The Cancer Buddy Booklet

The aim of this patient guide is to

assist in gaining knowledge that will
empower you to be an active member
of your treatment team as you start
navigating your journey with cancer.
Production of this book is made possible thanks to an unrestricted grant from
Novartis South Africa (Pty) Ltd. Tel. (011) 929 9111
People Living With Cancer, 0861 ASK NOW (0861 275 669)
info@plwc.org.za, www.plwc.org.za
Contents
Foreword
4
About People Living With Cancer 6
Patient Active Approach 8
What is Cancer? 19
Radiotherapy General Information 21
Chemotherapy Side Effects and Complementary Therapies 26
Nutrition During and After Cancer Treatment 27
Phase I: Cancer Treatment 28
Phase 2: Recovery from Treatment 30
Phase 3: Preventing Cancer Recurrence, Second Primary Cancers, 30
and Nutrition-Related Disease
Phase 4: Living With Advanced Cancer 31
Specic Nutritional Issues for Cancer Patients 31
Emotional Impact of Cancer on Patients and Families 35
Factors that affect the adjustment to a diagnosis with cancer are: 37
Information need 40
Possible Questions to Ask Your Oncologist 44
Resources for Cancer Patients and Their Families 46
F
Foreword
For many, September 11th conjures up images of death and grief. For me,
it was a good day. I was told I had beaten cancer.
For the 6 months prior to 11 September 1998, I had taken nothing for
granted. There was nothing certain about the next day. Each day was a ght for
survival. Each day, my body reacted differently to the level of toxic chemicals
in my blood. I was either sliding towards that point, 7 days after a heavy
dose of chemo where I couldnt move. Or, after getting through that low
point in the cycle I was moving with a sense of dread, toward the next date
in the calendar of receiving another nauseating round of the drugs. All in
the hope of killing this thing growing inside me, and not knowing if it would
consume me.
On September 11 there was nally real hope that the end of a dark
journey was coming to a happy ending. So I started thinking about my
future. Realizing there was a greater degree of certainty about what lay
ahead for me, I started to reect on the various promises I made to myself on
what I would do if I got back on my feet.
There were a number of aspects of my life I wanted to change, but there
was one thing in particular I wanted to do. I wanted to help others deal
with the uncertainty of what lay ahead when they were diagnosed with
cancer. I didnt want someone else to have to re-invent the wheel of
learning that I had been through. After all, I had learned so much during
this period I felt it was a waste not to pass this knowledge on. In addition
when I had been diagnosed with cancer I really needed to talk to someone
who understood what I was going through and who could help me cope.
So in 2002, after I was well enough mentally and physically, I co
founded People Living With Cancer (PLWC) with Linda Greeff, another cancer
survivor. We recognized that when a person initially discovers that they
have cancer, they may feel overwhelmed, vulnerable and alone. At the
same time they must also learn about complex medical treatments and
will need to choose the one best for them.
4
PLWC was started to ensure that all people diagnosed with, and living
with, cancer have access to information, peer support (Cancer Buddies),
resources and services that will assist them in regaining their lives after
being diagnosed with the disease. Through education and support the
organisation intends to empower patients and their families. My dream
is to make this kind of support network available to all people living with
different diagnoses of cancer countrywide.
So as you read through this Cancer Buddy information booklet, I sincerely
hope it helps you to gain a better understanding of the situation you are in
and what resources you have available to you. I also hope you will make use
of the Cancer Buddies around South Africa (by calling the 0861 ASK NOW
telephone number) to connect you to someone who has been through what
you are going through and to help you answer the many questions you may
have.
All the best,
Carl Liebenberg
Co-founder and Director
People Living With Cancer
5
AAbout Us
People Living With Cancer (PLWC) was established in 2002 by Carl
Liebenberg and Linda Greeff, both of whom are cancer survivors. For
the past seven years the organisation has set about developing volunteer
counselling guidelines that are aligned with international protocols and
this has allowed the organisation to have one of the most established
volunteer psycho-social programmes in the country.

PLWC is a national non-prot organisation and receives no state
funding. It is registered as a Section 21 Company with registration number
2002/026507/08.
PLWC offers a free buddy support network (Cancer Buddies) where cancer
patients can interact with and receive practical advice and support from
cancer survivors who have a similar prole, disease and treatment protocol.

The buddies are trained on how to assist patients that are currently facing
treatment to deal with diagnosis, treatment, emotional issues and living
with and beyond the treatment of cancer. PLWC volunteers also offer hope
because they themselves have survived the disease and have regained their
lives.
Patients are supplied with a buddy information pack which supplies
patients with relevant information about cancer and support systems
available.
People touched by cancer may independently contact the organisation or
may be referred to us by their treating doctors or hospitals. Once contacted,
PLWC assigns a buddy to the patient who has a similar prole taking into
account considerations such as religion, gender, race, type of cancer etc. The
volunteer will then offer their support through one on one visits; telephone
and/or email support. We have an interactive website where patients can
obtain information, post comments, ask questions and read the stories of
other cancer survivors. Monthly or bi-monthly support meetings are held,
where topics of interest are discussed. There are no charges for any of the
above.
In order to deliver on its vision, PLWC created a network of support groups
throughout the country and develop PLWC buddy support groups.
6
We have established branches in:
Mpumalanga Nelspruit
Gauteng North Johannesburg, Pretoria
Eastern Cape Port Elizabeth
Western Cape Cape Town, Stellenbosch/Somerset West
Should you, a friend or a family member have been diagnosed with cancer
and have the need to talk to others who have been in the same position;
have any questions or concerns or would like to attend one of our general
support group meetings please contact us on 0861 ASK NOW (0861 275 669)
or email us at info@plwc.org.za or info@ask-now.co.za or visit our website
www.plwc.org.za
Survivorship begins at the moment of diagnosis and continues throughout
the course of life, no matter how long or short that life may be. But there are
cycles and varying terrains on the journey of survivorship.
- National Coalition for Cancer Survivorship, USA.
7
8
A
Approaching your Cancer Journey Differently -
Empower Yourself and Become Patient Active

Do you recognise some of these thoughts:-
How will I manage to get through this crisis?
Why is this happening now?
Why me?
How do I tell my wife/husband/children?
I did everything right and now this! How can this be?
What must I do?
Should I be seeing an oncologist?
What do all these terms mean?
How do I know which option to choose?
What are my survival chances?
What will the treatment entail?
These are just a few of the thoughts racing through your head as you start
your journey with your cancer. It is of the utmost importance that you
develop a personal and individualised approach right from the start of
your treatment. You need an individualised plan that will address your own
personal needs on all levels of your life - body, mind and spirit.
In June 1982, Harold Benjamin, founder of The Wellness Community,
pioneered an approach called the PATIENT ACTIVE APPROACH.
The essence of this approach is that patients are encouraged to become
active members of their treatment teams thus engaging right from the start
with their oncologist as part of the team, developing and deciding on all
treatment decisions. Being actively involved in planning of your recovery
strategies on more than one level is crucial. According to Dr Benjamin,
People with cancer who participate in their ght for cancer will improve the
quality of their life and may enhance the possibility of their recovery.
The objectives of this program are:
Gain valuable information about cancer treatment and
treatment side effects
Learn patient active strategies to prevent and manage
common side effects
Develop an action plan for your personal experience.
Improve your partnership and communication with your
healthcare team.
Be well-informed.
Keep your treatment on schedule as much as possible.
Integrate medicine-mind-body-spirit.
Create a strong support system.
Set small achievable goals in all areas of your life.
Plan some fun lled events.
Surround yourself with the people you choose to be part of your teams.
Do not listen to all the stories that you are told.
Limit people that are negative.
Develop active partnerships with your health care team.
It is important to remember that Your Experience is Unique!
