CANSACare Kit

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THE CANCERCARE COPING KIT

Chapter 1 - Celebrating Life

The CancerCare kit offers information andsupport to empower individuals to deal withthe diagnosis of cancer, its treatment, possiblecomplications and changes in body image,emotions, social issues and how to getassistance. It also provides practical advice toindividuals, their loved ones, caregivers andfriends to ease the cancer journey and to takecontrol by making informed choices.

This programme contains the followinginformation:

Celebrating lifeWhat cancer is, treatments and

how to cope with possible side effectsCoping with the emotional

impact of cancer and the importance ofcommunication

Nutrition, Lifestyle and copingguidelines

When all of a sudden you are confronted withthe “Big C” or even hear that you are facingdeath, you may realise life is a gift that cannotbe taken for granted. The issue is whether welive every moment as if life is precious and thatevery moment of life is worth a celebration. Ifyou have not yet appreciated life and itsprecious moments, it is now time to do so.

It may seem insensitive to speak of celebratinglife to someone who has just been diagnosedwith cancer. Yet, this is one of the mostpowerful tools that you can use on your cancerjourney. By focussing on wellness on a physical,mental, emotional and spiritual level, you willbegin to appreciate and even celebrate life. It isimportant to experience quality life.

By celebrating life, you reduce stress andstrengthen your immune system. Bycelebrating life, you also take control. Thiscreates a sense of power and meaning at a timewhere everything seems to have lost itsmeaning. You learn to value the time you may

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Chapter 1:Chapter 2:

Chapter 3:

Chapter 4:

have left. A positive attitude will contribute tohealing on an emotional and spiritual level.

To believe that you will live, is not a guaranteethat you will live. Should you, however, believethat you are going to die; it will negativelyimpact on your hope and trust of continuing tolive.

A well known author, Ruth E Renkel, once said:“You will live longer as soon as you realise thattime spent on being unhappy, is wasted.”

We will address the following aspects duringthis session, namely:

Identifying and managing stressDeveloping a positive attitudeLearn to forgiveSetting goals and making plans for the futureFinding purpose in your lifeLearning to live in the momentAcknowledging the importance of faithPromoting physical restRemaining pain free

Stress is a reaction of the body to theenvironment. It is linked to your ability to adaptto change. Excessive stress causes you to feelout of control. It develops from illness, loss ofloved ones, work problems, daily irritationsand unresolved issues, to name a few. Highlevels of continual stress may depress theimmune system and lower your ability to fightillness. Mind and body are connected and justas negative thoughts can adversely affect theimmune system, so positive thoughts canbenefit you in your fight against cancer.

Short term stress such as exam nerves andinterview anxiety can motivate a person toperform well. It is the long term continual stressthat lowers your ability to fight disease. It is alsothe long term, continual stress that may causeyou to spin out of control.

As the kids need a ride to school, your spousedemands your attention, you can't find a

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Let’s start with stress

Is all stress always negative?

The use of self-help techniques

1

specific piece of clothing, your boss has justscheduled a tele-conference meeting and yourbest friend needs your help – all at the sametime!

It may feel as if your world is spinning out ofcontrol. Do not panic. This is the time to take adeep breath. Sit and relax in your favourite spotwhile having a cup of tea.

Like many others, you may have forgotten howto relax. A soon as you feel calm and morerelaxed, take a pen and paper and begin toprioritise and plan your day.

Here are some useful tips to alleviate yourstress:

If you think meditation meanstwisting your body into an uncomfortableposition and uttering "oohs" and "omms" for anhour, guess again. Any activity that helps keepyour attention calmly in the present moment oreven any repetitive action may be a source ofmeditation.

When you catch yourself thinking about yourjob, your relationship or your lifelong to-do list,bring your mind back to the present. Try this forjust 10 - 15 minutes a day and watch your stresslevels drop.

Feeling stressed evokes tense,shallow breathing, while being calm isassociated with relaxed breathing. So, changethe way you breathe to promote relaxation.

Let out a big sigh, dropping your chest,and exhale through gently pursed lips. Inhale,feeling your entire belly, sides and lower backexpand. Now exhale, sighing as you drop yourchest and feeling your belly, back and sidesrelax. Repeat these actions 10 times, relaxingmore fully each time on exhalation.

Mindfulness is the here-and-now approach to living that makes daily lifericher and more meaningful. It meansapproaching life like a child, without passingjudgment on what occurs. Mindfulness meansfocusing on one activity at a time. Staying

Meditate -

Breathe Deeply -

Try this:

Look Around You -

focussed on the present can help promoterelaxation and provide a buffer against anxietyand depression.

Practice by using your different senses to focuson your immediate surroundings. If you'reoutdoors, enjoy the shape and colours offlowers, hear a bird's call or consider a tree. Inthe mall, look at the details of a piece ofclothing in the window, touch and examinesomething attractive and focus on how it'smade, or window-shop for furniture, checkingout every detail of pattern and style. Sit down inyour favourite spot for a tasty cup of tea. As longas you can keep your mind focussed onsomething in the present, stress will take a backseat.

If you're acoffee-guzzler, consider going for tea. Coffeeraises levels of the notorious stress hormone,cortisol, while a cup of tea, especially healthyRooibos tea, offers health and relaxation.Rooibos tea is a traditional favourite forcalming the mind and reducing stress. It hasbeen proven to have a positive effect on yourimmune system and contains lots of anti-oxidants.

Induce the relaxationresponse by cuddling your pet, giving anunexpected hug to a friend or family member,snuggling with your spouse, or talking to afriend about the good things in life. When youdo, you'll be reducing your stress levels.

Experts say social interaction helps yourbrain think better, encouraging you to see newsolutions to situations that once seemedimpossible. This contributes to individualsfinding it easier to come up with new solutionsfor apparent irresolvable problems.

Adults need time-out too.When you sense your temper is flaring, find aquiet place to sit or lie down and put thestressful situation on hold. Take a few deepbreaths and concentrate on releasing tensionand calming your heartbeat. Quiet your mindand remember take time to relax. The stressful

Drink a healthy cup of hot tea -

Show Some Love -

Why?

Take Time-Out -

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situation and thoughts can wait.

By practicing the techniques discussed, youwill find more peace of mind. Old habits needto be replaced with new ones and this takes alittle time. So don’t give up, keep remindingyourself to practice your new techniques untilthey become part of your life.

Empower yourself through knowledge anddeveloping skills that will change negativebeliefs and attitudes that will enable you tocope better.

Some people believe that all they have to do toget better, is to visit a doctor and to receivetreatment. Your mental state can have a hugeinfluence on your physical wellbeing. To be anactive participant in your own cancer journeytowards health asks for courage, motivationand perseverance. Many changes may berequired in your life and new priorities mayhave to be identified.

Benjamin Franklin once said: “A man wrappedup in himself makes a very small bundle”.

Choosewhere and how to spend your time and energy.Take time out when you need it.

Build-upyour strength with good nutrition and as muchexercise as possible.

Learn to laughand let yourself see the funny side of situations.Laughter is still good medicine. Look for books,people and films that make you feel happy.

Surroundyourself with people and things that you like.Art, music and good books comfort you andfeed your soul. Get rid of clutter in your life.

Conserve your energy forimportant and pleasant activities by delegating.Realise that you don’t have to do it all on yourown.

Here are some other practical ways ofmanaging your stress

Develop time management skills -

Develop a moderate healthy lifestyle -

Develop a humorous outlook -

Create a comfortable environment -

Ask for help -

Learn to say ‘NO’ - Don't take on more than youcan handle.

If you believe that you are completelypowerless to do anything about your illness,your attitude will become hopeless andhelpless. You will find yourself using negativeself-talk.

If, however, you believe that you are able totake control of how you deal with yoursituation, your attitude and self-talk will bemore positive.

Direct the “why” of cancer into a “how to”.

Recognise that positive opportunities, such aslearning new techniques for self care, can arisefrom a diagnosis of cancer. Convert yourworries into positive actions.

After being diagnosed with cancer, you shouldtry and see your life as a cancer journey. Eventhough you cannot change your diagnosis, youare responsible for what you do on this journey.Each morning decide how you would wantyour day to be and then try and create it.

What is your attitude to your diagnosis? Insteadof letting it terrify you, try and see it as achallenge. By changing your perception, youwill find a source of strength you neverbelieved you had.

During a diagnosis of cancer people often feelthat they have no choice. You do have a choice- you can decide what your attitude will beduring these trying times.

Allow yourself to be sad or angry at times butalways set limits and allow yourself thepossibility of feeling better tomorrow.

First, let’s see what we are doing to ourselves bynot forgiving. When someone has donesomething that upsets us, we feel sad, angryand hurt. If we refuse to forgive, we use upenergy on staying angry and over time thiscreates stress in our bodies.

Develop a positive attitude

Learn to forgive

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Forgiveness does not mean forgetting whathappened to you. It is about healing thememory of what happened to you. It will stillbe part of your history, but it does not have todominate your life. By forgiving, you freeyourself from the emotions and thoughts of thepast.

Madiba has taught us the importance offorgiveness. It is only through forgiveness thatSouth Africa was able to become the rainbownation. Imagine for a minute the difference inall our lives if Madiba had used his anger,frustration and rage on our nation.

Instead he was able to forgive, set himself freefrom the past and was therefore able to create apeaceful change in South Africa.

Look at your own life, have you forgiven or areyou still angry? Learning to forgive is the mostbeautiful gift that you are able to give yourself.By forgiving you will feel and become more atpeace.

Setting and achieving goals will provide youwith focus and direction. Set small goals, forexample; “today I will allow myself to relax forten minutes”. When you achieve this goal youfeel a sense of control. It gives purpose to yourday.

Set bigger goals, perhaps getting together withfriend or doing some exercise and worktowards them. Each goal you set and achieve isanother way of celebrating life.

Plans for the future might need to change to fitin with your new outlook, but don’t give up onlife and the future. Each goal you set andachieve is another step on the way towardscelebrating life.

A cancer diagnosis may jolt you into action. Youmay feel that since your cancer diagnosis yourlife has no purpose. It may seem to drift fromone day to the next without you thinking ofwho you were and what contribution youwanted to make to the world. You must,

Set goals and make plans for the future

Find purpose in your life

however, remember that you have valuableknowledge to pass onto others.

Part of your journey is to talk to people whohave been diagnosed with cancer and helpsome of them through this difficult time.

Finding your own purpose in life meanscelebrating who you are.

What is so unique to cancer survivors is thatthey find new meaning to life.

Do you find yourself being with people but notreally listening to them? Do you find that youare distracted and unfocussed? Focus all yoursenses intentionally on the people with you. Bydoing this whenever possible you will start toexperience the fullness of life.

Instead of focussing on the uncertainty of yourlife ahead, embrace your loved ones and letthem fill your life and be thankful for eachsecond that you can be with them.

Faith can be a strong support and comfort. Nomatter what your religion, you will feel moresecure and cared for at a time when lonelinesscan overwhelm you. The practice of prayer andmeditation can bring about a sense of innerpeace and acceptance. Although medicinemay answer many questions, some questionsonly religion and faith can address.

If someone is sick, they might ask "why is thishappening?" If the illness was a common cold,medicine would explain, it's due to a virus.Some might add that a poor diet orcompromised immune system contributed tothe illness.

When seeking healing, the tools of faith andprayer are powerful. Multiple clinical studiesshow that those who attend church, synagogueor mosque are ill less frequently. Those who areprayed for tend to heal quicker. Faith andprayer positively influence an individual's

Learn to live in the moment

Faith can be of help

What does ‘living in the moment’ mean?

4

ability to cope with illness and otherchallenging situations in life. Ultimately, God isthe healer of the sick and the helper for those inneed.

