Simplify Cancer

When you’re dealing with cancer, the spotlight is on you. But what happens when your loved one has cancer?  For them, it’s just as tough if not more, because not only are they trying to help you and be there for you, they also want to have some sort of normal life, just living from day to day. We don’t get to hear this side of the cancer story.  That’s why today you’re going to meet Jill.  Jill’s partner had prostate cancer and Jill has some profound insights about what this experience was like for her.

She shares some unique strategies that enabled her and her partner to deal with cancer in a very proactive way, by taking back control, by taking the power away from cancer.  That’s what it’s all about, isn’t it?

Here is what we cover in this episode: 

Joe:                 I want to start with something we just touched on a few minutes ago.  We often have conversations and I feel like we should be recording this, and this was one of them.We were talking about gratitude and how expressing gratitude in the right way can really make you feel better and close the loop in some ways.  Can you talk about that in relation to cancer and the experience that you guys went through?

Jill:                   When Sam was diagnosed with prostate cancer, that was six years ago.  It was a huge shock.  I think it woke us up.  It made me realise that throughout life, we take our loved ones, in particular, for granted.  We expect them to be there, we expect them to do things.  Sometimes we forget to say thanks.  It’s not just thanks, it’s showing your appreciation, that you’re grateful for them, one, being in your life, and two, doing the things that they’re doing and showing you how they love and support you in return.  It’s that acknowledgment of their existence, of their experience and your combined experience.  It’s making sure that its always at front of mind now.

                        On a daily basis, I let Sam know how I’m grateful for the things that he does.  It’s not being sarcastic or condescending, it’s coming from the heart and it’s like, thanks, I appreciate what you’ve done.  It’s showing that type of appreciation.  Right throughout life, Sam has always been my rock, he’s been my go-to person.  Early in our marriage, we sat, and we had long conversations, as you do when you’re young.  We talked about what path we wanted to take as a couple and individually.  I always wanted to go on and do study and Sam was interested.  That was fine.  He enabled me to fulfil my dreams.

He always supported me.  We’ve got three kids.  When they were younger, Sam became their primary carer at one stage because he was working shift work.  It’s like, thank you for doing that, I appreciate that.  Sometimes we just forget, and we take it for granted.  Yes, this is going to happen and we all get on because we’re all busy living our lives, doing our things, thinking about work, thinking about home, the garden, the kids, finances, whatever.  Focusing on the individual and being grateful for them being in your life.

Joe:                 Exactly.  That’s so well put, Jill.  I think in many cases, like you say, we forget and start to take things for granted and cancer becomes this big wake-up call.  It’s a different modality because all of a sudden, every day is a gift.

Jill:                   Yes, it is.  You actually value the time that you’re having, rather than sitting thinking, “I wish it was next month because we’re going to do this.”  Or, I wish it was Christmas time, or I wish it was next year.  Yes, it’s fine to look forward to things but still appreciate every day and the gift that you’ve been given.  When Sam was diagnosed with cancer, everything became a blur in an instant.  Time stopped and all of a sudden, it was like there was nothing there.  My whole life flashed before me.  One, I was sitting thinking, I wonder how Sam’s coping with this news.

Then I’m thinking, I’m not going to have my life-long partner.  That seriously is a wake-up call, especially if you’ve found your soul mate and you’ve built such a strong relationship with each other.  To have someone tell you that, “Yes, you’ve got cancer.” While the prognosis is quite good, you’ve still heard that C-word, that stops everything dead in its tracks.  All of a sudden, the plans and dreams that you’ve had for the future have to be re-thought.  That’s why it comes back to being grateful for each day.

We still have plans for the future, we still look forward to holidays, but we also look at each other daily and say, “Thank you.” It just doesn’t mean the words, it’s by actions and affection and building things together.  We’ve built a family, we’ve built a friendship circle.  It’s about being grateful for all of that, as well.

Joe:                 Absolutely.  Jill, this is such an important thing, expressing gratitude and living in the moment.  How do you do that?  Does that come naturally, or did you have to build it into your daily practice?

Jill:                   Well, Sam and I have been married for 40-odd years, and because we’d gotten into such a routine of expecting each other to be there, you nearly go into automatic.  We did have to retrain ourselves to think about bringing it to front of mind.  Doing that whole mindfulness thing.  Being in the moment rather than thinking, while I was sitting next to Sam, “I wonder what the dog’s doing?” It’s fine to have those thoughts but come back and focus on the person that you’re with and the experience that you’re having at that particular time.  It’s those memories that you build as you’re going through are the things that you hold onto that give you hope.

