THE CANCER DIRECTORY
DR ROSY DANIEL
How to make the integrated cancer medicine revolution work for you

Contents

Cover

Title Page

Foreword by Bernice Miller

Introduction: How to Use this Book by Dr Rosy Daniel

Part 1 The keys to success: transforming health crisis into health creation

Chapter 1 How to make the integrated cancer medicine revolution work for you

What Is Integrated Cancer Medicine?

What Types of Integrated Medicine Are Available?

Timing Is All: The Four Phases of Recovery

The Importance of You: Letting Go of the Medical Model

Chapter 2 The psychological foundation for health

Facing the Demons

Getting into the Right Frame of Mind

The Psychological Basis for Remarkable Recovery

Blowing the Myth of Positive Thinking

Underlying States of Mind that May Need to Change

Getting the Help You Need

Facing the Cancer Diagnosis: Understanding Your Reactions and Identifying Your Needs

Asking for Help

In Summary

Chapter 3 Getting the right treatment for you

Getting a Clear Diagnosis

Working with Your Doctors

Information Gathering to Find Out What Treatment Options Are Available

Reviewing Your Options

Making Treatment Decisions and Creating an Integrated Medical Plan

Chapter 4 The medical frontier: getting the best orthodox treatment

What Is Cancer?

Diagnosing Cancer

Choosing Your Cancer Treatment

Current Medical Treatments

Newer Treatment Approaches

Cancer Treatments in Development

Clinical Trials

Chapter 5 Alternative cancer medicines: the best of today

Understanding Alternative Cancer Treatments

1. Anti-cancer Nutrients

2. Herbal Medicine

3. Hormone Therapy

4. Metabolic Therapy

5. Immunotherapy

6. Neuroendocrine Therapy

7. Physical Therapies

8. Nutritional Therapies

9. Mind – Body Medicine

Getting the Best of All Worlds

Chapter 6 Making your treatment decision

Getting a Second Opinion

Giving Informed Consent for Treatment

Saying ‘No’ to Treatment

Facing the Downside of Treatment

Chapter 7 Getting the best outcome from treatment

Mentally Preparing for Treatment

Physically Preparing for Treatment

Practically Preparing for Treatment

Once the Treatment Starts

Recovering from Treatment

Chapter 8 Complementary medicine for coping creatively with symptoms and side-effects

The Issues

The Energy Model of Health and Illness

Freeing the Body and Mind from the Effects of Fear

Natural Symptom Control

Maintaining Your Weight

Chapter 9 Long-term health creation

The Road to Recovery …

Thinking about the Timing of Your Illness

Getting Well Again

Getting Started Today

The Holistic Approach to Health Creation

The Mind – Body Connection

1. Improving Your Relationship with Yourself

2. Caring for Your Body

3. Improving Your State of Mind

4. Reviving and Honouring Your Spirit

5. Caring for Your Environment

A Clear Intention

Chapter 10 Help for carers

The Cancer Shock

Fight or Flight

Strategies for Being a Great Carer

Embracing Change

Creating Your Survival Strategy

Part 2 The cancer resources directory

Frontier Orthodox Cancer Medicine

Pioneering Hospitals Offering Integrated Cancer Care

Alternative Cancer Medicines

Alternative Cancer Doctors

Alternative Cancer Clinics (International)

Integrated Medicine Doctors and Services

Complementary Medicine Organizations for Finding Therapists

Counselling Organizations

Self-help Organizations for Finding Classes or Teachers

Support Services

Retreats, Spiritual Development and Holistic Holidays

Cancer Care and Practical Help: Nursing, Social, Financial, Insurance

Cancer Prevention

Product Suppliers and Diagnostic Centres

Bibliography

Glossary

Index

Acknowledgements

Other Works

Also by Dr Rosy Daniel and available from HarperThorsons:

References

Copyright

About the Publisher

Foreword by Bernice Miller

The Cancer Directory is a state-of-the-art guide to the best in integrated cancer treatment available today, incorporating the latest orthodox, complementary, alternative and mind – body treatments with the immense power of becoming active in one’s own defence through self-help approaches and lifestyle changes. The aim of this volume is to provide the vital information you need to obtain a comprehensive overview of the many and diverse approaches to cancer. This will enable you to make informed decisions as to your optimal combination of treatment, support and self-help that should prove most effective and right for you.

Huge strides are being made in all fields of cancer care. Holistic support and complementary therapies are finally becoming accepted into mainstream orthodox medicine; the powerful mind – body connection has at last been substantiated scientifically; numerous new technologies and developments in genetics and immunology are pointing to entirely new approaches to cures within the orthodox model; alternative medical treatments in pioneering clinics throughout the world are producing exciting results. The time is coming when the worlds of orthodox and alternative medical science will meet on such ground as vaccines and dendritic-cell therapies, which are now being given in both mainstream hospitals and alternative clinics.

But what is absolutely clear is that the best results are no longer to be found by choosing either one path or another, but by integrating as much knowledge and practice as possible for a result that will be far greater than the sum of the parts in both human and medical terms.

Until now, there has been no single reliable source providing patients and practitioners with a comprehensive overview of this brave new world of integrated cancer care and treatment, and reliable information or guidance within mainstream healthcare is scant. But there is a constant barrage of partial and often misleading information on new breakthroughs and discoveries: just enough to put new and ongoing cancer patients in fear of missing out on something that could save their lives.

As one of England’s foremost Integrated Medical Consultants, and 15 years as a doctor at and then Medical Director of the world-famous Bristol Cancer Help Centre, Dr Rosy Daniel is uniquely qualified to produce this authoritative and up-to-the-minute guide. She has helped over 20,000 cancer patients get the best combination of orthodox and complementary treatment, and this book will save those with cancer and their families hours of research and worry by bringing the most crucial professional information and experience of what has worked for others directly into their hands.

For over 20 years, Dr Daniel has developed her own highly valued approach to integrated cancer treatment, and she is now viewed as a truly reliable bridge between the worlds of orthodox and complementary medicine. Described by Professor Karol Sikora, one of the UK’s leading oncologists, as ‘the sane end of the alternative cancer world’, she is constantly being consulted by cancer healthcare professionals and by those providing cancer services for her advice on how to set up the ideal integrated cancer care of the future.

First, and above all, her approach involves a high degree of emotional and spiritual empowerment for the patient. This is followed by a sensitive eliciting of the state, needs, problems and values of each person she sees before a personalized action plan is created together with the patient. The plan has three phases: preparation to enable the best experience of and outcome from treatment; working to strengthen the body and repair the immune system; and changing the lifestyle of the individual to achieve optimal health in the long term.

In Part 1 of this book, Dr Daniel aims to embrace and comfort the reader, preparing him or her for the journey ahead and providing guidance on how and when to use the information in the Resources Directory. Dr Daniel’s extensive experience has taught her that almost more important than the medicines themselves is to set the right psychological foundations for getting the best treatment outcomes and recovering health. Scientific research has now established beyond doubt that the mind – body connection is one of the most powerful elements in the conquering of ‘dis-ease’ in the body, but this knowledge is scarcely applied in the orthodox approach to health and far from fully applied in many alternative models. The Cancer Directory contains the most up-to-date thinking in this field, and sets out the steps that readers can take to get themselves into the optimal state of mind to facilitate their recovery and get back into the driving seat fully in control of their lives, with a positive plan, hope and peace of mind.

The next most crucial step for those with cancer is to make the right treatment decisions in terms of the most effective treatment that will also be the least damaging in the short and long term. It is also vital that the course of action taken feels right to the individual involved, and is congruent with their personal life and healthcare values. Great emphasis is therefore placed upon help with information gathering, getting the best of all approaches, deciding on treatments, forming a plan, and working positively with doctors and practitioners to achieve the very best treatment outcomes. This is very hard for the recently diagnosed, who are still in shock and emotional turmoil. The objective is to set out guidelines to facilitate this process, and offer as much guidance as possible on when and how to make what types of decisions.

The current best practices in the most advanced orthodox medical treatment centres are outlined, giving the reader a bench-mark against which to measure the treatment they are being offered locally. Information is also given on what is going on at the frontiers of medicine around the world to enable the reader to check out the very best resources, research trials and treatments available for their individual problem, with advice on how to obtain second and third opinions as and when necessary.

Also described are the latest developments in alternative medicine in the fields of:

• herbal medicine, such as carctol, catechins, indole-3-carbinol and turmeric

• immunotherapy, such as immune boosters, dendritic-cell therapy and vaccines

• metabolic therapy, such as essential sugars, essential fatty acids, pH balancing, enzymes and antioxidant vitamins

• mind – body medicine, such as the ‘Journey’ process by Brandon Bays, and the transformational approach of the Bristol Cancer Help Centre

• physical therapies, such as hyperthermia, light therapy and oxygen therapy

• nutritional therapies, such as the Gerson diet and the Nutrition Trust.

The valuable role of complementary medicine as symptomatic relief and supportive care is described, using illustrations where recent research has shown maximum synergy. Information is provided as to how and when to build these into a treatment programme to minimize the symptoms of illness and side-effects of treatment. The Cancer Directory looks at the newest developments within these therapies, and their applications in pioneering hospitals and hospices.

Perhaps most important of all for a long-term sustained recovery is the section on proactive holistic health creation. New research continues to confirm the importance of incorporating the basic principles of promoting positive health and healthy lifestyle changes into any healing regime. Dr Daniel says, ‘After putting out the fire with cancer medicine, it is time to rebuild the house with holistic health creation.’ Long-term survival is most dependent of all, she feels, on this continuing work to achieve high levels of energy, immune function and happiness. She also considers the opportunity created by serious illness for a complete life reorientation, describing her unique new Health Creation Programme, which highlights and focuses the individual on where they are currently vulnerable, exactly what needs to change and how to change to maximize the potential for long-term sustainable health.

Once readers have identified their values and choices, they will be able to find the appropriate resources to get the help they need in Part 2 of the book, which contains the Cancer Resources Directory. This will provide the reader with a comprehensive set of resources in the areas of:

• frontier orthodox cancer medicine

• pioneering hospitals offering integrated cancer care

• alternative cancer medicines

• nutritional organizations

• alternative cancer doctors

• alternative cancer clinics

• integrated medicine doctors and services

• complementary medicines organizations (to find therapists)

• psychological and spiritual support services for people with cancer and their carers

• retreats, spiritual development and holistic holidays

• cancer information services

• cancer care and practical help with nursing, social needs, financial help and insurance

• cancer prevention

• product suppliers for natural medicines and supplements.

There is also a Bibliography containing a comprehensive collection of the most useful reading material, a section containing all of the scientific references for the research supporting the use of an integrated approach to cancer care, a Glossary of the terms used in this book and in the field of integrated medicine, and an Index for easy navigation through this book.

The Cancer Directory is essential reading material for anyone newly diagnosed with cancer and for the healthcare professionals who help them. Only by understanding the full range of needs and healthcare choices available to those with cancer will the very best choices be offered, the chances of survival be most enhanced and the most loving, compassionate care be given.

Only by fully empowering those with cancer during their treatment and recovery process will the innate creative intelligence and inner strength of each person be brought to bear in the quest to heal physically and spiritually through the crisis of illness.

Integrated cancer medicine is the medicine of the future, and Dr Rosy Daniel is undoubtedly leading the way.

This book is essential reading for everyone affected by cancer. Information is empowerment, and this volume contains all you need to know about cancer from both the orthodox and complementary worlds of medicine. This is simply the best guide to integrated cancer medicine there is!

PROFESSOR KAROL SIKORA

Introduction: how to use this book by Dr Rosy Daniel

If you are reading this book, it is likely that you, or someone very close to you, have received a diagnosis of cancer.

My heart goes out to you at this painful, confusing and frightening time. Nothing prepares us in life for the shattering blow of a life-threatening diagnosis. Almost all of us live our lives feeling immortal – as if bad things only happen to other people. But, from time to time, we are pulled in on the fishing line of life and brought face to face with our mortality – and forced to face the completely fragile nature of life. The more perfect and settled our life has been, the harsher the blow and the more imperative it is that both you and those around you treat you with the utmost gentleness, care and sensitivity as you come to terms with what is happening to you. You will need time and very good support to find ways to make sense of the crisis and, most important of all, to bring all possible creative intelligence to bear in finding the most effective healthcare solutions for you.

My own understanding of both the pain and possibilities within the experience of cancer came from my intense relationship with the remarkable Penny Brohn, co-founder of the Bristol Cancer Help Centre. Penny was diagnosed with breast cancer at age 38, with three children aged under 10. Both of her parents had died within the previous two years, and her marriage was so shaky that, at the point of diagnosis, her world collapsed completely. But, after a few weeks of abject misery, grief and despair, the combination of her own native cunning and the immense unconditional love of her great friend Pat Pilkington enabled her to pick herself up, dust herself off, and find the complementary, alternative and self-help approaches that enabled her to turn a five-year prognosis of survival into 21 years of a glorious and adventurous life.

Her journey took her all over the world – from the alternative clinics of Dr Issles in Bavaria and Dr Contreras in Mexico to monasteries deep in Wales and mind – body medical centres in London. This journey also took her into the depths of her own psyche and spirit with counselling and spiritual healing, and towards the gentle restorative energy medicines of acupuncture, homoeopathy and craniosacral therapy. She learned how to nourish her body properly with healthy food, metabolic supplements and immune stimulants, and how to meet her emotional needs with the love of women friends instead of focusing only on the love of her husband. She lifted her spirit by becoming a writer, painter, mosaic artist and gardener, and fulfilled her life purpose by setting up the pioneering Bristol Cancer Help Centre, thereby changing the face of medicine for ever.

Penny was very frightened but she was also an extraordinarily brave person. She had no idea where to start and what would work. Every step of her journey was an exploration, a negotiation with herself, her carers and her medical team. The only guiding star she had on her journey was her profound feminine intuition and the counsel she received from those whom she called her ‘gentle giants’ – the doctors, nurses, therapists and healers who had also been brave enough to step outside of the rigid box of medical thinking in an attempt to understand the big questions: What role does an individual’s lifestyle have in the development of cancer? What are the person’s needs during the illness and its treatment? Most important of all, what power could a person bring to bear to affect the health of his or her body and the chances of recovery?

As a spiritual woman, Penny was also constantly aware of the power of prayer and the immense benefits that could be available through spiritual healing and seeking spiritual guidance.

Penny’s amazingly comprehensive view of the nature of illness and healing sparked a revolution in cancer care. At first, it was explosive, as doctors feared that alternative doctors and practitioners would harm patients, taking them away from potentially effective medical treatment while fleecing them financially. Later, during the 1980s and 1990s, a truce was declared as many practitioners positioned themselves and their approaches as being complementary to medicine rather than alternative. But since the late 1990s, a new medical movement has emerged, led by His Royal Highness The Prince of Wales and his Foundation for Integrated Health, to help pull down the walls dividing care for the body from care for the mind and spirit, and help remove the conflict for patients between choosing between orthodox, complementary or alternative medicines. The aim has been to foster a climate in which people with cancer and their carers can be helped to obtain the best of all worlds – individually tailored treatment to meet their needs at all the different stages of cancer and its treatment.

This is vital, as one thing is certain – your needs will change. Sometimes you will feel strong, independent and entirely in control through the use of your self-help approaches. At other times you may feel ill, vulnerable and tempted to become dependent on the professional help of others. This was another of Penny’s great teachings for her doctors – to recognize the changes in her state and needs so that they were able to perform a complicated but perfect tango with her as she explored her options, defined her needs, made her negotiations, and flowed between fear and certainty.

To help you make sense of your reactions, needs and choices, you will find three main types of information in the pages that follow. The first type is emotionally based to help you recognize your state, define your needs and determine the kind of support you will need before embarking upon your healing journey. The second type of information is descriptive, giving you an overview of the kinds of approaches available so that you can define your healthcare values, and make your own choices as to what approach, or blend of approaches, is right for you. These two levels of information are found in Part 1 of this volume. The third type of information is factual, and is contained in Part 2. Once you have defined your needs and values, and made your choices, this Directory will help you to find the best resources that you need.

My goal in writing this book has been to share with you my understanding of the emotional map of the cancer experience for both those with cancer and their carers, which has come as a result of more than 20 years of working with people with cancer. I have also wanted to convey the theory, practice and benefits of each dimension of the integrated medicine model. Finally, I have wanted to act like a truffle hound, rooting out the treasures buried within the immensely complex terrain of alternative, complementary and self-help approaches to cancer to guide you directly to what I believe works.

Many people with cancer have said to me that they felt like they had to get a PhD in the subject within six weeks of their diagnosis. They have had to learn about their disease, the treatments and all the possible alternatives in a very short period of time to make their choices. In many cases, the Internet made things worse as the array of options has become so mind-boggling. So, the intention of this Directory is to share with you the pearls of wisdom I have gained over many years of sorting the wheat from the chaff, learning from the experience of the 20,000 or so people I have worked with. These individuals, like Penny, have by trial and error found their own way to fight cancer and heal themselves effectively, and their hope and mine is that you will be able with this book to ‘cut to the chase’, and avoid weeks of research and worry. I hope that, in the pages of this book, you will find everything you need but, if you do not, then both I and my team of Health Creation Mentors are available for consultation to coach you through getting the best treatments, the best treatment outcomes and getting yourself fully established on the road to recovery. I am available personally to help you through my Bath clinic (tel: 01225 423333) and through my interactive Cancer Lifeline Kit and supportive Health Creation Mentor Service, with backup from my three Health Creation doctor partners (contact the Health Creation Helpline on 0845 009 3366).

Most important of all, please be reassured that there are people living today who have survived every single kind of cancer. It is clear that the ones who do best are those who truly face their situation, go through their feelings, and then set about taking a positive course of action to become proactive in their own defence.

My love and very best wishes go with you as you embark upon your road to recovery, and I hope that this Directory will guide you to many exciting and fulfilling sources of invaluable help. Meanwhile, please be aware that this is a living document. I would be extremely grateful for your feedback, input, ideas and corrections. All possible efforts have been made to make this Cancer Directory as comprehensive and accurate as possible, but your help in improving it further for future readers will be much appreciated.

