Fresh out of polytechnic, she learnt she had stage 2 cancer. Medical history later impeded job search

 

• A young woman was diagnosed with cancer in her early 20s
• It affected her self-esteem, social life, job opportunities and possibly, her chances of conceiving naturally
• She will be taking part in this year’s Run for Hope to raise funds for cancer research at the National Cancer Centre Singapore
• The centre sees around 450 to 550 new cases of cancer in adolescents and young adults a year
• Cancer research can help improve survival outcomes and quality of life for patients and survivors, an oncologist said

 

 

SINGAPORE — After graduating from Temasek Polytechnic in 2017, Ms Azhany Mohamed was looking forward to getting a job and supporting her family financially. These plans were dashed when scans showed a cancerous mass covering about half of her lungs.

Diagnosed with Stage 2 Hodgkin lymphoma, a type of cancer that starts in white blood cells or lymphocytes, Ms Azhany spent her 22nd birthday and the subsequent months battling the disease.

The hardest part of being a young cancer patient, Ms Azhany said, was feeling left out of the things that her peers can do, and having low self-esteem from treatment side effects such as hair loss and face swelling.

She also faced rejection and discrimination from potential employers during her job search after treatment. 

“As a young adult, the physical changes affected my mental health severely; dating was challenging and I often felt self-conscious when socialising with friends,” she said.

“I think not having much of a social life — compared with my friends who were starting new jobs and travelling —made me have ‘fomo’ (fear of missing out).”

Now 26 and cancer-free, Ms Azhany is working in the civil service and will be taking part in Run For Hope, a running event that aims to raise awareness and funds for cancer research at the National Cancer Centre Singapore (NCCS) where she underwent treatment.

Every year, NCCS sees around 450 to 550 new cases of cancer in adolescents and young adults aged 16 to 39.

Young adults are more likely than younger children or older adults to be diagnosed with certain cancers, which include Hodgkin and Non-Hodgkin lymphoma, melanoma, testicular cancer and sarcoma, a rare type of cancer that arises in the bone and soft tissue such as muscles, blood vessels and nerves.  

Although some cancers in younger adults may be linked to a strong family history or genetic cause, for example, colon and breast cancer, the majority of the cases occur without a family history.

In Ms Azhany’s case, there is no history of cancer in her family.

Lymphoma, which is one of the most common cancers in young adults here, has been associated with a compromised immune system that may be present from birth, or infection with certain viruses such as the Epstein-Barr virus or human immunodeficiency virus. 

Having experienced the agonising effects of what cancer can do to her overall health, Ms Azhany wants to do her part to further raise awareness of cancer in young adults and support cancer research.

In particular, to remind more people, including those in her social circle, on the importance of early detection and having regular health screenings.

This year’s Run For Hope will take place from Nov 29 to Dec 26, in a virtual format with various distance categories of 2.8km, 10km and 28km.

More than 4,000 participants are expected to take part in the run.

Ms Azhany said that she will be encouraging her family and friends to join her and will likely “drag” her fiance along for the run.

“I hope that by contributing to cancer research, there will be improved treatments and enhanced care for patients and survivors. This would also mean helping survivors like myself to have a better quality of life and a chance at a long, fulfilling life,” she said.

A PERSISTENT ‘DRY COUGH’

The youngest in her family, Ms Azhany’s earliest symptoms was a nagging cough that would not go away, breathing difficulties and tightness in her chest for several weeks.

She also lost 5kg but thought that it was due to fatigue and stress of her final-year diploma studies.

When she finally saw a doctor, the cancer continued to be undetected for some time due to several missed diagnoses.

One general practitioner she saw said that it was just a “dry cough”.

When her symptoms worsened, she decided to consult her family doctor who noticed that her stomach was bloated, and advised her to go to the hospital if the swelling did not subside.

At the hospital, doctors initially thought that she had a lung infection.

Then, she went for a PET (positron emission tomography) scan, which can help detect early signs of cancer, and it revealed a large mass in her chest area.

She was transferred to Singapore General Hospital (SGH) and there, she was diagnosed with Hodgkin lymphoma.

“A Google search of the condition confirmed my worst fears (that I had cancer). Even then, I decided to share the news with my three older siblings first, and not my parents, as I believed that they would be able to deal with the news better,” she recalled. 

The medical costs weighed heavily on her mind.

Her father worked as a forklift driver and her mother was a homemaker, while her siblings had to care for their own families.

“Being diagnosed with cancer resulted in what survivors call the ‘involuntary gap year’, where my previous plans of getting a job and supporting my family financially were put on a back burner.

“My family were also concerned about the medical costs but thankfully, there were financial assistance schemes that helped,” she said.

She sought advice from the hospital’s medical social workers who helped her make an informed treatment decision and gave her peace of mind while she battled the disease.

TREATMENT SIDE EFFECTS

Another thing that bothered Ms Azhany as a young cancer patient was the impact cancer treatment could have on her fertility.

Different cancer treatments may permanently affect cancer survivors’ chances of conceiving later on.

In Singapore, most oncologists will discuss fertility preservation options with patients of child-bearing age before beginning cancer treatment.