Joe:                 Absolutely.  I even noticed in my own experience, being in the moment and becoming a part of, for example, if I was there with my son, if I was with Michael, when I stopped myself from checking the phone or thinking about other plans and just going crazy with anything, I would have a huge pillow fight.  It gave me such a tremendous lift.  Life, it became such a totally different experience.  Or when I would be with my wife, with Olly, when we would be sitting down having conversation and when we were fully engaged and not thinking about anything else.  It just gives you so much clarity into everyday life.  I think cancer just wakes you up and shakes you out of things and you go, no, this is what matters and it makes you feel so much better, right?

Jill:                   Yes.  When you’re diagnosed with cancer, it’s like some people look at it as a life sentence, whereas, we looked at it as we had opportunities.  We had choices.  We could sit and be sorry for ourselves and spend the rest of our days worrying about what was on the horizon, or we could choose to experience life and be grateful for the things that we’ve got and the experiences that we have.  That’s what we chose.  It’s not easy, it is very draining.  I see it from two different aspects, one from the cancer sufferer.

All of a sudden, you’re faced with your own mortality and that’s hard because we’d all like to think we’d live forever.  It’s like especially if you’re young, you’ve got your life ahead of you.  When Sam was diagnosed with cancer he was in his mid-50s, and it’s like we still had a lot of living to do.  He was faced with that and he turned around and said, “I don’t want to die.” From a carer’s point of view, I didn’t want him to die either.  We both had this mutual agreement that we were going to live for the moment, without be frivolous and silly, rather than saying, in ten years’ time we do this, we do it now.  It’s like, we also learnt that lesson from Sam’s dad.  Sam’s dad was a really hard worker all of this life.  He worked shift work, he sacrificed everything for the family.  We kept saying to him, “Why don’t you take a break?  Go on a holiday.” He said, “When I retire, I’ll do that.” When he retired, he was diagnosed with lung cancer and died within a year.  He never got that opportunity.

That was a wake-up call for us back then, that was 30-odd years ago, that never put anything off, always do things as you’re going through.  Our kids have grown with us and experienced things with us over the years.  We’ve got some amazing memories.  They’re the things that keep you going in the hard times.  When you face the black tunnel sort of thing, where you feel like you don’t know how you’re going to get through it, we draw on the memories and that gives us strength again.  Thinking, we’ve actually done and achieved some amazing things with our kids, with ourselves, with our friends and work colleagues.

Joe:                 That’s very powerful, Jill.  I just want to pick up on what you said about choice.  That sometimes pain in mandatory but really, that suffering is optional.  That we choose the experience and how we deal with tough times.

Jill:                   Exactly.  We sat back and said, okay, it’s not Sam’s fault that he got cancer, but we’re responsible for our emotions and feelings.  We’ve taken responsibility for that, rather than putting the blame on we didn’t eat properly or there are too many chemicals in our environment, or whatever.  We’ve taken responsibility for our emotions.  We’ve got those choices.  It’s about taking that responsibility.  While cancer at times can dictate how you have to live, you can still choose how you do live.  It’s having that support and that friendship around you.

Joe:                 Absolutely, Jill.  In terms of, obviously, from the time of diagnosis to treatment, to the reality of now, there’s a lot of ups and downs that happened.  This everyday reality of how you were dealing with it, mentally, emotionally, has that changed over time?

Jill:                   I still get neurotic.  When Sam was first diagnosed, I mentioned that I saw my whole life go in front of my eyes.  It took us a little while to come to terms with it.  It’s nearly like if we eat this and if we do that, it might go away.  It doesn’t go away.  It’s there.  It’s like, okay, we need to now deal with this.  Sam went through treatment and every three months he had to go in and have tests.  Leading up to that test, I get really scared, Sam gets really worried.  Until you actually get the results from those tests and you go, “We’re okay, we’ve passed this” and you get onto the next one.  Leading up to that again, you still get scared and you still get neurotic and you still worry.  That even happens today.  Sam’s now at 18-month check-ups, which is really good.

I’m always vigilant.  With prostate cancer, it can turn into metastatic cancer in the spine.  If Sam comes and complains of back ache, the first thing my mind does is go to, “Has the cancer spread?” Yes, it is an emotional rollercoaster going through that, but you have to keep going.  I haven’t felt the support from external organisations.  I’ve felt the support from the bond that Sam and I have.  We sit, and we talk about it.  Then, once again, we plan.  Well, if it’s this, we can do that, if it’s not, then, yes, let’s go and do something different.  It’s around that taking control and responsibility for how your life ends up.