Please send your ideas and feedback to:

Dr Rosy Daniel,

Health Creation,

77a Alma Road,

Clifton,

Bristol BS8 2DP

PART ONE

CHAPTER 1 How to make the integrated cancer medicine revolution work for you

Right now, if you are newly diagnosed or have been re-diagnosed with cancer, you may be feeling dispirited, frightened and confused. It is vital that you consider the following encouraging facts:

One | Cancer is a two-way process – it can grow but it can also shrink or go into remission.
Two | People have recovered from every kind of possible cancer and are still alive to tell the tale.
Three | A healthy body has detection and repair mechanisms specifically for cancer cells. The integrated medicine approach works to repair and boost these natural anti-cancer processes in the body.
Four | There are many factors in addition to orthodox medicine, over which you have primary control, and which can positively affect your health and well-being.
Five | Your personal response to your cancer can make a huge difference to both your quality of life and chances of survival.
Six | You are unique and the average medical statistics do not always apply to individuals.
Seven | Your conventional treatment is only one component of your approach to fighting cancer.
Eight | It is vital that you do not rely too much on the effectiveness of medical treatment alone to ‘cure’ you of cancer. Give up the passive patient role and join forces with your doctors, and become as pro-active as you can about recovering your health.
Nine | It is you and not your doctors who are in overall charge of your situation.
Ten | Astonishingly, many of those who have embarked upon the integrated-medicine approach to cancer have ended up admitting that they are actually glad they had cancer because they now feel so much happier, healthier and more alive than ever before.

Continue re-reading this list of facts until the message sinks in!

Go forward in the knowledge that you are a very powerful person in your anti-cancer team. There is a great deal of help available to strengthen, support and guide you in your treatment and self-help programme. It is possible to stabilize and live with cancer (rather than dying from it), and even to go into remission from cancer altogether.

A cancer diagnosis can start a profound and exciting journey of healing and self-development, giving you the push and permission to change what has been making you ill or unhappy for years. This book will help you to understand and discover every type of help that is available to empower you in both your fight against cancer and your personal healing journey.

What Is Integrated Cancer Medicine?

Integrated cancer medicine is the most powerful medicine available to those with cancer because it draws together every possible form of help that is available for you to fight cancer and heal yourself. Since the 1960s, there has been a revolution in medical thinking and science, and it is now clear that our health and chances of recovery from illness depend both on what the medical profession can do for us and what we can do for ourselves. Many of the factors that affect our health and well-being are within our own control, and involve us becoming stronger physically, mentally and spiritually to deal with and overcome illness. This means that, when serious illness strikes, we must seek to understand how the illness has developed, what our needs in going through the illness and its treatment are and, most crucially of all, how to use the help available at all levels of mind, body and spirit to get ourselves well again.

In practical terms for each person with cancer, this means opening up a treasure chest of possibilities to find the right type of help to crack the healing code. As mutually respectful partners on this detective mission, those with cancer, their doctors, therapists and supporters can draw from orthodox, complementary and alternative medicine the psychological, spiritual and self-help approaches necessary, as well as look longer term into the role of nutrition, lifestyle reorientation and environmental factors, all of which may play key roles in overcoming the disease and becoming a part of the winning statistics.

Historically, those who become ill have really only had the medical model to rely upon. In such a model, a person with cancer is completely dependent on the knowledge and skill of doctors and nurses, and the current level of scientific understanding of the disease. This puts the ill person in an entirely passive role – which is all very well if the doctors have the ability to fix the problem. But if the power of medicine is limited, as in most cases of cancer, this leaves the patient with nowhere to go, feeling as if he or she has gone over the edge of a precipice. Another weakness of the medical model is that it leaves you powerless, with nothing to contribute to your own recovery process and chances of survival.

In stark contrast, the integrated medicine model puts the person with cancer at the very centre of the recovery process, as the therapeutic team:

• seeks to understand your needs, values and insights in relation to the illness

• supports and empowers you to get the very best treatment options that best suit your values and needs

• helps prepare you psychologically and physically for your treatment

• helps you explore the meaning of the illness, the self-help path and how you can transform the crisis of illness into the opportunity for health creation.

In the integrated medicine model, illness is not seen as a random occurrence, but as a logical result of factors that have created a chink in your armour. Our job is to try to understand how the illness has developed, and use this message from the body to work creatively to get your health and life onto a stronger, happier footing than before.

Within the integrated approach, you will find loving care and recognition of the trauma and stress that diagnosis, illness and treatment may be causing you. You will find hope that a creative way can be found to overcome your illness. You will find empowerment and the vital help you need to become mighty in your own defence. You will find respect for your personal needs, values and insights, and you will find the opportunity to transform the total misery and threat of illness and its treatment into an opportunity for a profound re-engagement in living the life you love.

To make the integrated medicine revolution work for you, you will need to find your way to exactly the right resources nationally and locally. This means that you will have a map or overview of what is available, and what forms of help might be useful and when. So, in the pages that follow, you will find help to:

• understand the different types of help available

• understand when to use what type of help

• understand your reactions to illness

• understand the best state of mind to promote recovery

• set up your own support network

• get the information you need to make the very best treatment decisions, whether orthodox or alternative

• make informed treatment decisions that are right for you

• be well prepared for your treatment psychologically, physically and practically

• get the best treatment outcomes with support from complementary medicine

• convalesce properly after treatment

• get yourself on the road to recovery with positive health creation.

What Types of Integrated Medicine Are Available?

There are seven kinds of help available in integrated cancer medicine:

1. Orthodox cancer medicine

2. Alternative cancer medicine

3. Complementary supportive care

4. Psychological approaches

5. Spiritual help

6. Self-help approaches

7. Healthy lifestyle reorientation

1. Orthodox cancer medicine

This is the medicine provided by mainstream cancer doctors and nurses, and is written about in detail in Chapter 4. Within orthodox medicine, you will find help to obtain:

• an accurate diagnosis of your condition

• if desired, a prognosis for your condition (knowing the average outcome statistically for those with your condition)

• the conventional cancer treatments of surgery, chemotherapy, radiotherapy and possibly adjuvant treatments such as hormone therapies

• where available, the opportunity to be entered into a research trial in which the most up-to-date treatment is being tested

• where available, treatment with newly emerging technologies such as laser, cryotherapy and highly specialized radiotherapeutic techniques

• if appropriate, palliative care (treatment to control cancer symptoms) and residential respite care in a hospice

• where available, supportive care within orthodox settings from counsellors, psychologists, specialist nurses, chaplains, social workers and health visitors. Some enlightened units also offer complementary supportive care such as aromatherapy, massage, relaxation, visualization and group-therapy sessions.

2. Alternative cancer medicine

Alternative cancer medicines are those that may be used as an alternative to orthodox cancer treatment. These are written about in detail in Chapter 5 (The alternative frontier: getting the best alternative treatment), and fall into the areas of:

• anti-cancer nutrients that are taken by mouth to help combat cancer directly or to stimulate the body’s immune and tissue-healing systems

• herbal medicines that are believed to have direct anti-cancer properties or indirectly inhibit cancer growth

• intravenous metabolic cancer therapies that provide high-dose nutrients or herbal extracts for the body designed to exert a cytotoxic (cancer cell-killing) anti-cancer effect

• immunotherapy aimed at repairing or boosting immune function to get the body fighting cancer naturally

• neuroendocrine therapies aimed at rebalancing the body’s hormones and neurotransmitters to inhibit cancer growth

• physical therapies in which heat, light or oxygen is used to treat cancer

• nutritional therapies where strict diets are used to combat cancer

• mind – body medicine, where mind – body approaches are used to restore immune function and direct tissue-healing.

3. Complementary supportive care

Complementary cancer medicine involves the use of natural medicines or therapies that can be used in a supportive context alongside orthodox treatment for physical, emotional and energy support. These are written about in detail in Chapter 7; their role in symptom control is covered in Chapter 8. These are usually accessed in the community from complementary therapists practising in complementary therapy centres or from their homes, but are becoming increasingly available in hospitals and hospices (from nurses or complementary therapists). These include:

• touch therapies such as massage, aromatherapy, osteopathy, craniosacral therapy, shiatsu, acupressure and reflexology

• energy therapies such as acupuncture, reiki healing, spiritual healing and Johrei

• natural remedies such as herbal medicines, including European, Chinese and Indian Ayurvedic herbs, and homoeopathic remedies

• mind – body symptom control through hypnotherapy, visualization, relaxation, guided imagery and affirmation

• nutritional and immune support.

4. Psychological approaches

The psychological approach to cancer is covered in Chapter 2 and includes:

• providing sympathetic counselling to help in the recovery from the shock and trauma of diagnosis and re-diagnosis, and in facing the pain and loss

• ongoing support to rise to the challenge of the illness and its treatment

• using psychological approaches to increase the chances of recovery through:

a positive coping style

getting out of depression

finding the meaning or message of the illness

using illness to change to a far more fulfilling lifestyle

using positive mind – body approaches such as visualization, affirmation and hypnotherapy suggestion (where mind – body medicine is used as a form of alternative medicine).

5. Spiritual help

Spiritual help is needed by those facing a life-threatening illness as, almost immediately, the really big questions of the meaning of life and death are raised. The role of spiritual advisors as part of the support network is written about towards the end of this chapter. Another type of spiritual help is spiritual healing, included in Chapters 7 and 8. The broader aspects of the role of our spiritual health in long-term recovery are discussed in Chapter 9. Spiritual help is available from:

• spiritual advisors or religious guides, who help you to examine your beliefs and give spiritual support

• spiritual healers, who can help to provide energy support, spiritual uplift, relief of pain and symptoms and, sometimes, physical healing of disease

• transpersonal counsellors, psychosynthesis counsellors and Health Creation Mentors who can all help you to focus on creating spiritual health and fulfilment.

6. Self-help approaches

Self-help approaches, described in Chapters 7 and 8, can help you achieve the best outcomes from treatment and symptom control. They can also contribute to long-term health creation, as discussed in Chapter 9.

Self-help techniques to prepare for treatment and reduce symptoms include:

• relaxation, visualization, breathing techniques, affirmations and self-hypnosis.

Self-help techniques for long-term health creation include:

• healthy eating

• regular exercise, including aerobic exercise such as swimming, walking, running, a gym workout, dancing or tennis, as well as the more holistic types of exercise such as yoga, tai chi or chi gong

• spiritual practices such as meditation.

7. Healthy lifestyle reorientation

Healthy lifestyle reorientation, covered in Chapter 9, includes the key areas for creating long-term sustainable health, such as:

• stress reduction – both external stress and self-stressing tendencies

• establishing the correct work/play balance

• establishing healthy, loving relationships

• experiencing a sense of belonging

• becoming fulfilled and able to express oneself creatively

• feeling well nourished at all levels of the body, mind and spirit

• ensuring that your environment is healthy and free from negative influences.

Timing Is All: The Four Phases of Recovery

The healing journey from here, diagnosis, to there, recovery and a healthy, fresh new lifestyle, is, in the words of Penny Brohn, co-founder of the Bristol Cancer Help Centre, ‘a process and not an event!’

How dearly we all wish that there were a quick way to get rid of the uncomfortable feelings and symptoms of illness, get through our treatments, and back into a secure ‘normal’ life. But, unfortunately, the treatment and healing process does take time, and there are challenges associated with each step of the treatment and healing process. It is therefore important that you get the big picture, understand what you will have to go through, pace yourself appropriately and map out which aspects of the integrated approach will be right for which stage of the healing journey.

The main tendency is for everyone affected by cancer to get into a terrible panicky rush. The medical profession often sets the hurried pace, making it appear imperative that you receive treatment within hours or days of diagnosis. This is very unhelpful as it leaves you with no time to recover from the initial shock, to prepare for treatment and, most important of all, to take the necessary time to consider the treatment options on offer (while getting your head around the short-and possible long-term side-effects).

As for integrated approaches, people with cancer often confuse the more short-term use of supportive complementary help and symptom control with the longer-term health creation measures necessary for a sustainable improvement in health and, hopefully, prognosis. The worst pitfall would be to rush into making major life changes while in the middle of treatment!

Sometimes, having got the message that illness can follow long periods of stress or unhappiness, people become very motivated to change, but run into problems when they try to make big changes when they are weak and vulnerable. If illness has made you realize that you need to change your job, confront difficulties in your relationships or move house, do wait until you are well and physically strong enough, through your treatment and convalescence, before making such big life changes.

To help you identify the process of recovery, it is wise to see it in four distinct phases:

Phase 1 Getting through diagnosis and treatment positively

Phase 2 Dealing creatively with the problems of illness

Phase 3 Health revival: the state shift to get the body and mind strong again

Phase 4 Life revival: getting into a healthy, happy and fulfilling lifestyle.

Phase 1 Getting through diagnosis and treatment positively

• Take the time to go through your reactions to the diagnosis

• Set up your support network

• Make appropriate adjustments to your working and social commitments

• Obtain full and clear information on all of your treatment options

• Make a truly informed decision regarding treatment

• Prepare well for treatment psychologically, physically and practically

• Convalesce properly from treatment.

Phase 2 Dealing creatively with the problems of illness

It may be that the cancer itself, or the treatments you receive for it, creates some residual health problems or troublesome symptoms. Often, creative solutions are available for these problems from complementary and mind – body medicine. There are also specialized support organizations that can provide individually tailored help for specific cancers and the problems or disabilities associated with such cancers or their treatment so, in this phase, attention is given to:

• symptom control with natural medicines

• the mind – body approach to symptom relief

• complementary therapies for symptom relief

• complementary therapies for the side-effects of treatment

• help with specific cancers

• help with specific disabilities

• help with specific cancer-related issues.

Phase 3 Health revival: the state shift to get the body and mind strong again

This starts with good old-fashioned convalescence after illness and treatment – a sadly forgotten concept in the modern lifestyle! Often, people do not even stop work for their treatment, let alone take the time to recover properly. Yet, this phase is absolutely essential for the overall recovery process as cancer treatments are usually extremely taxing on the body and its resources. An intensive detox and health-revival period is needed to compensate for this.

But even more important for overall recovery is the need to change the underlying state and chemistry of the body and mind, so that it is no longer a hospitable place for a recurrence of cancer.

Creating a state shift in the health of the body and mind involves changing from being:

• low energy

• poorly oxygenated, unfit with sluggish circulation

• poorly nourished

• acidic

• under par or damaged in terms of immune function

• full of excess sugar, toxins and fat

• stressed, fearful and anxious

to being:

• high energy

• well oxygenated

• lean and well nourished

• fresh

• alkaline

• fit and supple

• calm, happy and positive.

To achieve this state shift, you need to focus on:

• excellent nutrition

• a low-acid diet

• detoxification of the body

• re-energization of the body

• physical fitness, stretching and oxygenation

• healthy breathing patterns

• relaxation and rest

• immune stimulation

• freeing the body and mind from the grip of fear, stress and tension.

Phase 4 Life renewal: getting into a healthy, happy and fulfilling lifestyle

In Chapter 9 you will find that the most important determinant of long-term health and survival is the state of our spirit. This means having a strong will to live, a clear purpose in living and a joyful spirit, with genuine sources of pleasure, personal fulfilment and spiritual uplift.

So, in this phase of the recovery process, we are doing the ‘earthworks’ to help bring ourselves fully alive into a lifestyle that totally expresses, inspires and energizes us.

This involves:

• changing your priorities in life to focus on that which is really important to you

• removing any destructive influences from your life

• replacing that which drains you with that which nourishes you

• taking time to enjoy yourself

• putting yourself first

• learning how to nurture yourself properly

• reconnecting with that which gives you true joy and excitement.

The Importance of You: Letting Go of the Medical Model

Most of us brought up in the developed countries are hard-wired into the medical model. This has taught us that, when we are ill, the doctor is in charge. He or she has all the knowledge and expertise, and we must do as we’re told and be good, compliant patients.

There may well be times in your recovery process where you will need to put your complete trust in your doctors, and their expert knowledge and skills. However, the medical profession is far from having the answer to cancer, and it is likely that your contribution to your recovery process will make as much of a difference, if not more, than the cancer medicine you are taking.

It is very hard to hear and believe this when you are first diagnosed with cancer, as we all believe that there is a great big medical safety net underneath us that will catch us if we fall. But, sadly, this is often not the case with cancer and, to make matters worse, doctors often (understandably) oversell the potency of cancer medicines. While it is important to empower the medicines and treatments that we are having, it is not advisable to be lulled into a false sense of security when doctors say you are all clear after cancer treatment.

Indeed, doctors may well have succeeded in removing all detectable cancer from the body, but what medical cancer treatment has not done is changed the underlying conditions in the body in which the cancer developed in the first place. In fact, medical treatments will have made the body more toxic and weakened the immune system. Moreover, it is not possible to detect the microdeposits of cancer that may cause recurrences in the future. So, as uncomfortable as it may be, it is important to wake up early to the potential threat of recurrence, and become fully active in your own defence from the time of the first diagnosis of a primary cancer, rather than waiting until a second or third recurrence before taking action.

Cancer is a lifestyle disease in which the main causes are poor nutrition and toxicity in the body due to chemicals, radiation, viruses, alcohol, smoking and lack of exercise. It is possible to revive your body’s ability to detect and heal cancer but, to do this, you must let go of your dependency on the medical model and belief that cancer medicine alone will cure you. Put yourself firmly in the driving seat and in control as the most important member of your integrated medical team.

This will mean from day one addressing the really big nitty-gritty issues of whether or not you really do have a genuine reason for living and whether you are therefore sufficiently motivated to put in the effort required for your recovery.

If you find that your will to live is shaky for any reason – perhaps because of loneliness, heartbreak, disappointment, grief or frustration – take heart. It is possible to obtain good-quality therapeutic help to revive the state of your spirit and will to live. The next chapter tells you how to find this sort of help, and how to make sure that you are primed in exactly the right frame of mind to maximize your chances of survival.

CHAPTER 2 The psychological foundation for health

Scientific research has now established beyond doubt that the mind – body connection is one of the most powerful elements in the conquering of disease in the body. But this knowledge is scarcely applied in the orthodox approach to health, and far from fully applied in many alternative models. This chapter sets out the most up-to-date thinking in this field, and outlines the steps you can take to get yourself into the best possible state of mind to facilitate your recovery.

When you are given a diagnosis of cancer, you have two main problems: first, of course, there is the physical illness itself; and second, there is the terrible emotional turmoil you are thrown into by the diagnosis, along with all the fear and upset that it creates in you and those close to you. Many people with cancer have said that their physical problem has been manageable, but that it is their peace of mind that has been completely shattered. Your emotional needs and state of mind are just as important as your medical treatment, and it is vital that you receive the support and encouragement that you need. It is also important for you to identify and change the negative beliefs you have about cancer, so that you don’t risk buying into these beliefs and giving up before you even start.