Use your resources
Learn from others
Make choices that are right for you
Develop an individual, personalised action plan for yourself which
embraces all the aspects that are important to you. This action plan will
focus on improving your quality of life all through your journey with
cancer and will address not only the physical aspects but also attend to the
emotional and spiritual needs that you have.
The development of healing behaviors and a healing attitude forms the crux
of this process.
9
Choosing to embark on the cancer journey more actively is a choice you have
to make. Making this choice is not easy as it requires you to address the
challenges of this cancer journey differently.
The focus of this approach is about making small day to day decisions
regarding your treatment that will assist you in staying in control of your life
as much as you can as you embark on your journey with cancer.
Being PATIENT ACTIVE means taking individual steps to learn about your
cancer and its treatment thus empowering you to make informed de
cisions about your treatment as well as the manner in which you will be
addressing your psychological, emotional, social and spiritual needs that
impact on your well being and your health in general as you navigate your
treatment journey.
By adopting this PATIENT ACTIVE approach you choose to deal differently
with the emotional stresses that are associated with the cancer experience,
namely: fear, anxiety, isolation, loss of hope and meaning.
By taking up the challenge of this journey in a PATIENT ACTIVE way you
empower yourself and your family to take actions with regards to all
aspects of your life thought by the cancer. This PATIENT ACTIVE approach will
encourage you to embrace support from your family, other cancer survivors
, peer support systems like the CANCER BUDDY program and any other
resources that may be needed as part of your action plan.
By empowering yourself and taking back your control and being part of all
your treatment decisions and planning of your treatment plan is of great
importance in determining your quality of life all through the journey with
cancer. This approach encourages the Combining the will of the patient
with the skill of the physician according to Harold Benjamin and in so
doing, a very powerful team emerges to assist you in this ght against
Cancer.

In this booklet you will some helpful information regarding the side
effects of treatment. Learn as much as you can about your treatment and the
management of side effects. By empowering yourself with knowledge
you will be able to ask more relevant questions and will then be more
able to plan a strategy for the management of these side effects that is
acceptable to you. We will like to encourage your design and development
10
of your own unique Action plan that will form the basis of your strategy in
becoming cancer survivor.
We would like to highlight the following most common side effects and
suggest some coping strategies in this regard to get your action plan going:
Side effects like:
Anemia and fatigue
Hair loss
Risks of infection
Pain and discomfort (including skin rash)
Nausea/vomiting
Emotional distress
Develop a specic plan to deal with the side effects that you are
experiencing most.
Managing fatigue
Conserve your energy by:
Asking others to help you (delegate tasks)
Take short naps
Plan your activities with realistic goals
Walk daily or develop an exercise routine
Limit caffeine, especially in the evening
Drink water at least 4-5 glasses a day
Eat a well-balanced diet
Discuss your fatigue problem with your doctor.
Managing Hair loss
Develop a plan:
Consult your hair stylist or visit a wig shop
Check to see if your cancer center has a wig bank
Consider a short haircut before hair loss begins
Obtain hats, scarves, or turbans
11
Protect yourself from exposure to sun and cold
Discuss your concerns with your healthcare
Remember: Not all treatments cause hair loss and not all hair loss is
permanent
Chemotherapy-related Infection
Causes: low white blood cell count (neutropenia)
Can lead to treatment delays or dose reductions
Decreased quality of life (missed work, family time, social connections)
Can be a life-threatening complication
Increased Risk for Infection when:
Chemotherapy given is known to decrease the white blood cell count
If you already have a low white blood cell count, or have been
previously treated with chemotherapy and/or radiation
If you are 65 years and older
If you have other conditions affecting the immune system your risk for
infection will increase.
Symptoms of Infection:
Fever and chills
Sore throat, cough, shortness of breath, chest pain
Urinary problems pain, burning, or difculty
Dental pain, impaired chewing, mouth sores
Red, tender, or draining wound sites
Diarrhea
Pain, redness, or heat around catheter sites
Take Control of the risk of infection
Assess your risk factors (type of chemotherapy, previous treatments, etc.)
Track your white blood cell count and temperature
Talk with your doctor about taking a white cell growth factor to
prevent low counts
12
Anemia
Anemia is when the number of oxygen carrying red blood cells falls
below normal
Symptoms include fatigue, exhaustion, shortness of breath,
confusion or loss of concentration, pale skin, rapid heartbeat
Affects tolerance & stamina
Decreases quality of life
Take control of Anemia and Fatigue
Track your complete blood count (CBC)
Talk to your doctor or nurse about red cell growth factors
Prioritize what activities are important to you (Ask for help or let go!)
Nap, get adequate rest
Pain from Cancer or its Treatment not the rule but if you have problems in
this regards address them immediately.
There are multiple causes and types of pain
Pain affects tolerance of treatment
Pain affects quality of life & hope
Pain impacts relationships
Empower yourself with knowledge re pain and do not get caught up
in the myths of Cancer Pain
Remember:
Not all pain is the same - Pain can take different forms and levels
of intensity
Pain does not mean advanced disease
Addiction to pain medication is rare
Ensure effective pain management as soon as possible
13
Mild pain (pain score between 1-3)
Common pain relievers may sufciently relieve the pain.
You are able to perform your normal activities.
Moderate pain (pain score between 4-7)
Prescription pain relief is necessary
You may not be able to perform your normal activities.
Severe pain (pain score greater than 8)
Active management with other medications or interventions
in addition to prescription medications.
You are not able to conduct normal activities.
Talk to your doctor or nurse and possibly consult a pain specialist
Integrate mind-body practices with medical management
Ensure that you also attend to constipation problems associated when
taking pain medication.
Remember: You do have the right to have your pain controlled!
Treatment of Skin rashes
Keep your skin clean and dry
Use mild soap and water
Use water-based lotions or emollients
Avoid hot water
Avoid tight clothes: pants, bra, shoes
Notify your doctor of any sign of infection or skin problem
that you cannot manage with these suggestions.
Managing Nausea & Vomiting
Avoid eating a few hours before chemotherapy
Eat several small meals during the day
Eat foods that are not hot or spicy
Avoid strong food odors
Drink cool, clear uids; stay hydrated
14
Practice relaxation techniques
Ask your doctor about medicines to prevent or help with
nausea & vomiting
Emotional Distress
Emotional distress is often ignored. Dont ignore it.
Emotional distress can include anxiety, stress, depression, mood swings,
irritability, insomnia, fear, isolation, denial, loss of hope
These have multiple causes get support and help to address these issues
right from the start as these are as important as all the other physical
side effects are .
Speaking to a therapist or a counselor can assist you in developing
your own individualised action plan as part of your own PATIENT ACTIVE
PROGRAM.
Expressing your emotions and dealing with the emotional aspects of your
journey with cancer is of the utmost importance. Do not underestimate
the importance of emotional aspects and plan a strategy to attend to
these issues.
General Strategies for Wellness
Get Physical Active
Elevates mood
Combats fatigue
Maintains function
Promotes rest
Choose the right Food to eat
Maintains energy
Strengthens immune system
Avoids/limits symptoms
Builds strength
Provides comfort
Assists in rebuilding normal cells as part of the healing process
15
Drink Plenty of Fluids
Drink enough water
Avoids dehydration
Promotes regularity
Combats fatigue
Personal Hygiene.
Limits risk of infection
Keeps skin healthy
Pampers the spirit

Communicating With your Health Care Team
Write questions down before you go to the doctor; bring them with you
Bring a friend or family member with you to appointments to assist in
listening to the oncologist to help increase your understanding.
Ask your doctor how you can work together as a team.
Tell your doctor about any alternative or complementary medications
you are using.
Ask your doctor whether an alternative dose or treatment schedule
might be appropriate for you, considering side effects.
