So you’ve survived cancer – that’s only the beginning


The cancer survivor community has been acutely aware for some time of the damaging mental side effective that comes with chemotherapy. They call it ‘‘chemo brain’ which covers a range of symptoms – a mental slowing down, fogginess and memory loss, that continues for months or years after chemotherapy (19). When patients first started reporting these effects, oncologists assumed they were caused by the cancer metastasising (spreading) into the brain. However, in 1980, it was recognised that chemotherapy patients with no metastases to the central nervous system experienced cognitive impairment independent of mood disorders or other psychiatric conditions.

Research is now uncovering how chemotherapy causes these problems – long dismissed by doctors as “anecdotal”. When healthy animals are given chemotherapy in proportionally the same doses as those used in humans, cognitive deficits occur, particularly disruption of nerve development and changes in the hippocampus – the region of the brain involved in laying down memories (18). A recent human study uncovered evidence for alterations in hippocampal size along with verbal memory difficulties following breast cancer chemotherapy (20).

Doxorubicin (Adriamycin) is a widely used form of chemotherapy that is particularly associated with Chemobrain. Even though the drug itself doesn’t get into the brain, research recently found it boosts production some naturally occurring compounds that cause inflammation and oxidative stress in the brain, which are likely to produce cognitive problems. (21). A new study of another widely used chemotherapy drug fluorouracil (5-FU) found it also probably causes brain inflammation as well as damaging the myelin sheath – the protective covering that surrounds nerves in the brain, which also causes cognitive problems (22).

Antioxidants such as vitamins C and E found in the diet might help to bring down this inflammation although there’s no good evidence for it. There is some evidence that home based programmes designed to train and practice cognitive flexibility, working memory, processing speed and verbal fluency have a benefit in “chemobrain”. Useful challenges include, switching games, mental acuity tests, maze navigation, memory games, route planning and puzzle solving (23).

Cancer/problem pairs

In general consultations for chronic diseases and psychosocial problems are increased: breast cancer patients have more contacts related to diabetes (55%), sleep disturbance (60%) and depression (64%); whilst prostate cancer patients have more contacts related to hypertension (53%) and chronic obstructive pulmonary disease (34%). Adverse drug effects to cancer drugs were almost twice as common in prostate and colorectal cancers compared to other cancer survivors. But, surprisingly, very few patients consult GPs about fear of cancer recurrence (24).

As if all these chronic problems facing survivors weren’t enough they are also more likely than other people to consult GPs for acute symptoms. Those who’ve had breast or prostate cancer are more likely to report abdominal pain and fatigue, while infections, such as cystitis or respiratory infections are commoner among breast and colorectal cancer survivors.

What’s to be done?

At the moment far too many of the GPs and other clinicians to whom survivors turn to for help, share the “hurrah, you’ve beaten cancer” attitude, all too common in the general population. . There’s little recognition that for some, the longer term challenge of cancer is surviving the damage caused by treatment and that this can be a lonely, dark road.

Most survivors complete their treatment with little understanding of what the future may hold. Quite apart from the physical and mental effects, there are social and economic penalties. Cancer can be expensive to treat and survive, since often the family loses a wage earner during treatment, and subsequent issues such as “chemobrain” can make return to the workplace difficult.

It is clear that there are many effective ways to maximise quality of life that aren’t expensive or time consuming. These include simple modifications to lifestyle, such as nutrition, weight management and exercise which need to be combined with a more welcoming and open dialogue to equip survivors with knowledge of what life after cancer might look like and how to deal with it more confidently. There is no reason why patients can’t get advice on the best way to plan these changes and to be supported in their new regime both during treatment and afterwards.

Unfortunately attention and funding is almost exclusively focused on new expensive high-tech treatments which can indeed by life-saving but at a cost. A cost that the patient has to bear. Promises are regularly made that more targeted treatments and advances in genetics will predict or reduce chemotherapy’s side effects but such developments are very much in the future. Nutrition and exercise barely make it on to the clinical agenda.

In theory every patient is supposed to get a discharge summary, a holistic needs assessment, advice on vocational rehabilitation, physical activity and weight management and a written care plan copied to your GP. In practice this only exists on some ‘wish list’ although you could always try asking. This is very different from US where by 2015 every cancer survivor will be mandated by law to receive a survivorship plan.

So at the moment the most useful people to turn to for help are those who have already been through it. As a first step is to contact your local cancer support group where emotional and practical help really exists. Macmillan Nurses is also an excellent resource who can also tell you which of the 900+ support groups around the country is nearest to you.

For somewhere with knowledge about the holistic approach it would also be worth contacting the charity

Mike Wakeman

Mike Wakeman

Michael Wakeman is a pharmacist and healthcare consultant with master’s degrees in pharmaceutical analysis, nutritional medicine, and shortly clinical oncology. He has extensive experience in natural medicines research, is a regular contributor to health publications and in 2009 his research was selected to promote the Royal Pharmaceutical Society’s scientific conference. Email
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  • Interesting, but I spotted two errors: in the section on obesity the author claims that the hormone leptin makes you feel hungry. This is incorrect, leptin is the hormone secreted by adipose tissue that signals to the brain that the fat stores are full and is known as the satiety hormone. Low leptin increase hunger. Ghrelin, secreted by the stomach, is the hormone that makes you feel hungry. Second, the studies by Harvie et al. use a low carbohydrate diet for two days followed by a Mediterranean diet for 5. It is likely that the low carb intake is the key to lowering insulin resistance. The actual intake on the two days of low carbs is about 1000cals per day. Alternate day fasting (ADF) as studied by Krista Varady and colleagues also demonstrates decreases in insulin resistance. Fasting is akin to low carb as the lack of carb intake during fasting allows insulin levels to fall and as a result increases in insulin receptors occur.

