting cancer with the burden of not being able to provide for your family is no joke. The stress can kill you”.

For his family’s sake, Joe was determined to begin and end his treatment well. He remembered telling himself at the start of his treatment that “everyday is a progress towards my recovery.” Although his cancer journey was fraught with challenges, Joe remains thankful for many things. He is thankful for his wife who was always there for him and his kids who were constantly looking out for him. His golf buddies also stood in solidarity with him throughout his treatment.

Medically, Joe is grateful for the care he received from ENT specialist, Dr Dennis Chua, and Radiation Oncologist, Dr Jonathan Teh. Dr Dennis’s clear and detailed explanation gave him the confidence to proceed with the treatment. Radiotherapy under Dr Jonathan, coupled with his close monitoring of the side effects and personalisation of cancer solutions helped Joe not only to complete his treatment but to recover well.

The Treatment & Side Effects

Radiation therapy (RT) with or without concomitant chemotherapy is a keystone in the treatment of locally advanced head and neck cancers. In fact, in the case of nose cancer, this non-invasive treatment is the key to cure for all stages, with no surgery required.

Historically, the head and neck region is one of the most gruelling radiation treatment areas for patients. But technological advances in radiation planning and delivery, as well as proactive side effect management has made it much more tolerable today. Still, it is not a walk in the park and patients need to work closely with their medical team to emerge stronger, just as Joe did.

In Joe’s case, Volumetric Modulated Arc Therapy (VMAT) technology, an advanced radiotherapy technique was used. This technology uses arcs of radiation, rather than individual beams, allowing a more targeted and accurate approach. In areas close to critical organs, such as the optic nerves or salivary glands, radiation doses can be curved by ‘modulation’ to spare these organs from collateral damage. In addition, its rapid treatment delivery improves patients’ comfort considerably.

Throughout the treatment, the Radiation Oncologist and his team of nurses and radiation therapists will closely monitor and address the patient’s side effects, so that he can customise the treatment and allow his patient to complete the RT fully without disruption.

Preparation for RT

The dental clearance that Joe had to go through before RT left him “devastated” and “depressed” as he learnt that he had to extract 12 teeth over a few visits. He was therefore very relieved when Dr Jonathan came back with an alternative solution.

Dr Jonathan recalled, “Every patient is different. I could sense that Joe was very affected by the recommendation to extract 12 teeth prior to radiotherapy”. As time was of the essence to complete dental clearance before RT, Dr Jonathan initiated an in-depth discussion on the condition of his teeth with the dentist to prioritise which teeth needed to be taken out. Based on a benefit vs risk assessment, he was able to propose a more palatable number for extraction so that the borderline teeth that were not extracted could be optimally spared from high doses of radiation using VMAT.

Side Effects #1 – Dry Mouth and Taste Alteration

Joe recalled that he experienced taste changes and dry mouth three weeks into his RT and had to rinse his mouth almost every hour just to get a funny ‘faeces’ taste out. During that period, Joe lost a total of 8 kg as his sleep and quality of life was adversely affected. He was thankful that Dr Jonathan was able to reassess the situation and make the necessary changes to the treatment so that he could cope better. Joe recalled, “That was a life saver!”

Side Effects #2 – Skin Peeling

Joe’s skin started peeling halfway through the treatment and peaked right after RT completion. Through the prescription of specialized creams from RECOVER@AARO, Joe’s skin was able to heal quickly.

Side Effects #3 – Fatigue

Joe was left feeling weak after concurrent chemotherapy and RT sessions. Fatigue is commonly felt by patients because of the accumulated chemoradiotherapy cycles. Upon observing that Joe had become very apprehensive and almost fearful as he approached his 6th chemotherapy cycle and the end of his RT course, Dr Jonathan initiated discussions with the medical oncologist. In order to expedite Joe’s post radiotherapy recovery, the last cycle of chemotherapy was omitted after careful consideration from the oncologists.

Life After Cancer

After four challenging months, Joe has finally completed his treatment. He was given an all clear on 23rd of June 2021, just three days after Father’s Day 2021. Looking back, Joe knew that he definitely hit a difficult bunker during his cancer journey and felt like giving up many times. But he was glad that he was kept on course by Dr Jonathan, who not only kept a close watch on him but also patiently and firmly helped him overcome the challenges throughout the treatment.

Dr Jonathan commented, “Joe faced his treatments bravely. It is most heartening to see that about one month after his chemoradiotherapy, he is well, more cheerful and able to continue with his exercise and golf.”

Joe’s experience shows how technology has enabled the development of non-invasive cancer treatments and how side effects can be managed and overcome. This heralds hope for other patients and gives them much needed confidence to face their cancer journey.

For Joe, he is glad to be able to take care of his family once again. “While things may look the same, I know that things are different. Daily routine doesn’t change much but the attitude and perception towards life definitely has. I now spend more time with family and live life with fun!”

This season, we are privileged to celebrate our Ambassador of Hope: Joe Ng.

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