Alcohol and Cancer

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Alcohol and cancer

In order to understand how alcohol or any toxic substance causes cancer in the body, we must first understand cancer itself.

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The truth about alcohol and cancer

This is not the article you want to be reading. I know, I get it. I’m Irish!

As a health care professional and advocate for adopting healthier lifestyle behaviours, it is my duty to at least bring to your attention the very real association between alcohol consumption and cancer. We’ve all heard it – too much booze is not good for us. A lot of us have felt it – too much booze does not feel like it is good for us. But how many of us are straight with the fact that too many a tipple can actually cause cancer?

In order to understand how alcohol or any toxic substance causes cancer in the body, we must first understand cancer itself.

What is cancer?

Our bodies are made up of hundreds of thousands of cells. Usually the cells in our body undergo a specific cycle. They grow, die and are replaced by new cells in a highly regulated way. The process happens in such a controlled fashion that cells must reach a certain size before kicking the bucket and being replaced.

Cancer cells on the other hand tend to grow fast and furiously. Instead of dying, they divide and replicate and start to spread to other organs due to overcrowding and a lack of space in the organ of origin. There is little control or regulation involved here.

Chemotherapy and other treatments are often needed to kill cancerous cells. Their purpose is to slow down the growth of cells or demolish a tumour completely.

How does a normal cell become a cancer cell?

We all have cells which have the potential to become cancerous. A lot needs to happen however before they can actually turn cancerous. Essentially the cells must:

    • be able to replicate
    • have damage to their DNA
    • develop faults in genes as a result of this damage

Cancer therefore occurs when DNA damage accumulates to cause faults in the genes. The damage can happen due to a whole host of factors ranging from alcohol consumption and smoking, to air pollution, unhealthy diets or asbestos exposure. Even the ageing process, which is largely out of our control, can result in DNA damage and therefore can be a cause of cancer.

For the purpose of this article though, let us now shine the light on alcohol.

Why does alcohol cause cancer?

The digestion of alcohol in our body is actually quite different from the digestion of nutrients from food. Alcohol gets absorbed rapidly into the bloodstream. Sometimes directly from the stomach and sometimes from the small intestine. It travels through the bloodstream to our body’s cells and to our wonderful natural detoxifier – the ‘liver’ – which works around the clock to help break down or digest alcohol. The breakdown product (or byproduct) of alcohol is a substance called acetaldehyde. Acetaldehyde has the ability to damage DNA and permanently alter it. If it is not broken down further it builds up in the cells (where alcohol is consumed to excess). If the cells are unable to repair the damage, then the cancer process can begin.

So in a nutshell, the more beers you consume, the higher the likelihood for cells to become damaged and for this damage to accumulate and give rise to cellular division and replication (cancer).

How much alcohol is ok?

Scare tactics over, the irony of this is, I’m writing this on a sunny Friday afternoon prior to a scheduled meet up with an old friend for a glass of vino… or two. Before you lock up the drinks cabinet, let’s not forget that many centenarians enjoy a regular tipple – but probably as part of an otherwise very balanced way of life. It is of course possible to live to a ripe old age and still enjoy a gin and tonic but really it all comes back to our old friend (or foe) moderation

Know your limits.

Guidelines

*The guidelines above are approximate and there are many factors that might affect how your body responds to alcohol (age, sex, physical size). 

What next?

If you think you are drinking more than you probably should be, you might want to chat to your GP or a trusted friend about what to do next. Some of the articles in the reference list below may be helpful to read.

Don’t feel you can’t ever en a drink, just be mindful of the potential effects of cumulative excess on your body.

Again, know your limits.

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What To Pack In Your Hospital Bag

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What To Pack In Your Hospital Bag

A hospital admission can be a worrying time for all concerned. In this blog post we hope to remove some of the uncertainty by providing a practical guide to hospital admission.

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Why do I need this guide?

Perhaps up until now your mind was rife with questions about your operation; how will they anaesthetise me, what if I wake up halfway through, what are the risks (that I completely forgot to ask about in the consultation room the other day), how long will the recovery take (will I recover…?). Sometimes the mind goes into overdrive and it can all seem a little overwhelming. The focus is on survival and recovery so it is inevitable that the practical things can be overlooked.

We thought we would make your life a little easier and develop a practical ‘what to take into hospital’ checklist. Because, the odds are, you will survive and we want to make your recovery in hospital a little easier. And incidentally, anaesthetists are really rather good these days. The likelihood of you waking up mid-surgery is similar to getting 5 balls in the lottery (a 1 in 11,098 chance).

What should I pack in my hospital bag?

This list is not exhaustive and we would love to hear from you if you would like us to add anything.

The list:

The first thing to remember is that space is limited. Your bag should ideally be something soft that can be squeezed into small spaces.

Your own pillow – this is not to say you will be deprived of a pillow to accompany your hospital bed, it just might be comforting if you are someone who has that ‘perfect’ pillow that you struggle to sleep without.

Personal items – Maybe tuck some photos or even a stuffed toy into your bag. Having something personal from home can be a huge comfort at times when you really need it.

Ear plugs – Let’s face it, a hospital ward is not exactly the paradise of peace and quiet. Prepare for night time beeps and chattering at the very least

Eye mask – as above but imagine bright lights on the ward when you are trying to get some important shut eye.

Wash bag with all the trimmings – think toothbrush, toothpaste, face wash, moisturiser, comb or hairbrush, lip balm (to combat dry lips post-op), shampoo, razor, soap, sanitary towels or tampons, or any other essentials to keep you feeling fresh.

Slippers – you want to have some grips on the bottom of your slippers or comfy socks but they should be loose fitting as your feet may swell after surgery.