Facing the Demons

You are up against three things straightaway. The first is your own negative beliefs about cancer. You may have heard upsetting stories, or have a view of cancer that is entirely based on the collective fear we all have about cancer in our Western society. Second, you have to face the reactions of those close to you, and all the upset and fears that they may be experiencing in relation to your diagnosis. Third, you may have gathered some statistics from your consultant on the average survival times with your particular kind of cancer. He may even have given you a prognosis in terms of the number of months or years that this ‘average person’ with your condition might be expected to live, based on the medical treatments available when the research was done – often many years earlier.

However, statistics never apply to individuals, and the course of your illness is unique to you. There are over 200 types of cancer and the way it develops or regresses is different in everyone who has it. Challenge your negative beliefs. Make sure you have really taken on board the encouraging information presented at the beginning of Chapter 1, and keep repeating it to yourself until you truly believe it! People do actually survive with every sort of cancer, and there is no reason why that should not include you.

Getting into the Right Frame of Mind

It has now been shown that there is a major survival advantage associated with getting yourself into a good state of mind, using positive coping strategies and learning how to use effective mind – body approaches that can reactivate your immune system and your body’s ability to fight back against cancer.

The way you react to a diagnosis of cancer comes down to four crucial factors:

• the beliefs you and others who influence you have about cancer

• the way you feel about your life

• how frightened you are about death and dying

• whether you believe in your own power to affect your health.

The hardest place from which to deal with your diagnosis and illness is where you are depressed, ambivalent about your life, fearful of dying, fearful of cancer and feeling impotent in terms of changing your state of health. But, I assure you, if you are prepared to look at and work with these things head on, with the right support, you can turn the situation around completely. The diagnosis of cancer inevitably throws you into a process of asking yourself and others the big questions about the meaning of life, the purpose of your life and what it is like to die. Certainly, if well facilitated, thinking about your relationship to living and dying can completely alter your ability to cope with your diagnosis and even turn it into a positive experience.

When you become aware of the many things you can do to enhance your chances of survival with cancer, your fear of cancer will start to diminish. You will begin to feel bigger and more powerful than the disease. You might even think of the diagnosis as a much needed wake-up call to enable you to go through a complete health and life revival, moving you step by step towards a life that really excites and fulfils you. As you do this, your attitude towards life will change and you will feel happier, spiritually stronger and more uplifted. The best thing is to see the illness as a message from your body that all is not well, and to use the illness as an opportunity to get your health and lifestyle onto a better footing.

By developing inner strength and thinking deeply about the true nature of life and death, it is likely that you will change your attitude towards dying, too. I do not say this lightly. It is said on the basis of having watched thousands of people with cancer go through the process of using this crisis of illness to completely transform their health and lifestyle. Strangely, a combination of becoming far happier and fulfilled in life, developing inner peace through self-help practices and looking at the question of death head-on almost always results in individuals being freed from their fear of dying. Often, with this release comes a profound new love of life and the realization that, previously, a great deal of life energy was being lost through a deep and somewhat unconscious fear of dying.

However, while you are going through your reaction to the news, it is very important to be aware of how you really feel and to find the support you need to express your emotions; then, as the shock subsides, you can work out how you are reacting and coping (or not) with the diagnosis. Your reaction can make a big difference to your prognosis, and some reactions will be helpful while others will not. There are also some underlying states of mind that can either boost or impair immune function. There is help available to change the way you are coping and to lift negative states of mind so that you can get into the best frame of mind for recovery.

The Psychological Basis for Remarkable Recovery
Caryle Hirschberg: The Role of Belief

In 1995, Caryle Hirschberg, a medical researcher, and Mark Barasch, a journalist who had cancer, published the findings of their Remission Project at the Institute of Noetic Sciences in America. Their book Remarkable Recovery was the first-ever publication on what it is that survivors of cancer have in common (rather than those who get cancer)!

In the questionnaire she sent to these survivors, they were asked which they felt were the most important of 30 self-help practices that had made them well. The practices ticked with the greatest frequency (by over 50 per cent of the participants) were:

Prayer | 68%
Meditation | 64%
Exercise | 64%
Guided imagery | 59%
Walking | 52%
Music and singing | 50%
Stress reduction | 50%

They were also asked which they felt were the most important psychospiritual factors in their recovery. Of the 26 items on the list, those reported with the most frequency (over 50 per cent) were:

Belief in a positive outcome | 75%
Having a fighting spirit | 71%
Acceptance of the disease | 71%
Seeing the disease as a challenge | 71%
Taking responsibility for the disease and its outcome | 68%
Renewed desire and will to live | 64%
Positive emotions | 64%
Faith in a higher power to heal them | 61%
New sense of purpose | 61%
Changing unhealthy habits and behaviour | 61%
Having a sense of control | 59%
Lifestyle changes | 59%
Self-nurturing | 57%
Good social support | 50%

The reason I love Caryle’s data so much is because these are not the theories of a scientist, but the reported beliefs and feelings of a group of people who have actually achieved the scientifically unachievable – recovery from a serious cancer. What is striking about these findings is the importance of belief – whether it be in one’s own power to heal through self-help, or belief in a higher power to heal, or in the power of prayer or believing that one is going to live and recover fully.

This is what I have witnessed again and again in my 20 years of working with over 20,000 people to recover their health after cancer. From often very sceptical beginnings, two things most frequently ended up astonishing those who apply themselves to the holistic integrated healthcare approach: the first is just how much help is available through prayer and spiritual healing; the second is just how powerful a person can be once he or she begins to use and harness the power of his own mind.

This can be achieved through pure belief, hypnotherapy or the use of your own creative will through visualization and affirmation. In these practices, you literally see in your mind’s eye or choose in words the reality you want for your future. This is another reason it is so important not to remain passive, waiting for either orthodox or alternative medicine to cure you, but to instead get yourself firmly in the driving seat, choosing that the illness will go from the body and visualizing yourself going on into the future, growing old disgracefully!

It also suggests that, if you are currently closed to or sceptical of the power of your own mind or of the help that is available through spiritual healing or prayer, it would be wise to suspend disbelief and at least try to explore such forms of help before dismissing them. They could ultimately provide the vital key to your healing, as has been discovered by so many former sceptics I have worked with.

So, the keys are:

• cultivate a strong belief in your own power to self-heal

• cultivate a strong belief in the power of your doctors and their treatments to cure you

• open yourself to the possibility of healing through spiritual healing and prayer

• use hypnotherapy, visualization and affirmation to choose health and recovery, seeing yourself healed, free of disease and well and happy in the future.

Dr Stephen Greer: The Role of a Fighting Spirit and Alleviating Depression

Before Caryle and Ian’s work, back in the mid-80s, psychosocial oncologist Stephen Greer published his work showing how the very different survival times among women with breast cancer depended on the coping style they adopted within a week of the initial diagnosis. The coping styles he defined were:

• a fighting spirit – taking an active stand against your cancer and believing fully that you can affect your survival

• denial - pretending to yourself and others that nothing is seriously wrong

• stoicism or fatalism – leading to becoming resigned to what is happening

• helplessness and hopelessness – becoming anxiously preoccupied, or collapsing.

His findings showed that those with a fighting spirit fared far better than those in the other three categories both in terms of quality of life and overall survival. Those in denial did next best whereas those who were resigned, depressed and anxiously preoccupied did least well of all. At the 13-year point, 80 per cent of those who had started with a fighting spirit were still alive versus only 20 per cent of those who had collapsed into helplessness. Worse, those who had psychologically collapsed had died quickly, within two years of diagnosis. This means that the average survival rate of 60 per cent for breast cancer at five years masks a huge difference between those who do very much better than expected because of a positive belief in themselves compared with those who do very much worse because they do not.

As this difference in survival rate is bigger than that seen with any medical treatment for breast cancer, Dr Greer realized it was very important to identify those who reacted negatively to their diagnosis and help them to change psychologically so that they could begin to believe in themselves more and become less depressed. Through the use of cognitive behavioural techniques, such patients gained self-esteem and confidence, and began to believe they could survive. Lo and behold, his later studies on the survival rates among these women showed great improvement.

The lessons here are:

• It is vital to feel empowered and believe in your ability to heal yourself

• It is vital to lift your depression

• It is vital for healthcare professionals to provide extra psychological help to improve the coping styles of those who have responded by becoming helpless and anxiously preoccupied by their illness.

Dr Candace Pert: The Scientific Basis for the Mind – Body Connection and the Need to Express Emotion

While both Hirschberg and Greer were gathering their data, huge breakthroughs were being made in the laboratory as the science of PNI, or psychoneuroimmunology, was rapidly expanding through the pioneering work of Dr Candace Pert. She studied the connection between our states of mind, the nervous system, the neuroendocrine system, and the function of the immune system and other healing tissues of the body. It all started with her discovery of the receptor for an opiate secreted in the brain. This naturally occurring opiate was later discovered and identified as endorphin (known as enkephalin in the US). This was a breakthrough, as endorphin was a new kind of messenger molecule different from the kind of neurotransmitters we had known about before. Endorphin was the first molecule to be identified as a neuropeptide or informational substance, and further informational substances were found to be present in all tissues of the body.

This finding started an avalanche of discovery so that, by the mid-1990s, a further 200 of these substances had been identified, secreted in response to different feelings and thoughts, and able to radically affect our tissue functioning. As the PNI findings began to link up with the medical studies, it became clear that those who are chronically stressed or lonely had depressed immune function – with both lower numbers and far lower activity levels in the immune cells. Similar findings were made in those with low self-esteem and those who chronically repressed their feelings. It was even found that the blood cells in depressed people actually carried less oxygen than those who are happy. Dr Pert had discovered that unexpressed emotions can become lodged in the body’s tissues in the form of ‘molecules of emotion’ inhibiting organ function.

The lesson here is:

• Stress over which we have no control, loneliness, grief and unexpressed feelings can inhibit both our immune function and tissue-healing capacity. Conversely, becoming happy and self-expressive can revive our tissue functioning.

Dr Susan Kobasa: The Role of Emotional Patterning

Things became even more interesting when it was found that the immune system has a memory, and that painful memories or repeats of past experiences in which a person has failed or been defeated, can also trigger immune collapse. Researcher Dr Susan Kobasa had described a psychological syndrome she termed ‘learned helplessness’, when those who had experienced failure earlier in life tended to keep repeating the pattern. Now science was showing that this result was mirrored in the immune system. On the other hand, she had also found that a ‘personality hardiness’ in those who respond to stress as a stimulating challenge resulted in a similarly healthy immune response. Here, at last, was a reason why earlier researchers could not make a direct link between stress and cancer – it depended not on stress per se, but on how the individual responds to stress.

The lesson here is:

• It is very important to provide psychological support to those who are not coping well and who see themselves as losers in order to change this underlying negative belief and replace it with strong, positive coping skills and experience of success.

Dr Leslie Walker: The Role of Empowering Cancer Treatment

The final piece of the jigsaw appeared more recently from UK researcher Professor Leslie Walker, who has worked for more than 20 years on the connection between mind – body approaches and improved survival in women with breast cancer. His recent study showed a staggering 17.5 per cent increase in survival 13 years after treatment in women who were taught relaxation techniques and, through hypnosis, to believe that their chemotherapy would cure them. In this case, the benefit of the treatment itself was 15 per cent, so the effect of the mind was greater than that of the medicine! Most interesting of all was the fact that the women who achieved this huge rise in survival rate were those whom Walker called ‘women who were too nice’. The medical description was ‘women with a high level of social conformity’ who tended to look after everyone else and bottle-up their own feelings. He also found an increase in immune function after relaxation and hypnotherapy, so once again it appears that a positive belief in cure and recovery is vital.

The lessons here are:

• It is vital to use visualization, affirmations or hypnotherapy to empower your treatments and to develop belief in their ability to cure you.

• It is important to identify and help those who are too ‘other-focused’ and to help them learn how to put themselves first.

Professors Spiegel and Fawzy: The Role of Support

This all fits with earlier studies done in the US, looking at the effects of psychological support on survival in those with breast cancer and melanoma. Professor David Spiegel showed a doubling of the average breast cancer survival time in those who had weekly support; Professor Fawzy showed a drop in the melanoma death rate from 10 per cent to 2 per cent in those who received weekly support, and confirmed an improvement in immune function, too. The emphasis in both interventions was on the expression of feelings (rather than being positive).

The lessons here are that:

• It is vital to receive support in expressing your feelings rather than bottling them up.

• Being positive does not mean hiding your grief or anger.

Blowing the Myth of Positive Thinking

If, while reading this, you have been feeling upset and emotional, please know that those who have a fighting spirit are almost always those who also have strong emotions and a big reaction to their diagnosis. It is absolutely normal to feel shocked and grief-stricken after receiving a diagnosis of a serious illness. Having a fighting spirit does not mean being permanently positive about having cancer and a fixed, determined grin on your face!

Some readers may misinterpret the information above, believing that it is harmful to become emotional or feel despondent at times about what is going on. This could not be further from the truth. According to PNI, a good cry or outburst of anger are just as good for boosting immune function as having a good laugh. It is repressing your feelings and becoming depressed that flatten the immune response. In fact, ‘fighters’ are defined by their ability to face reality, expressing the appropriate emotional response and ‘bottoming out’ with their feelings, and THEN to set about gathering the information and support they need to mount a realistic, proactive response to their situation.

Working Out How You Are Dealing With Your Diagnosis

Do you think you are reacting with a fighting spirit and believe in your power to heal yourself?

If you think you are reacting with anything other than a fighting spirit and want to change this, it important that you find help and support to deal with your diagnosis differently. Please go to the Resources Directory (pages 255–417) to find help in contacting a counsellor or psychologist trained in cognitive behavioural therapy to help you learn a more positive coping style. Your oncology department may also have a clinical psychologist who can help you, especially if your pattern is to give up and collapse in the face of difficulty.

Do you believe in the power of your cancer treatments to cure you?

You may choose to work with a hypnotherapist to develop powerful positive associations with your treatments, or you could use the relaxation and visualization exercises given in Cope Positively with Cancer Treatment, a CD available from Health Creation (call the Helpline on 0845 009 3366), to empower your treatments.

Do you need help from prayer or spiritual healing?

Contact the local prayer group associated with your church or religious group. Find a healer through the National Federation of Spiritual Healers (helpline: 0845 123 2767). They also do distant healing through prayer for those who are unable to get to a healer. Some of their healers will visit the home or hospital if necessary.

Have you got enough psychological support to express your feelings fully?

Find out about local support groups and counsellors from your GP, the hospital or the Resources Directory (pages 255–417).

So, far from pretending you feel all right if you do not, with support, try to face what is really happening to you, express your feelings, and then create an action plan based on your true situation and needs. Once you have done this, you will feel genuinely positive that you have a working plan and are back in control again.

Underlying States of Mind that May Need to Change

As well as the states of mind that arise in reaction to the diagnosis, there is the question of what was going on for you emotionally before you were diagnosed. As you move into your healing journey, it is important to look at the big issues of:

• improving your will to live

• decreasing your stress levels

• learning to express your feelings in everyday life

• letting go of loneliness and depression

• healing emotional wounds from the past

• identifying and changing the ‘limiting beliefs’ by which you live your life.

Looking at your will to live

The nitty-gritty issue for anyone facing a life-threatening diagnosis is the question of how strong is your will to live? This is a highly confrontational question, but a vital one to nail if you are going to succeed in fighting cancer. Carl Jung realized many years ago that all of us have an equal and opposite urge towards life (eros) and towards death (thanetos). When the eros side is strong, we feel powerful and passionate towards life. But when thanetos is dominant, death can seem very seductive.

So, do not feel that you are alone if the diagnosis of cancer has in some way excited you or felt like a good way out of the stress and distress of living. Ultimately, of course, we all have to die. Dying is a totally natural part of living. But it is awfully sad and wrong to give up and allow yourself to die because your spirit has been crushed by loneliness, grief, disappointment or a broken heart.

I have often witnessed incredible healing when someone has genuinely turned the corner and chosen life. For you, perhaps the diagnosis of cancer can be a real turning point and an opportunity to say ‘yes’ again to finding joy in living. This may happen quite naturally because often the diagnosis of cancer itself throws into sharp focus all that is precious about your life. But if you feel ambivalent about living, the best help you can get is to work with a transpersonal or psychosynthesis counsellor who will work with you gently and creatively to rekindle your zest for life. This is explored more fully in Chapter 9.

The problem of stress

A little bit of stress is healthy and often brings out the best in us. But prolonged stress, particularly stress over that which we feel we have no control over is a major depressant of our immune function. It may be hard to accept but, usually, the stress we are experiencing is of our own making. This is either because we get ourselves into or tolerate ridiculously stressful situations or because we have innate self-stressing tendencies, pushing ourselves to unrealistic limits. It really comes down to deciding that your health and happiness is more important than the goals for which you strive. The diagnosis of cancer can be the most perfect excuse to pull out of anything that is causing you stress.

Expressing your feelings

The next new trick you may need to learn is how to express your feelings in everyday life (not only in relation to the diagnosis). You have already discovered how those who are too nice have suppressed immune function. It is good to copy the Europeans and let rip with your feelings! Remember, anger is as good at improving white blood cell activity as laughter.

Getting out of isolation and loneliness

Another problem for our immune system is isolation and loneliness. So, do everything you can to get back into connection with people. This can be through belonging to groups who support and value you – whether that is a regular class, or a support, community or religious group. Nowadays, there are a huge number of growth and development classes you can join, and there are many support groups that either relate specifically to cancer or are less specific, such as women’s or men’s groups.

Getting out of depression, fear and anxiety

Perhaps you have more serious problems mentally and realize that you are actually depressed. Here again, you are not alone! It is estimated that up to 77 per cent of people with cancer are measurably depressed and it is really little wonder with all the uncertainty and trauma that are experienced. Most cancer units have a clinical psychologist whose job it is to help people come out of cancer-related depression or anxiety, so this route might be worth investigating if you feel really down. But a combination of support from a support group, counselling and spiritual healing can be equally good to lift depression. If you consider yourself to be a fearful or anxious person, this is another state of mind that it would be good to change. The best way of cracking fear and anxiety is by learning to relax and, better still, to meditate or to have a soothing massage or aromatherapy.

Freeing ourselves of limiting beliefs

Most of us allow ourselves to be governed by the limiting beliefs we have picked up during our childhood as to what we are able to achieve or not. This means that, if we have learned that we don’t ever succeed, or that we are not loveable or that good things never happen to us, then this is what happens to us. It is like we have been programmed with faulty software, which will always stop us from reaching our potential and achieving what we want. But through the integrated medicine revolution, a huge number of effective ways of changing our state of mind have surfaced, including developing self-esteem and confidence, and replacing negative beliefs with positive ones. If you recognize that you are being run by your limiting beliefs, then NLP (neurolinguistic programming) can be a powerful tool to change this.