Humans must have 6-8 hours sleep every nightto function adequately and remain healthy.

Late night TV, stimulants and meals disrupt theneeded cycle required for natural circadianrhythms. It also disrupts the normal productionof melatonin, which is our natural sleephormone. Melatonin has many biologicaleffects and it is also a powerful antioxidant witha particular role in the protection of nuclearand mitochondrial DNA. The formation ofMelatonin takes place during the early hours ofthe night; therefore, every hour of sleep beforemidnight is worth much more than sleepduring the early morning hours.

It's best for our bodies to cycle through the fiveknown sleep stages four or five times a night.The first four stages are key to maintaininghealthy metabolism, learning and memory.The fifth, Rapid Eye Movement sleep (REM) isimportant for regulating mood and formingemotional memories. Missing a cycle willinfluence your brain function, immune systemand heart health negatively.

Take the following steps to improve on yoursleeping:

Exercise regularly, especially before bedtimeTake an evening walkEstablish a relaxing bedtime routine likereading or taking a bathDo not watch TV while in bed, beforesleepingHave a cup of Rooibos tea an hour beforebedtimeGet to bed at a regular time to ensure at least6 to 8 hours of sleepCreate a sleep-conducive environment.

Rest and get enough sleep

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Remain pain freeIt can be said that emotional and spiritual painare just as real as physical pain and ways mustbe sought to address whatever kind of pain aperson may be experiencing.

Health professionals, like the staff andvolunteers of CANSA, are experts in palliativecare. They can advise you on the latestmedications and devices for pain and symptomrelief. They can help you work throughunresolved issues or practical problems causingdistress.

They can also provide instruction on how toassess pain and give suggestions for dealingwith it. Finally, chaplains can refer you and canassist family members and spiritual leaders andothers to assist you and your loved ones withcounselling.

The first step is to get physical pain andsymptoms under control. Nurses, together withyour doctor, will develop a medication planthat includes long acting medications tomaintain comfort and short-acting medicationsfor break-through or acute pain. Medicationsmay be taken orally or topically (through theskin) depending on which method works bestfor you.

We often hear people express concern aboutthe narcotic nature of some pain medications.Morphine and other pain medications are usedin the smallest amounts needed to effectivelyalleviate pain while maintaining alertness.

Occasionally, a patient develops tolerance tohigher doses because of intense pain.Medication dosages are carefully monitored bynurses in collaboration with your doctor, toensure that you -and your loved ones- remaincomfortable.

Medications are based on your need for paincontrol. Some people choose to tolerate ahigher level of pain in favour of remaining morealert. Some people prefer higher levels ofmedication in order to be completely pain-free. Some people work to achieve pain reliefthrough drugless therapies. The CANSA

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counsellor will assist you to achieve your goalsfor pain control.

Besides medication, there are other methodsavailable to manage pain and associatedsymptoms. Massage is a proven way to reducepain and stress, increase relaxation and overallsense of well-being and improve digestion,breathing and sleep. Caregivers may also beable to provide brief respites through shoulder,back and neck or foot massages.

Of course, not all pain is physical. Socialworkers can help to alleviate the pain thatunresolved issues or un-reconci ledrelationships can cause. A chaplain canprovide a listening ear and caring presence forthose experiencing the emotional or spiritualdistress often associated with a cancerdiagnosis.

By practicing the techniques outlined in thisprogramme, you can:

Gain knowledge and informationLearn self help strategies that will empoweryouReduce your long-term stressEnhance your body’s immune systemLearn to live positively with cancer andcelebrate lifeRemember: cancer can be beaten.

CANSA has several programmes that focus tosupport cancer survivors and to bring amessage of hope to individuals. You arecordially invited to visit one of CANSA’S CareCentres for further assistance and support.

Come and celebrate life with us during one ofour CANSA Relay For Life events

Contact CANSA for further information andassistance.

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We wish you Godspeed.

Remember: cancer can be overcome

Ruth E. Renkel said: “Never fear shadows. Theysimply mean that there's a light shiningsomewhere nearby”.

Chapter 2 - What cancer is,treatments and how to cope withpossible side effects

What is cancer?

General signs and symptoms of cancer

Cancer is a general term used for any cells thathave lost their normal control mechanisms,causing uncontrolled cell growth in any tissueor organ. There are more than 200 differenttypes of cancers.

Other terms used to describe cancer aremalignant tumours and neoplasms. Cancer isnot contagious and cannot spread from oneperson to another. A defining feature is therapid growth of abnormal cells to form a massof cancerous tissue that can then invadeadjacent tissue and spread to other organs.

The cells that are originally affected by cancer isknown as primary cancer. Cancer cells thatspread to other parts of the body is referred toas metastasis or secondary tumours. Cancercells spread via the blood or lymphatic systemto other parts of the body. It may also grow intoadjacent tissue or organs. Metastasis is the mostimportant cause of death in cancer.

One should be aware of the general signs andsymptoms of cancer. The presence of any ofthese signs or symptoms does not necessarilymean that the individual has cancer, as thesesigns and symptoms may be indicative of otherhealth problems. Should you have any of thefollowing signs and symptoms over anextended period of time, you should consultyour medical practitioner.

The presence of fever is a general sign incancer. Persistent fever of unknown origin maybe an early sign of cancer; especially in cancerof the blood such as leukaemia. Night sweatingis especially experienced by individuals withcancer of the lymphatic system or lymphoma.

Persistent tiredness or observablepaleness which does not improve with rest, isoften seen with leukaemia or cancers that

Fever -

Tiredness -

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cause blood loss, such as colon cancer orcancer of the stomach.

Pain, accompanied by swelling, may bean early sign of bone cancer or testicularcancer. A headache that will not dissipate orthat does not react to treatment may be a signof brain cancer. Continued backache may be asymptom of cancer of the colon, rectum orovaries.

Changes in the colour of the skin often appearas a sign of changes in the body. For example, ayellow discolouration of the skin may be anindication of liver problems whilst a bluediscolouration of the skin may be indicative ofbreathing problems or a bruise as a result ofone or other blood problems or as a result of askin problem. Changes in the skin may be theresult of a tumour of the skin, sun exposure orthe side effects of chemotherapy or radiationtherapy. Some changes to the skin mayimprove over time whilst others may bepermanent.

Be on the lookout for:Yellow discolouration of the skin and/or thewhite part of the eyeBlue or purple bruises of unknown originRed discolouration of the skin that bruiseseasily or the appearance of a skin rashSwelling of the skin that has changed colourItchingThickening of the skinChanges in colour and texture of the nails

Other general signs and symptoms of cancermay include the following:

Continued and unexplained weight lossHeadaches that may be associated withvomitingEnlargement of swelling in bones, joints,back and legsLumps or a mass in the abdomen, neck,chest, pelvic area, groin or arm pitsA white colour behind the pupil of the eye inchildrenContinued nausea with or without vomitingUnusual changes in stool or the functioning

Pain -

Changes of the skin and nails

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of the bladderContinued coughing or hoarsenessContinued indigestion, digestive problemsor difficulty in swallowingA sore that does not healAny unusual bleeding

Cancer knows no boundaries; it affects men,women and children of all ages, colours,cultures and ethnic origin. There is no singlecause of cancer. Scientists believe it is theinteraction of various factors. Cancer mayoccur as a result of genetic, physical orenvironmental factors.

Age is an important factor in the developmentof cancer. With aging, the body loses the abilityto protect or repair itself. Continued exposureto cancer causing agents or carcinogens mayalso affect the body’s immune system, whilegenetic causes of cancer appear mostly inchildren.

Let us first discuss the diagnosis, treatment andside effects of treatment before discussing thecauses and risk factors associated with cancer.

An evaluation for cancer begins with the takingof a history and physical examination to helpthe doctor assess the possible risks of cancerand to decide which tests are most appropriateto make a diagnosis.

Cancer screening tests serve to detect thepossibility that cancer is present.

If cancer is detected in its early stages, it canusually be treated more effectively. Screeningtests are usually not definitive and results areultimately to be confirmed or disproved withfurther examinations or tests.

The two most widely used screen tests forwomen are the Papanicolaou (PAP) smear testto detect cervical cancer and mammography todetect breast cancer. Both these tests havebeen successful in reducing the death rate fromthese cancers.

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Who gets cancer?

How is cancer diagnosed?

Screening tests for cancer

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Measuring the blood levels of Prostate SpecificAntigen (PSA) is a common screen test forprostate cancer in men. Although the PSAlevels tend to be higher in men with prostatecancer, the levels can also be elevated in menwith benign enlargement of the prostate gland.Drawbacks to its use are the high cost and thepossibility of false-positive results. A moreaffordable “finger-prick PSA test” is nowavailable.

A common screening test for colon cancer isthe checking of stool for occult blood. Thepositive finding of occult blood is an indicationthat something is wrong in the colon and mayindicate the presence of cancer.

Self examination of breasts, testes, skin, as wellas the mouth for sores, could help detectassociated cancers in an early stage which willcontribute to the more successful treatment ofthese cancers.

Staging describes the extent or severity of aperson’s cancer. Knowing the stage of thedisease helps the doctor to plan treatment andestimate the person’s prognosis. Most tumoursare described as stage 0, stage I, stage II, stageIII, or stage IV, where stage IV is the mostadvanced stage. Physical examinations, X-rays,scans, laboratory tests, biopsy and surgicalreports all provide information to determinethe stage of the cancer.

There are a number of ways how cancer can bedetected. It can be detected by taking anordinary X-ray or very sophisticated tests andspecific blood tests. When doctors make adiagnosis of cancer, they usually also determinethe stages of the cancer.

The first type of test we will discuss is a biopsy. Abiopsy is when a small piece of the tumour isremoved and looked at under a microscope todetermine the type of cancer.

Different stages of cancer

Let us look at some of the diagnostic teststhat are used to diagnose cancer

Taking several biopsies, sometimes in differentparts of the body, also assists in determining thestage of the cancer.

Another diagnostic test is a CAT scan. A CATscan (or computerised axial tomography) is apainless, non-invasive test that allows doctorsto see inside the body with more clarity than ispossible with a traditional X-ray. It combines X-rays and computerised technology to producecross-sectional image of an area inside thebody that is interpreted by a radiologist.

A further diagnostic test is a MRI scan. An MRI(or magnetic resonance imaging) scan is aradiology technique that uses magnetism,radio waves, and a computer to produceimages of body structures. The MRI scanner is atube surrounded by a giant circular magnet.The patient is placed on a moveable bed that isinserted into the tube.

An additional diagnostic test is a mammogram.This is an X-ray picture of the breast by lowdose radiation. The breast is compressedduring the procedure and may beuncomfortable although not painful for theperson.

The last diagnostic test which we will discuss isultrasound. During an ultrasound procedure,sound waves are caused to travel throughtissues and are reflected back where densitydiffers (e.g., the border between a holloworgan's wall and its inside). The reflectedechoes are received by an electronic apparatusthat measures their intensity level and theposition of the tissue reflecting it. The resultscan be displayed as still images or as a movingpicture of the inside of the body. Unlike X-raysor other ionizing radiation, ultrasound carriesminimal, if any, risk.

A doctor may order a bone scan for someonewho has unexplained skeletal pain suggestingbone loss, bone infection or a bone injuryundetectable on a standard X-ray.

Why is a bone scan sometimes necessary?

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A bone scan is also an important tool fordetecting cancer that has spread (metastasised)to the bone from a tumour that started in adifferent organ, such as the breast or prostategland. Similarly, a bone scan can detect someabnormalities related to leukaemia andlymphoma. It is a nuclear imaging test thathelps diagnose and track several types of bonedisease.