Afraid that chemotherapy might wipe out her chances of starting her own family, she underwent oocyte cryopreservation (egg freezing) before starting cancer treatment

Oocyte cryopreservation is a process in which the woman’s eggs are extracted frozen and stored to preserve reproductive potential.

Ms Azhany then underwent a six-month long chemotherapy treatment called BEACOPP, which involved taking intravenous and oral medications on alternate weeks.

She also had three months of radiotherapy after her chemotherapy.

She lost all of her hair a month after treatment, and after the third month, the symptoms worsened.

“My hair stopped growing, I vomited constantly and lost my appetite.”

In the last month of chemotherapy, she was too weak to travel on her own to SGH for treatment and chose to be admitted to continue with her treatment.

Ms Azhany said that losing control of her strength, physical health, mobility and appearance affected her mentally.

“For a long while, I did not have the courage to post photos of myself on social media. I also felt envious when I saw videos and photos of my friends going on holidays on social media,” she said.

Later, instead of wallowing in self-pity, she used what was left of her energy to take part in NCCS' activities for cancer patients, such as workshops and sharing sessions with other patients.

“These activities provided the emotional support I needed, as my family and friends could never completely understand what I was going through as a cancer patient, no matter how supportive they were.”

REJECTIONS DURING JOB SEARCH

Even after treatment and being cancer-free, life did not go back to normal immediately.

She had trouble finding employment and was rejected by various companies due to their concerns about her medical history.

“Although I sent my resume to various companies, nobody gave me a chance.”

Ms Azhany applied for deskbound jobs in areas such as marketing, graphic design and administration.

The recruiters’ doubts on whether she could carry out her job duties were especially jarring.

“I didn’t expect that because I wasn’t sick anymore. I was moving around and going about my daily life at the time. But maybe I was also a fresh graduate so it was harder for me to get a job.”

After a year of unsuccessful job hunting, she landed her first job as a graphic designer at an organic product company.

“I was upfront and honest during my interview, and told the boss I was going for regular follow-up check-ups. She knew I had cancer but she called me the next day to offer me a job. I was grateful for that.”

Based on her job hunting experience, Ms Azhany feels that employers should be more informed and keep an open mind during the recruiting process.

“A person’s medical history isn’t going to stop them from performing their job,” she said.

CHANGES TO LIFESTYLE

After cancer, one of the biggest changes Ms Azhany made was to give her diet and physical activity an overhaul.

From having processed food and fast food regularly, she now takes homecooked meals prepared healthily.

Her healthier eating habits influenced her family members to change their diet, too.

“I realised how physically unfit I was, so I joined a gym and fitness classes such as high-intensity interval training to improve my strength and endurance.

“I also go for health screening whenever I feel unusually tired, to ensure that I am in the clear.”

Ms Azhany is looking forward to a new chapter in her life. Next week on Nov 14, she will be married to her boyfriend of four years, a 30-year-old site supervisor whom she started dating after her cancer treatment.

They hope to start a family in the future. “It’s good that we have that ‘back-up’ plan,” she said.

“I don’t know for sure if my fertility has been affected by my cancer treatment, but I am grateful to have been given a chance to freeze my eggs to improve my chances of conception for when I am ready to conceive.”

PATIENTS NOT ‘LAB RATS’ IN CLINICAL TRIALS

Covid-19 has dominated headlines but cancer continues to be the leading cause of death in Singapore, as shown by the Singapore Cancer Registry’s latest statistics in March 2021.

Dr Eileen Poon, consultant with the department of lymphoma and sarcoma at NCCS, said that cancer research helps to develop better treatment that will improve survival outcomes and quality of life for patients.

And as diseases such as cancers continue to mutate, they can potentially outsmart current treatments, she said.

Dr Poon said that common misconceptions about cancer research is that clinical trials are not safe and people who take part in them are “lab rats”.

“The truth, in this day and age, is far from it. Science has evolved so much in the last couple of decades that in order for a research to be conducted, there has to be good science background and rationale.

“Research has allowed advancements in cancer and we have seen significant improvements. These improvements are not only in survival across cancer types, but also in areas of supportive care.”

IMPORTANCE OF CANCER RESEARCH

Due to advances in research, Dr Poon said that there has been a shift towards conducting more genomic profiling to identify “druggable” mutations. This means identifying specific changes in the cancer protein structure that may make it more sensitive to certain medications.

“It is similar to a lock-and-key model, where the key (the drug) is able to target places that carry the specific lock design (cancer cells). This has proven to improve survival in some cancers, notably in lung cancers, breast cancers, stomach cancers and lymphomas, just to name a few,” she explained.

For example, one of her patients has a very rare form of sarcoma, which was not responsive to standard treatment.

The NCCS team then recommended the patient to consider enrolling in a clinical trial, where fresh cancer tissue could be biopsied and evaluated for presence of mutations, as well as its response to a panel of different cancer treatments.

“The patient decided to enrol in the trial and we were able to identify a type of non-standard treatment that had an effect on the cancer she has.

“The cancer, which affects her pelvic area, has reduced in size and texture, making a big difference to the patient as she used to have difficulties sitting and lying in certain positions,” Dr Poon said.

To take part in Run For Hope and support cancer research, register online by Nov 28 at https://runforhope.sg.