Getting the Help You Need
Counselling

The first step is usually finding someone who will listen really well to what you are going through. This is usually found in a counselling relationship and, again, I would recommend transpersonal or psychosynthesis counselling, where the state of the spirit is given attention along with help to change our feelings, beliefs and behaviour in positive ways.

The counselling relationship is often believed to be only about helping you to accept what is happening to you, grieving appropriately and becoming adapted to the change. However, in transpersonal or psychosynthesis counselling, the relationship is more about trying to find out what is right about your life and only needs your focused attention to flourish. Help can be given to try to see the message in the crisis and to grow positively from the experience, rather than just learning to accept what is happening.

This is a far more positive and creative form of counselling that fits well with the integrated medicine model. Yes, you may need some straightforward compassionate counselling at first, to help you deal with the shock and your reactions but, later on, you need a counsellor who can help you reframe the crisis as an opportunity for healing and growth. A counsellor of this kind may also help you look at the benefits you may be gaining from illness, helping you learn how to get these benefits without having to be ill. A good counsellor will help you change from being passive in your life to taking an active role in the creation of your ideal lifestyle. He can help you rekindle your will to live and reconnect with that which really turns you on.

Often, a transpersonal or psychosynthesis counsellor will also be able to help you develop a positive mental focus through developing visualization or affirmations with you to help you strengthen your belief in yourself and in your healing. Your counsellor, or a spiritual advisor, can also help you in your spiritual explorations, perhaps helping you to open up to the possibility of healing from a higher source.

The important thing is not to see a counselling relationship as being only about helping you when you are in extreme distress or seeing it as meaning that there must be something wrong with you. Having regular counselling throughout your recovery process can completely transform a potential nightmare into a true blessing, helping you to grow and even benefit in the long term.

Preparing for the Worst, Working for the Best

Another helpful role of the counsellor is to help you, if you feel you need to, face and plan for the worst-case scenario that could happen. You can then spend much less time worrying and fantasizing about it, and get on with creating a different, much more positive reality. This may mean that you choose to use some of your early sessions with your counsellor thinking about how you would feel, and what would need to happen if everything went really badly.

If you do this, the level of detail that you go into is up to you, but it could involve thinking right through the practicalities of whether you have made a will, what financial resources are available for your dependants, who would care for them if you were unable to, and how you would like to be cared for if you become disabled and dependent. You can even go into the details of where you would like to die and what kind of funeral you would like to have. This will inevitably force you to face your feelings and beliefs about death, so you may also need the help of a spiritual advisor. This may sound extremely grim, but most people who have employed this head-on approach have found it tremendously liberating. Paradoxically, any step you take in the direction of both healing old wounds and preparing to let go of life will enable you to live all the more fully. This, in turn, will enhance your energy, vitality and health and, consequently, the chances of stabilizing your disease.

Healing Your Emotional Wounds

Another thing that might emerge from this process is the urge to complete unfinished emotional business with anyone against whom you are holding a grudge, or by whom you feel you have been aggrieved or hurt. It may not be necessary to go anywhere near these people to do this work – it may be quite possible to make your peace with others during your counselling sessions. This often has very surprising results, as the dynamics of these old and difficult situations and relationships can often change dramatically once you have shifted your position.

Attending to these background emotional issues will be part of your long-term Health Creation Programme (see Chapter 9) and be best addressed after you have been through your treatment.

Facing the Cancer Diagnosis: Understanding Your Reactions and Identifying Your Needs

Now that we have looked at the psychological foundation for recovery, let us take a look into the question of how you are feeling now. It is very possible that, having recently had a diagnosis, you are still in a state of shock. It is important to understand the effects of shock and how to deal with it.

Dealing with shock

The diagnosis (or re-diagnosis) of cancer can put you into severe emotional and physical shock. Extreme shock is an odd thing. You may feel that you are able to cope but, in fact, your thinking and reaction times may be severely impaired. If you do receive bad news when you are not expecting it, it is safer to wait at the hospital or surgery until someone can come and pick you up. It is certainly better not to attempt to drive or go out onto public transport while you are in such a state and feeling so vulnerable.

It is estimated that in a state of shock, less than one-tenth of what you are told is retained. Because of this, the most important thing to remember is to never make important decisions while you are in a state of shock! Yet, medical personnel may rush straight from telling you your diagnosis and prognosis to explaining your treatment options.

The sense of urgency created by doctors at the time of diagnosis is usually exaggerated. Yes, it is a good idea to move ahead with appropriate treatment for cancer as soon as possible after diagnosis, but the treatment will be far harder to cope with – and may even be less effective – if you are in a state of shock and fear, and feeling out of control. There is clear evidence that being well prepared psychologically, with a positive attitude towards treatment, conveys not only psychological and quality-of-life benefits, but also a distinct survival advantage.

It is therefore highly advisable to take the time you need to:

• go through your emotional reaction to the diagnosis

• think about what seems the best treatment option for you (and this may even be having no treatment)

• prepare yourself mentally, physically and practically for treatment, before it starts.

Possible emotional reactions to expect

Everyone is different. Initial reactions to a diagnosis of cancer can range from extremely strong emotions to total numbness, and any degree in between. Your state can also vary profoundly from one hour to the next, so that you may find yourself suddenly in a highly emotional state, unexpectedly feeling out of control.

If you need to withdraw, withdraw. If you need to scream, shout and rage, then scream, shout and rage. If you need to weep, please allow yourself to let go completely and grieve over your situation. There is no need to keep up a brave face. This will not ultimately serve you, and will definitely delay the process of your being able to get your feet back on the ground, able to make clearly thought-out decisions about the way forward. Take all the time you need to go through your reactions. Do not be afraid to cancel work and social engagements if you need to. You have effectively been bereaved, and everything will go much better if you allow yourself the proper space and time to begin to come to terms with what you are experiencing.

There is often a sense of intense disbelief and the recurring question of ‘Why me?’. Many people go straight into fear, or even terror, and this can be felt both mentally and physically. Such extreme fear can cause a racing heart, sweatiness, a feeling of weakness and sometimes diarrhoea. The mental anguish can make it impossible to concentrate, perform normal tasks, keep up a social front or sleep properly. Over time, this all-pervasive fear can become focused into more specific fears, such as fear of pain, disability, disfigurement, hospitals and doctors. But underneath it all, it is usually the having to come face to face with one’s fear of death and the deep uncertainty caused by the diagnosis that causes such a strong reaction.

Often, the next feeling experienced is grief. This may be grief at the thought that you might die and leave others behind, or grief for yourself and the loss of your sense of a certain future. Often, relatives, too, will go into anticipatory grief. This can sometimes be so extreme that you find people treating you as if you had gone already! Combined with the withdrawal of friends or colleagues who are too embarrassed to talk to you about what is happening, you may be left feeling abandoned and isolated – as if you have passed through an invisible glass wall and are no longer part of the ordinary world around you.

You may find yourself experiencing a mixture of feelings, such as jealousy, resentment or even anger, towards those who are still healthy. You may dread the thought of becoming dependent on people with whom you do not wish to have that degree of intimacy, or even feel guilt at the thought of not being able to fulfil your ordinary functions. Of course, this will be tempered by the enormous love, closeness and gratitude you will feel towards those who stick with you through this crisis, with whom your relationship will deepen and grow immeasurably.

There can then be the other side of the story. You may, as already mentioned, have been expecting something like this to come along. You may even welcome the illness, feeling that the whistle has finally been blown on what has been an unhappy or unproductive state of affairs in your life. You may even find yourself feeling excited by the challenge of cancer, experiencing it as a much-needed wake-up call. Some may even welcome the possible imminence of death.

Do not think it is odd if you feel this way. Many people feel this way, especially if life has been really tough.

You may have beliefs or even a deep ‘soul memory’ that dying is not so much an ending as a transition into a far freer state of being and, thus, actually look forward to making the transition. Or it may be that life has been so hard for you that dying seems like a blessed relief. But, on a more pragmatic level, it could be that the diagnosis and possibility of death make every moment of life seem extremely precious and exciting and that, in one fell swoop, any sense of boredom or depression with life evaporates.

There is also another phenomenon that people often experience – which is a sense of being almost unnaturally calm. It is as if you are at the still point, within the ‘eye’ of a hurricane. While relatives and friends are being thrown into chaos by the new development, you may find yourself strangely quiet and ‘present’ with the ultimate truth and reality of your situation. It is as if there is a spiritual acceptance of the truth of what is happening to you and, from somewhere deep inside, you are being given the inner strength to deal with it.

If you have received bad news, take all the time and space you need to go through your reaction before making treatment decisions.

Ask yourself:

• What am I feeling now about my diagnosis?

• How am I reacting to my diagnosis?

• What help do I need at this time?

Getting immediate help

Find out what support resources are available at the hospital where you have been diagnosed, or at your regional cancer centre, which may be larger and better equipped. Next, find out what help there is from your GP, community nurses or local hospice, then find out if there are any local or national support groups or local private counsellors who can help you. Do not be afraid to ask for the help you need, and use it for as long as you need it. Getting good support for your emotional state will greatly help you both in the decision-making process to follow and in getting you the best outcome from your treatment.

It may be that your GP, community nurses or health visitor could be called to the house to give you immediate support, or that a local support group could provide someone to keep a close eye on you for the first week after diagnosis. Certainly, if you avail yourself of the services of a Health Creation Mentor, they will be particularly vigilant in this initial time, helping you to access the best possible support available in your area (tel: 0845 009 3366).

It is very likely that you will need crisis counselling at this time to help you get through your initial reaction. This kind of counselling is beneficial and rather different from the kind of counselling you will need later on to help you get well again. This may also be the time you may wish to reach for the help of spiritual guidance from where you usually worship, or for a spiritual healer. There may be many questions you wish to ask, but the main role of these spiritual helpers will be to try to help bring you into your still, calm centre, where you may find peace and inner strength during the difficult times.

Finding Support

• Your local cancer unit or regional cancer centre

• Specialist nurses such as Macmillan, Marie Curie or practice nurses

• Your local hospice (which are not only for the seriously ill)

• Your GP

• Support groups (see the Resources Directory, pages 384–404)

• Counsellors (private or through your GP surgery)

• Spiritual advisors or healers (see the Resources Directory, pages 372, 404–6).

Also, find out what support is available from:

• Your family

• Your partner

• Your friends

• Your colleagues or occupational health department

• Your local church or relevant religious community.

Use the Resources Directory to see what specific help may be available from support groups or charities dealing with your kind of cancer or resulting disabilities, and any problems you may have arising from the treatment. Help may also be available to deal with the financial, legal or social problems due to your diagnosis.

Find out what help is available nationally from:

• Illness-specific support groups

• Disability-specific support groups

• National charities

• Legal services

• Social Services

• Citizens’ Advice Bureaux.

Telling other people

When you first become ill, especially if there is a health crisis or serious operation to go through, telling kind enquirers over and over again about what is happening can be very upsetting and draining, both for you and those close to you. Sometimes, it can help to delegate this task to a supporter who will be the message bearer, only putting through those you have placed on a special list.

As you emerge from the shock of the initial impact, it will be time to think about telling other people. You may initially feel like hiding what you are going through. A common reaction is to try to keep life as normal as possible, keeping what you are going through private. This is your choice and can be effective, but it can also be a stressful, lonely way to go about things, leaving you compromised at crucial moments when you may need help.

It is better, if possible, to enlist the help of friends and colleagues. Everything will be a lot easier if you can confide in those you work with so that they give you the best of their support now and in the future, and excuse from duties at short notice, if necessary. Of course, if you don’t want them to keep asking how you are, you can make this clear at the beginning. If you are asked something like this, be honest as it helps them know what to do.

The other big consideration is what you tell your family, particularly aged parents and children. Often, people do not tell their elderly parents what they are going through – partly to spare them the upset, and partly to spare themselves from having to deal with their reaction. Of course, everybody has to be the judge of their own situation but, if a parent is not given this information, you may be depriving yourself of a great deal of extra love and closeness that could come your way. Often, as hard as it may seem, giving somebody the opportunity to help you can be extremely important for them, helping them to feel valuable, and reassess their own values and priorities, too. It may even help an older person feel less depressed or sorry for themselves, putting their own worries into perspective and giving them a meaningful focus in terms of helping to care for you. This new closeness can sometimes be very healing for parent-child relationships that have gone awry in the past. Also, the older generation may have more experience and understanding to deal with illness and the concerns it creates. So, in the main, unless the individual concerned is very frail or the relationship is very conflicted, it is much better to be truthful about what is going on.

Deciding Whom to Tell

Whom do you need or want to tell?

Whom do you not want to tell?

What do you want to tell them about your situation, and how do you want them to be with you?

What ‘ground rules’ do you wish to set regarding confidentiality or the way you want them to interact with you?

Whose help will you enlist to tell others?

Who will tell them, what and when?

It is also good to be as honest as possible with your children. They will know that something is wrong even if you try to hide it from them. Being real with your children is probably the best education, gift and preparation for life you can ever give them. Children often have a better ability than adults to live in the present. This means that they tend to focus more on the way you are day by day rather than continuously looking at possible futures, which is what adults tend to do. However, what makes interactions with children easier is if you have managed to express your emotions and fears with your counsellor or close supporters before telling them. This will leave you in much more receptive state to allow them to express their feelings to you.

Asking for Help
Developing a personal support network

As well as needing immediate help to cope with your reaction to diagnosis, it is likely that you are going to need longer-term help both to support you through your treatment and to support you through your recovery programme. An effective strategy can be to form a support group of friends around you. This involves actively recruiting a group of friends that you can call on if the going gets tough. The need for this will depend on the seriousness of your situation and your own emotional state. But it is a mistake to assume that, because you have a close partner or family, you have a support network.

Those closest to you will be going through their own reactions and, quite often, distress ricochets around families like a ball in a pinball machine. You may feel you are able to offload your feelings, but find, later on in the day or week, that they come bouncing back to you in the form of a marital row or a sick child. It is therefore good to form a group of six to eight friends who are ‘signed up’ members of your personal support group who can pledge to be there for you in times of need. You may wish to have your support group meet once a month at your home to hear about what you are up to and what your needs will be in the forthcoming month. This will help them as well as you.

At first, this might feel like an embarrassing thing to do – to concentrate so much focus and attention on yourself. However, you are giving people an opportunity to express their care and love, and it is likely that they will find this very rewarding. You will also find that being clear and articulating your needs gets easier as time goes by. In so doing, you will be providing a tremendously healthy model for your friends and family to follow in their own lives. It doesn’t all have to be a one-way street either. You may choose to structure the support group so that everyone in it has a chance to express their feelings and ask for the support they need from the group each month. You will probably find this empowering as, although there may be some areas in which you are very vulnerable and needy, there will be others in which you are strong and able to give good-quality support to others.

Veronica’s Story

Before you become concerned about ‘being a burden’, read Veronica’s story below. In the 1980s, she changed her ‘three months to live’ with liver cancer secondary to a melanoma into more than nine years, living to see her children leave school. When she realized that her friends avoided telephoning her in the weeks following her diagnosis, perhaps through embarrassment or a lack of knowing how to help, she sent out this ‘round-robin’ letter:

Dear Friend,

Yes, I have cancer.

Yes, I have been told I have only three months left to live – but actually I AM STILL HERE and I need help!

If you would like to help me, the things I need or would really like are:

1. Flowers every week to cheer me up

2. My organic vegetables picked up each week

3. Money for my holistic therapy

4. Any information any of you can find out about alternative treatment for cancer, anywhere in the world

5. My children taken out while I meditate and visualize

6. A holiday in the Bahamas …

and on to a total of 20 wishes.

All 20 of Veronica’s needs and wishes were met, and she received letters filled with love and gratitude – such as:

Thank God you told us what you needed. We really wanted to help, but we had no idea what to do for the best.

Perhaps there are many people around you in your family, social and work circles who feel just like Veronica’s friends did, and who would be relieved if you would let them know how they could best help you! Let the people who care about you know exactly what help you need. Be specific about your needs, but do not get upset if they say no this time.

Mapping Out Your Personal Support Network

Think now about the family members, friends and colleagues who may be able to help support you now and in the future.

Setting Up Your Personal Support Group

• Ask yourself whether you want (or want supporters) to set up a personal support group.

• If the answer is yes, think about which of your friends you would like to invite to be part of this support group.

• Contact these friends and invite them to join the group.

Suggested guidelines for a personal support group

Below is a set of guidelines on which you could run your support group. Read out or send a copy of these guidelines to all the members of your personal support group.

A Framework for Setting Up a Personal Support Group

A personal support group is being set up by ________________.

I have cancer, and need ongoing emotional support and a ready source of practical help at times of crisis. I will also be very happy to provide support for other group members when I am able to do so, but this may not be possible all the time, and will depend on the demands of this illness and its treatment. I would like to invite you to join the group. Please think about the following suggestions for how the group will be run before saying ‘yes’ to joining. Perhaps you will want to make some suggestions of your own, too? I believe that:

• The group should ideally comprise a minimum of six people besides me, who are not themselves seriously ill at this time. It can include family members, but there should be as many or more non-family members if possible.

• The group members should be able to spare at least two hours every month to come to a group meeting, and have some extra time free each month to provide some care or practical help as needed.

• Ideally, none of this group should be involved with me professionally so that there is no risk of breaking confidentiality or compromising their professionalism.

• At each meeting, it is recommended that each person in the group take 10 minutes – entirely uninterrupted – to tell the others first how they feel, what they are having to deal with and then the support they would ideally like in the following month. The voicing of the support required is not necessarily an active request so much as an opportunity for each person to formulate and voice their needs.

• The time taken by each group member can be lengthened or shortened, depending on the time available and the group members wishes – even three minutes each can be highly effective.

• If possible, members should try hard not to jump in and try to ‘fix’ the way someone is feeling with practical solutions or advice, as this may shut them down emotionally, stopping them from having a good cry or rant. A great deal of the value of the group will be in supporting each other to express our feelings, and its effectiveness will depend greatly on the ability of the group to sit and bear witness to the others’ distress without trying to make them feel better immediately. It is important to think about whether this is possible for you.

• It will be important to keep the group to time. It can be helpful to pass a watch around to be held by the person talking, or for one person to keep time and gently ring a small cymbal or bell when the time is up.

• After the initial go around the group (which will take about an hour for six people), we can then move into practical mode, looking at the practical possibilities for the group to offer each other help in the forthcoming month.