Mobile phone – Unless you’re still in the age of the dinosaurs, this may well serve you well for keeping in touch with the outside world while you are an inpatient. Just don’t forget your charger!

Headphones for your personal device (phone /iPad /tablet) – These will act as a distraction when boredom strikes. Think about what you might like to have – it could be a podcast, some preloaded movies or a favourite TV series to help lighten the mood. Perhaps this is an opportunity for worried well-wishers to get involved by creating a playlist, or putting together a selection of your favourite programmes to keep you occupied during your hospital stay. It may help them feel like they are contributing to your recovery.

Books, magazines, crossword puzzles – Variety will be the spice of life when it comes to your hospital stay. Anything to take you away from the ‘mundane’ for just a little bit. Sometimes concentration can be affected after major surgery. Try to keep your mind active. A bit of brain training is a good habit to get into.

A notebook – this is so useful to write down questions to ask healthcare professionals sometimes they can appear when you least expect them, and that element of surprise makes you forget that crucial question you had been holding in the forefront of your mind all day. Write these questions down as and when they arise. For the more tech-savvy amongst us it may be worth downloading a notebook app instead. You might even take some inspiration from a potentially tough time and channel it into becoming the next Stephen King….or maybe just a bit of blogging or diary writing for yourself. It is also a good way to track your own progress. Make a note of how many steps you have walked, how many circuits of the ward you have done, how you are feeling or your pain score. That way, when you go home, you have an objective marker of progress.

Medications – bring the medications that you typically take with you along with a written list of what you take and when. Your clinical team should be able to tell you what to continue or stop prior / after your operation.

Night clothes, dressing gown, loose-fitting day clothes and clean underwear – all the usual suspects here. No harm having a fresh change or two. Changing from night to day clothes may help restore a sense of normality. Short sleeves are also good in case you need an IV line.

Money – you might fancy the newspaper or different snacks to what’s on offer from the hospital trolley occasionally. Just a small amount for your bedside locker is no harm just in case.

Glasses, hearing aids, dentures, crutches – Think of those pieces of equipment that will help you to communicate and get by as smoothly as possible.

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Onko programmes work alongside your cancer treatment.
Onko does not provide clinical treatment for cancer.

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Nausea Checklist

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Nausea checklist

A lot of people going through cancer treatment get struck down by nausea.

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A lot of people going through cancer treatment get struck down by nausea. For some, it comes and goes in waves and a noticeable pattern can be identified. For others, it can linger for weeks and destroy a person’s quality of life.

What is happening in the body?

Chemotherapy affects parts of the stomach and brain that detect toxic substances. As your body tries to rid itself of the toxins it can lead to nausea and sometimes vomiting. The dose and type of cancer drug will affect the degree of nausea. Chemotherapy infusions can lead to instant nausea because of how quickly they reach the bloodstream.  

Why it matters

There is no doubt about it – that awful ‘sicky’ feeling is downright debilitating! It puts you right off your food, your appetite disappears and your weight can start to plummet as a result.

Unintentional weight loss >5% (regardless of your initial weight) coupled with inadequate nutrition are not ideal during chemotherapy or radiotherapy.

They can:

    • dampen the immune system & increase your risk of infections
    • lead to worsening tolerance of treatment
    • zap your energy levels
    • make it difficult to remain physically active
    • lead to loss of muscle mass (strength!) as well as fat mass

What you can do

Everyone has their own way of dealing with what life throws at them. Coping with the side-effects of cancer treatment can be a real challenge even for the most resilient of us. At Onkohealth we aim to empower people to take back some control over what is happening to them.

Here are 10 tried and tested ‘Tips and Tricks’ which have helped people get through bouts of nausea:

    • Portion size: go ‘Michelin star’ – adopt a ‘little and often’ eating pattern rather than the old school ‘3 meals a day’.
    • Good days: Make the most of days or times that you feel less nauseous and try to eat a bit more then.
    • Eat before you get hungry: A lot of people claim their nausea is worst first thing in the morning. Hunger (and an overnight fast) can actually increase nausea. Try starting off with something plain and dry like a biscuit and continue with little and often throughout the day.
    • Ginger: Ginger root contains compounds that may help relieve or prevent nausea by increasing the flow of saliva and digestive juices. They may also help calm the stomach and intestines. Ginger tea, ginger cordial, ginger biscuits (and so on) have all been reported to help people struggling through nausea.
    • *Medication: There are lots of different anti-sickness tablets on the market. Try to take what you are given as recommended (read the instructions on the box).
        • Compliance: anti-sickness tablets can help prevent the onset of nausea altogether – don’t try to be brave by holding off. This will make your life a lot harder later.
        • Timing: Often they can take at least 30mins to kick in so leave enough time between taking the tablet and your meal.
        • No one-size-fits-all: If you are not finding them helpful, ask your doctor whether there is another you can try.
    • Cravings: Don’t fight these. A little of what you fancy is fine, especially when struggling to eat at all. Whether it’s a pork pie or a scoop of ice-cream, right now you need those calories.
    • Best foods: Salty (pretzels, crackers), dry, plain (bananas, rice, apples, toast), cold, acidic (grapefruit, fizzy lemonade)
    • Fresh air: Don’t underestimate the power of fresh air and a walk before meals. If you are cooped up in your room and really can’t face going outside, throw open the window for a bit.
    • Smells: Strong smells from cooking coming from the kitchen can really leave you feeling pretty peaky when you are most vulnerable. Try to keep away from the cooking zone where possible, and choose cold or room temperature foods over hot foods.
    • Fluids: Hydration is key. Try to sip fluids regularly between meals. Use a straw if this helps. Set an alarm for every hour or create a checklist /use a diary to track how much you have consumed each day.