Joe:                 I love what you say about taking control because I think that’s such a huge thing.  For me, it was a big moment when I accepted cancer, because when I had my first initial diagnosis and I had my procedure and I thought that maybe this is it, maybe it’s going away, and I pushed this reality away.  When it came back, and I had to go for chemo and all this stuff, it really hit me over the head with it.  I realised that it happened because I was denying the reality of what was happening.  I was hoping that maybe it’s going to go away, but it doesn’t.  It’s about acknowledging that it’s happening and starting to deal with it, having an action plan and executing, right?

Jill:                   Yes, exactly.  Like I said, you’ve got choices.  Initially, when Sam was diagnosed, we went through denial and it was like, “This is happening.  This can’t be happening.” Then we were really angry, well, why has this happened to us?  We’re good people.  It takes you on a whole journey of exploring what your values are as a person.  Denial, anger, and then you think, “Well, if we eat this way, maybe it’ll go away.” It’s that bargaining.  That was really bizarre.  We got quite caught up in having to eat organic foods.

We’ve now gone back to eating normal foods.  It’s like you try and grab hold of anything that you think is going to make this cancer go away, rather than acknowledging that it’s actually there.  It’s not letting it consume your whole life.  It’s like, okay, the cancer is part of me, but it doesn’t define who I am.  My family, my friends, and the things that I do, and my values define who I am.  It’s being authentic to yourself.  I think that takes a while to work through.  I know it did with us.  While Sam was on his three-month checks after his procedure and everything, it took us quite a while to work through it.  We were very fortunate that we’ve got a close family circle and we’ve got really close friends.  Some of our friends dropped off along the way.  They didn’t know how to do it, that cancer word is really scary.  What’s going to happen?

Are they going to disappear out of my life?  Stuff like that.  Some of our friends couldn’t face it and couldn’t talk to Sam.  That was really quite sad for Sam, but then the thing that kept him going and me was our close-knit family and our close circle of friends.

Joe:                 Yes, that’s fantastic.  I want to touch on the friends bit.  You said that it’s because they were afraid, you feel that they didn’t know what to say, or is that what it is?  Is it just the awkwardness of dealing with it?

Jill:                   It’s awkwardness, they didn’t know what to say, they didn’t know what it really meant.  We all hear cancer and immediately we think of death.  None of us like to think of death.  It’s like they were avoiding the issue.  it’s like, I’m not angry at these people, it’s just where they were in that point in their lives.  We need to be able to talk about death, dying, cancer, and not feel bad about it.  It’s like, it’s a fact of life.

Joe:                 If you can’t talk about it, then what are friends for?

Jill:                   Exactly.  It’s finding that strength and it’s having that courageous conversation.  For Sam to sit down with our close circle of friends and especially our kids, and say, “I have been diagnosed with cancer.” That was like putting it in concrete.  It became real at that point.  Whereas, up until then, it was like, there was that denial.  It might go away.  That anger that, why did it happen to me?  Once he actually could sit down and verbalise it and say, it’s like, okay.  The kids would say to us, well, what’s going to happen?  It’s thinking about it, to having a goal, and then that action plan and working through it.  Then you actually start to feel like you’re in control again.

Joe:                 Yes, Jill, I feel that with cancer, and something you just mentioned, when Sam was breaking the news to your kids, what often happens, and I know that this was in my case when I was going through treatment, I think that my mom and my wife were under more pressure than I was.  They were really struggling with it more than I was, because the way I see it, if you have cancer, the spotlight is on you.  If you, for example, are the partner, not only do you have to be the rock who supports your partner through it, you also have to deal with all of this daily life, and you have to try to maintain some sort of resemblance of normality.  How was that experience for you and how did you deal with this all?

Jill:                   It was very draining.  As you mentioned, the cancer sufferer is in the spotlight, and rightly so.  They’re the one who’s going through the treatment, but I felt I didn’t have the support.  Up until Sam was diagnosed with cancer, we used to share responsibilities.  Like, finances, cooking, cleaning, all of that.  When Sam was actually first diagnosed, I took over the finances, I took over all the cleaning, I took over all the cooking, I went to work full-time.  That was a strain on me.  There really wasn’t anywhere that I felt that I could turn.  I had to be the strong one because I had to support Sam.

Even now, I’m forever vigilant for how he is.  It’s like it’s always in the back of my mind, it’s something that you never forget.  It’s like, “How are you?  Are you okay?  Thank you for being there”, sort of thing.  It’s like the carer needs as much support as the person with the cancer, the sufferer.  I didn’t feel that there were many organisations or much information for me going through this.  When Sam was first diagnosed, the way I deal with things is I read about it and I study.  Then I can absorb the information and I can think, okay, well, this is the direction I need to go in.  There was very limited information for me on prostate cancer within Australia.  I found American sites and Googled all of that.

