A grandmother’s experience with lung cancer in Singapore
Living with Cancer
Stories of strength, support and hope
NOT being able to breathe properly had always been a part of Madam Sim Siew Hong’s life.
The 58-year-old former hawker’s assistant had suffered from nasal congestion for as long as she can remember. When she was 30, her late father-in-law encouraged her to start smoking.
“He said blowing the smoke through my nose would help clear the nasal passage,” said Mdm Sim, in Mandarin.
She took his advice and picked up the habit “just so I could breathe properly,” she said. “So, whenever I felt that the nasal passages were congested, I would smoke.”
“I bought cigarette paper and tobacco and rolled the cigarettes myself. I smoked two to three sticks a month for the last 20-something years.”
Mdm Sim believes her habit of smoking unfiltered cigarettes might have weakened her immune system. “Every time my grandson is sick with cough and cold, I will inadvertently catch the bug,” she said.
Her grandson Ethan is six years old. Mdm Sim helps care for him while her daughter is at work.
In May, Mdm Sim developed a bad cough she couldn’t shake, after catching the flu bug from Ethan. She was also down with shingles at the time.
“It was very painful and I was suffering both from the pain and from coughing,” she said.
A DEVASTATING DIAGNOSIS
A few trips to general practitioners (GP) temporarily reduced the coughing, before it returned worse than ever. She eventually consulted TCM practitioners, hoping that Chinese herbal medicine would help where Western medicine failed.
Nothing worked. Two months later, Mdm Sim became breathless. She was taking in air at a fraction of her lung capacity and had trouble eating and sleeping. Her weight dropped by 10kg.
“Every breath I took was laboured… whether I was lying in my bed or standing up,” said Mdm Sim. “Taking a couple of steps, like from the kitchen to the living room, made me breathless. I was practically crawling on all fours because I was so weak.”
Worried, her daughter took her to a GP, who immediately referred her to Parkway East Hospital. An X-ray revealed that both lungs were filled with liquid and that she needed immediate medical attention.
“I was rushed to Mount Elizabeth Novena where I was warded, and had tubes inserted into my sides to extract the water from my lungs. The pain was excruciating but it was necessary,” she said, adding that as much as 3,000cc of liquid was pumped out.
“That was when they discovered a tumour. A biopsy confirmed that it was cancer,” she said.
“Dr Daniel Chan informed me a few days later that the cancer was slightly above Stage 3… I had been so sick for the past two months so the news didn’t affect me. I was emotionally prepared for bad news but my daughter wasn’t. She burst into tears. And for the next few days she couldn’t stop crying.”
Mdm Sim was told she was a good candidate for immunotherapy instead of chemotherapy.
Breaking the cancer "handshake"
Medical oncologist Dr Daniel Chan explained that chemotherapy is the use of chemicals to directly kill cancer cells, while immunotherapy uses an antibody to awaken the immune system to attack the cancer cells.
“The former causes more collateral damage to normal cells while the latter causes less. Collateral damage comes in the form of nausea, diarrhoea, low blood counts,” he said.
“Mdm Sim has poorly differentiated squamous cell carcinoma subtype of non-small cell lung cancer. She is on first-line immunotherapy as her cancer markers are more than 50 per cent on the lung specimen biopsy test. That is in accordance to the landmark clinical trial, published in New England Journal of Medicine of 2016.”
The immunotherapy she was given is an anti-PD1 immune checkpoint inhibitor, which breaks the “handshake” between cancer cells and the immune cells and is applicable in about three in 10 lung cancer patients.
According to Dr Chan, this “handshake” between cancer cells and the immune cells is mediated through PD-L1 and PD-1 protein respectively. It is a form of biological camouflage that prevents the cancer cells from being attacked by the immune system. But through immunotherapy, the “handshake” is broken and the immune system will directly attack the cancer cells.
Fortunately, Mdm Sim responded very well to the immunotherapy, with only minimal side effects such as itchy skin and mildly cracked palms. Her breathlessness, which was due to cancerous fluid re-accumulation in the left lung, was resolved within days.
Her health scare also frightened her husband, who stopped smoking in May.
She now goes for treatment once every three weeks. “With government subsidies of S$3,000, I pay about S$5,500. It’s not exactly cheap but it has helped me to get my life back,” said Mdm Sim.
And that means being able to be the grandma she wants to be to Ethan.
“I continue to look after Ethan, taking care of his every need like I have been doing since he was born. I get him ready for school and he always wants me to be there when he comes back. My daughter’s mother-in-law is taking care of Ethan’s younger brother to relieve me,” said Mdm Sim.
Her daughter has also employed a helper to ease the load.
“When I was sick and breathless, I became grouchy and snapped at everyone. It was so bad that my beloved grandson told me that I had transformed from his loving po po (‘grandmother’ in Mandarin) into an evil wu po (‘witch’ in Mandarin),” said Mdm Sim, laughing. “The therapy took away my discomfort and made me a happy person again. To be able to get my grandson to accept me again was worth the cost.”
If you or your loved ones suffer from cancer, speak to your oncologist to find a suitable treatment.