*Anti-sickness medications work by either:

    • blocking the vomiting centre in the brain
    • blocking receptors in your gut that trigger nausea in the brain
    • acting directly on your stomach by increasing the rate at which it empties and moves food into your bowel

Complementary therapies

Acupuncture works by using special hair-thin needles on trigger points in the body which are thought to stimulate certain nerves and release chemicals in the brain. It has been shown in some studies to be effective as a therapy for poorly controlled nausea and vomiting related to chemotherapy and radiotherapy but more evidence is still needed.

If you do choose to go down the acupuncture route, please make sure they are either a regulated healthcare professional or a member of a recognised national acupuncture organisation.

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References:

https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/complementary-alternative-therapies/individual-therapies/acupuncture

The Register of British Acupuncture Council members: https://www.acupuncture.org.uk/component/com_quickfap/Itemid,918/view,theregister/

Integrative Therapies During and After Breast Cancer Treatment: ASCO Endorsement of the SIO Clinical Practice Guideline. (2018) G Lyman and others. Journal of Clinical Oncology. 2018 September 1;36(25):2647-2655.

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Tel: 020 3488 0182‬

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Onko programmes work alongside your cancer treatment.
Onko does not provide clinical treatment for cancer.

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Tel: 020 3488 0182‬

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Onko does not provide clinical treatment for cancer.

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Cancer Surgery and Prehabilitation

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Cancer surgery & prehabilitation

Prehabilitation is a proactive approach to preparing people for surgery that enables the patient to become an active participant in their own care.

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The best way to prepare

There has been a lot of hype surrounding an article recently published in the Sunday Times which puts “prehabilitation” on a pedestal in the context of cancer surgery. It highlights the importance of getting ‘fit’ for major surgery in exchange for benefits that include reduced risks and better surgical outcomes.

What is prehabilitation?

Prehabilitation, for those of you who are relatively new to the term, is a proactive approach to preparing people for surgery that enables the patient to become an active participant in their own care. Unlike rehabilitation, which is a reactive model of care, prehabilitation is a strategy to begin the rehabilitation process before surgery. It is an opportunity to tackle the management of a number of risk factors such as anaemia and malnutrition which may have an adverse effect on functional capacity and ultimately on postoperative outcomes and recovery.

Why does it matter?

The concept is comparable to marathon training: it is based on the principle that structured and sustained exercise over a period of weeks leads to improved cardiovascular, respiratory, and muscular conditioning which in turn is associated with fewer postoperative complications and a quicker recovery with an earlier restoration of strength. In short, training for major surgery enables people to better withstand the stress response that accompanies an operation, which would otherwise leave an unfit person physically vulnerable.

Patients comment frequently on how prehabilitation can be beneficial. They feedback on how it gives them confidence and makes them feel like they can contribute to their own outcome. Healthcare professionals start to see the changes too. Anaesthetists are now calling on prehabilitation schemes to become a ‘national priority’ in order to get patients fitter before operations. Anaesthetists are not just involved in providing anaesthesia for surgery, they are the key players in preoperative assessment for patients and most importantly the quantification of risk. They are acutely aware of the impact smoking, obesity, frailty, poor nutrition and anxiety has on post-operative outcomes and the role prehabilitation has played in mitigating this risk.

How can it be applied in practice?

Long waiting lists for hospital beds have traditionally been viewed negatively, causing distress and anxiety for many, however evidence has started to reveal that by using this time to optimise fitness through prehabilitation, the wait could be worthwhile.

Prehabilitation in its traditional sense has focused primarily on exercise prescription and has been rolling for some years now. What is really starting to gain momentum is the interdisciplinary approach to preoperative optimisation in cancer patients. This approach looks at the person as an individual, and goes beyond addressing just physical function.

Returning to our marathon analogy, training for sport does not just involve physical preparation. It includes a certain amount of mental preparation and confidence building to maintain a positive attitude. It also requires a certain level of self-motivation to achieve success.

Similarly, prehabilitation programmes are beginning to acknowledge the multidimensional aspects of preoperative preparation to include nutritional, psychological, and behavioural interventions in addition to exercise. Exercise when prescribed in a healthcare setting, can be a complex intervention. Initiation and adherence to a programme is determined by behavioural, psychological, physiological, environmental, and social factors. A thorough understanding of all these factors is critical to the success of exercise-based prehabilitation programmes. In a similar way, smoking cessation and weight loss in obesity can be quite complex to achieve and require a certain level of understanding from the healthcare team; such goals are not always easy to achieve and being told to ‘quit now’ or ‘eat less, move more’ is not always helpful. First unpicking what social, psychological or behavioural barriers exist may be important in achieving sustained change and therefore long-term success.

Restoring function and getting back to normal daily life is most likely a priority for every cancer patient faced with major surgery. Prehabilitation should be seen as an opportunity to turn one’s life around, to take control back and to do everything in one’s power to ensure quicker recovery and better quality of life. The proof is now out there – and results speak for themselves.