A bone scan is performed by injecting a smallamount of radioactive marker into anintravenous line. Three hours later the patientis placed through a scanner and the radioactivemarker will be concentrated in any regionwhere there is increased growth of bone cellsalso known as high bone turnover. It is a highlysensitive test to pick up tumours, infections orvery small fractures because these conditionsall result in high bone turnover.

It is a very sensitive test which can show uptumours, infections or tiny fractures. Bonescans, however, cannot distinguish what alesion represents, and, therefore, cannotdifferentiate between a tumour, an infection ora fracture. This type of imaging study usuallyneeds to be followed by a CAT scan and/or MRIscan to better identify the lesion.

Tumour markers are substances that can befound in the body when cancer is present. Atypical tumour marker is a protein that can befound in the blood at increased levels when acertain type of cancer is present. Tumourmarkers are found in blood, urine, other bodyfluid, tumours and some tissue. They can beproducts of the cancer cells themselves, ormade by the body in response to cancer orother conditions. Most common tumourmarkers are proteins, but some newer tumourmarkers include genes or other substances.

There are many different tumour markers.Some are seen only in a single type of cancer,while others can be found in many types ofcancer.

What are tumour markers?

To test for a tumour marker, the doctor mostoften sends a sample of the patient's blood orurine or even a piece of the tumour itself to thelab to test for tumour markers.

Tumour markers alone are rarely enough toshow that cancer is present. Most tumourmarkers can be made by normal cells, as well ascancer cells.

Prognosis is a forecast or prediction of theprobable course and outcome of a disease.

It also describes the likelihood of recovery froma disease depending on the response totreatment.

Despite a poor prognosis of cancer based onbeing staged as advanced, a person may reactbetter to treatment than expected, may livelonger and may even get well.

Prognosis for childhood cancers is differentthan for adult cancers. The main differencesare the survival rate and the cause of cancer.The difference is thought to be becausechildhood cancer is more responsive totherapy, a child can tolerate more aggressivetherapy and the prognosis is better.

The survival rate for childhood cancer is about72%, while in adult cancers, the survival rate is60%.

Malignant tumours have three majorproperties which differentiate it from benigntumours. Malignant tumours consist of cancercells that display uncontrolled growth, which isinvasive and destroys adjacent tissues, andoften metastasises, where the tumour cellsspread to other locations in the body via thelymphatic system or through the bloodstream.

These three ‘malignant’ properties of cancerdifferentiate malignant tumours from benigntumours.

What does ‘prognosis’ mean?

What is the difference between a ‘benign’and a ‘malignant’ tumour?

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A benign tumour, like a mole, consists mainly ofnon-cancerous cells which lacks the invasiveproperty of a malignant tumour as well as theability to spread or metastasise to other parts ofthe body. Depending on the location of thetumour, it may still produce negative healtheffects like the compression of vital organs suchas blood vessels, or the over production ofcertain hormones.

A number of factors are taken intoconsideration before a doctor will recommendthe best treatment for you. With regard to thecancer, the following will be considered: thetype of cancer, the size and stage of the tumour,how fast the tumour is growing and whether ithas already spread to other parts of the body ornot.

Certain personal factors and those pertaining toyour health will also be considered, namelyage, the general condition of your health, thesymptoms you present with, and whether youhave other underlying conditions such asdiabetes or hypertension.

The most common types of treatments forcancer are surgery, radiation therapy andchemotherapy or a combination of the three.Surgery and radiation therapy are mostly usedto treat cancer that is confined locally whilechemotherapy treat cancer that has spreadbeyond the local region. Radiation orchemotherapy may be given before surgery toshrink a tumour or after surgery to destroy theremaining cancer cells.

Some cancers, especially advanced cancers,are more successfully treated with radiation-and chemotherapy combined. However, if notcured, these treatments can often relievesymptoms such as pain associated withpressure or symptoms that result when thetumour infiltrates the surrounding tissues and iscalled palliative therapy.

Progress in cancer therapy over the past 50years has come up with more specific targetingdrugs, better combination of drugs, altered

Let us now look at the treatment of cancer

dosages and better coordination with radiationtherapy.

Where affected tissue is surgicallyremoved or cut out from the body.

Radiotherapy, also calledradiation therapy, is the treatment of rapid-growing cancer cells with ionizing radiation.

Dividing radiation therapy in a series of dosesover a prolonged period of time increases thelethal effects on the faster growing cancer cellsand decreases the toxic effect on normal cells,making it possible for the normal cells to repairthemse lves and func t ion proper ly.Radiotherapy may be used to treat localisedsolid tumours, such as cancers of the skin,tongue, larynx, brain, breast, or uterine cervix.It can also be used to treat leukaemia andlymphoma, that is cancer of the blood-formingcells and lymphatic system, respectively.

Ionizing radiation mostly destroys rapid-dividing or fast growing cells in the area beingtreated by damaging their genetic material,making it impossible for these cells to continueto grow.

Side-effects experienced from radiotherapywill depend on the area being treated. Forexample, if you receive radiotherapy to theneck, a sore throat and discomfort whenswallowing. Complications of radiotherapydepend on the irradiated volume of tissue, thedose administered, and the techniqueemployed.

The acute effects are usually mild and transientand may include:

associated withirradiation of the abdomen

associated with stomach andpelvis therapy

inflammation of the skin overthe irradiated area

associated with radiotherapy to thehead and neck

Surgery -

Radiotherapy -

Pain when passing urine -

Diarrhoea -

Dermatitis -

Dry eyes, dry mouth, hair loss, and loss oftaste -

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Low blood counts with a risk of infection -

Weight and appetite loss -

ild depression, inflammation of the ucousmembranes, nausea and vomiting, as well astiredness and fatigue -

Chemotherapy -

associated with therapy that affects the bonemarrow

associated withmouth or head and neck therapy

these are general sideeffects of radiation therapy

Chemotherapy is the use ofpowerful chemicals that can kill cells thatmultiply and grow too quickly, the maincharacteristic of cancer cells. These chemicalagents act by damaging the DNA of themalignant cells and limit the reproduction ofcancer cells. Since normal cells becomecancerous by the breakdown of their DNA andby altering their DNA, tumour cells becomeunable to multiply and eventually die.

Chemotherapy can be administered by thefollowing routes or a combination thereof.

It can be administered orally in the form of a pillor capsule. It can also be administeredintravenously or into a body cavity like theurinary bladder. It can also be injected into amuscle or even into the spinal canal.Chemotherapy is mostly administered bymeans of intravenous infusion although oraladministration of chemotherapy is becomingmore general.

Under certain circumstances it may beadvantageous to administer chemotherapy bymeans of a Venous Access Device also knownas VAD. The VAD is placed in a large veinwhere it can remain for a long period of time.Not all patients that need chemotherapy mayrequire the insertion of a VAD, but for thosewho have to have several sessions of treatment,blood tests and nutritional supplementation,the insertion of a VAD may be advantageous asit will decrease the number of skin pricks andthe associated discomfort.

Because most chemotherapy drugs are strong,admission to hospital may be required for a fewdays . Under cer ta in c i rcumstances

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chemotherapy may be administered on anoutpatient basis. Some individuals may evenreceive their treatment at home. Should you beable to take your chemotherapy at home, youand those taking care of you will be carefullyinstructed on how to administer it safely.

Although chemotherapy is designed to treatcancer cells, unfortunately, it often affects partsof your body not directly affected by the canceritself. This undesired result is referred to as acomplication of treatment, or a side effect.

Scientists have made a great deal of progress indeveloping therapies to help manage the sideeffects of chemotherapy. Newer cancertreatments and supportive care treatmentshave led to vast improvements in themanagement of side effects associated withcancer treatment. There is no way to tell whichside effects you may experience. You areunlikely to experience all the mentioned sideeffects.

How regularly chemotherapy is administered,will depend on the type of cancer, thechemotherapy drugs or combination thereof.

Chemotherapy is usually administered incycles with rest periods in between. A cyclemay last one or more days. A cycle oftreatments may be administered every 1 to 4weeks. A whole course of treatment maycomprise several cycles. Each course ofchemotherapy is different, but usuallycomprises 4 to 6 cycles.

The actual adminis t rat ion of somechemotherapeutic drugs may last a fewseconds or minutes, while the administrationof others may continue for several hours.

Side effects may be short term or acute, chronicalso known as long term, or permanent. Sideeffects may cause inconvenience ordiscomfort. Additionally, certain side effectsmay prevent doctors from delivering theprescribed dose of chemotherapy at thespecific time and schedule of the treatmentplan.

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Side effects from chemotherapy can includepain, diarrhoea, constipation, mouth sores,hair loss, nausea, vomiting, and blood-relatedside effects.

Although chemotherapy is designed fortreating cancer cells, it may also affect otherparts of the body not related to the originalcancer. This side effect is known as acomplication of treatment. Scientists havemade great strides in the development oftherapy to counteract side effects ofchemotherapy.

Side effects will be discussed more fully at alater stage.

There are various ways in which a doctor candetermine whether a patient is reactingpositively to treatment. Certain tests such asblood tests, scans and X-rays are conductedbefore and after treatment. By comparingthese results, the doctor can determine itseffectiveness.

The main aim of cancer treatment is remission.Successful cancer treatment focusses not onlyon the primary tumour but also on tumoursthat may have spread to other parts of the body.Combined therapies are often used to ensurethe most effective treatment of cancer with theleast side effects. Even when a cure isimpossible, symptoms can often be relievedwith palliative therapy to improve the qualityand length of life. Despite side effects,conventional treatment is scientifically basedand remains best practice towards possiblecure.

There are two classifications of remission -complete and partial remission. Remission is aperiod of time when the cancer is respondingto treatment or is under control. In a completeremission, all the signs and symptoms of thedisease disappear and cancer cells cannot be

How will a doctor determine that treatmentis effective?

Why go for treatment?

When it is said that someone is ‘inremission’, what does this mean?

detected by any of the tests available for thatcancer.

It is also possible to have a partial remission.This is when the cancer shrinks but does notcompletely disappear with a noticeabledecrease of cancer cells.

During the period of remission, the possibilityof return is higher if disease activity remains. Acancer that has recurred (come back) mayrespond to a different type of treatment, suchas a different drug combination or radiationversus surgery.

When you hear the words “you have cancer”,you may be shocked and find it difficult tocope . When you commence wi thchemotherapy, it may even be more difficult todeal with the disease because of the side effectsand complications associated with thetreatment. It is therefore important to beprepared on the possible side effects that maybe experienced to determine beforehand howto deal with it.

Contact the nearest CANSA Care Centre in thisregard or phone CANSA on its toll free numberby dialling 0800 22 66 22. You can also sharefears and anxieties on CANSA’s website atwww.cansa.org.za where a clinical specialistwill respond within 48 hours.

Individuals react differently to the differenttypes of cancer treatment. Not everyonereceiving cancer treatment will experience hairloss. Specific chemotherapy drugs may causetemporary damage to the hair follicles becausethey are fast growing cells.

Hair may thin only, fall out in clumps, or youmay become completely bald. The good newsis that hair will always grow back aftercompletion of chemotherapy. During theperiod of hair loss, one may opt to wear a wig, ascarf, a hat or a cap, according to personalpreference. When your hair grows back, it may

Complications and side effects ofchemotherapy

How to cope with possible hair loss

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temporarily be of a different texture and/orcolour. Contact your nearest CANSA CareCentre to assist with the purchase or hiring ofan affordable wig.

Chemotherapy acts on the whole body and allits systems. It also affects normal cells,especially the mucous membranes which mayresult in nausea, diarrhoea or constipation.There are anti-nausea medications availablethat is given before treatment. These medicinesshould be taken regularly, as prescribed by yourdoctor, to be effective.

