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

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.

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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