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References:

https://www.thetimes.co.uk/article/patients-could-be-sent-to-prehab-to-get-fit-for-surgery-r2b3tt5m9
https://www.telegraph.co.uk/news/2019/07/01/newly-diagnosed-cancer-patients-should-prescribed-fitness-plans/?fbclid=IwAR0YrU_QctcRySkVOhr5Nu2-ZM1o_tr0n2dD-4i-o3jvsCTiMq668ALVdm8
Prehabilitation: preparing patients for surgery. Wynter-Blyth V and Moorthy K. BMJ 2017; 358:j3702
Shaughness G, Howard R, Englesbe M. Patient centered surgical prehabilitation. Am J Surg 2017.
Gillis C, Li C, Lee L, et al. Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology 2014;358:937-47.
Pearse RM, Harrison DA, James P, Watson D, Hinds C, Rhodes A et al. Identification and characterisation of the high-risk surgical population in the United Kingdom. Crit Care 2006; 10: R81.
Moran J, Guinan E, McCormick P, Larkin J, Mockler D, Hussey J et al. The ability of prehabilitation to influence postoperative outcome after intra-abdominal operation: a systematic review and meta-analysis. Surgery 2016; 160: 1189 – 1201.
Desborough JP. (2000) The stress response to trauma and surgery. Br J Anaesth 2000;358:109-17.

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Habits

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Habits

As human beings, we all have our own pool of habits and behaviours rooted in our everyday lives

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“Understanding habits”

From a late-night serial snacker, to a man with purpose and control – even he would not have believed it. His habit was so deeply engrained that he had come to accept the feelings of guilt and despair that had started to creep in.

As human beings, we all have our own pool of habits and behaviours rooted in our everyday lives, each with their own consequences, some good and some, well, not so good. Smoking, overindulging, nose picking, late-night eating, boozing, losing our temper, staying up late, swearing… the list is endless.

Most of us are aware of our own ‘bad’ habits – perhaps we may even have tried at some point in our lives to kick them, either under the strict instructions of our GP, the plea of a loved one or maybe just after some critical self-reflection.

But how many of us with the best intentions having tried to change, instead have come up against a brick wall, relapsing back to our old ways? I would argue many. (Believe me, you are not alone!)

Transforming a habit is not always easy, but know this: it is possible. The key to success starts in understanding how habits come about and how they work.

What is a habit?

Let’s start with looking at the definition of a habit:

“Something that you do often and regularly, sometimes without knowing that you are doing it.” – Cambridge dictionary

Automatic routine of behaviour that is repeated regularly, without thinking. Learned, not instinctive.” – Merriam Webster Dictionary

“A learned behavioural response that has become associated with a particular situation, especially one frequently repeated”. – Collins Dictionary

In summary, it is a pattern of behaviour that is learned, that evolves over time and eventually happens so routinely that it is out of our control.

The brain is known as the control centre of the body and is also a key player in the formation of habits. Scientists now know that habits become stored in a specific part of the brain known as the basal ganglia. Once formed, they become encoded into the structure of our brain – so deep-rooted that when we try to kick the habit or change our ways it can be really difficult.

In order to change a habit, we must first unpick why we do what we do, day in and day out.

Habit formation

The process was famously coined ‘the habit loop’ by Charles Duhigg (1).

Habit Blog Image

Essentially there are three key ingredients needed to form the habit loop – a cue, a routine and a reward.

The Cue is what triggers the habit. It can be:

    • Visual e.g. the sight of food
    • A place
    • An emotion e.g. stress, boredom, anxiety
    • A sequence of thoughts
    • The company of a particular person

The Routine is the action that follows a cue. The routine can be:

    • Physical
    • Mental
    • Emotional

The Reward. For your brain to recognise a habit as meaningful – for it to be worth remembering in the future – there needs to be a reward. A reward can be a physical sensation (of pleasure or relief) or an emotional payoff for example.

Over time as the behaviour occurs more frequently, the loop becomes more and more automatic and we end up doing something without even thinking.

Let’s take a simple example:

    • Long, stressful day in work (emotional cue = stress).
    • Don’t feel like cooking for the family so take a trip to fast food outlet and buy burger and chips meal – eat the meal (physical routine).
    • Instant activation of pleasure centres in the brain following consumption of the fat, sugar and salt combination (reward = physical sensation of pleasure).
    • After the next long stressful day in work, your brain remembers the wonderful pleasurable sensation you got from eating the fast food and a craving emerges.
    • Give in to the craving with the same routine (trip to fast food outlet) and a cycle begins.
    • Regular behaviour like this becomes a pattern and eventually – you guessed it – a habit is born.

How can we overcome our bad habits?

The problem in everyday life is that we often don’t recognise the habit loops as they grow and are blind to our ability to control them. Simply put, if we learn to observe the cues and rewards, we can change the routines.

Don’t get me wrong, changing a habit is not always an easy task. It can take time (anywhere from 18 to 254 days, on average: 66 days), effort, grit and determination. Unless we fight a habit deliberately, the pattern will almost certainly unfold automatically. But if there is a true personal motivation and a good dollop of dedication then almost any habit can be reshaped. The key is to think big and to start small. Small shifts in behaviour over time can and will eventually break the pattern.

Our serial snacker, now having completed his treatment for cancer, realised that he had to change. His weight had rocketed and his confidence had hit an all-time low. His personal motivation was to regain control and feel stronger. First, he figured out that the trigger to the cycle of late night snacking was essentially boredom caused by a lack of motivation. Then he sought to make a change that would put a spring back in his step, a new habit to replace the old one. Thinking big, he thought back to his early years as a footballer and how so much he would love to play again but was too overweight and embarrassed to join a team. Starting small, he decided he would begin to move again. He started with 20 minutes walking every evening after dinner. And it worked. Within months his snacking had improved. He replaced the urges with walking and healthier options and he quickly started to feel the change. His train of thought had completely shifted towards his end goal. A nudge here and a nudge there maybe, but as he began to feel healthier, he grew more confident. Over time those late-night snacks were a distant memory and he pushed on!