If certain medicines do not work, the doctor orhealth professional should be able to give youan alternative. One may experience nauseawith or without vomiting. Nausea and/orvomiting can occur on the day you get yourtreatment and may last for a few days -depending on the drugs received.

Diarrhoea is a general side effect amongindividuals who receive cancer treatment. Thediarrhoea may even be caused by the cancer.Diarrhoea may, however, be moreuncomfortable for individuals with cancer. Itmay also be a sign or symptom of a moreserious kind.

Everyone experiences diarrhoea occasionally.If you have cancer, the ordinary causes ofdiarrhoea may still affect you. Cancer can be acontributing cause of diarrhoea.

Chemo- and radiation therapy does not onlykill cancer cells, it also affects and kills rapidgrowing cells such as the lining of the gut.

Damage to the lining of the gut may result indiarrhoea. Not all chemotherapeutic drugscause diarrhoea. Ask the doctor about specifictreatment.

What to do about nausea and vomiting,diarrhoea and constipation?

What causes diarrhoea in individuals withcancer?

Chemotherapy and radiation therapy

Surgery

Bone marrow and stem cell transplant

Infections

Stress and anxiety

Cancer itself

Causes of mouth sores in cancer patients

If parts of the intestines have been removed totreat the cancer, the ability of the intestines toabsorb fats may be affected and this may leadto the development of diarrhoea.

Both chemo- and radiation therapy that followon bone marrow or stem cell transplants maycause diarrhoea. It may also be a complicationof graft-versus-host illness if the body rejectsthe received bone marrow or stem cells.

Cancer treatment may make one more proneto infections which may be a cause ofdiarrhoea. An additional factor may also be theeffect of antibiotics which may beadministered to treat any possible infection.

Severe stress or anxiety may also causediarrhoea.

Certain cancers may be the cause of diarrhoea;health professionals will provide information inthis regard.

A tumour may also be the cause ofconstipation.

Should a tumour cause pressure on a spinalnerve, it may result in the decrease in activity ofthe intestines which may result in constipation.Tumours in the abdomen may also compressthe intestines causing narrowing which mayalso result in constipation.

Even before the commencement of cancertreatment one should be aware of the fact thatcertain cancer treatments may cause mouthsores. Mouth sores can be very painful andcause discomfort and distress. This may varyf rom mere d i scomfor t to ex t remecomplications.

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Mouth sores related to cancer treatmentappear on the inside of the mouth or lips. It islike burns and can be extremely painful. Thismay make it very difficult to eat, speak, swallowor to breathe. The sores may appear on anypart of the lips, mouth, gums, tongue, roof ofthe mouth or floor of the mouth. The sores mayeven spread to the oesophagus.

Chemo- and radiation therapy to the head andneck can be the cause of mouth sores.

Nausea is an uncomfortable feeling in the backof the throat or stomach which may result invomiting. Although treatment for nausea hasimproved, nausea and vomiting remain seriousside effects of cancer therapy. Continuednausea maybe more depressing to somepatients than vomiting.

It is important to prevent nausea and vomitingin cancer patients. Uncontrolled nausea andvomiting may be a hindrance in the treatmentand care because it may lead to an electrolyteimbalance, loss of appetite, physical andspiritual problems, a ruptured oesophagus,fractures of the ribs and the opening up ofsurgical wounds.

It usually presents within 24 hours ofcommencement of chemotherapy and maylast for a few days.

Anticipated nausea and vomiting may beexperienced following the third or fouthchemotherapy cycle. The smell, sight andsounds of the treatment rooms may remind theperson of previous episodes and may result innausea and vomiting even before a new cycleof chemo- or radiation therapy hascommenced.

This may affect individuals with advancedcancer.

Nausea and vomiting during cancertreatment

Acute nausea and vomiting

Anticipated nausea and vomiting

Chronic nausea and vomiting

Is breastfeeding feasible while receivingchemotherapy?

Taking other medicines while receivingchemotherapy

What about complementary or alternativetreatments while receiving chemotherapy?

Does chemotherapy af fect sexualfunctioning?

What is a clinical trial?

The answer is an emphatic ! Some drugswill be transmitted to the baby through thebreast milk. Consult a health professional in thisregard.

Always consult a health professional beforetaking any medicines that were not prescribedby a doctor. Certain medicines may lessen theeffectiveness of chemotherapy or cause sideeffects because of interaction with thechemotherapy drugs. This includes laxatives,flu medications, painkillers, contraceptives andmineral and vitamin supplements.

Refrain from any complementary or alternativetreatments without having discussed it with adoctor as it may negatively affect treatment.

Chemotherapy may affect sexual functioningin both men and women. It is important todiscuss this with a doctor even beforeundergoing treatment. Any resulting negativesexual functioning may adversely affect yourrelationship between partners and should bediscussed. Changes experienced may includefeelings of rejection, loss of libido, changes inbody image and sterility. It is advisable forwomen not to fall pregnant during treatment assome of the drugs may cause birth defects.Depending on age, both males and femalescould enquire about sperm and ova bankingprior to treatment if they are still consideringhaving children afterwards.

Clinical trials refer to newly developedchemotherapy drugs that are still undergoingresearch for efficacy and safety. When you donot respond to existing treatment protocols,ask your doctor about the possible availabilityof clinical trials. If all other treatment fails, the

“no”

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person may be selected to participate on avoluntary basis in an appropriate existingclinical trial.

There is no one single cause for cancer.Scientists believe that it is the interaction ofmany factors together that produce cancer. Thefac to r s i nvo l ved may be gene t i c ,environmental or physical characteristics of theindividual.

Genetic causes of cancer are more commonamongst children. Childhood cancers oftenoccur or begin in the stem cells, which aresimple cells capable of producing other typesof specialised cells that the body needs. Asporadic cell change or mutation is usuallywhat causes childhood cancer.

People with a chromosomal abnormality alsohave an increased risk of cancer for examplepeople with Down’s Syndrome have a higherrisk of developing acute leukaemia. Familyhistory may also play a role. Some breast andovarian cancers are linked to a specific genemutation which is more common in someethnic groups and families. A woman’s risk ofdeveloping breast cancer increases up to threetimes if her mother or sister also had breastcancer.

In adults, the types of cells that becomecancerous are usually ‘epithelial’ cells, whichare cells that line the body cavity and cover thebody surface. Cancer in adults mostly occursfrom environmental exposure to these cellsover time. Adult cancers are sometimesreferred to as ‘acquired’ for this reason.

A risk factor does not necessarily cause thedisease but it may make the body less resistantto it. The following risk factors and mechanismshave been proposed as contributing to cancer:

Lifestyle factors such as tobacco smoking,high-fat diets, physical inactivity, excessiveintake of alcohol, as well as obesity. Althoughthese factors are generally associated withadult cancers, it may also affect children if

Let us look at the possible causes of cancer

Risk factors associated with cancer

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exposed to these lifestyle factors over time.Exposure to biological carcinogens, such asinfections from certain bacteria, parasites orviruses. Certain viruses such as the Epstein-B a r r V i r u s ( E B V ) a n d H u m a nImmunodeficiency Virus (HIV), the viruswhich causes Acquired Immune Deficiency,or AIDS), have been linked to an increasedrisk of developing certain cancers such asHodgkin's and non-Hodgkin's lymphoma.Radiation causing agents (carcinogens) suchas ultraviolet (UV) rays through excessivesun, sunbed exposure and ionising radiationfor example uranium. In 2011 IARC -International Agency for Research on Cancer- declared non-ionising radiation (alsoknown as electromagnetic radiation) fromcell phones and other sources, a furtherprobable cause of cancer. Children over-exposed to UV rays before the age of 18 havean increased risk of skin cancer in adulthood.Environmental and chemical carcinogenexposure, such as asbestos, aflatoxin (a foodcontaminant), arsenic, pesticides andfertilisers have been linked to cancer.Man-made molecules such as Bisphenol A(BPA) and phthalates found in certain plasticshave been found to be hormone disruptorsand directly linked to hormonal cancers.Some forms of high-dose chemo- andradiation therapy have been linked tocancer. In some cases, individuals (mostlychildren) that have been exposed to theseagents may develop a second primarymalignancy later in life. These strong anti-cancer agents can alter cells and/or theimmune system. A second primarymalignancy is a cancer that appears as aresult from treatment of a different cancer.

Ageing is another fundamental factor for thedevelopment of cancer. The incidence ofcancer rises dramatically with age, most likelydue to a build-up of risks for specific cancersthat increase with age. The overall riskincreases because of the tendency for cellrepair to be less effective as a person growsolder.

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How to improve quality of life?Although there may be some unpleasant sideeffects, many people manage to lead a normallife while undergoing treatment. It is importantto prevent infection while on chemotherapy asit may negatively affect your treatment. Avoidclose contact with people who are ill. If youexperience times when you feel too ill tosocialise, accept it, be gentle with yourself andrest as much as you need to.

It is normal to feel anxious and to experiencefear of the unknown. Ask questions fromhealth professionals and obtain the neededknowledge about your condition.

When feeling worried or discouraged, talkopenly and meaningfully about this to lovedones or a support group. Find out aboutpossible support groups in the area bycontacting the nearest CANSA Care Centre.

Take time for introspection and try tounderstand what you are going through.CANSA has many facilities throughout all nineprovinces that can provide support.

CANSA programmes include:Individual counsellingSupport groupsCare Homes that provide accommodationand transport for out-of-town patients whilstundergoing treatmentStoma careLymphoedema treatmentLoan of medical equipment and devices, forexample wheelchairs and wigs

Please contact CANSA on the toll free number0800 22 66 22 for assistance and furtherinformation.

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Chapter 3 - Coping with theEmotional Impact of Cancer andt h e I m p o r t a n c e o fCommunication

Welcome to chapter 3 of the CancerCareCoping Kit

What emotions can be expected following adiagnosis of cancer and how to deal withthem?

In this chapter we examine the emotionalimpact following the diagnosis of cancer andhow it may affect you and your relationshipwith others. Some find it difficult to talk toloved ones, friends or doctors. To understandthe emotions involved, it is important torecognise that different emotions may occur atdifferent times for different people. Cancer is alife-changing event. For you, as the diagnosedperson, as well as for all the people close toyou, it affects all aspects of your being,including the physical, emotional, mental andspiritual spheres, as well as the family’s socialand financial structures.

Your cancer journey is unique. It cannot becompared to anyone else’s. You and your lovedones may experience reactions and needs thatdiffer from each other. Research shows thatthose who seek support, individually or withingroups cope better. Your past experience indealing with crises determines how you reactto and cope with cancer. If you dealt passivelywith situations in the past, you may findyourself reacting in the same way. This couldhamper your ability to cope well. People with aproactive approach will find a sense of control.After the initial avoidance behaviour, they takeresponsibility for what happens in their lives.

When hearing the words “you have cancer”,one will feel a whirlwind of emotions. Theseemotions often follow a common pattern. It istherefore important to deal with the differentemotions as they occur. In the event of feelingbeing caught up in an emotion, it may havepsychological effects which may even slowdown the healing process.

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Shock and disbelief

Uncertainty

Guilt

are often the first emotionsthat are felt. “Surely this is NOT HAPPENINGTO ME!” Many individuals see this as a deathsentence. This is not necessarily true as thedisease can be managed and treated most ofthe time. Disbelief about what is happening tous is understandable and it serves a usefulpurpose. It provides a numbing effect thatsoftens the news of the diagnosis. This providesa chance to adjust to major changes in life.