Is it relevant in Australia?  I had no idea.  It’s like, the statistics that they were giving, are they the same type of statistics in Australia?  Possibly not, I didn’t know.  I still don’t know.  You can get caught up too much in, yes, you’ve got a life expectancy of five years, or ten years.  The percentage of people who die within those times.  If you let that dictate, you’ll miss the life experiences as you’re going through.  It’s like, okay, I need to be responsible for myself and how I can be strong.  I do, I breakdown every now and then, but I’ve got, like I mentioned, that family support, and our close friends.  Being able to talk about it with somebody helps share the load.

Joe:                 How do you talk about it?  Sometimes it’s a hard thing to bring up.  How do you talk about it?  What do you do?

Jill:                   When Sam was initially diagnosed, when we sat and told our kids, we were sitting around the dinner table, as we do every week.  We’ve got this relationship with our kids, where everything is open and honest, and we discuss the good, the bad, and the ugly.  We sat, and we said, we’ve got some hard news to tell you.  It was, like, take a deep breath, here we go.  Sam actually told the kids.  It was coming from him and I was there.  Then we all sat and cried.  All gave each other a hug and said, “Okay, what are we going to do about this?” It was getting that support initially.  Having that courageous conversation and then having that support around.  When I’m having a hard time, I sit, and I talk to my kids.  They’re all adult.  I talk to my friends.

I do tell them that when Sam is coming up for his next round of tests, I get really worried.  I do tell them that if Sam has aches and pains in his body, I do think, “Has the cancer spread?” Our friends now do the same thing for him.  If Sam is saying, “I’ve got a really bad back today”, and I say, “Have you had that checked?” What can we do to help?  Do you want us to come around to do the gardening and stuff like that?

Joe:                 That’s the way.

Jill:                   Yes.  It’s sharing the experience.

Joe:                 Another thing you made me think of, and I’m no expert, but I was watching a documentary one day, and I saw this antelope or a zebra, it ran away from the lion, and as soon as it escaped, it started shivering, it literally started shaking.  They said that this is how this animal processed all of this fear and tension that was inside it.  I think that as human, they don’t really do that enough.  What you talked about, it’s okay to break down and cry because you have to let it out, right?

Jill:                   You do.  You need to be in touch with how you’re actually feeling.  You need to be able to express those feelings.  I’m sad, I’m scared, because once you’ve shared it, once you’ve verbalised it, it helps you deal with it.  Or at least that’s what we found in our experience.  Initially when Sam was diagnosed with the cancer, I was really run down because my whole focus was making sure he was living.  I took on the responsibility for everything initially.  I found that I got colds and flu and bronchitis that I had to take a step back and say, “I need to look after me, so I can care for Sam.” Now, he wasn’t an invalid, and he’s not an invalid, but it’s that whole mentally draining experience.

I do.  I look after myself.  I have to make sure that I’m well.  I mediate.  I do, and I get stressed.  I’ve got work pressures, I’ve got family pressures, financial pressures.  All part of life that I’ve got into the habit, where I mediate before I go to sleep each night.  I sit, and I have ten minutes, just for me, to clear my mind.  Sometimes I even go through an action plan in my head, because I can’t help doing that.

Joe:                 I’m not surprised.

Jill:                   Then it helps me relax and once again, I’m responsible and I can be in control of how I act and how I deal with things.  It’s really important, especially for the carer, the sufferer needs to find something that will give them hope, so that they can hold onto that.  The carer needs to find something to give them support and calmness to be able to deal with the things that you’re going through.

Joe:                 That’s very profound, Jill.  Especially the part about putting yourself first and finding a way for you, first and foremost as the carer, to find a way to deal with it, to deal with pressure.  You mentioned meditation.  How did you get into that?  I think mediation and mindfulness are some of those things that we all hear about, but they can be hard to put into daily practice.  How do you go around doing that?

Jill:                   I do a lot of reading.  I’ve done study on all sorts of things.  That when I find something that I think might be of interest, I’ll explore it even further, then I will try it out.  I’m the sort of person that I need to take the theory and then experience it.  It becomes practical for me.  Mindfulness, that was really an interesting topic for me.  I did, I read about it and I’ve tried to do it.  You need to be disciplined in yourself.  It’s like I keep having to remind myself to be present in the moment.  You don’t know when the next moment will be, and cancer is that wake-up call.  I think people generally today are so caught up with living and busy lives that we forget that you need to be in the moment.

You do, you need to be disciplined.  I read a lot, so that helps me explore different things that work for me.  Like, when I say I do mediation, I’m not some strange hippy that goes off and sits naked in amongst trees, but if I’m really stressed, I find being outside gives me solace.  It helps calm me down.  Sam and I, each week, make sure that we go out and experience parks or trees or nature or the beach or something like that.  There’s a calmness, a stillness about it.  It reminds you that things just go on.  That’s part of the mediation, as well.