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References:

Duhigg, Charles. (2012) The power of habit: why we do what we do in life and business New York : Random House,

Gardner, B; Lally, P; Wardle, J; (2012) Making health habitual: the psychology of ‘habit-formation’ and general practice. Br J Gen Pract , 62 (605) 664 – 666.

Lally, P., van Jaarsveld, C. H. M., Potts, H. W. W., & Wardle, J. (2010). How are habits formed: Modelling habit formation in the real world. European Journal of Social Psychology, 40, 998-1009.

Lally P, Wardle J & Gardner B. (2011): Experiences of habit formation: A qualitative study, Psychology, Health & Medicine, 16:4, 484-489\

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Onko does not provide clinical treatment for cancer.

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Onko does not provide clinical treatment for cancer.

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Coaching for Health

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Coaching for health

Emerging evidence is demonstrating a role for health coaching in cancer care, in improving patient outcomes, medical compliance and reducing health care costs.

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Health coaching for people with cancer

Many types of cancer are thought to be caused, at least in part, by a whole host of unhealthy lifestyle behaviours – smoking, alcohol, poor diet, too little physical activity or too much stress. Common sense would tell you that on being diagnosed with cancer, or on recovery from treatment a key priority ought to be in cleaning up one’s act i.e. addressing relevant lifestyle factors; adopting new habits and kicking old ones to the kerb. But is changing a behaviour as straightforward as it sounds?

Unhealthy behaviours can be long-standing, deep-rooted and intertwined with feelings and emotions making them harder to just leave behind. They require quite a bit of unpicking, a deep level of understanding of the individual – how they ‘tick’, how they are likely to respond to being asked to change and how the change would fit into their lives. Health coaching is an effective way of facilitating individual change.

What is health coaching?

Public Health England defines health coaching as: ‘a patient-centred process that is based upon behaviour change theory and is delivered by health professionals with diverse backgrounds’. Professionals equipped with skills in health coaching can play an important role in empowering people to change behaviours and equipping them with strategies to sustain those changes for life.

The term has been cited in numerous research journals with one paper going on to say it is about ‘advancing healthy lifestyle behaviour change using tools such as non-judgmental dialogue, goal setting, and accountability’.
Health coaching is not, therefore, about dictatorship – telling someone to do something – “Eat more vegetables!”, “exercise daily!”, “quit smoking!”, “Cut down on alcohol!” and off you go. (Let’s face it, very few of us in this world respond well to the ‘being told what to do’ approach.) It is more about releasing a person’s potential to maximise their own health.

People don’t just make dietary changes overnight off the back of a suggestion that meat consumption reduction could increase longevity for example. Most of us want to ‘live a little!’ Even where someone is extremely motivated and makes that executive decision (perhaps on a Sunday night after an indulgent weekend) to start a new diet or hit the gym, we all know the biggest challenge is in sustaining that change. Where will that person be three months down the line?

Health coaching is about providing new ways of engaging people and facilitating shared decision-making. In the clinical context “performance” equals self-management.

How to implement health coaching:

Five criteria have been set out in the literature as important aspects of health coaching:

    • Training: Health coaches should have the requisite skill set. They need to understand how to deliver behaviour change theory and coaching processes.
    • Professionals: Health coaches should be trained health care professionals.
    • Goals: Patients should partially or wholly determine behaviour change or health goals.
    • Accountability: Patient progress should be monitored.
    • Relationship: Patient-clinician relationship should provide an opportunity to develop. For example, there should be one coach per patient and at least 3 sessions.

Many people believe that coaching is about building a rapport with clients and communicating effectively with them. True health coaching however goes above and beyond this. It requires expert practitioners to step back from their usual role as educators and instead focus on becoming an ally to clients, potentially a difficult task for the ‘walking encyclopaedia’ types. It is about moving the conversations from ‘what is the matter with you’ to ‘what matters to you’. Effective health coaching requires high quality training. One researcher advocates it should be conducted using behavioural interventions and models such as adult learning theory, social learning theory, motivational interviewing, and the stages of change model.

Coaching in cancer care

Emerging evidence is demonstrating a role for health coaching in cancer care, in improving patient outcomes, medical compliance and reducing health care costs. Some studies have found improvements to measures of health, fitness and in particular psychological outcomes in cancer patients e.g. psychosocial outcomes, general mental health and quality of life. With high levels of anxiety and other adverse psychological effects associated with the disease and its treatment, and with Cancer Research UK now predicting that one in two of us will develop cancer at some point in our lives, it is crucial that we perceive measures like coaching, to be a vital part of effective healthcare.

We now know that increasing physical activity can improve survival in people with cancer, that diet, smoking and alcohol are linked to an increased cancer risk, and that better lifestyle behaviours can actually mean a better quality of life for people. Thus, implementing a health coaching programme that can effectively change behaviours in people with cancer for the better would not just improve quality of life for people but also quantity of life i.e. an extended survival period.

Given that most people diagnosed with cancer struggle with an initial loss of control, it seems obvious that interventions like health coaching, that are integrated into prehabilitation, rehabilitation, or in fact any phase of a person’s cancer journey, are instrumental in helping people to take back control and take charge of their health and outcomes.

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References:

Blanchard CM, Courneya KS, Stein K; American Cancer Society’s SCS-II. Cancer
survivors’ adherence to lifestyle behavior recommendations and associations with health-related quality of life: results from the American Cancer Society’s SCS-II. J Clin Oncol. 2008 May 1;26(13):2198-204. doi: 10.1200/JCO.2007.14.6217.