When in shock, one is unable to concentrate orto take in all the relevant facts and information.Don’t overreact but assure yourself of the facts.Let the doctor repeat the information withsomeone else present. Give yourself time toadjust to the diagnosis. Shock is natural underthese circumstances and one should not be toohard or demanding on oneself.

is created in one’s life. Instead ofseeing cancer as something to die from, it canbe viewed as something to learn to live with.Dealing positively with cancer allows one tomake plans for the future while living in thepresent.

is another key emotion to deal with.Often people blame themselves for their illnessand think that they have caused their owncancer. Some people mistakenly think that theyare being punished for things they have said ordone and see themselves as having failed. Theysay: “I did everything right, why did I still getsick?”. It must be emphasised that cancer iscomplicated and cannot necessarily beattributed to one single cause.

In dealing with guilt, look at unresolved issues;identify the feelings behind the guilt, such asremorse, anger or sadness. When feeling guilty,a person may actually be feeling regret for notbeing able to do what has to be done. Do notgive into self blame for the impact of whatcancer is having on loved ones. There shouldnot be any blame.

Cancer may affect anyone. Guilt may belessoned by talking to others or contact thenearest CANSA Care Centre for support.

of the future and what may lie ahead isvery normal and must be expected. Questionsoften raised include: Will I live? How will thisdisease impact my career? How will I managemy responsibilities as a breadwinner / wife /husband / partner/ parent/ employee / student?

Fear is often difficult to deal with. Remember,the more one knows, the less the fear. It isnatural to be afraid of the unknown. Byacknowledging one’s own fear and sharing itwith someone, the fears will become moremanageable.

Unsure of whether one isgoing to die may cause withdrawal from lovedones or others. Family and friends may stayaway because of their own fears causing themto withdraw to protect themselves. This oftenresults in isolation which can contribute todepression.

is often experienced andmay be associated with complications oftreatment, for example a mastectomy, loss ofhair, or an amputation. One may no longer feelcomplete and withdraw from life, resulting inloss of self esteem and confidence. This canlead to depression, as more permanentdisfigurement is difficult to face. It takes timeand a real effort to come to terms with one’snew body.

Even though there may be a feeling of notcoping with changes, reach out for assistanceand support. Face these fears through sharingyour feelings with your loved ones or a closefriend. Support groups and counselling will alsobe beneficial. Call the nearest CANSA CareCentre and accept the assistance.

even if the prognosis is good,death now becomes more real than everbefore. Coming face to face with mortality can

Fear

Fear of the unknown -

Fear of disfigurement

Fear of death -

What are some of the most common fears tocope with?

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be frightening. Having a strong spiritual beliefwill be of assistance during this time.Individuals, who are not religious, shouldaccept the prayers and thoughts of others.

Some may feelthat they are losing control of their lives as adoctor is in control of the treatment whilecancer is in control of the body. One may evenfeel worse when having to rely more on lovedones once treatment is commenced with. It isnot easy to have to rely on others.

Some types of cancer do not causepain. Should pain occur, it can be managedeffectively. Knowledge and information aboutthe pain and side effects cancer may cause, willalleviate this fear. Talk to a medical doctor orhealth professional as they are knowledgeableand will be able to provide help.

may become an immediatereality. Some may find that they cannotcontinue to work because of the disease. Fearof loss of income is especially a reality for anindividual who is a breadwinner or a singleparent.

Dependency on a medical team is acceptableup to a point. One must, however, empoweroneself to be involved in the treatment optionsand all those decisions that have a directimpact. Do not give up control over your lifeand your situation. Stand up for yourself andyour needs.

Ask questions and get answers. You mustalways feel that you are in control. It is your lifeand you must live it.

It is common to move from feeling strong andin control into sadness and short termdepression at this time.

Dr Elisabeth Kübler-Ross pioneered methodsin the support and counselling of personaltrauma, grief and grieving . She alsodramatically improved our understanding inrelation to bereavement and care. She makes itclear that trauma and emotional shock are

Fear of losing independence -

Fear of pain -

Loss of income

What other emotions can be expected?

relative in terms of effect on people as eachperson is a unique individual.

is a conscious or unconscious refusal toaccept the facts, information and realityrelating to the situation at hand. It refers to theinability to believe or acknowledge that one isbeing diagnosed with cancer. This is oftenexpressed as: “No! It can’t be true”. It is aperfectly natural defence mechanism. Somepeople can become locked in this stage whendealing with a traumatic change. Denialfunctions as a buffer allowing time to acceptthe current situation. If it goes on for too long,there will be a delay facing up to the reality andit could cause delay or postpone that whichcould affect the outcome of treatment.

Accept that denial is a normal reaction to acancer diagnosis. Make allowance for moodfluctuations that swing from hope to despair. Ittakes time for the reality to sink in. Lack ofcommunication at this time reinforces feelingsof isolation. It can cause breakdown in familyrelationships. Open communication andsupport between family and friends isnecessary.

can manifest in many different ways.Many times it is said: “How dare this happen? Iwon’t allow it! It isn’t fair! Why now? I don’tdeserve this”. Anger is a reaction to theunfairness of what has happened and theunjust loss of lifestyle. Anger can be directed atthe cancer, at God, at the medical profession,at friends, or at a loved one. It often happensthat people dealing with emotional upset areangry with themselves, and/or others,especially to those close to them.

When handling anger, it is important to identifywhy there is anger and then to address theanger. Yell, scream, and punch pillows torelease the anger. Don’t wallow in the feeling,use that energy to get well and live positively.Avoid frustrating situations and allow time tocry when there is need to. Do not mask truefeelings through jest. Rather clarify the feelingsand discuss them openly with someone thatcan be trusted.

Denial

Anger

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Anger may often mask other feelings like fear,panic or helplessness. It is easier to express thanto admit “I cannot cope”. Expressed anger ishealthy if it allows proactive thinking andmotivates you to action.

is traditionally the stage wherepeople facing emotional stress, attempt tobargain with God as the being in control of life.People facing trauma, grief, and even disbeliefmay bargain or seek to negotiate a compromiseto maintain life in accordance with theirbeliefs. For example: “Please don’t let this betrue! I will never again do the things I did in thepast if my situation can be changed”.Bargaining, however, rarely provides asustainable solution.

is often the dress rehearsal or thepractice run for the ‘aftermath’ although thisstage means different things for differentpeople. It is natural to feel sadness and regret,fear and uncertainty. It shows that the personhas at least begun to accept reality. During thisstage the person begins to understand thecertainty of the situation. The individual maybecome silent, refuse visitors and spend moretime crying and grieving. The process allowsthe person to disconnect from loved ones andobjects of affection. It is an important time forgrieving or for loss to be processed.

Relaxation exercises, talking about feelings,changing negative thoughts, acknowledginggrief and loss can help one deal withdepression. Prayer and meditation can lessenfeelings of anguish and sadness.

is a stage that definitely variesaccording to the person’s situation, althoughbroadly it is an indication that there is someemotional detachment and objectivity. It isdescribed as the final stage by Dr Kübler-Ross.It is a sign that the individual has workedthrough all that is important and that a decisionhas been taken to accept the diagnosis and thata person is prepared to fight the cancer andthere is an indication for a reason to live and tobe a cancer survivor.

Bargaining

Depression

Acceptance

With acceptance comes the opportunity to getthe most out of each day and to build a bridgeof hope.

Working through all the mentioned emotionswill help accept the situation. This will increasea feeling of being more hopeful, less resignedand despairing. This allows for a focus onfuture life goals and to be realistic aboutprogress and plans.

It is important to find someone who istrustworthy to talk to. This could be a closerelative, friend, counsellor or CANSA staffmember or volunteer. Talk to them aboutexisting fears, needs and things that maytrouble. This will help you to gain insight andacceptance.

You should seek help if the following symptomscontinue for longer than 6 to 8 weeks:

When you lose interest in things that used togive you pleasureWhen you sleep too much or too littleWhen you lose your appetiteWhen you feel constantly tiredWhen you lose the ability to think clearly orconcentrateWhen you feel guilty or worthlessLong term depression may lead to feelings ofworthlessness and even suicide that needs tobe addressed

True feelings are never right or wrong, but needto be expressed in a constructive manner.

All the emotions mentioned are normal after acancer diagnosis and are to be expected. Anyemotion that disrupts ordinary life and causesdysfunctional behaviour is cause for worry.

For example: instead of dealing with theiranger, some people may lash out at thoseclosest to them and further isolate themselves.The weeks and months following a cancer

How to reach acceptance

When should medical and other help besought?

Anything about emotions that need to beknown

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diagnosis can be a roller coaster ride foreveryone involved. One person may be feelingOK while another may be in denial. Honestand open communication about the issuesand feelings is important to preventmisunderstanding and resolve possibleconflict.

There may be a need to give ‘voice’ to thefeelings that may be experienced. Feelcomfortable saying the words that need to besaid. Sometimes the most di f f icul tcommunication is with those we love the most.For family and friends to understand what theirloved one is going through, goodcommunication skills will be a requirement.Words people use can cause misunderstandingand hurt. Communication style learnt inchildhood might either enhance or inhibitone’s ability to make one understood. Cancershould not be used to get sympathy or tocontrol others.

Good communication has two sides. Tellpeople how you feel so that they understandyou. Listen as the other person expresses howthey are feeling. You may think that othersunderstand you but perhaps they don’t. Goodcommunication doesn’t always solve problemsbut it can make them easier to manage.

Let us discuss five skills that will enable you toexpress yourself clearly:

The first skill is to be assertive, showing thatwhat you are saying is important to you.When it comes to your health there is nosuch thing as a silly question. You need to beinvolved in your treatment decisions.The second skill is using “I” messages, such as“I feel”, “I am” or “I think” rather thanmaking statements such as “you should”.This is an open and direct way of stating yourviews and taking responsibility for yourfeelings without being confrontational.The third skill is to listen to someonecarefully. Show them that you are listening.

The importance of communication

What is good communication?

Effective communication

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Clarify with them that you have understoodtheir message. Ask them “What I hear yousaying is ………..”. Ask for confirmation orlet the other person clarify what they havemeant to say.The fourth skill is to match words andgestures. We also communicate withoutwords. Make sure that your body languagematches what you say. Non-verbalexpressions can send a different messagethan your words. Smiling when you tellsomeone that you are in pain, could beconfusing to the recipient.The last skill is expressing your feelings aswell as your thoughts. Communicating bothfeelings and thoughts will allow others tounderstand and help you constructively.Suppressing feelings such as anger and fearcause unnecessary stress. Find a trustworthyperson to talk to. Someone who can bothunderstand and relate to what you aresaying. Join a support group to expressyourself. They allow you to connect withpeople who are going through a similarexperience. CANSA Care Centres canprovide more information on the availablesupport groups in your area.

In chapter 1 we covered a number of medicalterms.

Become familiar with medical terminology. Askyour doctor to explain the words you don’tunderstand. Write down all your questionsbefore your doctor’s appointment. Have afamily member or friend go with you to act as asecond pair of ears. Proactive participation inyour treatment means understanding anddiscussing your illness and treatment with yourdoctor. Don’t be afraid that you will waste yourdoctor’s time by asking questions.

Some doctors are not good communicatorsand may appear blunt or seemingly uncaring

Establish an open channel of conversation withyour doctor that will allow you to be informed

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How to improve communication with amedical team?

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and empowered. The more informed you are,the less you will be influenced by myths,unrealistic promises or the bad experiences ofothers. Learning about your treatment will helpyou to manage side effects and physicalaspects.

Effective communication is a crucial part oflearning to live with cancer.

Remember this is all about your life and yourhealth. By using these communication skillsyou will develop a good relationship with yourmedical team and other health professionals.