Ask the doctor if there are short-term side effects or side effects that can
accumulate over time.
Ask your doctor or nurse about issues related to intimacy or other
emotional concerns you may have with your partner. Remember no
question is not important, keep asking until you are satised and clear
on all your treatment issues.
Every persons experience with side effects is unique.
Ask about specic actions we can take to prevent or better manage side
effects.
Speak up about your specic needs.
16
In Conclusion
There is nothing magical or highly complicated about the PATIENT ACTIVE
APPROACH.
Building a positive attitude and action plan takes hard work and
dedication it does not just happen. You have to choose this model every
day on every level of your life and implement steps to make this action plan
real and a working document. This model allows the person learning to live
with their cancer with guidelines to a different approach in dealing with the
crisis of being diagnosed with cancer. It assists the patient and the family to
move away from being a victim of CANCER to becoming and an empowered
patient active team member participating actively in making all treatment
decisions right from the start of the treatment.
Always remember you are a cancer survivor from the moments you
survive your diagnosis so be proud of that and then get working on
becoming more empowered by adopting this PATIENT ACTIVE APPROACH and by
implementation of your personalised action plan that forms part of this
PATIENT ACTIVE APPROACH. It will not be easy but you will feel less
lonely, more in control and more empowered. This approach also allows the
space for experiencing a whole array of emotions and acknowledging the
emotions is an important part of your healing process.
17
Characteristics of the PATIENT ACTIVE APPROACH
The Patient Active Approach is an effective method to manage side effects
and to navigate your cancer experience differently.
This model strives to engage the patient as the driver of this initiative
Encourages the use of mind-body techniques can help reduce stress.
Progressive relaxation.
Mindfulness meditation.
Visualization.
Any other relaxation techniques
Keep a journal to track your emotional experience.
Keep track of all your medical treatment in a le so that you have all
your information together should you want to get a 2nd opinion at any
time.
Effective communication with your health care team is critical to side
effect management.
Our wish is that you will nd the courage to challenge yourself and your
team to adopt this new PATIENT ACTIVE APPROACH as you start your
Cancer journey. Know you are not alone and reach out to those you love and
to the Cancer Buddy Support network if you need any further support and
information http://www.thewellnesscommunity.org/corporate/pa-concept.
phpThe Patient Active Concept
Linda Greeff
Director PLWC (Ovarian Cancer Survivor -22 years)
November 2009
18
19
WWhat is Cancer?
When a patient is diagnosed with cancer, it is usually a turning point in
his / her life. Few forget the initial shock and disbelief after the diagnosis,
as well as the fear and the feeling of helplessness that is experienced.
In between all these emotions there is usually further tests that must be
done and an urgency to start treatment patients may be forced to make
important decisions in spite of feeling unsure and confused. The aim of
this information brochure is to provide more clarity on what may happen
to a patient when he / she is referred to an oncology unit after a cancer
diagnosis. Through knowledge comes empowerment for the patient
and his/ her carers in their battle against cancer.
A cancer cell is formed when there is a change in the genetic material
(control centre) of a cell; the total denition of the cell is changed in this
way. The cell starts to grow in an uncontrolled fashion, irrespective of the
bodys needs. The cells are abnormal in their appearance and function, faults
in their structure are however not recognised and the dysfunctional cells
continue to divide. Tissue planes do not bind cancer cells; it can invade and
destroy surrounding tissues, it can also break away from the main growth
and enter the bloodstream or lymphatic system.
What causes the transformation from healthy tissue to cancer tissue?
Various risk factors for the development of cancer exist, the transformation
process is however often multifactor and in most cases still largely unknown.
Factors that may play a role include:
Genetic factors (e.g. in breast cancer)
Physical factors (e.g. sunlight)
Chemical factors (e.g. smoking)
Viruses (e.g. HIV)
Hormones (e.g. testosterone in prostate cancer)
Immune status (the immune system must distinguish the bodys own
tissues from foreign structures and mustalso be able to destroy the
latter. The precise role of immunity in cancer is not clear yet; because
cancer growths consist of abnormal cells the immune system should
theoretically be able to recognise such growths as foreign and
destroy it.)
What are the consequences of a group of abnormal cells dividing
without control?
It can press on or inltrate surrounding tissues.
It can gain access to the lymph- or blood system to give origin to sites of
spread in other parts of the body (metastases).
It can inltrate spaces surrounding an organ and spread throughout
such a space.
Cancer cells can produce chemical substances that may cause symptoms
and signs in other parts of the body in an indirect way (paraneoplasms).
Different types of cancer exist; it is important to remember that cancer is
but a collective term for more than 200 different diseases sharing certain
qualities. A specic cancers name is derived from the tissue of its origin:
Carcinoma (epithelium or outlining cells)
Sarcoma (connective tissue, muscle and bone)
Glioma (nerve tissue)
Lymphoma, leukemia, myeloma (blood system)
Melanoma (melanocytes)
In an oncology center the management of a patient is aimed at
conrming the diagnosis of a specic cancer type and establishing the stage of
development thereof. This enables the treating doctor to decide on
the best treatment plan for the individual patient in order for denite
treatment to start as soon as possible.
20
21
RRadiotherapy General Information
What is radiotherapy?
Radiotherapy (also known as radiation or x-ray
therapy) is the treatment of cancer through the
use of high-energy x-ray beams. These rays can
penetrate tissue, in doing so they deposit their
energy to the cells in the treatment area and
cause cell damage and cell death resulting in
reducing the cancer growth.
Normal cells are also inuenced by radiation. In contrast to cancer
cells, most of them recover from the effect of radiation. Normal tissue
however still needs to be protected from radiation as far as possible; the
total amount of radiation is thus limited to the dosage normal tissue can
tolerate, the radiation treatment is also given over a varying period of time. Every
patients treatment is planned individually with the use of highly
sophisticated 3-D computer technology. Normal tissue is protected from
radiation beams when possible through the use of specialized alloy or lead blocks.
Aims and benets associated with radiotherapy.
The aim of radiotherapy is to kill cancer cells with as little risk as possible to
normal cells. Radiotherapy can be used in the treatment of different kinds
of cancer in nearly any part of the body.
Radiation, like surgery, is a local treatment. It thus inuences only the
tissue in the specic area of the body that is being radiated.
Radiation is often used in combination with surgery to treat cancer.
Radiation can be given before surgery to shrink a cancer mass, this may
enable them to remove all cancer tissue by using less extensive surgical
methods. Radiotherapy can also be given after denite surgery to reduce the
chances of regrowth of any remaining cancer cells.
In some cases radiation is used in combination with chemotherapy. The
radiation can be given before, during or after chemotherapy. Combination
therapy is tailored carefully to suit each individual patients needs according
to the type of cancer, the location thereof and the disease stage.
Where cure isnt a realistic option anymore, radiation is often used to shrink
cancer masses and in doing so to relief pressure, pain and other symptoms
associated with uncontrolled cancer growth. This treatment is known as
palliation (symptom relief). Most cancer patients nd that they can lead a
better quality of life after radiation for problematic symptoms.
How is radiotherapy administered?
Radiation can be given in one of two ways: external or internal
radiation. The treatment you will receive depends on the type and stage of the
disease as well as the location thereof.
Most people who receive radiation therapy for cancer have external beam
radiation. The beams are generated in a machine called a linear accelerator.
The machine directs the high energy x-rays at the cancer, treating that and a
small margin of normal tissue around the edge of the treatment eld.
When internal radiation therapy is used, the radiation source is placed
inside the body. This method of radiation is termed brachytherapy.
Some patients have both forms of radiation, one after the other.
Others receive one or the other.
What does treatment planning mean?
