Author Archives: Pam Evans

Cancer Survivorship – Treatment and Beyond

Over the past 10 years significant improvements in the diagnosis and treatment of cancer have meant that cancer survival is increasing and also the growth in our ageing population has also resulted in an increase in cancer incidence.  With these two main factors, the number of cancer survivors is estimated to likely grow by over 3% per year (Macmillan Cancer Support, 2013).


Until recently the focus has been on treating cancer and little attention has been paid to the long-term consequences of having cancer, but the impact of cancer does not end after treatment. Studies have shown that cancer survivors often have poorer health and well-being than the general population and following cancer treatment many people are left with physical and emotional issues.  Emotional issues may include anxiety, depression, isolation and negative feelings affecting self-confidence and self-image and physical issues can include fatigue and changes relating to treatment such as weight loss, hair loss, surgery (eg, mastectomy, head and neck surgeries) etc.  Additionally it’s very common for cancer survivors to suffer a loss of income and/or increase in household costs as a result of cancer. All of these factors can have a negative effect on the well-being of people, long after their treatment has finished.

However there is now a cultural shift in the approach to the care and support of patients following cancer treatment, with a greater focus on improving the quality of life for people living with cancer and enable them to live a healthy and active life and resume everyday activities. This encompasses providing them with information and guidance about follow-up clinical care and physical and emotional changes – empowering the individual to take responsibility for their condition supported by appropriate ongoing medical support throughout their recovery and promotion of health and emotional well-being after cancer treatment.

In The Cancer Journey – Positive Steps to Help Yourself Heal we offer lots of helpful tips and suggestions about how to take back control of your life during and after a diagnosis of cancer.  We also provide details about lots of sources and organisations that can offer information, support and guidance.

Cancer and Inflammation

Our body’s immune system forms a protective shield and within its armoury, one of its most powerful weapons is inflammation. This is a complex and carefully orchestrated biological response designed to eliminate harmful stimuli such as bacteria, pathogens, injured cells and chemical irritants and to initiate the body’s healing processes, and without it we probably wouldn’t survive beyond childhood.  But inflammation also has dark side and this can be a powerful force in aiding cancer to develop where it can encourage tumour growth and help it spread around the body.

There are two types of inflammation – acute and chronic. Acute inflammation is the normal process which benefits the body and is a rapid response to trauma (an injury or infection).  Signs and symptoms of acute inflammation are only present for a few days, but in some cases may persist for a few weeks.  These usually occur in the body as swelling, heat, redness and pain at the site of injury, and it may also result in loss of functional capacity of the tissues involved.   If the stimulus persists and the body is unable to repair tissue damage and the inflammatory cascade continues, the inflammation becomes chronic.  This type of inflammation can last months or even years. Chronic inflammation is abnormal and does not benefit the body – in fact chronic inflammation is a long term medical condition which is involved in a number of disease states such as rheumatoid arthritis and psoriasis and it has also been long associated with the development of cancer.

While there are a number of drugs being developed to help fight cancer-related inflammation, we as individuals can greatly help support our bodies by something as simple as modifying our diet. There are a number of dietary interventions which may be useful to decrease inflammation within the body.  Studies have shown that diets rich in saturated fats and foods with a high glycemic index can stimulate inflammation, whereas a Mediterranean-style diet rich in fruits, vegetables, olive oil, nuts, beans and whole grains have been shown to reduce inflammation.  Also increasing the dietary intake of omega-3 fatty acids found in oily fish and fish oils generally decreases several markers of inflammation.

In The Cancer Journey, Positive Steps to Help Yourself Heal – Chapter 10, Eating Consciously we give much more information about how inflammation affects cancer, and how you can adapt your diet and lifestyle to give yourself the best possible chance of supporting your body to mobilize against cancer. And in her interview with Dr Josh Axe, Polly talks about the important things you need to understand about inflammation to help you improve your health;

How to deal with hair loss during cancer treatment – Chemotherapy, Radiotherapy and Hormone Treatment

Hair loss (also called alopecia) is a potential side effect of chemotherapy and radiation therapy and for some people can be the most distressing side effect of treatment.  Hair loss can be hard to predict although for some fortunate people, having cancer treatment doesn’t affect their hair at all.  When it does occur it’s usually temporary and in most cases the hair will grow back. Hair loss may occur throughout the body, including the head, face, arms, legs, underarms, and pubic area and hair may fall out entirely, gradually, or in sections. In some cases, hair will simply become thin, sometimes unnoticeably, and may become duller or dryer.

For women in particular and also many men, hair can be an important part of their appearance and identity, and losing their hair can be very upsetting. It can leave you feeling uncomfortable about socialising, concerned about how your different appearance will affect relationships with family and friends and generally result in feeling less confident, vulnerable and exposed. For others – particularly as people today are much more aware of the effects of cancer treatment – their hair loss can act as a visible message that they are going through cancer treatment.  But this can also make the patient feel ‘labelled’ and forced to talk about their cancer even if they don’t want to.  So there are lots of different emotional reactions associated with hair loss and for some, losing their hair may feel like the final straw on top of the injustice of having to deal with a diagnosis of cancer and the associated treatment. But for some, accepting and adjusting to hair loss isn’t as bad as they had expected.