Living with cancer, you have the right to makeyour own choices without interference fromothers. After careful consideration and inconsultation with health professionals, youhave the right to make your own decisionsregarding the following:

The type and extent of treatmentA second medical opinionRefusal of continued treatmentAs much or little information as is necessaryConfidentiality and privacyCounselling and support

It is important that you know and understandyour rights.

For family members your cancer journey is alsotheirs. It is as difficult for them as for you. Whileyou actively fight the cancer they feel helplessas they can only observe. Talk to them aboutyour true feelings and allow them to do so aswell. They also need time to adjust to thesituation and learn how to listen and becomemore supportive towards you.

Pre-existing problems in a family can be madeworse by the diagnosis of cancer.Uncertainties and concerns about the diseasemay cause uncertainty. Normal family relationsmay become disrupted. Family members maybe unsure of how to react to a loved onediagnosed with cancer and may need guidance

What rights do you have relating to yourillness?

How will cancer impact on your family?

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on how to cope. A social worker or counselloras well as a support group can provide theneeded assistance. Learning to speak one’smind will help others to understand needs andfeelings. For example: you may be exhaustedand overwhelmed following treatment likeradiation and chemotherapy. Sharing thisinformation with your family will help themunderstand and know what to expect and howto become more supportive.

Family members may feel frightened about thecurrent situation and for not knowing what thefuture holds. They may even fear the newresponsibilities they now have to face as theirfamily roles might have to change. Fathers maysuddenly find themselves doing chores orpreparing dinner while wives have to becomethe breadwinner. These changes are likely todisrupt family life.

Sharing your fears and anxieties will helpeveryone to cope with the uncertainty of thefuture, and will allow all of you to live moremeaningfully in the present.

The family unit has great strength when theneeds of each person are taken into accountand respected. Help from friends may alsomake a difference. Allow them to run chores,cook and even do housework. This will reducethe strain on the family.

Cancer not only changes the cancer survivor,but also those around that person. Peoplebehave in ways one may not expect. Somefriends disappear and others hang around toomuch. To identify and deal with the varioustypes of behaviours, we will describe somecommon reactions that can result.

These people are convinced thatthey know what is best. They inundate withadvice, books and information. They areconvinced that their advice will ensure a cure.They are usually well-meaning and concerned.This makes them difficult to ignore even if their

How can you as a family deal with thesechanges?

How will friends and co-workers behave?

Know-it-alls -

21

advice is impractical. For example, insisting ona positive attitude when you are feeling really illmay be disempowering, especially if theyimply that not enough effort is being made. Beassertive in responding to them. Don’t allowany ‘brow beating’.

people have a tendency to makesilly comments that are thoughtless andtactless. They don’t understand the situationand are not interested in you. Concerned onlywith themselves, they want to be made to feelbetter. For example, by being cheerful evenwhen you are not, these people may exhaustyou and need to be avoided.

disappear when they are faced by adiagnosis of cancer. They blame their absenceon you or your illness, using excuses like “Iknew you would be tired”. Some faders arephysically present but emotionally andmentally absent. These are usually close familymembers and may even behave as if you areinvisible. Faders may stay away as they areafraid of their feelings and their own mortality.It is important that you address their behaviourin an honest and constructive way to allowthem to understand and adjust their ownbehaviour.

seem to know where and how to help.They treat you in the same way they always did.They listen when you need to talk and knowthat just by being there they are making adifference. Helpers don’t wait to be asked.They offer help where they think it is needed.Some people need to adjust to the situation tobecome helpers even if it may be awkward forthem at first. Be open and share your feelingswith these people and tell them that youappreciate them and would like to have themaround.

Cancer is a great challenge and requirestenacity and resourcefulness. Acknowledgeyour feelings and emotions and take control ofyour life and deal with areas of concern as apriority. Developing constructive attitudes andbehaviour patterns will aid you in living

Misinformed

Faders

Helpers

Can self-help make a difference?

positively with cancer. Acknowledge the issuesthat you have control over and deal with themas a priority.

What you can do to be in controlSeek knowledge and ask questionsParticipate in making treatment decisionsImprove your communication skillsLearn to express your thoughts and emotionsin an appropriate waySet goals on all levels of your lifeKeep a journal which puts you in touch withwhat is happening in your daily lifeLearn to ask for, and accept, helpLearn new skills like relaxation andvisualisationConsider counselling if you have difficulty incopingDevelop your acceptance of what ishappeningBe in touch with your own needsCultivate a moderate healthy lifestyleReduce stress through physical activity andrelaxation exercisesRely on your faith and spirituality to comfortand support youDeal with, and change, negative thoughtsand behaviours such as isolating yourself,blaming others, being a martyr and blamingGodJoin one of CANSA’s support groups in yourarea.

Develop a solution-oriented approach thatsolves problems. Keep the word stronglyin your mind, as each letter of the word standsfor an important part of learning to live withcancer.

is for take control of what youcan.

is for opencommunication with family, friends and yourmedical team

is for develop positive copingskills

is for learn to seek expert adviceand support to help you make informeddecisions

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To conclude

C CONTROL -

O OPEN COMMUNICATION -

P POSITIVE -

E EXPERT -

COPE

22

Being healthy is more than just being diseasefree. It is a healthy balance of the physical,emotional, intellectual and spiritual self.

Welcome to chapter 4 of the CancerCareCoping Kit where we discuss nutrition.

It is especially important during any illness tomaintain a healthy diet as the body requiresnutrients to fight disease and counteract theside effects of treatment.

The side effects of treatments, emotionalfactors like anxiety and stress can play a role inaltered taste, lack of appetite, digestiveproblems and general loss of interest in food.

Surgery on or around the digestive tract ofteninhibit the functioning of the mouth, throat andstomach. These areas may become painful anddigestion may slow down.

Both chemo - and radiotherapy can cause soresin the mouth, nausea, vomiting, changes intaste and appetite, diarrhoea and constipation.These symptoms may affect the ability to eatand the body’s ability to absorb nutrients fromfood.

A correct diet provides all the fats, protein andcarbohydrates, vitamins, minerals, fibre andwater for the body to function adequately. Eachof these nutrients fulfils a specific function inthe body. Without the needed nutrients, thebody may not be able to protect, repair,replace or cleanse itself.

As not all fats are bad for the body, it should notbe excluded entirely. Fats are important, as itprovides energy, contributes vitamins A, D, E

Chapter 4 - Nutrition Guidelinesand Coping with AssociatedComplications

Why is it so important to eat correctly?

How to eat correctly?

If fats are important why do people talkabout bad fats?

and K and essential fatty acids to the diet. Fatcells also insulate the body from cold and helpto protect internal organs from injury.Depending on the binding structure of fats, itcan either be called saturated fat that is mostlyfound in animal products, or unsaturated fatwhich is plant based.

Unsaturated fats, generally found in liquid format room temperature, are known as good fatsthat increase the good cholesterol, namelyhigh-density lipoprotein or HDL in thebloodstream. Unsaturated fats furtherdecrease bad cholesterol, namely low-densitylipoprotein or called LDL in the bloodstream.

Saturated fats function in directly the oppositeway as unsaturated fats. Mostly solid at roomtemperature, saturated fats decreases the goodcholesterol or HDL in the body and increasesthe bad cholesterol or LDL in the body or thatcan lead to long term cardiovascular problemsand obesity.

Monounsaturated and polyunsaturated fats areneeded by the skin, nervous system, immunesystem and circulatory system and is necessaryto keep the membranes healthy. A dry skin maydevelop when the body is in need ofunsaturated fats.

Omega-3, 6 and 9 are all important majorunsaturated fatty acids. A good balance of allthree is needed for good health.

Omega-3 is most probably the most importantof the three as it assists in boosting the immunesystem and keeps the cardiovascular systemhealthy. It further offers anti-cancer benefits bycounteracting inflammation which is also thecause of many degenerative diseases. Omega-3 does so by counteracting the pro-inflammatory effects of Omega-6.

As our bodies cannot produce Omega-3, itneeds to be ingested in the form of fatty fish,flax seed- and canola oil, legumes, green leafyvegetables, and cherries. Eat oily fish, such as

Let me tell you more about the twounsaturated fats

23

pilchards, salmon, mackerel, snoek, trout andsardines frequently, but in moderation, as itcontains a lot of salt.

Saturated fats are mostly found in animal fat.Foods high in saturated fats are foods such asfatty meats, chicken with skin, smoked andpreserved processed meats like polony, bacon,ham, cold meats, and sausages. Full creamdairy products also contain large amounts ofanimal fat.

Trans fats, also known as hydrogenated fats,have been processed and damaged by heat.Hidden in many foods, it degrades the cellmembranes, disabling cells to absorb nutrients.Foods to avoid are fried foods, biscuits,croissants, chips, cakes, pancake mixes,doughnuts, and pastries. Check the label ofproducts for the words ‘hydrogenated fats’ asthese are trans fats that should be avoided.

Minimise the intake of both saturated fat andtrans fat by checking the food labels. Allpackaged foods should have a food label thatprovides information on the content andcomposition. The amount of trans fats perserving of food will appear under the ‘Total Fat’section of the label. Legislation introduced in2010 restricts trans fat contents to 2% - that is 2grams per 100ml in all foodstuffs.

For those labels that do not list the amount oftrans fat, add up the values for saturated,polyunsaturated and monounsaturated fats. Ifthe number is less than the ‘Total Fats’ shownon the label, the unaccounted figure representsthe trans fat.

Be cautious of ‘hidden fats’ such as fried foods,pies, samoosas, doughnuts, rotis, mayonnaiseand ice cream. Also avoid foods with flour andcrumb coatings as it absorbs a lot of fat. Uselow-fat or skimmed milk rather than coffeecreamers or tea whiteners. Limit your intake ofdeep fried foods, poultry skin, full-fat dairyproducts and cheeses, fast foods, and fatty

Why you need to restrict saturated- as well astrans fats

Watch out for hidden fats

bakery items. Snack foods such as chocolatesand crisps also contain saturated fats.

Proteins are the building blocks of the body.Without a good supply the body is unable tofunction, repair or replace damaged tissueproperly. Every cell in the human bodycontains protein. It is a major part of the skin,muscles, organs, and glands. Protein is alsofound in all body fluids, except bile and urine.Two servings of protein should be eaten perday, if not possible; speak with a healthprofessional to suggest a protein supplementdrink. CANSA’s Stoma Clinics provide some ofthese supplements at low cost.

Complete proteins contain all nine essentialamino acids and is found in animal foods suchas meat, fish, poultry, eggs, milk, and milkproducts like yogurt and cheese. Soybeans arethe only plant protein considered to be acomplete protein.

Incomplete proteins lack one or more of theessential amino acids. Sources include beans,peas, nuts, seeds, and grain. A small amount ofincomplete protein is also found in vegetables.

Plant proteins can be combined to provide allof the essential amino acids and form acomplete protein. Examples of combinedcomplete plant proteins are rice and beans,wheat cereal, mealies and beans. Considerusing plant proteins such as soybean productsas well as complete plant protein combinationsmore often as these are both healthy and costeffective.

Carbohydrates are the prime source of energyfor all cells in the body needed for physicalactivity and organ function. The best sources ofcarbohydrates are fruits, vegetables, and wholegrains, by providing essential vitamins and

Are all proteins good for you?

Protein-containing foods are grouped aseither complete or incomplete proteins

If correctly combined, plant proteins canprovide essential amino acids

Let us discuss the importance ofcarbohydrates or starch in the diet

24

minerals, fibre, and a host of important phyto-nutrients to the body. There are two types ofcarbohydrates, namely: fast releasing and slowreleasing carbohydrates.