Before starting with the actual radiotherapy treatment, the precise
location of the area to be radiated must be determined. It is further
necessary to ensure that you will be positioned in the same manner
every day when receiving treatment. Your radiation will be planned
specically for you as an individual in order to deliver the maximum amount of
radiation to the cancer mass while limiting the dose to the surrounding
normal tissues to the minimum.
You will be asked to lie very still on a treatment couch while a radiotherapist
will use a special x-ray machine, the simulator, to dene your treatment eld.
Depending on the location of your cancer, single or multiple treatment elds
may be necessary. The planning process may also involve a CT scan of the
effected area in order to plan radiation elds more accurately by taking
different tissue densities into account. After completion of the CT scan it may
22
take another day or two to develop a nal treatment plan, a process during
which different radiation combinations and options are considered in order to
determine the best possible treatment plan for every individual patient.
Masks or other immobilization devices may be used to prevent any
movement during treatment. Again these devices are individualized
for the needs of each patient, and they will also be used every time when
treatment is delivered to ensure correct treatment setup.
Small tattoos in the form of pinpointed dots will be placed on your
skin to dene the treatment area. This is to ensure that treatment is
delivered to exactly the same area every day; the tattoos also enable one to
determine areas where radiation has been delivered previously, even years after
denite treatment. Non-permanent pen marks will also be used to ease daily
setup and treatment eld determination.
Before your rst treatment a set of special x-rays will be taken. This is
to again conrm that the radiation will be delivered to the correct area;
it also serves as a record of your treatment. These x-rays are often repeated
during your course of radiotherapy to verify the correctness thereof.
How long does treatment last?
Most cancers are treated with radiotherapy for 5 days per week over a 6 to
7 week period. (When radiation is given for symptom control only, shorter
treatment periods are used, which could be from a few days up to 3 weeks.)
Every treatment lasts 10 tot 20 minutes, the actual radiation therapy takes
only a few minutes per day, while setting you up in the correct position, and
adjustments between various radiation elds make up for the remainder of
the time.
The use of smaller daily doses of radiation given over a longer period of
time instead of a few large doses over a shorter time period helps to
protect normal tissue in the treatment area. Rest periods over weekends also
help normal cells to recover from the radiotherapy. Treatments are therefore
scheduled for every day except on a Saturday and Sunday. This ts in with a
normal working week that also leaves time for tissue repair.
23
What happens during radiation treatments?
Wearing clothes that are easy to take off and put on is advisable.
The radiotherapist will use the marks on your skin to position you correctly
and to determine the treatment eld. You will be asked to lie very still on
the treatment couch; although you will be alone in the room during the
treatment, continuous monitoring through a closed circuit camera system
will be done. External beam radiation is painless, and is comparable to
x-rays taken for diagnostic purposes. You will not see or smell the radiation.
You may hear a sound whilst the radiation beam is running, this is normal.
The radiation will not make you radioactive. After starting treatment, your
doctor will see you at least once a week to monitor your treatment progress
as well as your reactions to treatment.
You need to remain very still during the treatment so that the
radiation reaches only the area where its needed and the same
area is treated each time.
You dont have to hold you breath just breathe normally. The radiation
machine is controlled from the control area nearby. You will be watched on
a television screen from the control room. There is also an intercom system.
If you should feel ill or very uncomfortable during the treatment, tell your
therapist at once. The machine can be stopped at any time and treatment
restarted without any bad effects on the treatment.
What are the side effects of treatment?
External radiation therapy does not cause your body to become
radioactive. There is no need to avoid being with other people because you are
undergoing treatment. Even hugging, kissing, or having sexual relations with
others pose no risk of radiation exposure.
Most side effects of radiation therapy are related to the area that is
being treated. The side effects of radiation therapy, although unpleasant, are
usually not serious and can be controlled with medication or diet. They
usually go away within a few weeks after treatment end.
24
Depending on the area being treated, you may need to have routine blood
tests to check different levels as radiation treatment can cause decreases in
the levels of different blood cells.
What can I do to take care of myself during therapy?
Each patients body responds to radiation therapy in its own way.
Some general guidelines:
Before starting treatment, be sure your doctor knows about any
medicines you are taking and if you have any allergies.
Fatigue is common during radiation therapy. Your body will use a lot
of extra energy over the course of your treatment, and you may feel
very tired. Be sure to get plenty of rest and sleep as often as you feel
the need. Its common for fatigue to last for 4 to 6 weeks after your
treatment has been completed.
Good nutrition is very important. Try to eat a balanced diet that will
prevent weight loss.
Check with you doctor before taking vitamin supplements or herbal
preparations during treatment.
Avoid wearing tight clothes over the treatment area.
Be extra kind to your skin in the treatment area:
Wear loose, soft cotton clothing over the treated area.
Do not scratch, rub, or scrub treated skin.
Do not use adhesive tape on treated skin. If bandaging is necessary,
use paper tape and apply it outside of the treatment area.
Use only lukewarm water for bathing the area.
Use an electric shaver if you must shave the treated area. Do not use
a pre-shave lotion or hair removal products on the treated area.
Protect the treatment area from the sun. Do not apply sunscreens;
cover treated skin (with light clothing) before going outside.
Ask your doctor about washing the affected area
25
CChemotherapy Side Effects and Complementary Therapies
The following strategies can be useful in assisting you to cope with
chemotherapy.
Please discuss this with the counsellors in the unit.
(i) Distraction includes television, radio, reading, movies, needlework,
puzzles, building models or painting.
(ii) Hypnosis.
(iii) Imagery is a way of daydreaming that uses all your senses.
Usually done with your eyes closed.
(iv) Massage Therapy involves touch and different methods of stroking
and kneading the muscles of the body. A licensed massage therapist
should do the therapy.
(v) Meditation and Prayer - Meditation is a relaxation technique that
allows you to focus your energy and your thoughts on something
very specic.
(vi) Muscle Tension and Release.
(vii) Physical Exercise.
(viii) Rhythmic Breathing.
(ix) Visualization - is similar to imagery.
(x) Yoga - All you need is a quiet, comfortable place and some time each
day to practice breathing, stretching and meditation.
Most mineral and vitamin supplements also as prescribed by Homeopaths can
be used in conjunction to conventional medical treatment. Please be sure
to check with your Oncologist to ensure there is no potential for any cross
reactions with your chemotherapy.
26
27
NNutrition During and After Cancer Treatment
One of the most devastating effects of cancer is a profound sense of loss
of control. Behavioural research has clearly shown that those who have
higher levels of self-efcacy generally feel better and function better than
do those who feel they have lost control over their situation. Seeking ones
own course of treatment and disease management, as well as condently
choosing the best course of action for oneself, is extremely important for
enhancing quality of life. After a diagnosis of cancer, many survivors are
highly motivated to especially seek information about diet, physical activity,
dietary supplement use and nutritional complementary therapies. Soon,
though, they discover that it is difcult to nd answers to even the simplest
of questions! Cancer survivors and those who care for them thus desperately
need a credible framework of accurate information. The American Cancer
Society (ACS) through their Workgroup on Nutrition and Physical Activity
for Cancer Survivors strives to provide such information. It should be
remembered that the state of the scientic evidence regarding the effects
of nutritional factors on the clinical outcomes among cancer survivors is not
sufcient at this time to support a set of rm guidelines for cancer survivors.
There is sufcient information, however, to serve as a basis for a framework
for reasonable informed choices.
The different phases of cancer survival raise different nutritional issues.
These phases include an active treatment phase; a recovery phase in which
the body needs to be restored; a health maintenance phase to prevent both
cancer recurrence, second primary tumours and other preventable diseases;
and, for some, a phase of living with advanced cancer.
Adequate dietary intake can improve the nutritional status of nearly all
cancer survivors. During all the phases of cancer survival, even for cancer
survivors with no apparent nutritional problems, the principles outlined in
the ACS Guidelines on Diet, Nutrition, and Cancer Prevention should be
regarded as the basis for a healthy diet. These guidelines are as follows:
1. Choose most of the foods you eat from plant sources.
Eat 5 or more servings of fruits or vegetables each day.