Why does it happen?

The normal scalp contains around 100,000 hairs and these are constantly growing with new ones replacing old ones as they fall out.  Most adults lose between 40 and 120 hairs per day as part of the healthy hair growth cycle.

In cancer treatment, hair loss can happen when chemotherapy drugs travel throughout the body to kill cancer cells. As the chemotherapy drugs destroy the cancer cells they can sometimes also damage healthy cells, including the cells in the hair follicles and this damage can cause the hair to fall out. Some patients will be affected while others will not, even when they take the same drugs. Some drugs cause only the loss of scalp hair while loss sometimes happens to pubic hair, arm and leg hair, eyebrows, and eyelashes. The hair loss caused by chemotherapy is almost always temporary and the hair will start to grow back as soon as treatment is finished (and may even start to re-grow before the chemotherapy course has completed).

Radiation therapy also affects healthy cells but only affects the hair that is close to the specific area being treated. So radiation to the head often causes scalp hair loss while having radiotherapy to the breast and lymph glands in the armpit can cause loss of underarm hair for women and men and chest hair for men. And having radiotherapy in the pelvic or groin area can cause loss of pubic hair. Sometimes, depending on the dose of radiation to the head, the hair which grows back is not identical to the original hair, with difference in texture, thickness and colour sometimes being seen. Hair re-grow is sometimes also patchy and can take 6-12 months to grow back fully.  Very occasionally the hair does not grow back at all.  This is usually associated with the radiotherapy being given at very high doses and a very high number of treatments.

Some hormone therapies for cancer such as tamoxifen can also cause hair thinning.  This is usually mild and may only occur during treatment.  Once treatment is complete the hair will usually grow back normally.


Unfortunately there is nothing you can do to prevent hair loss caused by radiotherapy, but with chemotherapy it’s sometimes possible to reduce hair loss by cooling the scalp with the use of a cold cap. This technique reduces the blood flow to the hair follicles which in turn reduces the amount of drugs reaching them and in some cases can prevent the hair from falling out. Scalp cooling only works with certain drugs and the level of success varies from person to person. Some people find wearing a cold cap very unpleasant and uncomfortable.  As well as being very cold the caps tend to be quite heavy and need to be changed every 20-30 minutes during treatment to keep your scalp cool. They can also give you a headache but this will usually wear off very quickly. There are a number of different types of cold cap and ways of cooling the scalp so the method used will depend on what’s available at your treatment centre.


If you think you may want a wig, and if it’s important to you that it matches your hair colour and style, you may want to choose one before your hair actually falls out. Alternatively you could cut and keep a swatch of your hair to use for matching, in case you decide later that you want or need a wig. Or you may decide you want a complete change from your usual style. Ask if it’s possible if the wig can be adjusted as your head size can shrink as you lose your hair, especially if you have very thick hair.

If you decide you want a wig you may be eligible for a free one.  However, this varies from centre to centre so you need to ask your healthcare professional.  Free or subsidised-cost wigs are usually synthetic as these are significantly cheaper than those made of real hair.  Synthetic wigs are lighter in weight than real hair and are relatively easy to care for. They are often pre-styled and can be easily washed and left to drip dry.  Real hair wigs need to be handled more carefully and may need professional cleaning and restyling. They are also usually considerably more expensive than synthetic wigs.

Hair and scalp care

If your hair is going to fall out, the first thing you may notice is your hair starts to come out more when you brush, comb or wash it. You may also find hair on your pillow in the morning. During cancer treatment the following recommendations may help you deal with hair loss;

  • Your scalp may feel very sensitive to washing, brushing or combing so consider not washing it every day, don’t scrub vigorously and choose a mild shampoo such as baby shampoo.
  • Try to use hair products which are natural and chemical-free.
  • Choose a soft hairbrush and avoid using high heat to dry, curl or straighten your hair.
  • You lose a lot of heat through your scalp so cover your head during cold weather to prevent loss of body heat.
  • In warm weather use sun protection on the scalp such as sunscreen, hat or scarf when outdoors.
  • Avoid colouring or curling your hair with chemical products.
  • Gently massage the scalp to remove any dry skin or flakes.
  • When your hair begins to re-grow it may be much finer and more easily damaged than your original hair so treat it very gently.
  • It may take up to a year before your hair returns to its original texture and colour.  Before starting to use semi-permanent or permanent colour or curling products again, patch test a small area first because you may find your hair reacts differently after cancer therapy.
  • Always ask your healthcare team before using any hair-growth creams or lotions.

For information on other side effects associated with cancer treatment and how to cope with them please see Chapter 3 of The Cancer Journey – Positive Steps to Help Yourself Heal.

How to heal Lymphedema

Lymphedema is an accumulation of lymphatic fluid in soft body tissues which in turn causes swelling.  It’s a common problem in cancer patients and may be caused by the cancer itself or the cancer treatment. It mostly occurs in the arms and/or legs but can occasionally happen in other parts of the body.