Fast releasing carbohydrates include productssuch as sugar, honey, sweets, white bread andmealie or maize meal, while slow releasingcarbohydrates include vegetables, wholegrains, brown rice, oats, legumes and freshfruit. Energy levels are sustained throughoutthe day by limiting the intake of fast releasingcarbohydrates and by eating small, regularmeals of slow releasing carbohydrates.

Make carbohydrates high in roughage andwholegrain the basis of most meals.Carbohydrates, such as coarse mealie meal,samp, brown rice and whole wheat bread,pasta, potatoes, mealies on the cob and sweetpotatoes should be considered as staple foodsin the diet. It is important to eat wholegrainbread or cereals for breakfast as it sustainsenergy levels during the day. Look out for theCANSA Smart Choice logo on food labels.

It is beneficial to eat five servings of vegetablesand fruit per day. It is best to eat fruit andvegetables fresh and raw if possible, as it playsan important role in the prevention of cancer.

Use sugar and sugar containing drinks and foodin moderation, as it promotes inflammatoryprocesses in the body which are linked tocancer.

To keep blood-sugar at constant and safe levels,insulin further promotes the storage of fat. Sowith the intake of a lot of sugar, you are makingway for rapid weight gain and elevatedtriglyceride levels. Both of these conditionshave also been linked to cardiovasculardisease.

Since 2003 all mealie meal, as well as whiteand brown bread flour must be fortified withvitamins and minerals or micronutrients asdetermined by legislation. Look out for SouthAfrican fortified mealie meal which contains,

The importance of fortified carbohydrates

Vitamin C, iron, zinc, Vitamin B6 and VitaminB12, copper, selenium, Vitamin E andriboflavin that significantly reduces anaemia,help lower body weight, boosts the immunesystem and helps protect against cancer.

Glycaemic index or GI is the measure of thefood's ability to elevate blood sugar. Theglycaemic response is influenced by theamount of food eaten, its fibre content, the fatcontent of the food or amount of added fat, aswell as the way the food is prepared.

High glycaemic carbohydrates are bestconsumed during and after exercise. It entersthe bloodstream quickly and is readilyavailable for fuelling exercising muscles.

Low glycaemic carbohydrates enter thebloodstream slowly and is best eaten beforeexercise. It provides sustained longer-termenergy, and helps maintain stable blood sugarlevels during extended exercise periods ofmore than one hour. Low GI carbohydrateintake like low GI bread is recommended fordaily use.

Legumes such as dry beans, kidney beans,black beans, peas, chick peas, lentils and soyprovide an opportunity to increase variety ineconomical menu planning while increasingthe intake of fibre, keeping blood sugar levelssteady and promoting health in general.

Most legumes contain important nutrients,carbohydrates, proteins, fibre, vitamins andminerals and are low in fat. Legumes are alsotasty and a healthy substitute or extender ofmeat.

Legume fibres further promote healthy bowelfunction and prevent constipation. It also helpsprevent diseases such as heart disease andreduces the risk for cancer.

Carbohydrates and protein fibres are notdigested in the body. Fibre absorbs water andkeeps bowel matter soft and easy to move. It

Let’s discuss the meaning of glycaemic index

Legumes as a carbohydrate in the diet

The role of fibre in the diet

25

cleans out the bowel and removes wastebefore it can affect the body. Whole grains,vegetables, samp, mealie meal, mealie rice,fruits, nuts, seeds, lentils, beans and high fibrecereal are good sources of fibre.

It needs to be eaten daily to keep the bowelfunction regular. Whole grains are rich sourcesin fermentable carbohydrates.

A well balanced diet should provide all thenecessary vitamins and minerals required tomaintain good health. Vitamins have importantfunctions in almost all the processes of the bodywhich include the immune, hormonal andnervous systems. It must be obtained from foodor supplements as the body is unable toproduce or manufacture vitamins. There arethirteen vitamins classified as either fat soluble,that is Vitamins A, D, E and K, and water solublewhich include Vitamins C and B complex.

Fat-soluble vitamins, for example A, D and Kare absorbed with fat into the circulation and isstored in the liver. Vitamin E is distributedthroughout the body's fatty tissues. Goodsources mainly include green leafy vegetables,vegetable oils, egg yolk and dairy products.

Excessive water-soluble vitamins, such asVitamin C and B complex remain in the bodyfor a brief period before being excreted by thekidneys. The one exception to this is VitaminB12, which is stored in the liver. Water-solublevitamins need to be taken daily. Good sourcesmainly include organ meats, dairy products,eggs, legumes, green vegetables and fruits, withemphasis on citrus fruits, mainly for Vitamin C.Vegetarians and vegans might need tosupplement their diet with Vitamin B12. TheBritish Vegan Society recommends soyproducts as an excellent source of Vitamin B12as replacement for meats, eggs and dairyproducts.

Minerals form important components of theteeth, bones, tissues, blood, muscle and nervecells. It can be found in varying amounts in a

The importance of vitamins in the diet?

Minerals are also important in your diet

variety of foods such as meat, cereals includingcereal products such as bread, fish, milk anddairy products, vegetables, fruit especiallydried fruit and nuts.

Minerals are grouped under 2 categories,namely macro minerals and trace minerals.Macro minerals include calcium, sodium,phosphorous and potassium. Edible bones inpilchards and sardines are good sources ofcalcium and needed for blood clotting, bonehealth and wound healing.

Trace minerals are needed in small amountsand include zinc, selenium, iodine, copper,chromium and manganese.

The more food is heated, the more nutrientsare destroyed. Eat vegetables semi-cooked orraw if possible. A Europe-wide study by theInstitute of Food Research in Norwich,published in June 1999, indicated thatcaretonoid uptake from cooked carrots andgreen vegetables, especially spinach andbroccoli, are five times more in the semi-cooked state as when eaten raw. The tough-walled cells in these raw vegetables prevent therelease of caretonoids - an importantantioxidant that helps in the prevention againstcancer. The best preparation methods to useare steaming, poaching, boiling or baking,where heat is kept as low as possible for a shortperiod of time. High temperature cookingmethods such as grilling, deep frying, roastingand braaiing on coals should be avoided. Stir-frying is the best frying method as its keepscooking time to a minimum.

Choose lean meat cuts suchas chicken breast. Trim all visible fat beforecooking and remove the skin from chicken as itcontains a lot of fat. Be careful with servingsizes to decrease the volume of fat. Whengrilling, make use of a slotted baking pan so thatexcessive fat can automatically drain off.Poultry/mince meat, boerewors and sausagesmay contain a lot of fat. Check the fat contentbefore you buy such items. Also, do not use

The best way to prepare food

Some useful tips:

26

additional oil or fat when making stews orpreparing boerewors and sausages. Rather usea little canola oil or cooking spray for browningmeat instead of fat or other oils.

A person loses between 1 and 2 litres of waterper day through the skin, bowels, lungs andurine as part of normal body function. It isimportant to replace this water and keep thebody sufficiently hydrated. On average aperson should drink about one glass, that is200ml, of water for every 10kg of bodyweightper day. Eating fruit and vegetables is also anexcellent way to replace fluid, as thesefoodstuffs are composed of 90% water.

When considering what to drink, limit theintake of alcohol, coffee with a high content incaffeine, as well as most teas with high tanninand caffeine content, as these products tend todehydrate the body. Substitute these drinkswith herbal-, ginger-, rooibos- and honeybushtea. Rooibos tea has been proven to promoteanti-oxidant formation in the body. It containslittle tannin and no caffeine.

Dilute fruit juice with water as it normallycontains high levels of sugar - even pure fruitjuices may contain high levels of fructose orsugar.

Alcohol is not an essential food or nutrient andis not required as part of the diet. People tendto look at the drinking of alcohol as anacceptable habit but alcohol is in fact a drug,albeit a legal drug. It is addictive and peopleuse and abuse it daily. Alcohol is consumed torelax, escape from reality and to fit in socially.Teenagers may start drinking due to peerpressure. Many people drink because theyhave become addicted to alcohol.

Alcohol increases the risk of various healthconditions, such as heart and liver disease andworks directly on the central nervous system,impairing brain function. Over time, excessivealcohol consumption can damage the functionof many organs such as the brain, liver and

Is it important to drink water?

How much alcohol is safe to drink?

pancreas and may even cause cancer.

People who should avoid alcohol are: pregnantwomen or women trying to become pregnant;those who plan to drive or engage in activitiesrequiring alertness and skill; people takingmedications, including certain over-the-counter medicine and people with medicalconditions.

Most people know that cigarette smoking is nothealthy. One in four smokers dies at an earlyage because of smoking. Smoking causes heartdisease, emphysema and many cancersincluding cancer of the mouth, throat, lung andurinary bladder.

Non-smokers are harmed by the smoke fromother people's cigarettes, pipes or cigars. Thiskind of smoke is called environmental tobaccosmoke or second hand smoke. It is the mixtureof smoke exhaled by the smoker and thesmoke that comes off the burning end of thecigarette, cigar or pipe between puffs. Itcontains thousands of chemicals that can harmboth smokers and non-smokers alike.

Breathing in other people's smoke can causecancer and heart disease in adults. If a pregnantwoman or her partner smokes, she has agreater chance of having a low-weight baby.Her child may have breathing problems duringits early years of life. Second hand smoke causechildren to develop asthma and ear problemsand is linked to an increase in cot deaths.

People become addicted to smoking. Mostsmokers do not realise that nicotine can be justas addictive as heroin or cocaine. More so, itcauses more death and disease than all otheraddictions combined.

Food production, includes growing ,harvesting, transportation, preparation andserving thereof, which are important factors toensure good and quality foods. At all times caremust be taken to ensure food quality is notcompromised. Poor food quality, whether it is

Is it safe to smoke?

Is food preparation and storage important?

27

caused by poor procedures, storage, or humanerror, is a costly and potentially deadlyproblem. Food not suitable for human oranimal consumption is potentially lethal. Twocommon contaminants are E. coli, spreadthrough faecal matter, and mold or aflatoxinswhich are formed in poor storage conditions.

Bisphenol A (BPA), is found in plastics like babyfeeding bottles, food packaging and in theinside lining tinned foods, have been classifiedas a hormone disruptor. In order to determinewhether a plastic container contains BPA is tocheck for the presence of a recycle triangle atthe bottom of the container. If the trianglecontains the number ‘7’ with the letters ‘PC’ forpolycarbon below it, the plastic contains BPA.

Always wash your hands before you work withfood. Wash vegetables and fruit with cold,running water. Try to use separate cuttingboards, one for "animal" products like meat andfish and another for fruits, vegetables andbread. If you only have one cutting board, washit when you switch from one food type toanother. Plastic or glass boards are best -wooden ones tend to harbour bacteria.

Refrigerate freshly cooked food within 2 hoursas bacteria can grow at room temperature afterthis time. Store dry food in sealed containers.Avoid eating inadequately cooked or rawmeat, fish, eggs and shellfish. Always check the‘sell by’ and ‘use by’ dates on labels.

Tiredness or fatigue, associated with a lack ofenergy is often the result of a lack of sleep orexcessive stress. When asleep, the brain has tocomplete a number of complex tasks. It goesthrough five different sleep stages. The mostcommonly known sleep stage is called the REMor rapid eye movement sleep.

If you wake up at the end of your sleep cycle,you may feel fine. If you wake up in the middleof a cycle, you will feel tired, sleepy and groggy.People often reach for a cup of coffee whenthey wake up and hope to feel better. We haveall been there! Drinking coffee won’t help.

How to overcome fatigue and restore energy

Coffee or any energy drink is a stimulant andeventually wears off. You will feel better for awhile, but it only lasts a short time and then youare back to feeling tired again or even worse.