Joe:                 Yes, absolutely, just making it part of your everyday experience.

Jill:                   Yes, experience.

Joe:                 You touched on having practical things that fell on you.  I think you said that you didn’t really have much help as you would have liked.  Do you think it’s okay to ask for help?  Would you have done that differently if you had the chance?

Jill:                   Looking back, yes, I would do it differently.  We’re all very proud.  No one likes to think that my partner, my husband has got cancer.  Have I failed as a wife because he’s got cancer?  You become introspective and you think, “What can I do?  I need to do something to make this right.” Whereas, looking back, I should have reached out more.  I’m sure there are resources out there, I still haven’t found them.  I’m sure they’re there somewhere, but it was me that didn’t reach out.

I could have gone back to our oncologist, and I did a couple of times, and what I got was, “Don’t worry about it.” That is superficial.  I needed more information so that I could understand, so that I didn’t have to worry about it.  It’s overcoming your personal inhibitions to be able to say, “I need help.” From a carer’s point of view, you’re so focused on the sufferer that you don’t want to have to see that you’re needy, so you don’t necessarily say, “I need help.”

Joe:                 That’s so true.  I remember that we had friends saying to both my wife and myself saying, “Just let me know how I can help.” I remember that was such an infuriating experience because you kind of go, “Well, I wish you would be a little bit more specific and offered something helpful and practical.” I’m not going to just come up with a favour to ask you.  At the same time, I guess people want to help but they really don’t know how.  They really need to be guided sometimes, right?

Jill:                   They do.  You need to find the inner strength to be able to say, “I need somebody to help me do the gardening.  Or I need somebody to take the dog for a walk.  Or I need somebody to help me with the cooking” or stuff like that.  It’s finding that inner strength.  As I mentioned, your pride gets in the way, because we all like to think that we’re able to do things and you struggle to say, “I need help.”

Joe:                 I really want to thank you for your time.  It’s been absolutely fantastic.

Jill:                   Okay.  Thank you, Joe.

Joe:                 Thank you.

Jill:                   Good luck on your journey.

Joe:                 Thanks.

I’m really excited today because I get to talk to my new friend, Frances Goodhart who wrote this great book called “The cancer Survivor’s Companion: Practical ways to cope with feelings after cancer”.  Frances is a clinical psychologist and it’s a real privilege to hear from her because she genuinely cares about people like you and me who go through these tough times.  Today, Frances shares some fantastic insights and practical tools to tackle cancer that you can start applying right away:

About Dr Frances Goodhart

The Cancer Survivor’s Companion: Practical ways to cope with your feelings after cancer

Joe:                 Frances, first of all, what made you write a book on cancer?

Frances:           I was working in a cancer psychological support service.  I was seeing a large number of people post-cancer treatment.  They were coming in for appointments.  They came in just incredibly apologetic.  It’s as if they felt embarrassed, guilty even about using up psychological resources for particularly at the end of treatment.  I would spend a lot of certainly the first session, and often many sessions, trying to reassure people that it was very natural, very appropriate for them to be coming to a psychological support service.

What I wanted to do was to be able to add to my own voice by directing people to information that would illustrate that, that would reassure them that post-cancer treatment was valuable and important to address psychological issues.  I couldn’t find a book anywhere because I was particularly looking for a book because I feel that seeing things printed out on paper that have been published just adds a weight to that information.  I couldn’t find a book anywhere, so in the end I thought, it’s not there, there’s a gap in the market and I better fill it.  That’s how I came about the idea of writing.

Joe:                 That’s fantastic.  I think I found the same.  I found that there’s really not that much out there at all, in terms of real practical advice.  One thing I want to come back to, Frances, one thing you said that really surprised me is that you said that the people you actually spoke to, that the people felt guilty about coming to you and asking for help.  What’s with that?

Frances:           Well, it may be something about being British.  I think as a nation there’s somehow an element of stiff upper lip.  I think there’s still an element of just keep pushing on through.  I think it’s changing hugely now, but this was ten/fifteen years ago, and I think there was still a stigma actually about seeking psychological input, seeking emotional support.  I think that people were bringing that, in a sense, in the consulting room with me.

Joe:                 Yes, absolutely.  I think there is definitely that.  I think people feel guilty in a way.  I think I certainly did at one point because you feel that you’re supposed to deal with it on your own.  If you don’t, it’s somehow like a weakness.  Does that make sense?