The lymphatic system is part of the circulatory system and is a major part of the body’s immune system.  The lymphatic system comprises a network of organs, lymph nodes, ducts and vessels that run throughout the body and these work together to aid the immune system to cleanse the body of any debris, abnormal cells or pathogens. Lymph is a clear colourless fluid that contains white blood cells (called lymphocytes) that help the body get rid of toxins, infections and other waste materials. The lymphatic system also absorbs fats and fat-soluble vitamins from the digestive system and delivers these nutrients to the body cells and also removes excess fluid and waste products produced by the cells.

In a person with cancer, lymphedema can be caused when surgery and/or radiation has removed, damaged or blocked the lymph nodes in the underarm, groin, pelvis or neck area. This condition can develop immediately or sometimes occurs weeks, months or even years after therapy has finished and the swelling can range from mild to severe. Lymphedema of the arms often occurs in breast cancer patients who have had all or part of the underarm (andaxillary) lymph nodes removed. Lymphedema in the legs may occur after surgery for any pelvic, gynaecological, colon, bladder, testicular or prostate cancer or melanoma. It can also develop in the face, head and neck after surgery and/or radiation to treat head and neck cancer.

Treatment can help control symptoms of lymphedema and can include exercise, compression treatment, skin care and massage.  Exercising and keeping active helps to improve the flow of lymph and moving the affected limb helps to drain excess fluid.  The use of compression garments such as sleeves, stockings, special bras and bandages can compress the affected area. Specialised massage called lymphatic drainage massage can also help. There are two types -manual lymphatic drainage (MLD), which needs to be administered by a trained professional or self-massage called simple lymphatic drainage (SLD) can help drain fluid and reduce the swelling.

In Chapter 3 of The Cancer Journey – Positive Steps to Help Yourself Heal both Polly and Pam describe how they had considerable success treating their own lymphedema and on her website, Polly’s Path To Health & Happiness, Polly gives her 10 tips to heal lymphedema

Complementary Therapy

First, it’s important to distinguish between alternative and complementary therapy.  Alternative therapy is used instead of standard or mainstream medical treatment whereas complementary therapy is used alongside conventional medical care.  Alternative therapy generally implies rejecting mainstream anti-cancer treatment (chemotherapy, radiotherapy, surgery) and is largely lacking in biological and scientific evidence of efficacy and also can be of questionable safety.  Because of this the medical establishment is generally not supportive of alternative therapy. Over the past decade or so, complementary therapies have become increasingly acceptable and popular as part of cancer care and few cancer specialists would argue against the use of complementary therapies alongside conventional treatment to ease the side effects of radiation or drug therapy, strengthen the immune system and improve well-being.

Combining complementary therapies with mainstream oncology care is commonly known as integrative therapy and is a total holistic approach involving the patient’s mind, body and spirit. By supporting this approach, the cancer physician enables a patient to have an active role in their own care and this in turn improves the overall quality of cancer care and well-being of patients and their families. The ability of the patient to choose the therapy and when to have it, helps to restore some control over their life which can sometimes feel  hi-jacked by a feeling of having to passively endure their medical treatments. These non-pharmacological therapies can lift your mood and spirit, reduce anxiety and stress, alleviate symptoms and side effects such as pain and nausea, and can enhance quality of life and recovery.

There is a rich array of complementary therapies such as meditation, guided imagery, mindfulness, nutritional support, counselling, massage etc, and in The Cancer Journey – Positive Steps To Help Yourself Heal we describe lots of these.

Express Yourself

A diagnosis of cancer can make an individual feel they’ve lost control of so much resulting in both physical and psychological damage.  Doing something creative or expressive such as art, writing, gardening  or music can really help improve a person’s physical, mental and emotional well-being.  Expressing yourself through engaging in this way can give you  greater self-awareness and a positive sense of well-being and has demonstrated numerous benefits including promoting inner peace and relaxation, reducing stress and anxiety and  providing positive meaning to our lives as it helps re-focus our attention away from our illness.

Pablo Picasso is quoted as having said “Art washes away from the soul the dust of everyday life”.

In Chapter 8 of The Cancer Journey we share a few simple ideas for ways you can express yourself and  guide you to take some very easy steps to regain control and greatly enhance your well-being.

“Let food be thy medicine and thy medicine be thy food” (Hippocrates, 460-370 BC)

Being positive and looking for ways to help yourself recover and cope with cancer can at the same time be very empowering and also very frustrating.  There is so much information on the internet, sometimes from dubious sources, that this was why the 3 of us decided to combine our individual first-hand knowledge and experience and share the things we found helpful.  It is an interesting fact that even in the span of time since we were first diagnosed, there has been a huge shift of attitude in the medical profession towards the acceptance of patients integrating self-care with conventional treatment.

One of the things we feel passionate about is encouraging recovery and supporting our bodies through really good nutrition.  Good nutrition is vitally important as it enables you to cope with the side effects of treatment, prevents weight loss and body tissue breaking down.  It also helps repair damaged tissue, fights infection and provides energy.

In Chapter 10 of The Cancer Journey we look at what really makes cancer tick and how we can change our diet to make better food choices.