Eat other foods from plant sources, such as breads, cereals, grain
products, rice, pasta or beans several times every day.
2. Limit your intake of high fat foods, particularly from animal sources.
Choose foods low in fat
Limit consumption of meats, especially high fat meats.
3. Be physically active achieve and maintain a healthy weight.
Be at least moderately active for 30 minutes or more on most days
of the week.
Stay within your healthy weight range.
4. Limit alcoholic beverages, if you drink at all.
Individual phases also warrant individual consideration, these are discussed
below.
Phase I: Cancer Treatment
Cancer treatment may interfere with the ability to eat, digest, or absorb
food due to side effects such as nausea, vomiting, changes in taste or smell,
loss of appetite, or bowel changes. When these problems occur, usual food
choices and eating patterns may need to be temporarily adjusted. For
example, small, frequent meals or snacks may be easier to tolerate than are
three large daily meals. Food choices during this time should be easy to chew,
swallow, digest, and absorb and should be appealing, even if they are also
high in calories or fat.
During active cancer treatment, maintaining caloric balance through intake
of proteins, carbohydrates and fat is the most important nutritional goal.
Loss of appetite is commonly experienced during and after treatment. The
list below suggests ways to perk up your appetite when its poor and to make
the most of it when you do feel like eating.
Eat when you are hungry, even if it is not mealtime.
Eat several small meals during the day rather than three large ones.
Eat when you feel best.
Keep simple meals in the fridge for when you become hungry; also
keep healthy snacks close by for nibbling when you get the urge.
28
If other people offer to cook for you let them. Dont be shy about
telling them what youd like to eat.
If you are able to eat only small amounts of food, you can increase the
calories per serving by:
Adding butter or margarine.
Mixing canned cream soups with milk rather than water.
Drinking eggnog and milkshakes
Adding cream sauce or melted cheese to your favourite vegetables.
Some people nd they can drink large amount of liquids even when
they dont feel like eating solid foods. If this is the case for you, try
to get the most from each glassful by making drinks enriched with
powdered milk, yoghurt, honey, or prepared liquid supplements.
Eat your favourite foods; if familiar foods no longer taste good, try new
foods and use different methods of food preparation.
If it is not possible to meet nutritional needs through regular diet alone,
nutritious snacks or drinks (Ensure, Nutren, etc) may be advisable. These
products are best used as only temporary aids.
Even though cancer treatment can cause fatigue, light, regular
physical activity during treatment should be encouraged to improve appetite,
stimulate digestion, prevent constipation, maintain energy level and muscle
mass, and provide relaxation or stress reduction.
The use of nutritional supplements is a topic of considerable controversy,
especially in the cancer treatment phase. It is counterproductive for
patients to take vitamin supplements that contain high levels of folic acid,
or to eat fortied food products that contain high levels of folic acid when
using chemotherapy agents that specically act by interfering with folic acid
metabolism. Moderate amounts of foods such as breakfast cereals that do
not exceed the Recommended Daily Allowance for folic acid are unlikely to
reduce efcacy of these drugs.
Many vitamin supplements contain higher levels of antioxidants,
such as vitamins C and E, than the Recommended Daily Allowance while other
dietary supplements may contain high levels of non-vitamin antioxi-
dants, all combating free radicals. Since free radicals are involved in cancer
29
development and since some studies have suggested that certain
antioxidants may reduce cancer risk, it may be concluded that
antioxidants are effective in preventing cancer recurrence. However, free
radicals are also involved in the mechanisms of action of radiotherapy and several
classes of chemotherapy agents. Taking antioxidant vitamins during
chemotherapy or radiation therapy might therefore reduce the effectiveness of
those therapies. Although the possible harm of supplements may only be
hypothetical, this is one of the many critical questions without a good answer
at this time. Therefore, it would be prudent to advise patients undergoing
chemotherapy or radiotherapy not to exceed the upper intake limits of the
Recommended Daily Allowance for vitamin supplements and to avoid other
nutritional supplements that contain antioxidant compounds.
Phase 2: Recovery from Treatment
After treatment is completed, the nutrition and physical activity plan
should help rebuild muscle strength, and correct problems such as
anaemia or impaired organ functioning. During this phase, survivors need a
nutritionally balanced diet sufcient in caloric intake and sufciently
varied to provide adequate micronutrients (as specied in the ACS
Guidelines for Diet, Nutrition and Cancer Prevention).
Phase 3: Preventing Cancer Recurrence, Second Primary Cancers,
and Nutrition-Related Disease
In general, there has been very little research on the nutritional factors that
inuence cancer recurrence. In the absence of such data, it seems reasonable,
though, to recommend that cancer survivors follow carefully the guidelines
for prevention dened by the ACS and others. In addition to the risk of
recurrence of the primary cancer, survivors can be at increased risk for
second primary cancers, either at the same site (e.g., contra lateral breast
cancer) or at other sites (e.g., lung cancer after oral cancer). Again diet
may play an important role.
30
Phase 4: Living With Advanced Cancer
Nutrition is an important factor in establishing and maintaining a sense
of well being and quality of life in survivors with advanced cancer. In
addition to adapting food choices and eating patterns to meet changing
nutritional needs, effective management of symptoms and side effects, such
as pain, constipation, and loss of appetite, can help promote optimal nutrition
support. Various medications and physical activity can help to increase
appetite, and, if needed, nutritional support can be provided in other
ways for those whose intake is still not enough.
Specic Nutritional Issues for Cancer Patients
Food safety is of special concern for people with cancer, especially during
episodes of bone marrow suppression. During any immunosuppressive
cancer treatments, patients should be particularly careful to avoid eating foods
that may contain unsafe levels of microorganisms. To make food as safe as
possible, patients should follow the general guidelines for food safety namely:
Wash hands thoroughly before eating
Keep all aspects of food preparation clean and use special care in
handling raw meats, sh, poultry and eggs
Cook food to proper temperatures and store foods promptly at low
temperatures to minimize bacterial growth
When eating in restaurants, avoid foods that may have bacterial
contamination such as salad bars, sushi, raw or undercooked meat, etc.
Avoid consumption of impure water.
Cancer and its treatment can place extra demands on the body,
greatly increasing nutrient and caloric needs. Body weight changes often
occur, intentional weight loss during cancer treatment is however not
recommended and should only be attempted after the active treatment
and recovery phases are complete. Some cancer survivors, especially breast
cancer survivors, may gain weight during and after treatment. In these
situations, a healthy eating plan that meets, but does not exceed, caloric
needs is advisable, along with increased physical activity.
31
Regular physical activity is associated with reduced risk of several
cancer types; the impact of physical activity on the prognoses of people
with cancer is less clear. Increased levels of physical activity can however
improve overall quality of life, and result in less fatigue, lower levels of anxiety,
increased energy, and a renewed sense of vitality. Cancer patients and their
family members should be encouraged to engage in moderate regular
physical activity dened as activities that make a person breathe as hard
as they would during a brisk walk. Activities such as walking, biking, and
swimming are considered of moderate intensity, as well as activities such
as yard work and brisk house cleaning. Ideally, at least 30 minutes of
activity should be accumulated each day. Even if the disease and/or treatment
results in connement to bed rest, limited physical therapy should still be
initiated to maintain strength and range of motion of joints. Some situations or
conditions may limit the ability of cancer survivors to be active. For instance,
some cancers can cause electrolyte imbalances and deplete the body of u-
ids. In these situations, adequate hydration should be ensured. Survivors with
metastasis to the bone, or with bone loss due to therapy, should be careful to
prevent bone fractures by avoiding activities that involve jumping or twisting
the hips. Survivors with chemotherapy-induced neuropathy that affects their
balance should be careful to exercise in ways that avoid the risk of falls.