Frances:           It makes total sense.  Again, I think this is changing now, but ten years ago, I don’t think all of the medical teams were perhaps as aware of the psychological impact of the cancer diagnosis and treatment and weren’t exploring with their patients how they were coping emotionally.  I think if you’re going to a cancer service and you’re being told you need chemo, you need radiotherapy, surgery, whatever it might be, I think the teams were addressing psychological issues, weren’t signposting people onto psychological support services.

I think that was a real problem because if your medical team are talking to you from the start about both the physical and the psychological consequences of diagnosis and treatment, then it’s just a natural part of the process.  If you are having to bring up the fact that you’re struggling or anxious or finding the whole process difficult emotionally as well as physically, that’s a tough ask, really, I think.  I’m really pleased that within the NHS in Britain, we’re now routinely screening for and thinking much more holistically about cancer support.

Joe:                 That’s fantastic, Frances.  One thing I want to touch on is, you mentioned that when it comes to writing the book, you felt that there was definitely a gap, in terms of the approach to the book and how you were thinking about it, did you find certain patterns that came up when you were talking to people?  Certain themes that would come up over and over again, that maybe made you think, “I need to write this down”?

Frances:           Absolutely.  In a sense, I think the chapters in the book that I cover, in a sense, illustrate most of those areas.  The overarching issue, I think, for people was anxiety, was fear of recurrence.  There was a lot beyond that, as well.  I think that cancer diagnosis and treatment and then coming through the other side, it just inevitably makes the people who were coming to see me, I recognized that was a self-selecting group, and other people may be able to just put treatment behind them.  The people that I was seeing were acknowledging impact on mood.

I think particularly at the end of treatment, there are huge expectations that you’re going to feel elated, excited that you’re going to get back to normal very quickly.  Actually, in my experience, that’s not what happens to people.  Then I think, again, that array of distress, guilt, shame, low mood, sometimes a clinical level of depression, impact on relationships, sex life, of course.  That was something that, again, being British, we’re not always comfortable in talking about.  Actually, it’s really key to look at and to acknowledge and to talk about.  I think that people’s self-image is often really profoundly altered by a cancer diagnosis and treatment.

Then the interface between psychological and physical, I think people were often bringing issues around sleep, around fatigue, around some of the consequences of chemo brain and memory issues.  I suppose those were probably the key themes that struck me.

Joe:                 That makes so much sense, Frances.  One of the things I really love about your book is that it’s so practical, it’s so heads on, it’s got so many things that you can apply today in real life.  Cancer is such a difficult place to be, right?  You’re constantly in between tests and treatment and visiting specialists.  How do you deal with worries, with stress, with anxiety?

Frances:           Thank you, Joe.  Thank you for your comment about my book, but also for picking up the fact that it’s a practical book, because that was so important to me, to create this companion in a sense, that people can carry with them, can dip in and out of, and pick out practical techniques.  In terms of managing worry and anxiety and fears, I think the first thing I would say is you don’t go through cancer or beyond cancer without those emotions.  I just don’t believe anyone is super-human enough to face all of that without some level of anxiety.  I think that sometimes we put pressures on ourselves and we have expectations of ourselves that are super-human, that are beyond what any of us can manage.

Partly, I think in terms of managing anxiety, one of the things is not to build it up into something greater than it is.  You just recognise, okay, today is a worry day, or actually I’m coming up to a check-up moment, my mind is going to be racing, I am going to be anxious.  Not building on that anxiety by feeling that somehow, you’re not coping, you’re not managing.  That’s the first thing.  I think just being able to acknowledge and at some level accept, okay, this is an anxious day for me today, that’s okay.  It’s not going to have any impact on me long-term.  That’s the starting point.  I think that there are also very practical things that one can do to stop those thoughts from dominating.

I don’t think you can stop them from coming into your mind.  I hope that’s one of the themes that comes from my book, this isn’t about making you go through life without emotion, it’s just how do we manage it?  With worries, write them down.  If you put them onto paper, they’re out of your head.  I think our brain is this extraordinary organ that works once we’re anxious.  It seems to want to keep us anxious.  We will mull over, ruminate, repeat anxious thoughts.  Actually, if you can just write them down, that’s a starting point, that can help.  I think the other thing to do, another thing, is to try, I recognise it’s not easy, but try to give yourself a part of the day where you say, “Okay, now it’s my worry time.” You actually allow yourself to look at those thoughts, to let them come into your head, to explore them, to examine them.  You do that for a time limited period of time.

I think sometimes this idea of just don’t think like that, push those thoughts away.  Sometimes when we’re strong, we can do that, but other times we can’t.  I think just saying, “Okay, I’m going to have ten minutes of worry time now and then I’m going to cook the kids supper or watch a TV program or call a friend”, so that it’s time limited.  I think that there are relaxation strategies that one can use.  Again, not to make the thoughts go away but just to help them feel like they’re more controlled.  Then I think the other thing is that worries, and anxieties sometimes need to be explored and verbalised, but also looked into.