As you prepare for and go through treatment, and then embark upon your recovery process, your wider support network will then also include the holistic therapists you take on to help you.

Your support network will give you great security as the days go by and, even if not needed all the time, will give you a tremendous resource to call upon if things get difficult at any point.

Finding a cancer ‘buddy’

Sometimes the most helpful thing may be to find someone else to talk to who is going through the same thing as you are. This is often referred to as having a cancer ‘buddy’. You can then compare notes about the treatments you are being offered and share support as you go through them. If you feel this would be helpful, you could ask your consultant, local cancer healthcare personnel or support group network for help to find a ‘buddy’ for you.

Preparing for the moment of ‘peak vulnerability’

People with cancer always say that the moments of peak vulnerability are when they:

• visit their doctor

• wait for test results

• receive bad news

• go through cancer treatment

• stop the cancer treatment.

It is important to arrange to have special support available to you at these times. Take people with you to your appointments. Ask your medical team to get results to you as quickly as possible. Protect yourself at times of receiving bad news, cancelling social and work commitments as needed so that you can take the time to work out what it means to you before having to deal with everyone else’s feelings.

Longer term, have a good proactive Health Creation strategy in place for when the treatment stops. Find out about alternative medicine routes, too, in case there is no medical treatment available for your condition, or for times when the medical profession can offer no help.

In Summary

In this chapter, you have been advised to:

• Have support when you receive the news of your diagnosis, taking action to find the results yourself if you have been waiting for more than a week for results.

• Be aware of the powerful effects of shock and be very protective of yourself.

• Avoid having treatment or making big decisions while still in shock, asking for more time to consider your treatment options.

• Seek help from counsellors or other support services before you tell the news to others. You’ll need to express your emotions.

• Take advantage of the support available. You are not alone!

• Develop a strong belief in your treatments, your self-healing ability and the power of spiritual healing.

• Gather a strong emotional-support network behind you comprising friends, therapists and a support group.

• Use hypnotherapy, visualization and affirmation to empower your treatments and recovery.

• Find counselling help to enable you to express your feelings, decrease your stress, heal past emotional wounds, and start living a lifestyle that is truly fulfilling and exciting.

• Bring yourself out of isolation, depression, stress, fear and anxiety by changing negative beliefs and coping styles for positive ones, getting professional therapeutic help until you are strong and positive.

CHAPTER 3 Getting the right treatment for you

Becoming clear about what you are dealing with and the choices you have is hard when only recently diagnosed and when you are still in shock and emotional turmoil. The aim of this chapter is to facilitate the process, and to offer as much guidance as possible on when and how to make what types of decisions.

Getting the right treatment depends on:

• getting a clear diagnosis

• working well with your doctors

• information gathering to find out what treatment is available

• weighing up your options from all aspects of integrated medicine, and being clear as to what benefits are actually on offer

• making treatment decisions and having a plan that integrates the best of all treatment approaches.

Remember that an important part of the Hippocratic Oath, taken by all doctors, is a pledge first to do no harm. Bear this in mind when deciding what cancer treatments to undergo. Try not to use medical treatment just to treat your fear, or that of your supporters or doctors. There are much better ways to deal with fear, such as through healing, counselling, relaxation, meditation and loving support. Only subject yourself to harsh medical treatment if the result will be a definite improvement in your physical state and prognosis. Watch out for being oversold on the benefits of medical treatment especially if your cancer has been resistant to earlier treatment. Often, people say their doctor has given them a 35 per cent chance of the treatment working – but this may actually mean a 35 per cent increase in disease-free time (the time till symptoms reappear compared with having no treatment) and not a 35 per cent chance of cure. While it is understandable for doctors unaware of alternative routes to put pressure on patients to have medical treatment, sometimes this pressure is out of proportion to the true benefits and personal costs of receiving such treatment.

Getting a Clear Diagnosis

A great many of us, when looking at a possible symptom of cancer or cancer recurrence, simply cannot face going to the doctor to hear the diagnosis, and just sit in a kind of limbo hoping it will go away. Some people in this situation will seek out alternative cancer treatments or embark on a holistic health regime to be on the safe side.

While the fear of having and facing a cancer diagnosis (or re-diagnosis) is entirely understandable, not getting a proper diagnosis means that you may live for years thinking you have cancer or a recurrence – and even treating it – when you do not. Alternatively, it may mean that you can lose the opportunity to treat what could be cancer or pre-cancer in its early, potentially curable, stages.

However you choose to deal with the diagnosis once you have one, getting the support you need to go through the diagnostic tests is very important. Having an accurate diagnosis and staging of your illness means you can then make an informed decision about what you are going to do. This puts you back in control.

Early symptoms of cancer

The symptoms to look out for which could be cancer include:

• a new or unusual lump anywhere on the body or in the abdomen

• a change in the appearance of a mole

• a sore on the skin or in the mouth that won’t heal

• persistent coughing, hoarseness or blood in the sputum/spit

• prolonged constipation or diarrhoea, or blood in the stool

• difficulty in passing urine or blood in the urine

• unexplained weight loss

• unexplained fatigue

• difficulty swallowing and unexplained nausea

• severe headaches and odd neurological symptoms (such as weakness or numbness)

• unexplained abdominal swelling

• vaginal bleeding between periods and any vaginal bleeding after the menopause.

Of course, all of these symptoms can also result from much less serious conditions than cancer and, more often than not, a doctor will be able to reassure you that nothing is seriously wrong. However, it is important to wait until all of the appropriate diagnostic tests have been done. Too often, GPs give reassurance on the basis of a clinical examination in their surgery, only to be proved wrong at a later date. GPs expect patients to come back if symptoms persist, so it is important to trust yourself and keep going back if you think something is not right. Although most people are sent for tests immediately, far too many visit their GP over and over again before they are sent for the appropriate X-rays, blood tests or other investigations. They can then discover in the end that their intuition was right – that something is seriously wrong and that a cancer that could have been treated easily as a primary has now spread to other parts of the body. So, please be alert to whatever messages your body is giving you.

If you are really concerned that a GP is not responding to you appropriately, get a second opinion from another GP or even arrange to have investigations done privately or through an integrated medicine doctor.

Ask yourself what support you need to get through the diagnostic process.

Visiting your GP

Once you have overcome your fears and are able to actively seek a diagnosis, make an appointment with your GP. If you wish to, take a friend or partner with you. Clearly explain your symptoms and your concerns about having cancer or a recurrence of cancer. This is important so that the GP takes your situation seriously and so that, if you do not have cancer, you can be properly reassured.

Receiving good news

Once the tests have been done, it is often possible for doctors to give you reassurances that all is well. This is particularly common for those who have had a primary cancer and who understandably then suspect every headache or twinge of being a recurrence. What is important here is your peace of mind, and the doctors should help you to get the reassurance you need until you feel better and settled again.

But even if the news is good, you may perhaps wish to treat the incident as a ‘wake-up call’, and embark upon a Health Creation Programme as an insurance policy to avoid your ever having a scare like this again.

Receiving bad news

Regrettably, 270,000 people per year in the UK do receive a diagnosis of primary cancer, and an equal number have a diagnosis of secondary spreading. A cancer diagnosis is something we all dread. If you are sitting in the horrible hot seat at this moment and have just got the news, be reassured that a great deal of help is at hand!

Despite the high rates of cancer in the developed countries (four in every 10 of us will develop a cancer during our lifetime), most of us live our lives feeling immortal, believing that these things only happen to other people. The news of a life-threatening diagnosis can be like a bomb going off in the centre of our lives, completely shattering our security and our sense of the life we expected to have.

Nevertheless, there are people reading this who can say, ‘No, I actually expected my diagnosis of cancer. I knew that my life and health were seriously out of kilter and that it was only really a matter of time before I got seriously ill.’

Most probably, if you are reading this book, you have already been through the initial impact of receiving a diagnosis of cancer. However, if you are waiting for test results, it is important that you are protected at that moment of greatest vulnerability. Try to take someone with you, and ask for the privacy and time you need with the doctor to enable yourself to take on board fully the information you are being given.

Getting support while waiting for test results

If you are waiting for test results, what support do you need to help you through this tense time?

• A talk with my GP

• A talk with my practice nurse, health visitor, social worker or practice counsellor

• A talk with the consultant or hospital support team

• A talk with a private counsellor

• A talk with a spiritual guide

• Being able to confide in a friend or family member

• Being able to tell colleagues at work and arrange to be excused from normal duties

• Being able to take time off to go into ‘retreat’.

If you have you been waiting more than a week for test results, it is reasonable to seek help to find out what has happened to your results. You could try telephoning your GP, the practice nurse or your consultant’s secretary. Ask them to chase your results for you. Make it absolutely clear that you wish to receive your results over the telephone or face to face from one of your medical team.

The moment of truth

The time will come for you to get your test results. If you are expecting bad news, it may be helpful to find out before your appointment with the consultant what kind of assistance is available from a member of the support team (if there is one) or a specialist nurse at the hospital. This is particularly relevant if you live alone, have no close partner or confidante and nobody around to look after you and see you through your vulnerable period after you get home. You may also wish to find out what support is available from the GP’s surgery, the local community nurses or hospices, counsellors, skilled volunteers, support groups, chaplains, spiritual helpers or psychologists. Quite often, resources are to hand which busy doctors and nurses forget to tell you about. So, it is advisable to do some homework in advance if you are at all worried.

Finding Out What Support Is Available at the Hospital

This information is available from the clinical staff (nurses and clerks) where you go to see the consultant, from the cancer or unit information centres (if they have these), and from those in charge of the surgical wards, and chemo-/radiotherapy treatment units.

Getting Support When You Receive Your Results

Ask yourself whether you prefer to be alone to get your test results or with a supporter. If you do take a supporter, who will you ask to accompany you?

If you prefer to go alone or have no choice, who can be at the end of a phone to support you or stay with you overnight if the news is bad? Is this arrangement confirmed? You can celebrate with them, too, if the news is good.

If you want someone to be with you after the appointment, let him know the time of your appointment and arrange where you can meet when you are finished. Ideally, arrange to have him pick you up if you need support.

Working with Your Doctors

Establishing the best relationship with your doctors – whether that is your GP, surgeon, oncologist or radiotherapist – will be very important for your ongoing security and peace of mind. You may be lucky and find an enlightened doctor who will help you obtain the best integrated medicine, but you may find yourself in a position where you need to gently, but firmly, inform those who are caring for you as to your values and needs. It is hard to have to do this at the point when you are so vulnerable, and would like and expect the care you get to be completely appropriate. However, as with any new relationship, unless you make your needs and feelings clearly known, it will be difficult for others to arrive at any appropriate responses.

It is important to remember that doctors are there to serve you and not the other way round! You have a right to the proper time, attention and care from your doctors and, if for any reason you do not feel comfortable with the consultant you have been referred to, you should go back to your GP and ask to be referred to someone else. We now live in a time when healthcare services are supposed to be patient-centred, so it is essential that you are satisfied with the service you are getting. If not, you need to register this with the cancer services manager in your area or hospital – otherwise, things will never improve.

Right from the start, it is important that your consultant treats you as an equal partner in your healthcare management. If you have taken on board what has been said at the very beginning of this book, you will have already realized that you are a vital member of your cancer management team. This view is backed up by leading UK oncologist Professor Karol Sikora and by the scientific evidence showing how strong a survival advantage is experienced by those who are active in their own defence.

You want to be treated as an individual, so it is useful to let the doctor know:

• how you are viewing your situation and the way you are choosing to deal with it

• how much information you want to be given

• how hard you want to fight your cancer and to what lengths you are prepared to go medically

• if you prefer not to have medical treatment or to stop the treatment you are having

• how you are reacting emotionally to your situation and how well you are coping (or not)

• which treatments (if any) you are not prepared to have

• whether you are ready emotionally and physically to start treatment.

It is important that you:

• take full charge of your situation, never allowing yourself to be railroaded into any treatment decision

• let the doctor know your current situation, values, needs or desires which may affect your treatment decisions

• ask for understanding, flexibility and help if at any time you feel too vulnerable to have treatment

• ask for the support you need

• explain (or seek professional help to explain) to your doctor the science and theory underpinning any approaches you may be using as a complement or alternative to medical treatment

• ask your doctor to be tolerant of and support the choices you are making with regards to your healthcare.

It may cheer you to know that there is an American study that proves that ‘difficult’ patients do best and survive longer. One support group even had T-shirts printed saying ‘I am a difficult patient’ to wear on hospital visits to wake up the medical team. I’ve even heard of a woman who always attended her outpatient appointments in a ballet tutu so she would be remembered and treated as an individual!

This may be too drastic a step for you, but it is a good idea to try to establish a personal rapport with the team looking after you – even if it is because you are always the one asking the searching questions or making your needs known. Humour is, of course, always the best way, and the combination of wit, cunning, being well prepared, assertive and funny is irresistible.

Your aim is to:

• obtain all the appropriate information about your situation

• be given the time to digest and react to this

• make informed consent to treatment only when you have truly understood what the treatment entails, and its potential benefits and side-effects compared with other treatments on offer

• prepare yourself well for treatment, building up your belief in the power of the treatment with visualization and affirmation

• embark upon your treatment feeling fully confident that you have picked the very best course of action for you.

Remember, too, that if you are not happy with your consultant or his opinion, you have the right to ask for a second opinion.

Information Gathering to Find Out What Treatment Options Are Available
Knowing the right questions to ask

To get the information you want, you need to ask the right questions. Knowing what these questions are is difficult unless you have a basic understanding of cancer as a disease. A full explanation of cancer and its treatment is given in Chapter 4 for those who desire the full details. In essence, the information you need in order to ask the right questions is as follows:

• There are as many different types of cancer as there are types of cells in the body. Cancer arises from a single cell in which genetic material has been damaged. The damage allows the cell to replicate and spread out of control. As these ‘wild’ cells continue to grow, a lump or tumour is formed – this is known as a primary cancer. If the cell that started to grow out of control originated from breast tissue, this will be a breast cancer; if it was a bone cell, it will be a bone cancer, and so on.

• As the tumour grows, it may begin to invade the local blood and lymphatic vessels. At this point, cells may break off from the main tumour and travel to nearby lymph nodes, which may also become swollen because of the cancerous tissue that starts to grow in them. From there, the cancer may travel even further afield through the bloodstream or lymphatic vessels to distant sites in the body. There are certain preferred sites where these cells will become lodged, leading to a possible secondary cancer, or metastases, to start growing – for example, breast cancer secondaries can show up in the bones, lungs, liver or brain.

When a doctor is initially assessing the cancer, he will try to establish:

• the histology or type of the tumour – the cell type of origin of the cancer

• the grade or degree of aggressiveness of the tumour

• the stage of the disease – whether the tumour is still at its primary site or whether it has spread locally from the tissue of origin to nearby lymph nodes or even further afield to form secondaries or metastases

• whether there are any special markers (such as blood tests) by which its progress can be measured, or unique characteristics, such as being hormone-positive.

For most tumours, stage one means there is a primary only; stage two means the primary has begun to invade the blood vessels locally; stage three means that the tumour has spread to nearby lymph nodes; and stage four means that it has metastasized throughout the body. These stagings will differ somewhat from one type of cancer to another.

To diagnose and grade the tumour, the specialist will take a sample of the tumour tissue, usually by taking a biopsy. The tissue sample is then studied under the microscope to determine just how aggressive the cells are, and the results will appear on a histology, pathology or histopathology report. Cancer cells are described as well differentiated if they still closely resemble the cell of origin – in other words, a well-differentiated cancer of the breast will contain cells easily recognized as having originally arisen from breast tissue. Because the cells are also still similar in nature to normal breast tissue cells, the tumour would also be described as slow-growing and low-grade.

At the other extreme, the tumour cells may be barely recognizable as breast tissue cells because they had become ‘wild’. Such cells would then be described as poorly differentiated, and the tumour as fast-growing or aggressive and high-grade. Again, the grading system varies with different types of cancer, but most tumours will be graded on a scale of one to four.

Staging the tumour means having further screening tests done after a positive biopsy. These may be blood tests, X-rays and/or ultrasound, CT (computed tomography) or MRI (magnetic resonance imaging) scans of the parts of the body to which the cancer may have spread. How much you wish to know will also affect how much screening you allow your doctors to do. Some consultants, on discovering a primary tumour, will leave no stone unturned in looking for possible secondaries. Other consultants take a much more passive view, waiting until there are symptoms before looking for the presence of metastases.

Generally speaking, there is not much point in undergoing extensive screening unless it will potentially change the treatment being offered. For example, if the chemotherapy for a primary cancer is the same as for a similar cancer that has already spread, your consultant may not think it necessary to carry out widescale screening. But you may wish to know if there are secondaries, as this may significantly change your approach to the cancer and your life choices. So, you will need to be clear with your doctor as to just how far you want him to go with this process and how much information you wish to be given.

To get a clear picture of what you are dealing with, you need to find out:

• the type of cancer you have or its histology

• the stage of the cancer or how far it has spread

• the grade of the tumour or how aggressive it is

• the markers of your tumour by which the effectiveness of treatment or progress of the disease can be measured

• if the tumour is hormone-positive.

Once you have this information, you will then be armed, if you so choose, to go away and read about the cancer you have and discover the possible treatment options for your cancer type, stage and grade.

The exception is in the case of tumours of the blood cells. These are the leukaemias, in which there is no solid tumour because the cell that has grown out of control is one of the various types of white blood cells. The way this sort of tumour is diagnosed is by performing blood counts or looking at bone marrow. These tests might reveal that one cell type is growing very fast at the expense of other blood cells, the levels of which may be lower than normal. With leukaemias, classification is in terms of whether the illness is chronic (slow-growing) or acute (fast-growing).

Depending on how much information you wish to be given, you might ask your doctor for answers to some or all of the following questions:

IF YOU DO NOT WANT TO KNOW THE ANSWERS TO THESE QUESTIONS, TELL THE CONSULTANT AND GP WHAT YOU DO and DO NOT WANT TO KNOW.

• What type of primary cancer do I have (or what is the histology of the tumour)?

• How large is the primary site?

• Has it spread to the lymph nodes draining the site from which it has arisen?

• Has it spread elsewhere in the body, and what is its stage (1, 2, 3 or 4) (or how far has the tumour spread)?

• What is the ‘grade’ or degree of aggressiveness of the tumour?

• Are there other prognostic indications from the pathologist?

• Is the cancer hormone-receptor-positive? If so, to what hormones is the tumour sensitive?

