SINGAPORE – Between October 2024 and August 2025, 108 terminal cancer patients hospitalised at the National University Hospital (NUH) benefited from an initiative that aimed to relieve them of the burden of unnecessary medications and interventions.
During this period, these patients took an average of three fewer oral medications, with some taking 13 fewer. They also underwent fewer vital-signs checks and finger pricks to check their blood glucose, with some experiencing up to 52 fewer blood glucose pricks.
The patients were also able to save on expenses, with the reduction in blood glucose pricks alone allowing them to save an average of $60 each, with some saving up to $740.
This approach allowed them to focus on their comfort and quality of life, as well as spend more meaningful time with their loved ones, the hospital said.
Since October 2024, NUH has collaborated with the National University Cancer Institute, Singapore (NCIS) to introduce an appropriate care end-of-life pathway for cancer patients.
The initial cohort of 108 was selected based on criteria such as a prognosis of about one month to live, said Adjunct Associate Professor Samuel Ow, who leads the project.
Doctors, nurses and pharmacists came together with the aim of enhancing care for these patients, the senior consultant with the haematology-oncology department at NCIS, told reporters on Oct 9.
“Once the patient is identified, we will then provide an individualised care plan with appropriate interventions, and these may include reducing non-essential medications, such as cholesterol-lowering drugs that have been shown in advanced cancer patients to not change lifespan,” said Prof Ow.
Outpatient appointments are also re-evaluated to reduce unnecessary appointments for patients who may be frail and have difficulty going to the hospital.
“Patients have reported less pain and discomfort as a result of cutting down on non-essential procedures. By limiting consultations to only key ones, patients gain more time to spend meaningfully with their loved ones,” he said, noting that the approach may be expanded to patients with a six-month prognosis in the future.
This approach has also freed up the time for clinical staff, he said, noting that this has allowed them to focus on their patients’ more critical needs.
The initiative is part of NUH’s Appropriate Care campaign, introduced in March 2024, which aims to provide patient-centred care that maximises health outcomes for patients, while relieving them of medications and procedures that add to their cost and discomfort but provide only minimal benefit.
Otherwise known as Apt Care, this is in line with similar efforts by the National University Health System (NUHS) public healthcare cluster, which operates NUH.
In August, Minister for Health Ong Ye Kung identified the implementation of appropriate and value-based care as one of the approaches Singapore is taking to develop a system that provides quality healthcare that is both accessible and affordable.
Speaking at the International Forum on Quality and Safety in Healthcare, Mr Ong noted that NUH had first adopted the value-driven care approach in 2015, with the Health Ministry introducing the National Value-Driven Care programme in 2017.
The programme had produced “good results”, he said then, noting that between 2017 and 2023, it had helped save some 320 lives and avoid 1,753 re-operations, or surgical operations to correct conditions not addressed by a previous procedure.
Another initiative at NUH aims to reduce unnecessary blood glucose monitoring for patients, with clear criteria introduced to empower nurses to safely reduce the frequency of finger pricks in clinically stable patients.
Over the past three months, 87 patients at NUH had their average daily blood glucose finger pricks cut from four to two, with no significant increase in the rates of hypoglycaemia or hyperglycaemia, said project lead Ada Teo.
“Patients who participated reported an improved treatment experience, as it reduced discomfort, pain and their out-of-pocket costs,” said Dr Teo, an associate consultant at the endocrinology division of NUH’s department of medicine.
A 48-year-old diabetic patient, who wanted to be identified only as Mr Noor, was admitted to NUH in September for a heart stent procedure.
While at the hospital, he had to undergo four daily blood glucose monitoring finger pricks, which could potentially disrupt his rest times.
Based on his stabilising condition and blood sugar level, nurses were able to reduce the number of such pricks to just twice daily from Oct 6.
“I was happy to reduce the finger pricks. I can pay less and get better rest without being woken up late at night,” said Mr Noor.
Adjunct Associate Professor Adrian Kee, a senior consultant at NCIS, said that while such appropriate care initiatives have been around for some time, the new programme represents an effort to consolidate and formalise such initiatives, allowing them to be realised more quickly.
Adjunct Associate Professor Amelia Santosa, one of the co-leads of the Apt Care campaign, noted that with Singapore facing an ageing population and an increasing number of people with multiple medical conditions, they are having to go for more appointments and take more medications.
“Hence, now more than ever, Apt Care is becoming a more critical concept for healthcare institutions to embrace and incorporate,” said Prof Santosa, who heads the division of rheumatology and allergy at NUH.
“Our ultimate objective is to continuously find ways to deliver care that is clinically effective and focused on patient-defined outcomes, while at the same time, promote greater healthcare value for everyone involved – from patients and their families to our healthcare staff and the hospital itself,” she said.