Gordon, N. F., Salmon, R. D., Wright, B. S., Faircloth, G. C., Reid, K. S., & Gordon, T. L. (2016). Clinical Effectiveness of Lifestyle Health Coaching: Case Study of an Evidence-Based Program. American journal of lifestyle medicine, 11(2), 153–166. doi:10.1177/1559827615592351

Grimmett C, Bridgewater J, Steptoe A, Wardle J. Lifestyle and quality of life in colorectal cancer survivors. Qual Life Res. 2011 Oct;20(8):1237-45. doi: 10.1007/s11136-011-9855-1.

Meyerhardt JA, Giovannucci EL, Holmes MD, Chan AT, Chan JA, Colditz GA, Fuchs
CS. Physical activity and survival after colorectal cancer diagnosis. J Clin Oncol. 2006 Aug 1;24(22):3527-34.

Sforzo, G. A., Kaye, M. P., Todorova, I., Harenberg, S., Costello, K., Cobus-Kuo, L., … Moore, M. (2018). Compendium of the Health and Wellness Coaching Literature. American Journal of Lifestyle Medicine, 12(6), 436–447. https://doi.org/10.1177/1559827617708562

https://www.researchgate.net/publication/238258578_Longitudinal_Benefits_Of_Wellness_Coaching_Interventions_For_Cancer_Survivors_886

https://www.pcc-cic.org.uk/sites/default/files/articles/attachments/dr_andrew_mcdowell_a_different_way_to_talk_with_patients.pdf

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How to Sleep Better

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How to sleep better with cancer

If you’re suffering from insomnia, there’s every chance that you’re hoping this article will put you to sleep! Don’t worry, you’re not alone.

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Investigating insomnia

If you’re suffering from insomnia, there’s every chance that you’re hoping this article will put you to sleep! Don’t worry, you’re not alone.

Insomnia is defined as difficulty falling asleep or staying asleep and it can become a problem when it starts to have a negative impact on your day-to-day life. [1] Difficulty sleeping and tiredness are two of the most common side effects reported by patients with cancer, with between 20-50% of patients being prescribed medication to help with sleep. [2]

Insomnia often occurs with other symptoms, most commonly pain and fatigue. Fatigue, which is defined as lack of motivation and sleepiness, can lead to behaviours like day-time napping, which in turn can contribute to insomnia. [3] This tricky trio of cancer related fatigue (CRF), pain and insomnia affect more than 50% of cancer patients, and is one of the major barriers to improving quality of life.

Sleep Matters

The benefits of catching forty winks might seem self-evident, particularly on a Sunday morning, but research has shown that getting enough shut eye can have a positive impact on our overall health.

Sleep has an important role to play in brain function, heart health, immune system function, emotional regulation and the removal of toxins. 

How much is enough?

The amount of sleep we need varies according to our age and activity level (yes, science supports the benefits of lie-ins for teenagers!), but a large study by the American Thoracic Society suggested the following guidelines: [5]

    • Less than 6 hours sleep in 24 hours has been linked to poorer health outcomes
    • It is recommended that optimal sleep duration for adults is 7-9 hours per 24 hour period, although some variability exists.

There are two phases of sleep. REM sleep is active sleep and includes dreaming. This is mentally restorative. Non-REM sleep is quiet sleep. These phases alternate throughout the night.

Why does cancer affect my sleep?

There are many reasons why cancer can affect sleep. This article has highlighted some of the factors that may play a role: [6]

    • Stress and lifestyle: emotional stress can play a huge role in cancer and its treatment. Stress causes the release of the stress hormone cortisol. Having too much cortisol in the body can disrupt sleep.
    • Symptoms related to cancer and its treatment, such as pain, nausea and vomiting, can also affect sleep.
    • Sleep hygiene: sleeping in a brightly lit, uncomfortable or noisy environment can result in poor sleep.

Top Tips for a Satisfying Sleep

Before Bed

    • Try to leave at least 2 hours between eating and going to bed, and avoid fatty or spicy foods in the evening.
    • Try a cup of chamomile tea before bed. This is a common herbal tea that can help with relaxation.

In the Bedroom

    • Go to bed when you are tired, but if you can’t fall asleep after 20 minutes then get up again. This helps your brain associate the bedroom with falling asleep.
    • Make sure your bedroom is cool, dark and quiet as this helps increase melatonin levels (sleep hormone).

Relaxation Techniques

    • Techniques such as deep breathing, yoga and meditation have all proven to be effective in helping to eliminate stress and reduce cortisol levels.

Here’s to hoping this article will help you nod off after all.

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References:

Roth T. Insomnia: Definition, Prevalence, Etiology, and Consequences. Journal of Clinical Sleep Medicine [Internet]. 2007 [cited 22 July 2019];35(5):S7-S10. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1978319/

Roscoe J, Kaufman M, Matteson-Rusby S, Palesh O, Ryan J, Kohli S et al. Cancer-Related Fatigue and Sleep Disorders. The Oncologist. 2007;12(suppl_1):35-42.

Sharpe M. ABC of psychological medicine: Fatigue. BMJ. 2002;325(7362):480-483.

Waking up to the Health Benefits of Sleep [Internet]. Oxford: University of Oxford; 2019 [cited 22 July 2019]. Available from: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=2ahUKEwjutLaZiMnjAhWoUhUIHVv_BJ4QFjAAegQIAxAC&url=https%3A%2F%2Fwww.rsph.org.uk%2Fuploads%2Fassets%2Fuploaded%2F50220c8f-febb-416e-8f3f7a4d2f973897.pdf&usg=AOvVaw17HZE5iLm1VNosWPLd6MuD

Mukherjee S, Patel S, Kales S, Ayas N, Strohl K, Gozal D et al. An Official American Thoracic Society Statement: The Importance of Healthy Sleep. Recommendations and Future Priorities. American Journal of Respiratory and Critical Care Medicine. 2015;191(12):1450-1458.

