SINGAPORE — Having dedicated more than three decades of his career to the field of urology focused on prostate cancer, Professor Christopher Cheng was aware of the sobering possibility that he may eventually succumb to the very same disease he knows well as a specialist.
In 2017, the urologist and trailblazer in the use of robots for surgery found himself on the other side of the treatment room after becoming a patient himself.
He was diagnosed with advanced prostate cancer and underwent treatment. However, the disease recurred.
In an interview with TODAY, Prof Cheng, who completed radiation therapy in December 2021 for the recurrence, offered his perspective on death and dying as a doctor who battled a life-threatening disease.
The 66-year-old is a senior consultant urologist with Singapore General Hospital and Sengkang General Hospital.
“I have a 50 per cent chance of being on pal (palliative) care eventually, with the recurrence,” he said candidly.
Palliative care is a patient-centred approach that enhances the quality of life for patients and their families who are coping with life-threatening illnesses such as cancer.
EQUAL CHANCE OF MIRACLE OR DEATH
Prof Cheng is among 20 eminent doctors featured in a series of video interviews called Doctors’ Die-logues.
Produced by the Lien Foundation, it is part of a new focus to help healthcare professionals gain a better understanding of the topic of death and dying, and the need for compassionate care.
Lien Foundation, a Singapore-based philanthropic organisation, has been championing training, research and advocacy for end-of-life care for more than a decade.
In the video, Prof Cheng said: “Scientifically, based on databases and whatever I tell my patients… (I would also say to myself), ‘I think you have a 50-50 chance — 50 per cent chance that you’ll have a miracle and 50 per cent chance you’ll die of the disease.”
Last month, the urologist spoke at the 8th Singapore Palliative Care Conference at Marina Bay Sands, alongside other doctors on the Doctors’ Die-logues panel to explore experiences and leadership lessons learnt within end-of-life care.
The conference was organised by the Singapore Hospice Council, with Lien Foundation as one of the supporting partners.
As a nation, Singapore aims to boost palliative care services, including home palliative care, and reduce the proportion of people dying in hospitals.
In a past survey by Lien Foundation, 77 per cent of Singaporeans expressed hopes of dying at home but only about a quarter (26 per cent) managed to do so.
The lack of awareness of such services, even among healthcare professionals here, had been highlighted as one of the key barriers.
In a 2020 survey done by the Singapore Hospice Council, less than half (around 46 per cent) of the respondents — who included doctors, nurses and allied healthcare professionals — were familiar with hospice and palliative care service providers and referral processes in Singapore.
The survey also found that a significant number of healthcare professionals had not done any personal anticipatory care planning in case of serious illness, with 7 per cent rejecting hospice and palliative care entirely.
Such barriers to palliative and hospice care among healthcare professionals may affect how they promote care planning for the patients and families under their care.
A LESSON IN HUMILITY
For Prof Cheng, the cancer diagnosis has been a “humbling” experience, one that he has detailed in his book, titled I Thought I Knew: A Professor Turned Patient, published in 2020.
He is married to Associate Professor Brenda Ang, 64, who is a senior consultant with the department of infectious diseases at Tan Tock Seng Hospital and the National Centre for Infectious Diseases. They have a 34-year-old son.
On the lessons he has learnt after his initial diagnosis, Prof Cheng said in the video: “I was this arrogant, impatient young surgeon, thinking I’m a godsend for mankind — until I became afflicted with prostate cancer, an area I’m supposed specialise in.”
Prof Cheng has since gone through many episodes of emotional ups and downs while waiting for his PSA test results.
“After treatment, every blood test becomes that lying-in-wait to know what the result is,” he said.
“As someone who is supposed to be an expert and knowledgeable in this, I know about all the bad things that can happen.
“It’s either relief or disappointment, multiple (times of) fear, anxiety, anticipation.
His experience has changed the way he informs patients of their progress. Previously, for patients with a good PSA test result, he would print out the result and congratulate them.
“Now I do an extra step,” he said. “If I see an undetectable PSA after surgery, I give the patient a hug and I may have tears in my eyes. Because I think they are free.”
Prof Cheng said that after his cancer recurred, the oncologist proposed an “all-in, kitchen sink” approach, which meant giving maximum treatment available.
“I opted out of it and decided to have very focal, localised (treatment). After a long, long discussion, I didn’t want an all-out treatment that would most likely give me many side effects,” he added.
“People ask me, ‘So, how are you?’, they are concerned. (I tell them) I’m as good as could be, nothing to panic.
“I’ve everything I need to be happy, and more. I don’t think that being at the receiving end of the kitchen sink is going to make me any happier.”
Prof Cheng is considering writing “season two” of his experience but expressed some hesitation over it.
“Part of the reason is because one man’s experience is a drop in the ocean. When you write something, you need to basically present a scientific account because people will hang on to those little things.”
For now, he is doubling up his efforts to live life to the fullest, and to be fully present in all that he does.
“No more postponing meeting the people I really like to catch up with; no more procrastinating on things I would like to complete. Every task is taken as though it is the last chance,” he said.
“For the first time, I have a cycling coach and I am winning races for the first time in my life. My paintings are now exhibited, good enough to be sold for charity. Most of all, I make peace with things I accept as being beyond me.
“Every moment is precious. Every encounter is ‘here and now’, like this (interview), at 100 per cent attention,” he added.
“And I’m not in a hurry to go anywhere.”
The Lien Foundation’s Doctors’ Die-logues video series can be found online.