Alcohol can be irritating to patients with inammation of the mouth and
oesophagus; alcohol intake should be avoided or limited among these
patients and among those starting head and neck radiotherapy and/or
chemotherapeutic regimens that put them at risk for mouth and throat
sensitivity. Alcohol should also be avoided during chemotherapy with
methotrexate and other agents that may cause liver damage. While there is
substantial evidence that alcohol may increase the risk of developing several
cancers, there is less evidence related to alcohol and survival from cancer. If
alcohol is consumed, cancer survivors should be encouraged to limit its use
to no more than one to two drinks per day. Caffeine will have no adverse
impact on cancer.
The evidence that total fat intake is a cause of breast cancer is quite weak
and inconsistent; the evidence for a role of dietary fat in the cause of
colon and prostate cancers is stronger. Consumption of red meats and fat
from animal sources may increase risk more than total fats or fats from
vegetable oils. Low-fat diets have not yet been shown to be helpful in either
treating cancer or preventing recurrence, this is still under investiga-
tion. While no specic recommendations regarding low-fat diets in the
32
management of cancer can be made at this time, if individuals and their families
choose to follow very low-fat regimens (about 20% of calories from fat), they
should ensure that the diets are nutritionally balanced, contain essential fat-
soluble vitamins (e.g., vitamins A, D, E, and K), and are adequate in
calories to maintain a healthy body weight. Especially during cancer treatment,
adding moderate amounts of fats and fat- containing foods can help to
improve calorie intake.
Fruits and vegetables seem to be strongly associated with a lower
incidence of colorectal and several other common cancers. A diet high in
fruits and vegetables might therefore also be benecial for improving cancer
survival, though there are few studies that have examined this question. In
the absence of clinical trials, it is reasonable for cancer survivors to adopt
the general dietary recommendations to eat at least ve servings of fruits
and vegetables - fresh, canned, frozen, or juiced - each day. A serving size
of fruit or vegetable is dened as: 1/2 cup of cooked vegetables or chopped
fruit, 1/4 cup dried fruit, one piece of fresh fruit, one cup of raw green leafy
vegetables, or equivalent amounts from multi-ingredient foods. Vegeta-
bles and fruits are low in fat, contribute bre and micronutrients, and are
generally more healthful than many other food choices.
Dietary supplements include nutrients, vitamins, and minerals that are
essential for human health, as well as a wide variety of non-essential
nutrients, such as phytochemicals, hormones, and herbs. As a general
rule, dietary supplements should never replace whole foods; there is also
no evidence that any nutritional supplements can reproduce the
apparent benets of a diet high in vegetables and fruits. Dietary
supplements, especially those that have not been well studied, are
further best used in moderate doses. It is also important to note that the
belief that an herbal or botanical supplement is natural and therefore
can be only benecial, even in high doses, is incorrect. Many vitamins and
herbal compounds are toxic at high levels. As mentioned earlier, a current
area of controversy is the advisability of using nutritional supplements during
cancer treatment. Folic acid and its derivatives, for example, should
be avoided with methotrexate administration, as this nutritional
supplement can alter the efcacy of this chemotherapeutic agent. There is
also some reason to suspect that high doses of antioxidant supplements might
interfere with free radical mediated cytotoxic mechanisms of radiotherapy
and some chemotherapeutic agents. Despite the lack of rm evidence,
it may be reasonable to use nutritional supplements after the active
33
treatment phase for cancer survivors who cannot eat enough to obtain
sufcient nutrients. A reasonable health recommendation to aid recovery
after treatment would be for cancer survivors to use a balanced multiple
vitamin and mineral supplement (once or twice a day) to correct possible
deciencies. Multivitamin supplements of this type are manufactured by a
wide variety of companies, with levels of nutrients usually at approximately
the levels recommended for daily consumption known as the Recommended
Daily Allowance.
34
Emotional Impact of Cancer on Patients and Families
The diagnosis of cancer is a life-changing event for the person touched by the
illness as well as the special people surrounding the person living with cancer.
Cancer impacts on all aspects of life namely the physical, emotional, spiritual,
social and nancial aspects of the whole family.
Each person living with the illness and his or her family members will have
unique experiences as their reactions and needs differ. It is of the utmost
importance that the distress associated with cancer by all parties concerned
should be identied and dealt with effectively. Research has shown that
patients that seek support individually or within groups have a greater
chance of going into remission and also show better coping abilities.
It is impossible to make an informed decision with a lack of information to
assist you. Consider the reading list provided as well as the list of Internet
addresses given for your convenience. Please also think of inquiring about
joining one of the Hoping is Coping courses presented country wide and any
other appropriate support groups.
As you live with cancer, you will experience many emotional ups and downs.
These feelings will involve uctuating between times of hope and despair.
This emotional roller coaster can leave you, your family and friends with
uncertainty about how to deal with all the issues that you have to face.
Adjusting to all these emotions requires you to come to terms with all the
changes that take place in the course of learning to live with a disease like
cancer. Dealing with all these emotions associated with the diagnosis of
cancer is important, as this is the rst step in learning to live with your illness.
Remember emotions are not wrong or right; they are true to you and need
to be expressed in a constructive manner. Learn to use them as a means to a
much greater end.
35
E
The following destructive attitudes should be avoided as much as
possible as they will not assist you in coming to terms with your cancer
experience. The challenge is to address these issues in a therapeutic relationship
with a counselor or oncology social worker to assist you in changing these
negatives by means of talking it through and acknowledging the fact that these
feelings are real :
Bitterness
Guilt
Despair
Pride
Shutting yourself away
Blaming others
Anger
Being a martyr
Cursing God
Work on developing more constructive attitudes that will aid your
adjustment to the process of learning to live with your cancer. Work on
developing your
Acceptance of what is happening
Faith in future
Ability to make the most of everything
Willingness to work towards small goals
Willingness to accept help
Spirituality
Control versus no control issues need to be dealt with as a priority as being
out of control will mean:
Letting other people decide for you.
Abdicating responsibilities for treatment decisions.
Being alienated by your body and ignoring its special needs during
treatment and rehabilitation.
36
These reactions will make you feel as if you have no choices and will en-
hance fear and anxiety, isolating you from much needed support systems.
Work on taking more control by means of:
Being free to ask questions (make a list of questions and ask your
oncologist or any of the other team members that you encounter in
your treatment unit)
Being able to participate in making treatment decisions by getting
information and asking questions
Being able to set goals on all levels of your life
Learning to embark on the journey with cancer (keep a journal and
consider going for counseling. This might mean dealing with
unresolved issues from the past)
Learning new skills like relaxation and visualization.
Focusing on body, mind and spirit issues that will ensure that you are
accepting of your emotions and that you learn how to express your emotions
in appropriate ways that would contribute to your own healing process.
Factors that affect the adjustment to a diagnosis with cancer are:

(A) Interpersonal Issues
1. Emotional Aspects:
You need to be aware of the fact that you will experience many different
emotions like:
Shock and disbelief
Hearing you have cancer can be paralyzing, because cancer has a
reputation for shocking and disrupting the lives of the people touched
by it. Many people consider it a deadly, spreading and fatal disease.
Disbelief is an understandable reaction to the diagnosis. Thoughts like;
Cancer is a disease that will strike someone else, not me! are very
normal. Surprisingly, disbelief can actually serve a useful purpose, since
it provides a calming, numbing effect that softens the harsh news.
It acts like a local anesthetic when you need it most. While insulated
37
from the reality of the diagnosis, the person with cancer has an
opportunity to begin adjusting to a major life change. It is however
very important not to stay stuck in this emotion.