• Are there any blood markers by which the growth or shrinkage of the tumour can be measured?

• To which parts of my body might this type of tumour spread?

• Would it be advisable for me to be screened thoroughly for secondary cancer?

• If secondary cancers were found on screening, how would this affect the choice of treatment I am being offered?

• In the case of leukaemia, is it acute or chronic?

• Left untreated, what is the usual course of events with this type of cancer?

• What is the prognosis (or average survival time) with this cancer if medically treated?

Finding out more about your cancer

When you have found out the type, stage and grade of your cancer from your consultant or GP, you may wish to gather more information before making any decisions about medical, complementary and alternative medicine approaches to treatment.

It is best to think a bit about how and where you should look before you embark on this process. Information about cancer is divided into two main categories – what has been written for people with cancer; and what has been written for doctors, nurses or other healthcare professionals.

In the former, the medical and scientific jargon will have been translated into plain English and (hopefully) it will have been written with consideration of your feelings. In contrast, the latter information will have been written for those with an understanding of science who only need to know the facts – and is likely to be very blunt.

It is important now that you do not become overwhelmed with information and, even more essential, that you do not become overly depressed by what you read. Your approach will therefore depend on your personality, and how much information you can take and in what form. A helpful source of information on cancer for those who have cancer is CancerBACUP. As well as a full range of informative leaflets about every type of cancer, they also have a nurse ‘phone-in’ service to answer your specific questions about your situation. For medical and scientific information, there is the Internet and medical libraries. However, people often complain that the Internet can lead to information overload, and that the information gleaned from medical libraries is often non-user friendly.

Other sources of information are the big cancer-research institutes such as:

• Cancer Research UK

• National Cancer Institute USA

• The American Cancer Society

• The Royal Marsden Hospital, London

• Memorial Sloane-Kettering Cancer Hospital, New York

• University of Texas MD Anderson Cancer Center, Houston.

Going to the Frontier with the Internet

Useful websites for more information about orthodox cancer medicine include:

www.cancerbacup.org.uk: The best UK information site on all aspects of cancer with good links to other sites

www.cancer.gov: The largest cancer website in the world, belonging to the US National Cancer Institute in Washington

www.oncolink.org: The excellent site of the University of Pennsylvania Cancer Center with good links to other US sites

www.oncology.com: The website of the American Society of Clinical Oncology, where treatment protocols and drugs are well explained

www.cancerhelp.org.uk: Smaller, manageable site from the University of Birmingham

www.cancerresearchuk.org.uk: Britain’s cancer research charities site

www.macmillan.org.uk: Site of the Macmillan Fund, with useful contacts especially for support groups and palliative care

www.cancereurope.com: The European School of Oncology site, with good links to other cancer sites in the EU.

Look in Chapter 4 for more cancer-treatment information, and in Part 2 of this Directory for useful websites and contact details of those offering helpful cancer information.

If you would like to speak to a doctor in more detail about your cancer, you may be able to get help from the pathology department of the hospital that diagnosed your tissue samples. Pathology departments have doctors called ‘pathologists’, whose job it is to understand the course that specific diseases tend to follow. Because pathologists do not see many patients, they usually have quite a lot of patience. You may find that one of these doctors is willing to come to the phone, if you ring the pathology department, and tell you in detail about the nature of your tumour and its likely behaviour in the future. Of course, it is possible that all this information will simply raise more questions than it answers, so it is perfectly appropriate that, having gathered your information, you go back to your consultant and/or GP to ask your next round of questions.

If you would like a broader integrated medicine perspective, this may also be the time to seek the advice and help of an integrated medicine doctor (see the Resources Directory).

Knowing when to stop

It is important to know when to stop with this process of seeking information about your cancer so that you do not become overly preoccupied with reading more and more about your condition. As soon as you feel satisfied that you have a reasonable grasp of the situation, it is time to move on to making your treatment decisions.

Understanding the medical approach to cancer

Once you know about your cancer and have assessed your situation and the level of risk, you can consider the treatment options.

Generally speaking, the aim of cancer doctors is to attempt to remove the primary tumour before it has spread, then to destroy any stray cells around the site of the primary with radiotherapy, or more distantly spread cells with chemotherapy. With blood cancers, attempts are made to destroy the cancer cells in the blood with chemotherapy and then to remove the abnormal parent cancer cells from the bone marrow, replacing them with healthy cells. This involves bone marrow grafts, which use healthy new marrow from a donor after the patient’s unhealthy bone marrow is destroyed.

Nowadays, cancer treatments tend to be more aggressive, offering the whole gamut of surgery, radiotherapy and chemotherapy right from the start of the treatment process. In the 1970s and 1980s, it was more usual to treat the primary tumour only, saving radio-and chemotherapy for recurrences. However, the thinking these days is that it is better to go for complete eradication or cure from the outset rather than allowing the cancer to become established in the body.

Because doctors want to ‘nip cancer in the bud’ as soon as it has been diagnosed, there is often an enormous sense of rush and panic at the time of diagnosis. And being on the receiving end of this can be traumatic. While you are still reeling from the news and going through an emotional reaction, those around you are busy trying to get on with starting your treatment. So again, it should be stressed how important it is that you slow them down until you have made the right choice for you and are ready to undergo your well-considered treatment.

On occasions, you may be advised to have chemotherapy first to shrink and contain the primary tumour before attempting to remove it surgically. Sometimes, the primary or secondary tumours may be deemed inoperable – in which case, the treatment offered is usually chemotherapy. If the tumour is widespread throughout the body, the treatment given may be palliative – intended to deal with the symptoms rather than cure the disease. This usually amounts to shrinking the tumour with radio-or chemotherapy to buy vital time for you to get your own integrated health creation programme together.

When thinking about treatment, the following are the questions you need to ask:

• What treatments are suggested for my cancer and why?

• What are the chances of the tumour being cured?

• What are the side-effects of treatment in the short and long term?

• What are the risks of treatment?

• Do I trust my cancer consultant or do I need to seek a second opinion?

• Is my hospital able to give me access to the most up-to-date treatment for my type of cancer, or should I be looking further afield?

• Which are the centres of excellence for my particular kind of cancer nationally and internationally?

• Are there treatment research trials going on for my kind of cancer and, if so, would I like to be entered into one of those trials?

• Do I want to go straight into medical treatment of my cancer or do I need time to prepare myself mentally, physically and practically first?

• If the results with conventional medical treatment are not likely to be good, do I want to keep medical treatment on hold as an option while I work entirely on improving my health with alternative cancer treatments and holistic health promotion?

• If I wish to defer treatment while trying to work with natural methods, am I sure that I am not putting myself at undue risk in doing so?

• You may also wish to ask: If the tumour cannot be cured, what is the likely progression of the disease and my life expectancy?

Specialists who look after people with cancer

There are four different types of specialists who look after people with cancer:

• surgeons, who are usually the first to be consulted if there are primary or secondary tumours that are removable (but who are not necessarily cancer specialists)

• medical oncologists, who specialize in the treatment of cancer with chemotherapy and/or radiotherapy

• palliative care physicians, whose role is to help manage your symptoms, and arrange for your support and care

• anaesthetists, who can offer specialist help if there is a problem with severe, ongoing pain.

It varies from place to place whether you see an oncologist or surgeon first, but it is wise to make sure you do see an oncologist at some point because they are specialists in cancer and its treatment. Ask your GP whether there are any other relevant specialists who may be able to help you.

Getting more details

When your specialists tell you about your treatment options, it is important to establish the details of the proposed treatment so that you can make an informed decision.

As you focus on a particular treatment as the most likely one for you, make sure to ask the following questions:

• What will the treatment involve?

• When and where will it take place?

• Who will be responsible for my treatment?

• How long will it continue for?

• How will it make me feel?

• How long should I take off work for treatment and convalescence afterwards?

• What side-effects can it cause?

• How long will it take me to get over these side-effects?

• Will these side-effects be permanent or temporary?

• What are the benefits of the treatment in terms of prolonged survival, symptom improvement or disease-free interval (the time you can expect to enjoy with no problems from the cancer)?

• Are there any extra (adjuvant) treatments that might further improve my well-being or chances of survival while having this treatment?

• Does the doctor see any problem with my taking vitamin/mineral supplements alongside the treatment (making sure his or her opinion is a well-informed one)?

• Does the doctor know of any promising ‘medical frontier’ treatments or trials that might offer a better chance of prolonged survival than the treatment I am being offered and, if so, where are these treatments available and at what cost?

Once you are in possession of this information, you will be able to decide whether the side-effects (temporary and permanent) of the treatment outweigh the possible benefits you may receive in terms of symptom improvement and life expectation.

You may find this in-depth questioning of your doctors too difficult to go through. Some people do not want to know exactly where cancer is in their bodies if it is not causing problems nor do they want to pin their doctors down to telling them the exact facts about the effectiveness of the treatments being offered, as this may inhibit their being able to put 100 per cent of their faith in the treatment.

However, I would strongly recommend that, at the very least, you get a clear diagnosis of the primary tumour so that you are certain that you do have cancer, and get some indication of how serious your situation may be. In this way, you can make an informed decision about whether to go ahead with conventional treatment or not with an assessment of the risks involved if you do not feel able to undergo medical treatment.

Thinking about Timing

Next, think about the timing of your treatment. Ask yourself:

• Do I want to go straight into medical treatment for my cancer, or do I need a little time to prepare myself mentally, physically and practically first?

Take the time you need to get yourself in the right frame of mind for treatment. Preparing properly for treatment is covered in detail in Chapter 7.

Understanding the treatment offered

Before you commit to a particular treatment, be sure you understand both the benefits and side-effects that you may experience.

Quite often, because people are so anxious about what the treatment will do in the short term, they do not really hear or take on board what is being said about long-term side-effects. For example, a woman asking about chemotherapy treatment may be thinking about its effects on her hair, nails and energy levels, and whether she will be able to work and look after her children. She may completely miss the fact that, in the longer term, the chemo could cause infertility, depression or nerve damage.

While thinking about the possibility that tamoxifen treatment for breast cancer may cause weight gain, a woman may miss the point that it also carries a 5–10 per cent risk of causing endometrial cancer. Clearly, doctors and other healthcare professionals do not like to dwell on the downsides of treatment but, as mentioned earlier, it is better to be aware of and prepared for the worst-case scenario than having it sprung on you at a later date, facing you with a new set of losses and fears. It may be worthwhile having two separate discussions with your doctors or nurses – one about the short-term effects of the treatment and a blow-by-blow account of receiving the treatment; and another about the possible or likely long-term side-effects of the treatment.

A useful source of information about drug treatments is the drug information centre found in most big hospitals. This is usually staffed by helpful pharmacists, who will take the time to answer your questions or send you printed material about the medicines you are being offered. Pharmacists are far more knowledgeable about drugs and treatments than doctors and other healthcare professionals, and will have detailed information sheets and research data for each medicine being offered at their fingertips. If you do not have access to a big hospital, you can still speak to the pharmacist responsible for the oncology ward who will often be only too pleased to share his or her knowledge and experience with you.

Learning more about the proposed treatment

Make sure that you are asking the right person about the nature of the treatment – the consultant or nurses involved with each aspect of your treatment – and about any relevant details, be it surgery, chemotherapy, radiotherapy or hormone therapy (or any other forms of treatment on offer).

It is then wise to ask yourself if you are satisfied with the information that you have been given, or do you feel the need to seek a second opinion?

Reviewing Your Options

When reviewing your options for treatment and before you make your treatment decision, make sure you have collected together all the relevant information by going through the checklist below.

• Options on offer at the hospital in your area

• Range of options on offer at the leading centre of excellence for your particular cancer

• Options that might be available in other parts of the world

• Research trial alternatives

• Alternative cancer medicine choices

• Your integrated medicine complementary and self-help options.

Hopefully, all this information has given you clear guidance on how to find what options are available at your hospital, including getting the opinions of the different specialists mentioned, where appropriate.

If you would like an opinion from a centre of excellence, you need a referral from your GP or consultant. In the UK, it is usually possible to get such an opinion on the NHS if it is clear that the services offered by such a centre are more comprehensive than what is available in your own area. If you have health insurance, check first that your policy covers you for second or third opinions. Treatments in another country are unlikely to be covered by your health insurance, and you should check costs carefully before embarking on this route.

Sometimes, doctors in foreign medical centres are prepared to give an initial opinion of what they can offer you on the strength of letters from your consultants, and having seen your X-rays and/or scans. Because of major advances in digital technology, it is now also possible to send scans to distant locations via e-mail (not to mention by post or courier).

This form of consultation, while lacking the personal touch, can save costly and exhausting trips abroad unless there is likely to be a significant benefit.

How far you wish to go with this process of getting a ‘world picture’ is entirely up to you. For some, this may feel like far too great a burden whereas, for others, it will be a source of great comfort to know that no stone has been left unturned.

Reviewing your alternative cancer treatment options is covered in Chapter 5. A great number of alternative cancer remedies are on offer around the world, with variable levels of information as to their effectiveness. In Chapter 5, you will find:

• basic information on how to use the most well-known alternative cancer medicines

• the approximate cost of their use

• the current level of scientific information about them

• whether you can self-administer them or not (i.e. are they available for sale, by prescription only or clinic-based?).

Reviewing what the complementary medicine and self-help approaches have to offer is the subject of Chapters 7 and 8.

Making Treatment Decisions and Creating an Integrated Medicine Plan

Chapters 4 and 5 will tell you about the treatment choices that are available, and Chapter 6 offers a checklist to go through to make sure you are ready to make your final decision. Chapters 7 and 8 will help you to prepare for your treatment and find the relevant, effective complementary supportive care during treatment.

Once you are clear as to the choices you wish to make, it is wise to draw up your plan of action so that you remain crystal-clear about what you are going to do, how you are going to do it and with what support. If you need help in doing this, or a short cut, then seek specific guidance from an integrated medicine doctor (see the Resources Directory) to devise a medically supervised programme that is tailor-made for you and your needs.

If you choose to receive neither orthodox nor alternative medicine, you should proceed straight to Chapter 9 on the long-term health creation approach to recovery.

Meanwhile, if you are looking for creative solutions to help with troublesome symptoms, they can be found in Chapter 8.

CHAPTER 4 The medical frontier: getting the best orthodox treatment
The oncologist’s perspective by Professor Karol Sikora with cancer nurse Patricia Peat

This chapter covers the current best practices available at the most advanced treatment centres, giving you a benchmark against which to measure the treatment you are being offered locally. This information will enable you to check worldwide for the very best resources and treatments available for your individual situation. Advice will be given on how to obtain second and third opinions as and when necessary.

In the last 20 years, there have been dramatic strides in our understanding of what cancer is and how best to treat it. Some cancers that were almost uniformly fatal in the past, such as Hodgkin’s disease and testicular cancer, are now mostly curable, thanks to chemotherapy. We are more open about the diagnosis of cancer in society and there is much media interest in cancer stories – good and bad. We are also living longer, which means that, as cancer is more common in older people (due to the declining effectiveness of the immune system, and longer exposure to poor dietary habits and environmental pollutants), the incidence of the disease is increasing.

Above all, we have managed to break some of the taboos that surround cancer so that the diagnosis is now usually acknowledged between doctor and patient, family and friends. This new frankness means that the need for information has never been greater.

Consumerism is hitting healthcare in a big way and, if used correctly, can change for better the way in which we obtain care. But, to avoid tilting at windmills, it is essential that you arm yourself with facts. To this end, we offer you here an unbiased guide to the world of cancer and its treatment to help you find the combination of orthodox and complementary medicine that will provide you with the best springboard to deal with your situation.

Nevertheless, on a cautionary note, please remember that with all forms of research the end results cannot be guaranteed. So, some of the areas being currently researched or developed and included in this chapter may not ultimately become available treatments. To confirm what really is available now, the major cancer information services listed in the Resources Directory (pages 257–63) can give you up-to-date information on all orthodox treatments, surgical procedures and clinical-trial availability to help you assess the potential effectiveness of any treatments you have been offered.

But first, let us go back to the beginning of the story and think more about the nature of cancer so that the modes of treatment can be better understood.

What Is Cancer?
The cancer cell

To understand cancer, we need to think about the construction of the body. About one thousand billion cells are needed to make a person. Each cell carries information on how to function from the time it is developed till the time it is supposed to die. Depending on where it is situated in the body, the cells of different tissues are specialized to have different functions. A muscle cell has tiny molecular ropes that allow it to contract, so pulling other structures to cause a movement. A skin cell has a tough waterproof coat to protect us from the environment, while a liver cell is a chemical refinery that is continuously clearing the blood of potential poisons.

All organisms, including man, grow from a single cell that splits into two in a process called ‘mitosis’. In health, the two new cells are identical to the one they came from. These two daughter cells then divide to form four cells, then eight, and so on. In most people, the cells work in perfect harmony, but sometimes they go wrong. If a cell dies, then one of its many identical kin takes over its job.

But if a cell starts to grow and divide in an abnormal way, problems may arise. The information carried in the cell’s DNA, the thread of life, becomes altered, forming an abnormal cell with abnormal growth patterns. This is called ‘malignant transformation’ and is the first change towards cancer. The abnormal cell continues to grow, but does not mature properly, and has characteristics that differ from its healthy parent cell. As this cell reproduces, over time, each new generation of cells becomes a little less like the cell it originated from and, thus, less effective at performing its designated tasks. Cancer cells can develop because the DNA in the cell nucleus has been damaged by either radiation, chemical toxins or viral infection. This is more likely to happen in tissues that are inflamed and poorly nourished due to a low blood and oxygen supply.

Characteristics that distinguish a normal cell from a cancer cell
Cell Recognition

A normal cell recognizes its borders. It sees other cells next to it, but knows it is not supposed to invade and spread into their territory. A cancer cell lacks this information and will invade the surrounding tissues.

Immune Attack

In health, when a cell becomes abnormal due to infection or cancer, the immune system recognizes its abnormality and destroys it. When cancer develops, the ability of immune cells to recognize the abnormality is lost, thereby allowing the abnormal cells to carry on growing unchecked.

Staying in Place

A normal cell knows where it should be, and stays there until it dies, when another cell takes its place. It does this by sticking to the cells surrounding it. A cancer cell loses this ‘stickiness’ and breaks away from its surroundings to be transported via various body systems to other organs, where it takes up residence and starts to divide and grow into a new tumour. This is known as ‘metastatic spread’, or the development of a secondary cancer.

Metastatic spread

With different types of cancer, there are differences in how quickly metastatic spread can take place. But it also depends on the individual who has it (more about this later).