    • Editorial

      Thanks for picking up leptin error – is of course saiety hormone. You may well be right on low carb – personally think it makes a lot of sense for a number of metabolic disorders but know there is still disagreements over differening effects of low carb, low calories and different dietary schedules. Fascinating area, maybe Mike has a view.

  • That’s an interesting discussion, Mike, and as you say, attention and funding majors upon bringing forth high-tech treatments. Cancer does respond positively to low carbohydrate diets, and several decades ago some proponents saw highly saccharine diets as being a risk factor for cancer.

    What are your thoughts about cancer rates as apply to humans in the context of time an place, and how do cancer rates compare across species, including those species who live wild, and those we have domesticated and brought into our homes?

    Are there factors present and common in aspects of the world we’ve largely shaped for ourselves, and perhaps rising in prominence within the last century, that you might reason could be capable of accounting for cancer rates?

  • An excellent article – most people could improve their health by walking more but some are reluctant. Walking for health is a scheme to help people with this gentle but effective form of exercise, walking in groups to give encouragement and mutual support. They have a website that provides more info.

  • Mike, what an excellent article, but you will be aware that the difficulty is getting the physicians to consider the value in nutrition when they only receive six hours tuition in nutrition in two years of their basic science part of the their medical degree. It is just as bad in the US where only six percent of graduating physicians have had any training in nutrition. Perhaps Mike there is an opportunity now with the new Academic Health Science Networks to get this ‘innovation’ promulgated. After all it was another pharmacist, the famous apothecary William Cookworthy who advised the naval officers in Plymouth that scurvy might be prevented and treated by supplying crews with fresh fruit and vegetables and in their absence sauerkraut which is rich in Vitamin C.

  • “Excellent read and very insightful. Certainly has given me more food for thought given my current academic learning curve. The piece flows really well and is supported by a diverse range of research. Would the inclusion of direct comments/experience from cancer survivors have given the literature more richness/depth?

    You could perhaps include local Macmillan Cancer Support and Information centres and the national website as additional resources. To highlight the referral criteria for most Community Macmillan Nurses across the UK care for patients with a 12 month prognosis or less. However, there are a range of service models who also see patients deemed ‘curative’ however in my experience this is generally not the case. Hospital based Macs do see patients across the disease trajectory and also use the ‘buddy/mentor’ programme”. An excellent concept Mike – in reality given the current economic climate in an era were GP led commissioning is upon us the evidence would need to ensure a both a positive health outcome for survivors and cost efficiency.

  • medical ozone!Please.

    • Editorial

      I discovered that this refers to: prof v bocci,uni siena “the use of ozone in medicine

  • Thanks for highlighting this important issue, Mike. Doctors have consistently underplayed the long term effects of cancer treatments, and the sufferers have all too often been ignored. RAGE – Radiotherapy Action Group Exposure has campaigned – and been rebuffed – consistently since the early 90s on behalf of women whose lives have been a misery as a result of the unintended consequences of radiotherapy.

    At Yes to Life, we know that still, a quarter of a century later, doctors describe radiotherapy as an almost completely benign procedure, and the fact that it could even kill you by promoting cancer is never mentioned. My daughter died of radiotherapy induced osteosarcoma, but even the circumstances of her death were ‘sanitised’ to keep the truth about radiotherapy below the radar – her death certificate said respiratory failure. This is rather like saying that someone who got shot dead, died from respiratory failure, rather than from being shot.

    Importantly, also, your article highlights the dire situation that cancer patients find themselves in on ending their treatment. They are sent off with nothing other than the hope they’ll avoid a recurrence, with no strategy and no idea what to expect in terms of long term after effects of treatment. In the 21st century, this archaic denial of reality, stemming from institutionalised problems in health services the world over surrounding empathy and simple human relations, needs to be called exactly what it is – complete absence of care coupled with pathological clinging to an increasingly untenable status quo. Dr Robin Youngson’s ongoing campaign against old style clinical detachment is In need of all the support it can get. We need nothing less than a revolution in the way that healthcare providers relate to the people who find themselves in need of care. Only then will the difficulties of these huge numbers of people start to be heard.

    All in all, a topic, or indeed range of topics that needs a lot more airspace. thanks Mike.

    • Radiation and Chemo will never give a good outcome as they merely have one pathway of killing aberrant cells. Cancer is a metabolic disease with multi pathways and thus the current conventional protocols are little more than an Emperor with only a jock strap.

  • I am a Medical Herbalist in Canada, trained out of the UK. I treat cancer and it has become a speciality for me personally. There are plenty of Medical herbalists in the UK who can not only treat cancer in its primary form but also when chemo etc are used both maximise its beneficial effect to the patient and minimise and/or remove the negative aspects. As Medical Herbalists are highly trained practitioners of biochemistry and phytochemistry they usually know more than the so called oncology professionals. Sadly the mandarins in the UK government continue to block this eminent profession which has been licensed since 1542. Every cancer patient should have a Medical Herbalist at part of the team and there would be far better outcomes with considerable cost reduction. As this is a general post I am not giving references but they are mostly all on Pubmed as it is MH is evidenced based medicine. Cancer is a metabolic endocrine disease driven in the first instance by excess circulating glucose for most cancers, now recognised as the Warburg effect. Cancer is a completely preventable disease but it is never treated as such because it is a huge money maker and the protocols are very ineffective for real health. Perhaps readers could start to educate the public

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