Anger
How dare this happen? I wont allow it! It isnt fair! Why now?
I dont deserve it.
All these reactions are examples of expressed anger. Anger at the
cancer. Anger at God for letting it happen. Anger at friends and
loved ones who are still healthy reminders of the way life used to
be. Anger is a mask to cover other feelings that are more difcult to
express. To admit youre hurting or afraid means acknowledging
that you are vulnerable. Expressing anger is easier than admitting
helplessness. Anger also sometimes disguises feelings of panic.
By denying the disease or lashing out in anger, people with
cancer can buy some time to let the debilitating panic they are feeling
subside. Many people believe that if their cancer had been diagnosed
earlier with the rst symptoms, their chances of survival could have
been greater. It is wise to remember that the diagnosis of cancer is often
difcult and not easy to ensure early detection. When the
diagnosis is nally conrmed, this anger at the medical fraternity is
normal and is the result of built-up frustration. Although anger is generally
considered a self-defeating emotion, when dealing with cancer,
some anger can be viewed as healthy. It indicates a persons active
involvement in life.
Sadness and Depression
Depression has been dened as anger turned inward. If anger cannot
be openly expressed, or once denial is nally replaced with reality,
depression commonly occurs. For people with cancer
depression is usually the result of feeling helpless. One day youare
strong and vital and in control of your life. The next day you nd
out you have cancer. The control is lost. People begin to feel that
the cancer, the medical team and their family members are controlling
their lives. When people see their health fading and they no longer
feel in control of their own destiny, they begin to question their self-
worth. Almost overnight, this active, productive family member may
feel like a dependent invalid. In this situation, in order to cope it is
important to: take control in of your treatment process by becoming
involved, asking questions, seeking emotional support, and deciding on
38
the way in which you would like to face your journey with this illness.
These steps will assist you in becoming a active member of your own
treatment team
Dependence:
Feeling really dependant on the medical practitioners and other
professionals that form part of your treatment team is normal.
Be careful not to abdicate your own control/power over your life
and situation. Learn to stand up for your needs and plan to set goals
and targets. Your loved ones canalso experience dependence and this
may add to your emotional concerns. Reach out for assistance and
support if you feel you are not coping.
Disruption
The cancer experience requires adjustment to many disruptions:
- Disruption of your future perspective
- Disruption of your daily routine
- Disruption of your peace of mind
- Disruption of your familys peace of mind and daily routines
I am sure there are many other issues that you could add to this list.
Acknowledge these disruptions and learn to deal with them as creatively
as possible.
Fears
Fears are part and parcel of the cancer experience as you move through
the different phases of the illness from diagnosis, special investigations,
start of treatment, ending of treatment. The following issues should also
be considered.
- Disability:
Fears and uncertainty about what lies ahead in facing the diagno-
sis and treatment of the cancer are part of your quest in coming to
terms with your cancer experience. Questions about what your life
expectancy entails, how the illness is going to inuence your career
and uncertainty about your ability to deal with your responsibilities, as
wife/husband/parent/employer/employee/sibling/daughter/ext. are real
and take a lot of emotional energy. Be aware of these thoughts and
feelings and discuss their impact on you with a neutral person that
understands your situation.
39
- Disgurement
Facing the reality of disguring procedures after surgery (like
dealing with the realities of a mastectomy, stoma bag, loss of hair,
amputation or whatever physical changes your illness requires you to face.)
These realities are hard to face and require time and effort in coming to
terms with.
- Death
The diagnosis with cancer destroys our illusion that we might live
forever and forces you to come to terms with the reality that you will die
some day. This realisation is harsh and very difcult to come to terms
with, but the challenge is to learn to live fully and joyfully until you die,
not die while you are living.

2. Information need
You will need knowledge and information about the physical process of the
illness and the different treatment options you may be required to consider.
Seek information before agreeing to any treatment.

You need to learn about your treatment in order to develop coping
strategies for your different treatment options. This will assist you in
managing the side effects and physical aspects of the disease and treatment.
Its crucial if you want to learn to cope with your illness. Detailed information
on different aspects associated with a cancer diagnoses is available on the
internet; please also think of inquiring about joining one of the Hoping is
Coping courses presented country wide or any other appropriate support
groups.
Learning to take things slowly will assist you to focus on the future and
on the quality of life after a diagnosis with cancer. Knowledge about
resources will assist you in developing a holistic approach to your treatment
options. Focus on body, mind and spirit by exploring medical, psychological and
complementary approaches for the treatment of your cancer.
40
(B) Family aspects:
Individuals who are diagnosed as having cancer are not alone in this
experience; they are always a part of some type of a family unit
or relationship system. The cancer experience effects the whole family
/ system and causes disruption and turmoil in many ways as family
members roles may change as they move through the experience
with cancer. It is important to talk about these changes in roles and
expectations to ensure open and effective communication though the
cancer experience. The fact that you loved one is diagnosed with
cancer disrupts the family in a real way and adjustments have to be
made to ease the emotional distress of all concerned. It is important to
remember that the issues of importance will differ for all
families depending on the life stage of the family and the
children. Families with young children will have other issues and needs
than a family with adolescents or a retired couple would have a whole set of
different needs to deal with. It is however important to seek
professional assistance in addressing these family issues as they can
become very difcult and sensitive issues.
Remember that the problems existing in a family prior to the
cancer being diagnosed can be made worse by the added pressure of the
illness. Marital problems are often made more unbearable because of
the impact on the family and may prove to be devastating. I would
like to encourage you to seek professional assistance when you are
experiencing these kinds of problems as it is important to lessen the
emotional pressure on you while going through the cancer crisis.
There are many uncertainties and concerns about the illness and the
treatment process, these issues make it very difcult to continue living
your life normally. Allow yourself as well as your family time to adjust.
Family members are often out of step with your needs and
experience because of the illness and are often not sure how to handle
the person living with cancer. The treatment process may for example
leave you exhausted and feeling overwhelmed. This is a well-known side
effect of both radiation and chemotherapy and should be discussed with
the treatment team. Other guidelines are often also needed about how
the family should cope and a social worker may be able to be of
assistance in this regard.
41
(C) Social consequences:
Dealing with all the changes in the family and social relation-
ships are very difcult as there are often changes in family roles and
functions. Open communication about your feelings and needs are very
important and you need to learn to speak your mind, as this will
assist every one around you to be aware of your needs and
expectations.
Living with cancer in the community is also very difcult as there are still
many misconceptions and stigmas attached to the word cancer. People
often do not know how to behave around you.
Part of the social impact of cancer refers to the overcoming of nancial
obstacles, nancial instability, job insecurity and problems with medical
insurability. All these factors increase the burden on the person living
with cancer
(D) Navigating the health care system
This has become a major factor to contend with when diagnosed with
cancer and requires people living with cancer to consider the following
aspects:
1. In the current economic environment it is often very difcult to dea
with inadequate medical insurance and the red tape of acquiring
authorization for treatment. All these issues add emotional pressure and
can cause unnecessary concern.
2. Finding your way through the cumbersome state health system with
limited resources and support can also be a daunting process and a
true challenge.
3. The nancial burden of comprehensive cancer care, or the inability to
access such care (including rehabilitation, complementary therapies and
spiritual care), can add stress to an already pressured situation.
42
(E) Conclusion

After considering all these factors, it is important to develop a solution-
oriented approach that works towards solving problems rather than being
dragged down by problems. Consider the word COPE:
To C O P E means
C for Creativity - in learning to see the problem differently
O for Optimism - learning to see the most positive side of the problems
P for Planning - learning to identify the steps to take to reach a solution
E for Expert - learn to seek adequate information to assist you in making
informed decisions and learn to accept help
HEALING is therefore much more than being free from cancer.
It means accepting that death is not a failure but part of the cycle
of life.