There are two types of tumour – benign or malignant. Benign tumours are usually localized and do not spread. They are often enclosed in a clear capsule – a rim of normal tissue – which demarcates the limits of the abnormal cells. These tumours may be detected because, as they grow, they press on other structures in the body such as blood vessels or the intestines. In contrast, malignant tumours are virtually never encapsulated, but erode adjacent tissues by extending crab-like infiltrations in the body in all directions.

Most cancers do not spread completely haphazardly – certain tumours have favoured sites of metastases. Prostate cancer, for example, tends to spread to the bones, often the spine or pelvis. Breast cancer usually goes first to the lymph nodes, but then favours the liver, bones and lungs. Colon cancer spreads first to the liver, following the blood flow from the colon to the liver.

Cancer cells produce chemical factors that enable them to grow as a group, and we are only just beginning to understand the growth factors involved in sustaining cancer cell growth. In future, we may be able to devise anti-cancer drugs that can block these growth factors.

Classifying cancer

Cancer can strike any organ of the body, each with its own pattern of behaviour. There are currently 208 classifiable sites at which cancers arise, and many of these are broken down into further subtypes. This reflects the many different cell types that make up the human body, many of which can grow out of control.

Tumours are named according to the site at which they originate, not by the organs they spread to. For example, a patient with breast cancer that has spread through the bloodstream to the liver is said to have metastatic breast cancer. If it then spreads to the bone, it is still breast cancer, but metastasized to bone. On the other hand, it is possible to have a primary bone or liver cancer, which has arisen in these tissues and metastasized elsewhere. This may cause confusion because of poor communication in rushed clinics.

Tumours are also named to reflect the type of structure from which they have come. A carcinoma, for example, comes from cells lining body cavities called ‘epithelial cells’. Such cells are found in the lungs, colon, breast and prostate gland. Carcinomas are by far the most common type of cancer. Tumours derived from the body’s structural tissues, muscles, tendons, bones and cartilage are called ‘sarcomas’. Those arising from the lymphatic system are called ‘lymphomas’, and cancers of the white blood cells and bone marrow are known as ‘leukaemias’.

If you ever hear any terms used to refer to your particular cancer which you do not understand, ask for an explanation. Cancer classification is complicated, and there are often several words that mean much the same thing. If you don’t understand a term, don’t go away feeling too embarrassed to ask what it means – check it out and save yourself unnecessary stress.

Diagnosing Cancer
How is a cancer diagnosis usually made?

The only way to diagnose cancer definitively is to test a sample of abnormal cells from the site of the tumour. The usual way of doing this is to obtain a biopsy, or a small tissue sample, under either a local or general anaesthetic, depending on the site of the tumour.

Cancer has no specific symptoms – it depends on where the tumour is, how big it is, which structure it is invading and whether it has spread to other parts of the body. A patient with lung cancer, for example, may have a cough with or without blood or phlegm, or a persistent chest infection that does not respond to antibiotics. The usual symptom of breast cancer is a lump in the breast, although it may well have spread by the time it can be detected this way. If it has spread, then its symptoms will depend on the site of the metastases – in the lungs, it may mimic a lung tumour; in the liver, a liver tumour, and so on.

Because cancer produces so many different types of symptoms which can be mistaken for minor illnesses, there may be a period of several weeks with repeated visits to the GP before the symptoms are taken seriously. The best rule of thumb is that any progressing symptom that does not disappear after two to four weeks should be further investigated. Usually, this involves being referred to a hospital where the investigations can be done rapidly.

If cancer is suspected, there are two important requirements: to do a biopsy to find out exactly what type of cells have gone wrong and, therefore, how best to treat them; and to ‘stage’ the disease to find out how far the disease has spread as this, too, dramatically affects not only the optimal treatment, but also the likely outcome.

The tests to determine the site and stage of the cancer include:

• Biopsy, to study a piece of tissue thought to be cancerous – the definitive way to make the diagnosis

• Blood tests, to check for anaemia, bone-marrow function, liver and kidney function, and search for tumour markers – substances produced by cancer cells and detectable in the blood, thereby alerting doctors to the presence or spread of cancer

• Plain X-rays, to provide information about various parts of the body

• Contrast X-rays, injecting or ingesting a radiopaque substance to increase what can be seen on the X-ray

• CT (computed tomography) scans, to provide detailed information about the structure of various internal organs

• MRI (magnetic resonance imaging), a powerful imaging technique based on magnetic field shifts in the body

• Bone and liver scans, to show areas of dysfunction in the bone and the liver that may be due to the spread of a cancer.

Staging

Determining how far a cancer has spread is a critical starting point before deciding on treatment. There are several systems available and this often causes confusion, even among doctors.

One of the most commonly used staging systems is the TNM system, developed by a committee of the International Union Against Cancer. Here, the letter T stands for ‘tumour’, with T₁ referring to a small tumour and T₄ referring to a very large one.

The N stands for ‘nodes’, the lymph nodes draining the organ in which the tumour is found. Enlarged nodes containing growing tumours are classified as N₁ or N₂ depending on their site and number.

The M stands for ‘metastasis’ (spread) and is either present (M₁) or absent (M₀).

Other staging systems are often simpler. Early-stage disease may be called stage 1 whereas late-stage disease, or more advanced cancer, is then stage 4. Different criteria may be used for cancer at different sites of the body, so ask your consultant to explain exactly what the staging means for your type of cancer. A person with disease that has not spread is likely to have a better outcome than a patient whose disease has already left its primary site. This is because a localized tumour is more likely to be cured or removed altogether by either surgery or radiotherapy.

Grading

The grade of a cancer, determined by the pathologist by looking at the cancer cells through a microscope, is also useful in predicting the outcome of a cancer. A high-grade tumour contains very abnormal cells, which have mutated greatly, grown rapidly and often spread throughout the body. This is also referred to as ‘poorly differentiated’. At the other end of the spectrum are low-grade tumours, which can look similar to the tissue from which they have been derived and are referred to as ‘well differentiated’. Such tumours grow more slowly and are less likely to spread quickly. The outlook is usually better for low-grade tumours, but there is a paradox. High-grade aggressive tumours are often more sensitive to chemotherapy as the chemicals work best against the most rapidly dividing cells in the body. Unfortunately though, rapidly growing cells can continue to evolve and can become resistant to specific drugs rather rapidly, too.

It is also possible to have varying opinions as to the grade of a tumour among pathologists. So, if you are in any doubt, or the pathology seems uncertain, ask for a second opinion from another pathologist.

Secondary cancer

Cancer that develops in the body away from the site of the original tumour is called a ‘secondary cancer’ or a metastasis. These may be found at the time of diagnosis or they may develop later on. If secondaries appear, it can often be a more severe blow than the original diagnosis.

Cancer can spread around the body by:

• invading local tissues

• entering the lymphatic system and lymph nodes

• entering the bloodstream and travelling to distant sites

• direct infiltration of a neighbouring organ.

Some cancers have a predictable route of spread and favour certain organs for secondaries whereas others are more unpredictable.

Assessing your situation

Working out the chances of your treatment being successful is difficult because the response to treatment varies considerably from one person to another. However, the three essentials that guide your outcome are the:

• primary site of the tumour

• stage of the tumour

• grade of the tumour.

Another important piece of information is how you respond to treatment. There are four types of response and you will hear the following terms being used:

• A ‘complete response’ is where the tumour has disappeared completely

• A ‘partial response’ is where it has shrunk to half its size, as visualized by X-rays or some other quantifiable measure

• ‘Stable disease’ means that the disease is not growing

• ‘Progressive disease’ means that growth is continuing despite treatment.

Following surgery, if the primary tumour has been completely removed, then technically the patient has had a complete response. With chemotherapy, it is vital to assess response early on in the course of treatment to make sure there will be benefit and that it is worthwhile to continue the treatment.

Choosing Your Cancer Treatment
Cancer statistics

The best way to assess the cure rate for a particular type of cancer is to look at survival curves compared with those who do not have cancer. If 100 patients with lung cancer are treated and we look at their survival curve, it will be clear that they do less well than those of the same age without lung cancer. The definition of ‘cure’ means that the survival rate of a treated group of patients is the same as those of similar age and gender who did not have cancer.

Getting information about your cancer

As already discussed in previous chapters, people with cancer vary greatly in the amount of information they wish to receive about their illness. Most doctors have come to respect their patients’ preferences, and most cancer specialists try to answer questions as honestly as they can. Because people differ greatly in their needs, the oncology team will generally be tentative as to how much information to impart to you until they get to know you, and what your needs and preferences are. This is to avoid giving information to those who don’t want it.

You therefore need to make sure that you let them know exactly how much you want to know, and initiate discussions about any aspects they may not be covering. The team will take their cues from you. As you encourage good communication, you will find they will do their best to meet your needs. This is not easy at a stressful time, so having somebody with you and a list of questions you need to have answered will be helpful.

To get the information you want, you have to know what to ask. This is a major problem especially at a time when you are feeling emotionally vulnerable. Many people are unfamiliar with the workings of a car, but are quite happy to nod wisely while the mechanic explains in technical terms what is wrong. But with cancer, you cannot just do that. Having a reasonable understanding of your options makes good sense, and getting information often requires tenacity and persistence. Some doctors and clinics just won’t seem to tell you anything – partly because there is often never enough time. Giving information takes time, especially if it is a genuine dialogue between the doctor and patient. However, it is your life we are talking about, so arming yourself with information is an important way to empower yourself and get yourself back in control.

Living as we do in a consumer age, you have a right to expect high-quality information that allows you to explore different avenues. So, to get to grips with your situation, see the Resources Directory for recommended websites, and other resources for the information you need to guide you to integrated medicine doctors who can help you review your options.

Alternatively, use the Cancer Options team (see the Resources Directory) and have specialist cancer nurses do the research for you, break down the information into clear, readable formats and provide background explanations to the treatments. They can also advise you on how to discuss the treatments with your doctors, how to go about getting a second opinion and how to get into clinical trials. They can then provide you with a report and work through it with you until you feel happy and confident that you have received all the information you need to decide on your best treatment plan.

Another useful method is networking. People diagnosed with cancer often feel they are alone. Yet, once they start discussing their situation with others, they are often surprised to find how many other people known to them or their families are also dealing with cancer. So, find out from them where they are getting their information. They may be using the Internet or specific cancer charities and support groups. However, it is always worth remembering that everyone’s cancer is unique to some degree, and treatments and progress cannot be compared specifically.

Chapter 5 on alternative cancer medicines will provide access to further information with which to arm yourself as you make your treatment choices.

A cancer question checklist

Comprehensive lists of questions to ask your doctors are given in Chapter 3 and cover:

• your cancer

• your treatment options

• the nature of your treatment once you have chosen.

Nowadays, most cancer doctors tend to avoid giving estimates of survival time as individuals are very different, and there is a risk that a time given by ‘the voice of authority’ may become a self-fulfilling prophecy. Rather than having a timescale ticking away in the background, focusing on your recovery is essential.

Getting a second opinion

Doctors often disagree, which may seem surprising, but medicine is still in many ways an art rather than science. There are several ways in which the same result can be achieved, and cancer medicine is no exception. Many large centres have case conferences where individual patients are discussed and treatment options reviewed. There is regular disagreement on even the simplest decisions, such as whether to recommend radiotherapy after an operation or how many doses of chemotherapy should be given. Where doctors don’t yet have the knowledge, clinical trials are set up to try and determine the best way to treat a certain type of cancer. Doctors have to come up with the best treatment plan for each person, with constantly moving goalposts as treatment techniques and drugs are continuously evolving.

Variations in treatments are offered by different NHS doctors, and you may also choose to get your treatment privately. Treatment approaches vary around the world and you may feel you would like to look further afield to:

• check that the treatment being offered to you is considered the best regime available

• establish if any other countries have any new developments or technology not yet available in your country

• look at other treatments to see what fits best into your personal approach and value system.

To find out what other options are available to you, you can:

• explain your preferences to your doctor and ask him to find you other options to be looked into

• use your own resources and information to research what is available and discuss it with your team

• use the UK Cancer Options team to do your research and work through the choices with your doctors.

There are several issues to consider when looking at your options:

• Would you be prepared to have treatment in another part of the country?

• Would you be prepared to have treatment abroad?

• Do you have any financial resources that can be used to increase your options?

No doctor of any standing will be offended if you ask for a second opinion in your own country. We all realize the complexity of modern medicine and that no one is infallible. If you are not happy with what is being proposed, ask for a second opinion. It will save time and money to take all your test results and a letter with your complete medical summary about your condition with you.

You can either leave the choice of who you see for a second opinion to your doctor, or you can use the websites in the Resources Directory or the Cancer Options team to find top specialists for your kind of cancer, then request a referral from your GP to the doctor of your choice.

Taking your time

After researching and gathering the information you need, making your decisions will take time. It may take you a few weeks to gather all the details you need to work out the best treatment plan for you. Unfortunately, this often conflicts with the natural urge and pressure from others to take quick and decisive action, and begin your treatment as soon as possible. Nevertheless, remember that many people have done this and, later on when they have looked around and have a greater understanding of cancer, wished they had taken more time to look at the pros and cons of each treatment option. The fact that you are reading this book shows that you are already taking a careful and measured approach to choosing your treatments.

If you have only just been diagnosed, taking the time to consider the future implications of your treatment and your own personal philosophy of how you want to deal with your cancer, and devising a treatment plan that suits you may be the most valuable time you spend to ensure your longer-term well-being.

However, especially when first diagnosed, you may feel unsure if it will be detrimental for you not to start treatment immediately. It would be worthwhile checking how much time you can take safely with your own doctor or an integrated medicine consultant (see the Resources Directory pages 351–3).

Explain that you wish to consider all the options available and ask them the following questions:

• How aggressive is my tumour and how fast is it growing?

• How long would you estimate my cancer has been there?

• Do you feel it would be detrimental to postpone action for a few weeks while I look at all the options? (If the answer is yes, ask why. What do they think will happen to your cancer during the delay?)

If you are considering treatments that are beyond your doctor’s field of expertise, such as immunotherapy or intravenous metabolic treatment, you may find that some doctors will not consider them a worthy alternative, and will try to influence you into looking only at more conventional treatments. You need to be sure that you are getting a balanced and reasoned opinion. Sadly, it is not unusual for a doctor to write off a treatment approach while having absolutely no knowledge of what it’s about. Conversely, some alternative doctors may be overly dismissive of the value of conventional medical treatment. In this case, arrange to speak to an integrated medicine doctor who is genuinely committed to getting you the very best of both worlds – orthodox and alternative.

Discussing complementary and alternative options

While your doctor may be happy to discuss various orthodox treatments, a frequently different reaction may appear when you bring up the subject of integrating alternative treatments with what he has to offer.

Ideally, your doctor will be receptive and open to what you want to consider. If he has no knowledge of a particular treatment or approach, he should welcome any information you can supply him and study it. He can then consider whether there are any contraindications to using it alongside orthodox treatments, and he can engage in an informed discussion with you about formulating a treatment plan which best meets all of your needs.

However, this scenario is not typical of what happens to the majority of people who try to discuss integrating their cancer treatments with their doctors. You may encounter a number of reactions, ranging from dismissal to an outright declaration that what you are considering is rubbish and a waste of money. So, you need to be prepared with the right attitude to achieve the best possible working relationship on this matter.

Attend the appointment armed with as much information and research evidence about the treatments you are considering as possible. If your doctor dismisses the treatments out of hand, ask him:

• How much does he actually know about the treatment?

• On what evidence is he basing his opinion?

If your doctor has little knowledge of the treatment, offer him the information so that he can give you an informed opinion. If he offers you a sound reason why he considers your proposed treatments unsuitable for you, or has reason to doubt the reliability of the treatment or practitioner, that may be information you need to know. If, however, your doctor displays pure prejudice, then you have to consider whether this particular doctor is going to be the best person for you to work with.

The words ‘working with’ are key here. If you feel you are unlikely to develop a partnership with your doctor without feeling compromised, then you might want to think about changing to a team that will better fit your needs. Though this may seem drastic and difficult to consider when feeling under pressure, bear in mind how important it is that, in the long term, you are involved in your own decision-making process, that your opinion is listened to and that you are ‘choosing your treatment’, not being ‘given it’.

In summary, when diagnosed with cancer and evaluating treatment options:

• Get the facts about your illness

• Make a list of questions you want answered (see Chapter 3)

• Ask to see the consultant (rather than the juniors) responsible for your care

• Do not be afraid to ask anything, but let your team know how much you want to know

• Insist on being told the truth

• Make sure you know what alternative and complementary approaches are available

• Take a relative or close friend with you to make notes (or take a cassette recorder, although this might be intimidating for medical staff and often means that their answers will be far more guarded)

• Discuss any queries with your GP

• If you are not happy about any aspect of your care, tell your doctors or the cancer services manager of the unit where you are being treated

• Talk to nurses, radiographers and pharmacists, who are often useful sources of information and have more time to explain things that you may not have understood in the short time spent with the doctor

• If you are unsure about what to do, ask to see the consultant again or seek a second or third opinion

• Take steps to prepare and support yourself and your immune system throughout your treatment programme (see Chapter 7).

Current Medical Treatments

The main treatments used currently for cancer are:

• surgery

• radiotherapy

• chemotherapy

• hormone therapy.

Surgery

Often, the first step in cancer treatment is surgery. The aim of cancer surgery is to remove the whole tumour, leaving behind as much of the normal tissue as possible. The tumour must be removed in its entirety for the operation to be a success and the pathology department must find that there are clear margins of healthy tissue around the entire tumour. If not, then further surgery will usually be recommended.

You may have heard that operating on a tumour can encourage it to spread. That is a consideration your surgeon will take into account, and great care will be taken to minimize the risk of spread during surgery. If your surgeon thinks this might have occurred, he may well recommend that you have follow-up systemic treatment, such as chemotherapy, to take care of it.

Both orthodox and integrated cancer doctors agree that the risk of cancer spreading during surgery is far outweighed by the risk of leaving the tumour to continue to grow, metastasize and cause further problems. New evidence also shows that existing tumours secrete proteins that can facilitate secondary growth in other organs. So, the removal of all possible cancer from the body is vital.

Success with cancer surgery comes from knowing exactly how much tissue needs to be removed, so an accurate assessment of tumour size and shape is essential before deciding on the type of operation for your particular type of cancer.

Cancer Surgery: The Key Issues

• Find out what sort of operation is being proposed.

• Establish how experienced and skilled at this type of surgery your surgeon is.

• Find out if there are any new developments in surgery for that operation.

