by Mike Wakeman
Surving cancer is often portrayed as winning a war but as returning soldiers know that is all too often only the beginning. There is a new and much more lonely set of personal battles to be fought. There are currently around 2 million people in the UK “living beyond cancer” and for years the damage they suffered while winning their personal cancer war went largely unrecognised.
According to the latest report from Macmillan Nurses the charity that has shouted most loudly on this issue, 500,00 cancer survivors in the UK face poor health. That’s a pretty damming indictment of not only tendency of specialists to consider that the serious side-effect of treatment just come with the territory but also of primary care who could do much more to help survivors through the aftermath.
As screening becomes better able to detect cancer earlier, not only will numbers increase, but more young patients will be struggling to create a life after cancer that is worth living. And the current numbers are bad enough – 240,00 with mental health problems such as depression, 350,000 reporting fatigue and the same number having sexual difficulties, as well as 200,000 experiencing ongoing pain. Any of these can emerge just a few months after treatment has finished and can persist for up to 10 years.
Breast cancer treatment, for instance, can damage the lymph nodes, making it hard for lymph fluid to drain away and causing chronic painful swelling. Blocking oestrogen can be life-saving but it causes premature menopause, associated with loss of libido and hot flushes. Pelvic radiotherapy for prostate or ovarian cancer can lead to bladder and bowel incontinence.
Unpleasant as these symptoms are survivors often find it hard to discuss them because they seem relatively trivial compared with the cancer they had “defeated”. But even if they do seek help, there is little in the way of a system to provide it. So the excitement that surrounds new cancer treatments need to be balanced by more attention to supporting survivors in their struggle to deal with the accompanying side-effects.
So here are the kind of areas where problems are likely to emerge with tips on what you can do about them.
At the most basic level there is a need for better information. Many patients say they aren’t told what to expect once they become survivors and then when the problems become clear, they are left without any formal help. This claim isn’t just based on anecdotal reports, a study of endometrial cancer survivors found that the majority were unsure of the health risks they faced and knew nothing about the long-term and late effects of cancer. They also weren’t provided with any resources, support, self-management techniques or education tools (1).
Side effects of breast cancer treatment
Doctors and nurses are well aware of complications of surgery and chemotherapy in breast cancer, these include swollen lymph glands and heart problems but they usually pay far less attention to the psychological issues that are equally real and distressing. One study found a significant number of patients experience psychological and sexual issues, relationship difficulties, fatigue, insomnia, and depression (2).
Once a tumour has been removed patients face the difficult choice of whether to have hormonal therapy to block oestrogen (tamoxifen and aromatase inhibitors) because the hormone can encourage tumour growth. This brings on all the symptoms of the menopause along with other side effects such as arthralgia (joint pain). Menopausal symptoms including hot flushes, vaginal dryness and mood swings are usual treated with HRT (hormone replacement therapy), which obviously isn’t an option.
But there are treatments that can make a difference. Plant based oestrogens, such as soy isoflavones, are one option. Originally viewed with scepticism, studies now show they are safe and effective (3-6). Research also shows that as little as a 6 week walking program or 8 weeks of physical therapy significantly decreases joint pain, stiffness and fatigue in elderly breast cancer survivors on oestrogen blockers (7,8).
Better dietary advice
Even though many cancer patients make changes to their diet, such as cutting out processed meat and dairy foods, most cancer specialists pay little attention to diet, claiming there is very little evidence it is effective. However there is research suggesting it can be. A five year observational study of breast cancer patients found those consuming the highest levels of omega 3 fatty acids enjoyed around a 5 times greater response to chemotherapy and 5 times less incidence of secondaries compared to those with the lowest levels (9).
In June last year oncologist Professor Robert Thomas of Addenbrooke’s Hospital in Cambridge presented the results of a placebo controlled trial which showed that capsules containing concentrated extracts of foods claimed to have cancer fighting properties – pomegranate, green tea, turmeric and broccoli – lowered the cancer marker PSA in patients with prostate cancer.