Learn to create an innate gentleness towards your body, mind and spirit;
take time to be quiet and to reect on what your needs are.
Healing means living with loving-kindness and with greater harmony.
Learn to explore the illness with greater awareness and participation on
all levels of your life.
Learn to live fully one day at a time making memories that are special
and lasting and that inspire you to live until you die, not die while you
are living!!!!
To face cancer is a great challenge. This process of learning to come to terms
with this illness requires tenacity and creativity but when the challenge is
faced, a special journey lies ahead that may assist you in learning to live with
the diagnosis of cancer creatively.
Having cancer means that youre never the same again ,
but what is important to me is to make my life count.
Linda Greeff
Head Of Oncology Social Work Services
GVI Oncology
43
Possible Questions to Ask Your Oncologist
QUESTION NOTES
Where is the cancer?
What type of cancer do I have?
Has it spread? If so, where to?
At what stage is my cancer?
What does that mean?
How fast or slow-growing is
this cancer?
What symptoms will the
cancer cause?
Is there any room for doubt
regarding the test results and
diagnosis?
If I seek a second opinion, can I take
copies of test results x-rays?
Are any other tests required? If so,
what are they and what would
they be looking for?
Will further tests hurt?
What symptoms are likely if the
cancer progresses?
What are my treatment options?
Which treatment do you recommend,
and why?
How often is the treatment necessary?
What are the benets versus risks
of treatment?
44
Is the treatment aimed at a cure,
remission (control) or a response?
What are the likely side effects of the
treatment? How can these be minimized?
How much will treatment cost?
What should I do or not do
while having treatment?
How long will it be before I know
if the treatment is working?
Can I receive specialist help for
pain control?
Are there long-term side effects
to treatment/ medication,
and what are they?
Who will be in charge of
treatment?
How will the treatment impact on
my work, my relationships and my
lifestyle?
Should I follow a special diet or
make other lifestyle changes?
Do members of my family have a
greater risk of getting cancer?
What counselling or support
services are available?
What happens after treatment?
Can you suggest any reading
material?
45
Resources
National and International Cancer Related Information
For any cancer information, http://www.plwc.org.za
support or advocacy contact 0861 ASK NOW (0861 275 669)
the national cancer call centre
Monday Friday, 9:00am 3:00pm
American Cancer Society http://www.cancer.org
ASCO http://www.cancer.net
Good information on all cancer types.
Campaigning for Cancer http://www.campaign4cancer.co.za
An advocacy organisation which 0861 275 669
allows South African cancer patients
to voice their rights.
CANSA http://www.cansa.org.za
South African Cancer Organisation 0800 226 622
Choc Childhood Cancer Foundation SA http://www.choc.org.za
Support to children diagnosed with 011 486 1212
cancer and their parents.
GVI Oncology http://www.cancercare.co.za
Home Nursing Services http://www.plwc.org.za
There are nursing agencies in all the provinces. 0861 275 669
For more details contact our ofce on or
visit our website for a list.
46
Hospice Palliative Care http://www.hospicepalliativecaresa.co.za
Ass of SA
Provides palliative care to all
cancer patients.
Lance Armstrong Foundation http://www.laf.org
Leukaemia Information http://www.gleevec.com
Look GoodFeel Better http://www.lgfb.co.za
082 344 6693
Macmillan Cancer Support http://www.cancerbackup.org.uk
National Brain Tumor Society http://www.braintumor.org
Nutrition Information Centre http://webhost.sun.ac.za/nicus
This is an initiative by the
University of Stellenbosch
Oncolink http://www.oncolink.upenn.edu
University of Pennsylvania Cancer Centre
People Living With Cancer http://www.plwc.org.za
Quackwatch http://www.quackwatch.com
Your guide to quackery, health fraud
and intelligent decisions
Reach for Recovery http://www.reach4recovery.org.za
Provides practical and emotional support
to breast cancer patients and their families.
47
Roche Oncology patient website http://www.becanceraware.co.za
Sunower Fund http://www.sunowerfund.org.za
Education and recruitment of potential 0800 121 082
bone marrow stem cell donors who are
ethnically diverse.
Survivorship Care Plan http://www.livestrongcareplan.org
OncoLink has teamed up with the
Lance Armstrong Foundation to create an
individualized plan of care for cancer survivors
48
Books
Most are available at the public library,
local bookstores or on-line booksellers.

A Guide to Complementary Therapies in South Africa
Fenn, C.
After breast cancer
Hester Hill Schnipper & Lowell E Schnipper
Always on call: When illness turns families into caregivers
Carol Levine
Allen Carrs Easyway to Stop Smoking Method
is the worlds most successful stop-smoking program.
National booking line number: 0861 100 200
www.allencarr.co.za
Breast Cancer Husband
Marc Silver
Challenge Cancer the Holistic way
Monica Fairall
Chicken Soup for the Breast Cancer Survivors Soul
Jack Caneld, Mark Victor Hanse & Mary Olsen Kelly
Crossing Divides: A Couples Story of Cancer, Hope,
and Hiking Montanas Continental Divide
Scott Bischke
Hit below the Belt: Facing up to Prostate Cancer
F. Ralph Berberich
49
Its Not About the Bike: My Journey Back To Life
Lance Armstrong
Listen With Your Heart: Talking With the Person Who Has Cancer
(Online Booklet) When someone close to you who has cancer starts to talk
about the disease, do you change the subject? Do you stand in silence,
worried that youll say the wrong thing? If so, you share these feelings with
many others.
http://www.cancer.org/docroot/MBC/MBC_4x_listen_with_your_heart.
asp?sitearea=MBC
Love is a journey: Couples facing cancer
Jan Latona & Gary Stricklin
Lymphedema: A Breast Cancer Patients Guide to Prevention
and Healing
Jeannie Burt and Gwen White
Making the Chemotherapy Decision
David Drum
On Death & Dying
Elizabeth Kubler-Ross
On Grief and Grieving: Finding the Meaning of Grief through
the Five Stages of Loss
Elizabeth Kubler-Ross & David Kessler
When a parent has cancer: A guide to caring for your children
Wendy Schlessel Harpham
50
7KHEXGG\ 7KHEXGG\
+DYH\RXDIULHQGRUDID PLO\PH PEHUEHHQ
GL DJQRVHGZLWKFDQFHU"'R\RXKDYHDQ\TXHVWLRQV
RUFRQFHUQV "'R\RXIHHOWKHQHHGWRWDONWRRWKHUV
ZKRKDYHEHHQL QWKHVD PHSRVLWLRQ"
People Living With Cancer offers a buddy support network
where cancer patients can interact with and receive advice and support
from cancer survivors who have a similar prole, disease and treatment
protocol. Using their experience in successfully coping with the
disease, they are trained how to assist patients that are currently
facing treatment to deal with diagnosis, treatment, emotional issues
and living with and beyond the treatment of cancer.
Carl Liebenberg, co-founder and director of People Living With
Cancer (PLWC) said that the most important support I needed after
my diagnosis was to simply talk to others who understood.
:HXQGHUVWDQGZKDW\RXDUHJRL QJWKURXJK
For more information send us
an email at info@plwc.org.za or
give us a call on 076 775 6099
Visit our website at:
www.plwc.org.za
CAPE TOWN: Eldr Strydom 076 775 6099
JOHANNESBURG NORTH: Chris Olivier
083 640 4949
NELSPRUIT: Mary Stevens 082 495 0029 /
013 759 0800
PORT ELIZABETH: Mariana Lourens
041 391 0300
PRETORIA: Wilma Lotter 082 573 7342
Toll-free number 0861 ASK NOW / 0861 275 669
Cancer buddy flyer & poster 2009.indd 1 10/23/09 12:21:57 PM
www.plwc.org.za