• Find out how long you will need to be in hospital and need to take off work afterwards.

• If you are having surgery done privately, make sure you know all the costs involved.

• If you have health insurance, make sure in advance that all the fees will be covered.

• Do not sign the consent form to surgery unless you fully understand what is being proposed and the potential long-term side-effects.

• Make sure you are prepared physically, psychologically and practically before you undergo the operation (see Chapter 7).

If you are told your tumour is inoperable, you should certainly consider getting a second or even a third opinion. There may be a great variance in opinion, depending on the particular surgeon’s skill and experience, and certain hospitals specialize in certain types of cancer. You may find a surgeon who is specialized in your particular type of cancer and is highly skilled in removing difficult tumours. For example, some neurologists will operate to remove bony secondary tumours from the spine and reconstruct the vertebra using a titanium prosthesis whereas, in other places, only radiotherapy is on offer. Your scans and X-rays can also be sent to specialists in other countries for their opinion of the possible surgical help for more complex tumours.

Following Surgery

If your tumour has been completely removed and no spreading to other tissues is detected, you may not need follow-up treatment. However, you will usually be offered either or both radiotherapy and chemotherapy, as well as hormone therapy if your tumour is hormone-dependent.

Radiotherapy

Radiotherapy uses ionizing radiation in the form of X-rays to treat cancer. Wilhem Roentgen discovered X-rays in 1895. Within a year, they were being used in the treatment of cancer. We have come a long way since then, and radiotherapy for cancer treatment is now incredibly sophisticated. Often, radiotherapy is given to effect a complete cure – called radical radiotherapy. Alternatively, it can be used after surgery to ‘mop up’ any stray cancer cells persisting around the operation site. Another important use of radiotherapy is for symptom control in palliative care.

Types of Radiotherapy

The most common type of radiotherapy is the use of an external radiation source produced by a linear accelerator, a large machine that delivers a precise dose of radiation to a particular site of the body. An alternative form uses internal radiation, where a radioactive source – such as radioactive needles or ‘seeds’ – is temporarily placed in the part of the body affected by tumour, such as the womb or prostate gland.

Different types of X-rays are used as each has a different level of penetration. Laboratory evidence tells us that radiotherapy works by damaging DNA in the nucleus of rapidly dividing cells. The DNA molecule has a particular sequence, creating a vital code for proteins that have important functions both inside and outside the cell. Radiation breaks the ‘backbone’ of the DNA molecule so that, when the strands join back together, the coding sequence is altered, resulting in the cell’s death. It only affects cells that are reproducing, which is why radiotherapy is given in multiple doses – to catch the cells at different phases of their growth cycle.

Radiotherapy damages cancer cells whereas normal tissue is usually able to repair itself. We have learned how to exploit this difference, and establish a balance between destroying cancer cells while causing minimal damage to normal tissues. Also, the delivery systems for radiation are now so precise that it is almost possible to irradiate only the tumour. However, if the individual survives for some time after radiotherapy, it is possible for a new, different second cancer to arise as a result of the radiotherapy treatment.

The Radiotherapy Process

A consultant radiotherapist will be in charge of your radiotherapy treatment and will help with decision-making. So, discuss any problems or questions you have with him. When receiving radiotherapy, the radiographers who deliver the treatment will see you on a daily basis. They are an excellent source of information and can often be far more helpful than the consultant. Despite a lot of adverse publicity, radiotherapy is a remarkably safe form of treatment. There are clear guidelines for the calibration of the machines, and it is a legal requirement that the machines be frequently checked.

Having decided on radiotherapy, the next part of the process is the planning. This is usually done on a machine called a ‘simulator’, which simulates your treatment on the X-ray therapy machine to set up the exact position of the intended treatment. The area to be treated is marked on your skin with an indelible pen so that the markings last throughout the treatment period. However, if the areas are complicated or where marks are unsightly or less likely to stay put, a perspex shell can be contoured to fit your body precisely and act as a marker. This shell can also prevent even the slightest movement during treatment so that the X-ray beam only strikes those tissues it is supposed to hit. If intended for the head, holes are cut out of the shell to leave your eyes, nose and mouth uncovered.

As no two individuals are the same, do not be alarmed if you compare notes with others and find that your radiotherapy is different from theirs. There are all sorts of reasons for this. If you are at all worried, question the radiographers during one of your visits or ask to see the consultant oncologist who has planned your treatment.

Different centres may use different machines, with larger centres having a wider choice for more specialized treatments. But it may be appropriate to be treated at a small centre nearer home to cut down on the hours spent travelling to and from the hospital each day. Once again, a relative-benefit evaluation needs to be done, involving both you and your doctor.

If the most important aspect of treatment is the cosmetic result, then this may necessitate a lengthier treatment using a relatively lower dose to avoid long-term skin damage from the radiation. However, if the final appearance is not of concern and the area being treated is very small, it may be possible to have a shorter course of radiotherapy using a higher dose. Radiotherapy treatment is flexible, and it is important that the patient makes his needs apparent at the outset so that the consultant can tailor the treatment appropriately.

New research by Professor Kedar N. Prasad in the US has shown that, far from potentially diminishing the effectiveness of chemo-and radiotherapy, high-dose vitamin and mineral therapy can potentiate both forms of treatment. This is because the abnormal tumour cells become more vulnerable after having taken up high levels of antioxidants (see Chapter 5).

Side-effects of Radiotherapy

A full description of remedies to reduce the side-effects of radiotherapy are found in Chapter 7.

Fatigue and Nausea

One side-effect that many people experience during their radiotherapy treatment is general fatigue and nausea. This is thought to be due to:

• your body having to work harder as cells are destroyed

• the toxicity of the radiation

• the disruption to your body’s natural energy fields.

So, you should not be at all surprised if you need an extra two or three hours of sleep every day, and spiritual healing to lift your energy and spirits. See Chapter 7 for ways to help your body cope with this treatment with the help of homoeopathic remedies and acupuncture, which releases the stored heat and energy radiotherapy causes.

Nausea may be experienced at the beginning of treatment, but this should gradually improve with time. This may occur especially when a large part of the body is being treated, and is particularly common during radiotherapy to the abdomen, although it may also arise when having treatment to nearby areas.

Skin Burns

With skin cancer, the area being treated is likely to be affected by the radiation, leaving your skin red and sore, rather like sunburn, towards the end of treatment. (Again, for information on helpful radiation cream, see Chapter 7.) Individuals vary in their sensitivity to radiation. The same dose may produce a severe skin reaction in one person and only a mild reaction in another. As a rule, symptoms are worse towards the end of treatment, often reaching a peak after four or five weeks.

Difficulties with Eating and Drinking

If treatment affects your oesophagus or throat, you may find it becomes rather inflamed and sore. This is because radiotherapy initially causes an inflammatory reaction. You may have difficulty swallowing, and find eating and drinking painful. Discuss this with your doctor to try and prevent this as much as possible, as this problem is unpleasant and can make you feel miserable. A nutritional advisor would be helpful at this time for advice on suitable food, drinks and remedies, and also to support you if the going gets tough. Again, see Chapter 7 for any complementary therapies that may help. You may also experience diarrhoea if the bowel is irradiated.

Possible Flare-up of Symptoms

Because the effect of radiotherapy builds up over weeks and because the tissues being irradiated become inflamed, your initial symptoms may temporarily get worse before they get better. For example, if the problem is a bony secondary tumour pressing on a nerve, then, for up to six weeks post-treatment, the pain or nerve impairment may get worse. But as the inflammation subsides, relief will be experienced.

Infertility

Radiotherapy to the reproductive organs may affect your ability to have children. Some effects are transient and return to normal after a while, whereas others are permanent. If you are considering having children in the future, check with your doctor about the possible risks, and find out what steps can be taken to aid fertility in the future. For example, men may wish to have sperm frozen for use later or, for women, egg collection and later IVF (in vitro fertilization) may be considered.

Limitations of Radiotherapy

Tumours are given a dose of radiotherapy that is close to the maximum tolerated by the normal tissues in the area being treated. The risk of damage to normal tissue is the major factor limiting the dose of radiotherapy given. There is also an overall limit to how much radiation can be given to one area or the whole body.

Should the tumour recur, further radiotherapy to the previously treated area may then exceed the normal tissue tolerance, so it is unusual to be able to repeat a course of treatment if there is a recurrence in the same place. Especially sensitive structures include the brain, spinal cord, lungs, liver and bone marrow, and great care is taken not to cause radiation damage in such areas.

It can be very frustrating for someone who responded well to radiotherapy the first time not to be able to have further radiotherapy for a tumour recurrence at the same site.

Radiotherapy, like surgery, is a form of local treatment. So if the tumour has spread beyond the confines of its primary site, radiotherapy cannot be considered a curative treatment.

Palliative Radiotherapy for Symptom Control

Radiotherapy is often used to control symptoms in a palliative setting. In general, palliative care is aimed at improving your comfort and quality of life. Palliative radiotherapy is given in short bursts or sometimes as only a single treatment.

Radiotherapy can be very effective for pain relief, especially of that caused by bone metastases. Studies have shown that single treatments for pain can be as effective for many symptoms as a long drawn-out course requiring many hospital visits. If you are in any doubt as to the usefulness of radiotherapy for your symptoms, ask the oncologist, the radiographers or a palliative care consultant.

Here is a checklist of questions for the radiotherapist:

• What is the treatment being offered?

• When will the treatment be planned?

• How long will this take?

• When will the treatment start?

• How many treatments will I have and how long will each one last?

• Can I drive myself to treatments and, if so, where can I park my car?

• Can I stay in hospital or in a hostel nearby during my treatment period?

• Can I choose the time I will be treated each day?

• Are there any days that I will not be treated?

• What are the immediate side-effects and what should I do about them?

• Will it affect my fertility?

• Is there anything I should avoid, such as sunbathing, swimming or washing?

• When will I next see a doctor?

• What happens when I finish the course of treatment?

• Is there any support available if I am frightened or upset during treatment?

Leading-edge Developments in Radiotherapy Treatments

There are ever-changing and more sophisticated methods of tackling cancer cells with radiotherapy. However, some of the treatments described here have not yet reached the UK.

Intensity Modulated Radiation Therapy

This is precision radiotherapy that targets the tumour with a high dose over less time. Because it is so precise, it reduces radiation exposure to healthy tissues.

In addition to boosting effectiveness, the combination of accuracy and increased dose also cuts treatment time by 90 per cent compared with conventional radiotherapy. This significantly reduces side-effects and improves tolerance of treatment.

Treatment outcomes are expected to be the same as with standard radiotherapy. So far, this has been used on a wide range of tumours, with much better cosmetic effects when used on breast cancer. It is likely to become a standard method in the future.

Its main disadvantage – as with any precise treatment at this time – is that your doctor has to be absolutely certain that he is able to target the entire tumour within the exact treatment field. If this is not possible, your doctor may choose to use a more conventional form of radiotherapy.

Intraoperative Radiotherapy

Intraoperative treatments involve a miniature X-ray source inserted into the body during surgery to administer the radiotherapeutic dose.

This may be used to apply radiotherapy to where the surgeon has just removed a tumour or to a space where a tumour has been removed previously. While this treatment has been around for a while, new developments mean that more precise technology can deliver the radiotherapy to the appropriate tissue without damaging the surrounding areas.

Radiofrequency Ablation

This uses electrical energy to create heat at a specific location up to a specific temperature and for a specific period of time and, ultimately, results in the death of unwanted tissue.

The ablation probe is placed directly into the tumour tissue. The radiofrequency energy flows through electrodes, causing ionic agitation and, therefore, friction in the nearby tissue. This friction creates heat and, once sufficient temperatures have been reached, the heat will kill the target tissue within a matter of minutes.

This procedure can be used for liver tumours:

• by putting an electrode through the skin and using an ultrasound, CT or MRI scanner to guide the needle to the tumour

• during open abdominal surgery, when the specialist has direct access to the liver

• during a laparoscopic or ‘keyhole’ surgical technique.

Heat is a very effective means of killing cancer tissue. As tissue temperatures rise above 113°F (50°C), protein is permanently damaged and cell membranes fuse. The process is rapid, typically requiring less than 10–15 minutes of exposure for a 3-cm tumour. This can be done without causing too much damage to surrounding tissues. There are some specialists in the UK who use this procedure, but it is only useful for tumours that are 5 cm or less in size.

Effects are similar to that of a microwave, where heat is generated from the inside out. Destroyed cells are reabsorbed by the body over time.

Therasphere

This is a system whereby millions of microscopic glass beads embedded with a radioactive element are delivered directly into the blood vessels feeding a tumour.

It is currently used for tumours in the liver – both primary and secondary. The tiny beads (one-third the diameter of a human hair) are passed through a catheter placed in the femoral artery (in the thigh). They are then guided via the hepatic artery (the main blood vessel in the liver) to the blood vessel supplying the tumour. The beads remain in the body and lose their radiation within two weeks.

Patients can return home the same day, and there is no risk to family members. Possible side-effects include vomiting, mild fever, abdominal pain and gastric ulcers but, so far, the main complaints have been fatigue and nausea.

Clinical trials in many different countries so far show that patients are living twice as long with this treatment – and with good quality of life. It has also been successfully combined with chemotherapy. There have even been one or two recorded incidences where a liver cancer had shrunk sufficiently to become operable, or potentially curable. Its limitations, as with all forms of treatments involving radiation, are related to the size and volume of the tumour, as too large a tumour would require an unsafe dose of radiation.

Fractionated Stereotactic Radiosurgery

This is a non-invasive therapy for brain tumours that, in the past, have been very difficult to treat. It directs precisely guided beams of radiation from many hundreds of different angles to converge on the tumour. It is called radiosurgery because the surgeon uses the radiation beams like a knife to cut out the tumour. By focusing these beams from so many different positions, the effects on the normal healthy brain and tissue are minimized while striking only the target with the prescribed treatment.

The main difference between standard radiation and fractionated stereotactic radiosurgery is that standard radiation will also irradiate large amounts of normal healthy brain compared with radiosurgery, which is focused almost exclusively on the tumour.

This approach is also proving effective for treating tumours of the head and neck, where there are many important nerves and structures very close together in one area.

Traditional surgery may result in a degree of facial paralysis and functional loss, so this form of treatment, if available, is highly desirable.

Brachytherapy

This is being used for prostate cancer that has been detected early and not spread beyond the gland. In this case, tiny radioactive ‘seeds’ or pellets, containing radioactive iodine, are implanted directly into the middle of the cancer via thin needles, where they will keep on giving off radiation for up to a year. Up to a hundred pellets are implanted through the skin, under either a spinal or general anaesthetic.

The radioactivity of the pellets slowly decays during the months after the operation; few long-term risks have been reported with this treatment.

Chemotherapy

We have seen how surgery and radiotherapy are used to deal with disease that is localized in a particular area. But if the disease has spread, or metastasized, then the treatment has to reach all parts of the body to eliminate cancer cells wherever they have lodged. Such treatments are called ‘systemic’, as they go right round the system. Since the 1940s, around 150 drugs with anti-cancer effects have been developed. They act in various ways to destroy or slow down the growth of rapidly dividing cancer cells.

There are several ways in which different types of anti-cancer drugs work:

• by preventing the DNA in the cancer cell nucleus from being copied, a vital process for cell division and growth of the tumour

• by depleting the cancer cell of the building blocks for DNA so that fewer raw materials are available for DNA to replicate itself

• by preventing the binding of enzymes that enable the production of key protein molecules in the cancer cells

• by blocking protein synthesis, especially those that maintain healthy cell activity as well as cell division.

The Discovery of Anti-cancer Drugs

The majority of anti-cancer drugs were discovered by accident. Initially, a few were designed specifically to inhibit tumour cell growth, but this is now changing.

Many successful cancer drugs come from natural sources – adriamycin comes from a fungus found on buildings on the Adriatic coast; vincristine originated from the pretty blue Vinca (periwinkle) plant, often seen in English gardens; taxol and taxotere, collectively called taxanes, were derived from the Pacific yew tree – and were also found by accident. There are now several other derivatives synthesized in the laboratory.

Chemotherapy Regimes

Chemotherapy is often given as a mixture of two or three drugs in a fixed pattern, known as a ‘chemotherapy regime’. There are many regimes, which are constantly changing, as research is ongoing to define the optimal combinations for the best effects. Specific regimes are not covered here as they would quickly become out of date. Once you know what chemotherapy drugs your oncologist is offering, further information about them can be obtained from:

• CancerBACUP. This organization has excellent leaflets about the various anti-cancer drugs, and a website with a comprehensive section on chemotherapy (www.cancerbacup.org.uk)

• Pharmacologists in the information departments of major hospitals

• Part 2 of the Resources Directory. This lists other useful websites and resources for more information about your treatment

• The UK Cancer Options team, which offers in-depth information, including the results of clinical trials using the drugs, the rates of responses, and how frequent and severe the side-effects were. It will also research the clinical evidence for you and let you have the facts.

Administration of Chemotherapy

There are several ways drugs can be given for cancer. Some can be taken as pills or capsules, but the majority are given through an intravenous drip. They may sometimes be delivered straight into a body cavity such as the bladder or abdomen. Most can now be given via an outpatients clinic.

Chemotherapy suites with comfortable reclining chairs and a bright, supportive atmosphere have sprung up throughout cancer-treatment centres. These are usually run by nurses, who are expert at dealing with the administration of chemotherapy. They are huge founts of knowledge about the side-effects, any likely problems that may be encountered and how to deal with them creatively.

The Side-effects of Chemotherapy
Effects on Fast-growing Tissues

Because tumour cells are so close in structure and function to normal cells, it is not surprising that any drug that reduces cancer growth also affects normal cells. This means that many cancer drugs have very potent side-effects, and are only prescribed by specialists in the field. Anti-cancer drugs inhibit cell turnover in general and so affect most severely the most rapidly dividing cells in the body. These include those in the bone marrow that form blood cells, and those in the lining of the intestines, skin and hair follicles. A depressed immune system is common with many anti-cancer agents because of their effect on bone marrow. Therefore, when considering your treatment plan and assessing your tolerance levels, you may wish to consider how to offset this effect on immune function by immune stimulation (see Chapters 5 and 7).

Nausea, Vomiting and Diarrhoea

The side-effects of chemotherapy are nausea, vomiting, diarrhoea and fatigue, from both the immediate shock to the tissues and bodily systems, and your body’s ongoing natural reaction to expel toxic substances from the body. This is the same mechanism that comes into play when you inadvertently eat something that gives you food poisoning, and is a normal defence mechanism.

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