If you find a useful source of information, use that, look at that, but be very careful about Dr.  Google.  Sources of information that we don’t know how reputable they are, they can increase anxiety.  Actually, if you want to look at some of your concerns and you have a website or a book that you’ve been recommend or that you just feel instinctively has been helpful, use that.

Joe:                 That’s fantastic, Frances.  I love it and I especially love the tool about worry time.  I haven’t obviously used it just yet, but it intuitively feels just right.

Frances:           Thank you.   I think what intuitively feels uncomfortable to me is this idea that one simply pushes worries, distress away.  I think that can work for a while but actually, long-term, I have a concern that it actually over time allows the distress to build up.  I think that idea of just accepting, yes, I have some worries, let me look at them, but not look at it so that it’s disrupting your whole day.

Joe:                 Absolutely.  You mentioned that it is incredible stressful.  That makes me start to think about the fact that many people don’t get the emotional support that they need from their friends, from their family, from their co-workers, is that something you come across?  If so, what should you do if you feel overwhelmed and when you feel alone?

Frances:           Thank you.  Yes, of course, I come across people who feel incredibly alone.  I remember a very powerful session I had with a man who talked to me, he said, I went into this room full of family and friends, I think it was a party setup to celebrate his successful end of cancer treatment.  He said, “I was surrounded by my closest family and friends and I’ve never felt more alone.” That has stuck with me.  I also think that emotional support is an incredibly difficult thing for family and friends to provide.  I think that a lot of the time, people going through cancer and people after cancer treatment don’t always know for themselves what would be helpful.  One hour talking would be helpful.

The last thing someone wants to do is to talk.  I do want to acknowledge that I think it’s a minefield.  Support from family and friends is really difficult to provide at times.  Of course, there are amazing intuitive, supportive family and friends who get it right, but I think a lot of the time, people get it wrong.  I don’t think they mean to, I’m quite sure they don’t.  I think people long to help and support, but they don’t always know how to best do that.  That’s where I really think finding a listening ear, finding whether it’s a psychologist, a counsellor, an online cancer support chat room.

I just think that sometimes what people need is the chance to talk, to think, to reflect with someone who isn’t emotionally involved themselves.  I would encourage people to think about that, not to see seeking outside help as weakness.  Very far from it.  I see it as a very positive, proud step that’s part of the armoury of tackling cancer.  It doesn’t replace support from family and friends, it’s just a different way of seeking emotional backup, I guess.

Joe:                 Absolutely, Frances.  I couldn’t agree more.  I also have a deep belief that if you’re going through cancer or after cancer, or wherever you may be, that you should use every available tool at your disposal to help you get through it.

Frances:           I couldn’t agree with you more.  I’m quite sure that there are a whole raft of approaches and tools that I don’t know of.  I would say to people, follow your instincts.  If you think something would be helpful, try.  There’s no harm in trying things out.

Joe:                 Absolutely, because you’re going through an incredibly rough time and you’re experiencing a whole range of emotions.  At times, you feel angry.  Speaking of angry, Frances, is it okay to be angry when you have cancer?  How does it work?

Frances:           Not only is it okay, I think it’s completely natural.  At times, really helpful to acknowledge anger.  I think cancer is a threat.  Cancer is just the most enormous threat that most of us ever face and our natural instinctive response to threat is the fight/flight mechanism.  The fight bit is a very strong part of that.  I don’t think most people can go through cancer without experiencing and at times, expressing anger.  What I think is important is firstly that the anger doesn’t impact on your treatment.

Secondly, that the anger doesn’t irreparably damage the relationships and the support around you.  Obviously, you need to be able to manage and control the anger, so that it’s not hurting either yourself of other people.  Actually, I would say beyond that, express it.  Find a place either with somebody that wants to come with you or on your own, shout, scream, let the anger out, punch a pillow, go for a run if you can.  Just never hurt anybody else or yourself but let it out and express it.

Also, don’t forget, that you can also say sorry to someone.  If you’ve shouted at them or you’ve responded in an angry way that isn’t your usual style, just acknowledge that and acknowledge that this isn’t how things are always going to be, it’s just that you’re under threat and you’re angry.

Joe:                 Absolutely.  That makes so much sense, Frances.  All the normal rules apply.  If you screwed up, it’s a good idea to say sorry.

Frances:           I think sorry often seems to be quite a hard word for many of us, but it’s a good one.

Joe:                 I wouldn’t really know because I’ve never been wrong in my life.