The effect is hard on the body. It can cause aniron and Vitamin B deficiency, which will leaveyou feeling constantly tired or chronicallyfatigued. The next major problem is thatstimulants will only hide the symptoms of yourtiredness - it does not address the cause of theproblem. By ignoring tiredness the body ispushed to its limits and beyond. It will weakenthe immune system and eventually lead toburnout and the development of chronicdiseases.

A natural approach to help cure chronic fatigueis the eating of a balanced diet rich inantioxidants, such as berries, broccoli,tomatoes, red grapes, spinach and evenRooibos tea. You will need to adjust your eatingpatterns while on treatment. Loss of appetite iscommon among people who are ill or oncancer treatment.

The best source of vitamins and minerals is awell balanced diet. Supplements cannotcompletely replace natural vitamins in food.However, if the illness or treatment ispreventing healthy eating, supplements maybe necessary. Please consult your medicalpractitioner before taking any form ofsupplementation as it may affect the treatment.

Fresh garlic is a natural antibiotic that will helpfight bacterial and viral infections. Peel a smallclove of garlic and swallow it whole if you donot like the taste. Garlic can also be added tosoups and stews. Fresh herbs add flavour tofood.

Salt is required to maintain a balance of bodyfluids, transmit nerve signals and for muscles tofunction properly. Unfortunately a lot ofpeople take in an excess amount of salt.

Should I take vitamin supplements?

What about herbs and salt?

28

Research indicates that we should reduce theamount of salt in our diet.

Unfortunately excessive amounts of salt arepresent in many products that are generallyconsidered to be healthy. According to theNational Department of Health the desiredamount of salt for one’s body is 4-6 grams perday. This is one teaspoon of salt per day. Justone cup of canned soup can contain more than50 percent of the recommended allowance. Aserving of lasagne at a restaurant can put youover your sodium allowance in one meal.

Limit dailysodium intake to between 1 500 and 2 400milligrams. Ask for unsalted dishes when eatingout. Season your food at home with herbs andspices rather than salt. Remove salt fromrecipes when possible. Don’t put the saltshakeron your dining table.

Check labels for foods high in sodium likeprocessed meats and biltong. When preparingfood use iodated salt. Iodated salt is table saltmixed with a minute amount of various iodine-containing salts. Worldwide, iodine deficiencyaffects about two billion people and is theleading preventable cause of mentalretardation. It also causes thyroid glandproblems. Iodine is a micronutrient that isnaturally present in the food supply in manyregions. However, where natural levels ofiodine in the soil are low and the iodine is nottaken up by vegetables, iodine added to saltprovides the small but essential amountneeded by humans.

Some patients may have asignificant loss of saliva production. To remedythis, drink small amounts of water as frequentlyas possible and suck ice cubes. Freeze a fruitjuice in ice trays to make flavoured ice cubes tosuck. Add a few drops of lemon juice to waterto stimulate saliva production in the mouth andsip the water slowly. Apply Vaseline, Aloe Gelor honey balm products to your lips to prevent

How to limit your daily salt intake:

A dry mouth -

Complications associated with chemo- andradiotherapy

it from drying out and cracking. If this problemcontinues, ask your health professional foradvice.

eat soft foods like yoghurt, oats andstews. Sauces and gravies moisten foods,making it easier to swallow. Avoid food anddrink that is very hot. Try drinking through astraw.

Avoid rough or dry foods such as toast, biscuitsor raw vegetables. Acidic foods like pineapple,citrus and tomatoes may aggravate theproblem. Keep the mouth as healthy aspossible at this time. Brush your teeth with asoft brush after each meal or use a softpaediatric toothbrush. If wearing dentures,soak it overnight in a cleansing solution.Treatment may cause the tongue to be coated.Use a solution of one teaspoon of bicarbonateof soda dissolved in 0.5 litre water to clean.Stop smoking as this can worsen the problem.

If you experience difficulty in chewing orswallowing , a soft or liquid diet isrecommended that is high in protein, energy,vitamins and minerals. Choose a good mealreplacement supplement.

Chop up fish, eggs, chicken and well-cookedvegetables and moisten them with gravy orstock. Ensure that all foods are soft and wellchewed before being swallowed.

Eat any healthy food that you feel like,whenever you can. Your appetite may be betterin the mornings - try to eat a little more at thistime. Eat small meals with snacks like fruit inbetween. Experiment with different flavours asyour ability to taste might have changed. Mashcooked beans and legumes to make asandwich filling.

If you are unable to eat, substitute meals withone or two glasses of high protein drinks toprovide your body with much needed proteinand energy. Add Weet-Bix to soups or stews to

What to eat when you have a sore throat andmouth -

General guidelines for a soft or liquid diet:

A loss of appetite is very common

29

thicken its texture and to make it a completemeal. Eat out of small containers or cups as it iseasier and makes it more attractive andpalatable than having to face a large plate offood.

Many times friends would like to help but don’tknow what to do. Asking them to do theshopping and cooking not only gives you abreak, but gives them a chance to besupportive.

Eat small meals with snacks in between. Chewthe food thoroughly and slowly beforeswallowing. Avoid greasy foods, fried foodsand rich sauces that may make this problemworse. Limit the intake of liquids at mealtimesand rather drink it 30 minutes before or after ameal.

Nausea, with or without vomiting, is acommon side effect with various forms ofcancer treatment and of the disease itself. It canprevent you from getting the needed nutrients.Bland foods are easier to tolerate when feelingnauseous. These foods include dry toast, low-fat yoghurt, sorbet, pretzels, boiled skinlesschicken, clear liquids, soups and crushed icechips.

Greasy, fatty, fried, spicy or very sweet foodsmay contribute to your nausea.

Here is a list of ideas that may be helpful to dealwith your nausea:

Let someone else prepare your meals so thatyou don’t smell the food cookingTake a short walk before each meal tostimulate your appetiteEat in a room with good ventilationEat soft fruit such as melon and paw- paw ordrink lemon in sparkling waterIf you feel sick when you wake up, eatsomething dry, such as toast or Provitapreferably before getting upDo not drink during a meal. Wait ½ hour

What to do if too tired to eat

If feeling full after a small meal

Feeling nauseous is one of the most commonside effects

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after meals before having a drinkEat small meals during the dayEat and drink slowly to give your stomachtime to adjustEat cold foods like grated apple slowlySip iced water or suck an ice cubeAvoid lying flat after eatingRest after meals to let your meal settleDistract yourself while eating by listening tomusic or watching TVIf feeling nauseous, avoid your favouritefoods as you may end up developing anaversion to itCertain foods, events or surroundings maytrigger nausea. Keep track of these triggersand change your diet and schedule inaccordance to avoid the reaction

Fresh or powdered ginger is effective in treatingnausea. It can be used before or afterchemotherapy. Make a refreshing drink bygrating a little ginger into water. Place it in thefridge and sip throughout the day. Ginger teaand ginger ale may also be helpful incontrolling nausea. Mint is another goodremedy for nausea and indigestion. Makeyourself some tea by putting mint leaves in hotwater and allow it to cool before putting it inthe fridge. Add lemon to any of these drinks toimprove the taste and sip this throughout theday.

Vomiting may occur with nausea. If vomiting issevere it may lead to dehydration which mayhave serious consequences. Relaxation andbreathing techniques are helpful to prevent orcontrol vomiting.

Once vomiting is under control, sip smallamounts of clear liquids. Start taking ateaspoon full every 10 minutes and graduallyincrease the volume. If the vomiting remainsunder control, you can start sipping dilutedfruit juices and clear soups to build up yourstrength. Eventually add soft bland foods suchas mashed potato to the diet.

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Remedies that may help with nausea

What will stop the vomiting?

30

When unable to taste the food

Constipation may become a problem

Diarrhoea may also be experienced

People undergoing cancer treatment oftencomplain that they experience changes intheir taste and smell. They may have a metallictaste in their mouths and an aversion to specificfoods. If food begins to taste different, try thefollowing to increase palatability:

Eat the foods you like as often as possibleTry different foods that are new andinteresting to tasteEnhance the flavour of foods by using moreand stronger natural seasonings and herbslike lemon, mint, rosemary, oreganum, basiland gingerEat foods at room temperature, rather thanhotTea and coffee can be replaced with dilutedgrape juice, rooibos and herbal teas

Changing your diet may help to alleviate thisand prevent it happening again. Consult yourdoctor before taking any laxatives as it mayinterfere with your treatment. Drink plenty offluids, especially water.

A warm drink, first thing in the morning, mayalso help. A glass of water with a little lemonjuice and honey added is recommended. Yourdiet should include foods that are high in fibre,such as dry beans, lentils, fresh vegetables andfruits. Add Weet-Bix to soups and stews as theadded fibre will assist in the prevention ofconstipation. If able to exercise, take a shortwalk as it will help the digestive tract to remainactive. Prune juice and foods such as dried,stewed fruit, high fibre cereal and paw-pawcontribute to a healthy bowel functioning.

If the diarrhoea lasts for more than two days,contact your doctor. Avoid too much high fibrefoods. Eat small frequent meals and drinkplenty of fluids to alleviate this problem. Eatfoods and liquids high in salt and potassium,such as clear soup, bananas, grated apple,marmite and mashed potato. Sachets ofrehydrate (available from your pharmacy) orLucozade are excellent products to treat

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dehydration. Avoid milk and milk basedproducts and replace with soya milk and tofu.

A recommended remedy for diarrhoea is thefollowing: boil white rice and drink some of thewater that the rice has been cooked in as oftenas possible. Foods to eat are oats, steamed fish,rice, mashed potato, mashed banana andgrated apple.

Don’t be influenced by everybody’s advice.People mean well, but remember you are incontrol. Eat as well as you can as often as youcan. Do not allow your diet to become a sourceof stress to you. Remember; you don’t need tobe too hard on yourself - try to enjoy your foodand adjust your eating pattern to suit yoursituation.

Do not hesitate to contact CANSA on the tollfree number or visit CANSA’swebsite a for assistance andfurther information.

To conclude

We wish you strength and all of the best.

0800 22 66 22t www.cansa.org.za

A word of thanks

Content:

Translation & Editing:

Disclaimer

Magdalene Seguin (Clinical Specialist)Prof Michael Herbst (Head: Health)

Sue Janse van RensburgLorraine KleinhansAntoinette Pienaar

Whilst the Cancer Association of South Africa(CANSA) has taken every precaution incompiling this presentation, neither it, nor anycontributor(s) to this presentation can be heldresponsible for any action (or the lack thereof)taken by any person or organisation whereverthey shall be based, as a result, direct orotherwise, of information contained in, oraccessed through, this presentation.

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There are CANSA Care Centres in communities throughout South Africa. If you wish to find outmore regarding CANSA's care and support programmes, please contact the CANSA Care Centrenearest you.

Alternately, call CANSA toll-free on , email us at or write onOur Wall - be sure to join us on Facebook, Instagram & Twitter and stay in touch with CANSAand others affected by cancer.

0800 22 66 22 info@cansa.org.za

Get in touch with us

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Free State:

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CANSA East London Care Centre: 043 727 0120CANSA Port Elizabeth Care Centre:041 373 5157

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CANSA East Rand Care Centre: 087 940 8097CANSA Houghton Care Centre: 087 940 8075CANSA Pretoria Care Centre: 012 329 3036CANSA Soweto Care Centre: 011 935 1295CANSA Vaal Triangle Care Centre: 016 423 3506CANSA Western Gauteng Care Centre:011 768 4342

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Western Cape:

CANSA Modimolle (Nylstroom) Care Centre:014 717 4741CANSA Polokwane (Pietersburg) Care Centre:015 297 1268

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