 Naydis E. [Internet]. Fredhutch.org. 2019 [cited 22 July 2019]. Available from: https://www.fredhutch.org/content/dam/public/Treatment-Suport/survivorship/MBCTW-2016/Sleep%20in%20Cancer%20Care%20THIM%2006-04-2016%20FHCRC.pdf

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Onko does not provide clinical treatment for cancer.

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Onko programmes work alongside your cancer treatment.
Onko does not provide clinical treatment for cancer.

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Stress

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Stress

A diagnosis of cancer can come as a huge shock, and the subsequent appointments and treatments can be a stressor to both the patient and their loved ones.

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What is Stress?

First things first, lets define it- stress is probably a familiar emotion for most, and describes mental strain in response to situations that put us under pressure. Examples of such situations are financial problems, examinations and relationship breakdowns, as well as physical illness- including cancer.

Stress varies from person to person, and whether or not a situation will cause stress depends on two things…

    • The event- does it have potential to harm your wellbeing?
    • Your ability to cope- do you have the skills and social network?

What is the science of stress?

When subjected to a stressor, two systems in our body are activated as part of the ‘fight-or-flight’ response which prepares us to deal with potential threats. These systems are the ‘Hypothalamic-Pituitary-Adrenal Axis’ and the ‘Autonomic Nervous System’- put simply, our hormones and our nerves!

Our hormonal system increases the level of cortisol in our blood, this hormone helps us mobilise our energy resources, and our nervous system increases our heart rate, dilates our airways and causes adrenaline release. All of this gives the feeling of ‘stress’.

What is the impact of stress?

Stress isn’t all bad. A little bit can help us change our thoughts and behaviours and pull on required resources to develop ways of coping with adverse situations.

However, prolonged high stress levels can exhaust our resources and have consequences on our wellbeing- this is known as ‘allostatic load’. Research has demonstrated that it may cause insomnia and thus fatigue, blockage of our arteries, increased inflammation, immune function suppression, insulin resistance and a decline in memory.

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Cancer and Stress

A diagnosis of cancer can come as a huge shock, and the subsequent appointments and treatments can be a stressor to both the patient and their loved ones. Of course, worry and heightened emotions around this time are entirely normal, however, to avoid added physical and mental difficulties, it is important to take steps to manage the symptoms of stress.

So, some simple but effective tips…

    • Seek help and information!
      Don’t leave burning questions unanswered. As well as knowledgeable members of your healthcare team, there are many reliable resources available to help you make sense of what’s going on- your diagnosis, your treatment, how you may be feeling- NHS and Macmillan websites offer thorough, easy to understand information.
    • Set aside time for relaxation and mindfulness!
      Self-care is vital. Take time to yourself to do things that you enjoy. Mindfulness is a form of meditation which encourages awareness of your present self and surroundings- engaging in such practices can help you cope with stress and anxiety, and there are many resources available to introduce you to it.
    • Recruit social support!
      Gather your troops. Family and friends will be invaluable for offering advice, a listening ear and help when needed. There are also many opportunities to build new support networks, for example through cancer support groups or volunteering roles- such activities are fantastic for relaxation and engaging your mind elsewhere.
    • Try some gentle exercise!
      We all know that exercise reaps benefits for our physical health, but it works wonders for our mental health too. Gentle exercise such as a stroll through local green spaces, or a swim at your local pool will release positive endorphins and give your brain time out.
    • Ensure restful sleep!
      An important one. As we mentioned, stress can disturb your sleep, but things like reducing caffeine consumption, limiting nap time and avoiding screen use in the late evenings can help ensure you get the rest you need.

So, remember- feelings of anxiety are to be expected, but by employing some simple strategies you can keep these under control and prevent any troublesome consequences!

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References:

Mind. How to manage stress. [internet]. 2017. Available from: https://www.mind.org.uk/information-support/types-of-mental-health-problems/stress/#.XTM8BS_MxQI

Lazarus R, Folkman S. Transactional theory and research on emotions and coping. European Journal of Personality. 1984. 1(3): 141-169

Selyye H. Stress and the general adaption syndrome. British Medical Journal. 1950. 1(1383). 

McEwen B. Physiology and neurobiology of stress and adaptation: central role of the brain. Physiological Reviews. 2007.

McEwen B. Stressed or stressed out: What is the difference? Journal of Psychiatry and Neuroscience. 2005. 30(5): 315-318.

NHS. How to deal with stress. [internet]. 2017. Available from: https://www.nhs.uk/conditions/stress-anxiety-depression/understanding-stress/

NHS. Mindfulness. [internet]. 2018. Available from: https://www.nhs.uk/conditions/stress-anxiety-depression/mindfulness/

Macmillan Cancer Support. [internet]. Available at https://www.macmillan.org.uk 

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Sugar and Cancer

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Sugar and cancer

With any diagnosis, there comes a lot of questions, and with questions, people crave answers. It is not uncommon therefore for those affected to turn to the internet for answers.

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Sugar and Cancer

If I had a penny for every time someone asked me about sugar and cancer… or in fact expressed a genuine fear of sugar in relation to cancer…. I’d probably be a far richer woman!

With any diagnosis, there comes a lot of questions, and with questions, people crave answers. It is not uncommon therefore for those affected to turn to the internet for answers.

