‘Patients need to be better informed about treatment options’
Keum Ki-chang
Professor in Department of Radiology and Oncology,
Yonsei University College of Medicine
Keum Ki-chang is one of the most renowned radiology oncologists in Korea. After years of contributions to the development of radiotherapy at Severance Hospital in Seoul, he became the director of Yonsei Cancer Center in March 2019.
Six years ago, a patient with a tricky form of cancer visited Severance Hospital. A tumor was growing fast behind his eye, not far from his delicate optic nerve. After considering the tumor’s location, radiation oncologist Keum Ki-chang came to the conclusion that tomotherapy, an image-guided intensity-modulated radiation therapy, would work best for the patient, so he went for it. After receiving tomotherapy as well as drug treatment for several months, the patient fully recovered. “He has not experienced any side effects since and now looks healthy as if he was never ill,” Keum, vice director of Yonsei Cancer Center, said in an interview. However, his fate would have been very different if he had taken the advice of some people to receive surgery instead. “To reach the tumor, a surgeon had to cut open his cheekbone. It would have been a major operation, which could lead him to a loss of his eyesight or something else,” Keum said. “His life certainly wouldn’t be the same.” A few years ago, Keum also treated a flight attendant with an aggressive tongue cancer. “Surgery would have been the only, albeit ineffective, treatment option for patients like her about 10 years ago. The young woman was fortunate to tomotherapy. She is perfectly fine now,” he said. Radiotherapy, or radiation therapy, is a method of treatment using Ionizing radiation, which damages the DNA of cancerous tissue leading to cellular death. The therapy may be used in combination with surgery or chemotherapy – two other main cancer treatment methods.
The best part of radiotherapy is that most of its side effects are predictable and limited only to the body area that radiation affects, unlike those of surgery and chemotherapy. Radiotherapy is also considered less painful than the two. “And yet radiotherapy remains underused in most Korean hospitals. Many patients receive surgery without being informed about other treatment options and possible consequences,” Keum said. “This is because surgeons usually exert the biggest influence in making decisions for treatment, and they tend to follow the familiar pattern of ‘surgery first.’”
For example, he noted, about 60 percent of prostate cancer patients in Korea receive surgery and many of them end up with side effects such as urinary incontinence and impotence. He said the surgery rate is higher than it should be, compared with those in the United States and other developed countries. “The use of radiotherapy for more patients is not the point,” he said. “The important thing is to find the best combination of weapons to fight various types of cancer. This can be achieved only if doctors with different specialties become more open-minded and better communicate with one another.” “Doctors have more weapons to fight cancer than ever before, and they are responsible for how to make the best use of what they have. When they do, they can make the difference between life and death.” Last year, Severance Hospital’s radiation oncology department added robotic intensity modulated radiation therapy, which uses multiple small photon beams of radiation to irradiate tumors, to its “weapons list,” becoming the first hospital in Korea to do so. It also plans to set up the system for particle therapy using carbon ions by 2020. Keum hopes that the new therapy will enable the hospital to cure more conditions that are currently considered untreatable by any other means. “Saving lives is one thing, but in doing so, we (doctors) should think more about how to minimize the damage patients have to live with for the rest of their lives,” he said. “That, in my view, is the new standard of good medicine.”
Reviving the spirit of Horace Newton Allen
Medicine in Korea used to be all about giving without expecting anything in return. Reviving the spirit of Horace Newton Allen, an American missionary who established Gwanghyewon, the first modern medical facility in the country and the predecessor of Severance Hospital, is one of Keum’s goals as the vice director of Severance’s cancer center. “When it comes to equipment and manpower, Yonsei Cancer Center is world class. There’s no doubt about it,” he said. “But simply having great technologies and medical workers does not make the hospital great. We also need the spirit of Allen.” At a time when money controls almost anything, including in medicine, he believes doctors should take Allen’s spirit seriously in doing their work. “Not long ago, that’s how Korea received medicine. We should not forget that,” he said. “When no one wanted him, Allen risked his life to come here and served people in need. His altruistic devotion touched many people’s hearts.” As part of this effort, Keum and Director Noh Sung-hoon have reflected the perspectives and needs of patients in transforming Yonsei Cancer Center over the past few years. “One of the things we focus on is to provide ‘special pain care.’ Pain is an important issue for patients but is often overlooked by doctors. Under the slogan of ‘Painless Hospital,’ we have tried hard to prevent and solve issues of pain,” Keum said. Another focus has been minimizing unnecessary medical checkups and procedures. Two years ago, patients with breast cancer had to receive radiotherapy 33 times, but the center has reduced that number to 16 times, based on the latest research results showing the same effect could be achieved with fewer treatments. In addition, many patients often complain about a lack of explanation on the treatment they receive. To solve this problem, Keum has led the “Good Doctor Team” of 49 doctors and 17 coordinators since 2014. “Our primary mission is to provide patients with the psychological care and medical information they need,” he said. The center has also challenged one of the most disturbing hospital cultures in Korea. “We have banned collecting blood from patients and checking their blood pressure at dawn except for serious cases. We concluded that the practice has long been conducted in Korea hospitals mainly for the convenience of doctors, not patients. So we wanted to change it,” he said. “All these changes may seem trivial to some people. But what we are trying to do here is changing the way we look at medicine, into the way Allen looked at it.”