Dr Google

Today, people with cancer frequently look to Google or other search engines for alternative remedies, purported cancer ‘cures’ or anything that could give them an edge during treatment or increase their overall chances of survival. Who would blame them? Humans are hardwired to survive. And having a ‘can do’ attitude with a ‘kick cancer’ mind-set can be really beneficial from a coping perspective. The problem with deriving information from the internet is that it is not always clear what is true and what is complete and utter fabrication. And let me tell you this – there is a lot of false, misleading and potentially harmful information out there, particularly in respect to nutrition and cancer.

Sugar feeds cancer is a common claim that is thrown around all over the internet as if it were as black and white as people need oxygen to survive.

On the back of this rumour, a lot of people will avoid all sweets, chocolate, cake, ice-cream, sugary drinks (you get the gist), in the hope that they will slow the cancer growth, or more alarmingly, in fear that consuming sugar would reduce their chances of beating cancer.

The claim is an unhelpful oversimplification of a highly complex area that scientists themselves are only just starting to understand.

What do we know about sugar and cancer?

For starters, let’s be very clear: cutting out refined or processed sugary foods may be healthy, but alone will not kill cancer cells. Why? Well, the hypothesis is that sugar feeds cancer, but sugar goes beyond just the sweet stuff. It extends to all carbohydrates. Carbohydrates get broken down in the body into units of sugar called glucose (the body’s most readily available source of energy).

Therefore, to cut out sugar, would mean to exclude all sugars and that extends to rice, potatoes, bread, pasta, fruit and oats to name but a few. (Be warned: case reports in humans with cancer have shown that doing this can actually be a very difficult feat!)

So, you think you can still do it?

Before embarking on a carbohydrate free (or “ketogenic”) diet, it would be prudent to consider the following:

Full O

Cancer cells may like sugar but they like other
stuff too

We now know that cancer cells have an affinity with other nutrients, and in particular amino acids (these are building blocks of protein – yes protein!) such as glutamine. Scientists have even suggested that in certain cancers, glutamine is the more important component. So, if we are going to start demonising sugar, should we be doing the same for other important nutrients that our bodies need to keep strong?

Full O

Cancer cells may need sugar (carbohydrates),
but healthy cells need it too

The problem with restricting carbohydrates is that all cells require and prefer glucose as a source of energy. Carbohydrates are important – for many things. They provide energy for the body and the brain and they provide dietary fibre to keep constipation at bay. They are such an important food group that even without carbohydrates in the diet, your body has other clever ways of getting glucose such as making it from other food sources like protein and fat stores. An important function of carbs is therefore to prevent the breakdown of proteins for energy. The breakdown of proteins could result in lost muscle, weight, strength and energy.

So yes, sugar feeds cancer cells but it also feeds every cell in the body so please think carefully before depriving your body of important nutrients.

The future of research

Scientists know that cancer cells process sugar differently to normal cells. They do it rapidly and through a different mechanism. This has prompted researchers to develop drugs designed to selectively inhibit the ability of cancer cells to process sugar without interfering with this necessary process in healthy normal cells. A recent study (4), led by Arthur Dyer at University of Oxford, demonstrates how this could work. There is no doubt that researchers are working around the clock to tackle cancer from all angles.

How should I approach sugar?

In the meantime, my best advice to you, is firstly stop fretting!! Secondly, if you are able to eat, and are lucky to have an appetite and can physically consume food (a lot of people will lose these two everyday functions), then eat as well as you can. Eat plenty of vegetables, fruits, whole grains, beans and lentils. These foods contain natural sugars, and they also contain important substances such as vitamins, minerals, fibre and phytochemicals – naturally occurring plant chemicals which are said to be good for our immunity and health.

Yes, limit the junk – we know too much sugar and processed food (especially over a long period of time) can make us gain weight, can affect our mood and energy levels and can increase the risk of long-term disease, especially if these are replacing well-balanced meals. But why not enjoy a treat now and again? A slice of cake or a few squares of chocolate on a Friday night? Life is to be enjoyed remember, not always endured.

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References:

Boroughs LK, DeBerardinis RJ. (2015) Metabolic pathways promoting cancer cell survival and growth. Nat Cell Biol. 17:351–359. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939711/

Choi, Y. K., & Park, K. G. (2017). Targeting Glutamine Metabolism for Cancer Treatment. Biomolecules & therapeutics, 26(1), 19-28. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5746034/

Chung, H. Y., & Park, Y. K. (2017). Rationale, Feasibility and Acceptability of Ketogenic Diet for Cancer Treatment. Journal of cancer prevention, 22(3), 127-134. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5624453/

Weber, D. D., Aminazdeh-Gohari, S., & Kofler, B. (2018). Ketogenic diet in cancer therapy. Aging, 10(2), 164-165. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5842847/

Dyer A, Schoeps B, Frost S, Jakeman PG, Scott EM, Freedman J, Seymour LW. (2018) Antagonism of glycolysis and reductive carboxylation of glutamine potentiates activity of oncolytic adenoviruses in cancer cells. Cancer Res. 2018 Nov 28. pii: canres.1326.2018. http://cancerres.aacrjournals.org/content/early/2018/11/13/0008-5472.CAN-18-1326.long

Schmidt, M., Pfetzer, N., Schwab, M., Strauss, I., & Kämmerer, U. (2011). Effects of a ketogenic diet on the quality of life in 16 patients with advanced cancer: A pilot trial. Nutrition & metabolism, 8(1), 54. doi:10.1186/1743-7075-8-54 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3157418/

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102, Sydney Street,
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Tel: 020 3488 0182‬

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Onko programmes work alongside your cancer treatment.
Onko does not provide clinical treatment for cancer.

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102, Sydney Street,
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Tel: 020 3488 0182‬

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Onko programmes work alongside your cancer treatment.
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