Frances:           Of course, Joe, of course.  Should we discuss that with your friends and family?

Joe:                 Yes, I’ll definitely call my wife over to talk about that.  Frances, speaking of that, from personal experience, I know that many relationships are tested during cancer.  We spoke about this earlier, about friends, about all this stuff.  What advice do you have in this area to avoid common pitfalls and misunderstandings and so on?

Frances:           Thank you for asking that.  I completely agree with you.  I think the impact on relationships is one of the most profound impacts of going through cancer and treatment.  Again, I think saying sorry when one needs to, both sides, it is worth considering.  Actually, at a more practical level.  I think the advice I would give is to really try to listen to each other.  That’s an easy thing to say, how do you actually do that?  In the book, I talk about trying to bring, in your own personal relationships, to bring some of the structure of therapy sessions into that.  In a therapy session with a couple, I start by getting each member of that couple to talk about why they’re there and to talk about their concerns and their issues.  I don’t let the other person interrupt.  You’d be surprised, actually, how hard that is.  Actually, maybe you wouldn’t be surprised.

Joe:                 I’ll take it as a compliment.

Frances:           I think that thing of that actually in a relationship and friendship, often conversation is a rapid two-way process.  Actually, just when you’re dealing with such deep and profound emotions around cancer, try not to interrupt.  Listen to each other, let that person, that first person talks until they’re talked out.  Then the second person gets the chance to reply.  I think the other thing about therapy is that it’s time-limited.  I think a lot of times people are anxious about really talking or listening to each other, because they think, “We’re going to open this can of worms and we’re never going to be able to stop.”

I think saying to each other and setting an alarm, saying, “We’ve got an hour, or half an hour” – I wouldn’t do more than an hour, really.  It might be 20 minutes, that you just – and then you set the alarm, then when it goes off, you draw it to a close and you stop.  I think having a way to bring these deeply, at times, distressing conversations to a close actually can help you start them.  The other thing is, try, if you can, not to have these conversations in the bedroom, in your kitchen, in your sitting room.  If you can, be somewhere outside of your home.  I think, again, in therapy you’re outside of your home, and I think that means that the home doesn’t get contaminated with all of those articulated expressed feelings.

Joe:                 I love this advice, Frances.  Really, it’s another theme that I’ve just picked up on, this idea of time-boxing.  I think that’s really fantastic, like putting this time box around your worries, putting a time box around talking things through.  I think that these are fantastic tools.  Frances, what about fatigue?  It’s something that affects pretty much everyone going through treatment, how can you manage your energy better?

Frances:           Again, I think at times I may sound a bit repetitive, but I think one of the things is look at the expectations of yourself and try to be kinder or simply more realistic to yourself.  Going through cancer treatment and coming through cancer treatment, your body has been through the most gruelling experience and you are simply not going to have the same energy levels.  Really try to prioritise things, work out what is the most important thing for you to be using your limited energy on and then let some of the other things go.  It doesn’t mean they’ve gone forever.

It might be, you might decide, I never want to do the hoovering again.  More seriously, I think it’s about just prioritizing what you need to focus on.  I think the other thing is just building in planned, structured breaks or rests in your day, so that you’re not only resting when you’re exhausted.  You’re actually trying to give yourself some downtime before you’ve become worn out.  I think that’s something I would really recommend to people, try to rest before exhaustion has kicked in.  I recognise that for some people, even the term “rest” is an unforgettable one.  Change the language.  Talk to yourself.  Don’t say, “I’m going to have a rest”, say, “I’ve got some downtime, or I’m going to have some restoration time, or I’m going to take a break.” It doesn’t have to be rest, but it needs to be conserving your energy.

Don’t look at is as self-indulgent or weak.  I sometimes prescribed it.  For my clients, and sometimes they needed me to do that, but I think it’s really important to – as part of your wellbeing – to look at your energy levels and conserve them, but, and this is a big but, I also think that counter-intuitively you also need to look at your exercise levels.  You need to look at your fitness levels.  I know for many people it’s very counter-intuitive, but our bodies decondition so quickly.  I think just having some advice from your medical team about how to exercise.  What’s safe?  What’s appropriate?  What’s comfortable?  How to build up your exercise and build exercise into your daily routine?  Actually, does start over time, in fact, rather than to tire you out, it helps to build up your energy reserves again.

Joe:                 That’s fantastic advice, Frances.  I remember that when I was going through treatment, my oncologist recommended that I do walks every day.  I started doing it every night.  It was pretty tough sometimes, but it actually helped me to clear my head and I was actually incredibly grateful because it made me feel so much better and it became something that I’m doing to this day now, more than a year from treatment.

Frances:           Yes, I’m so glad to hear that.  I can’t believe I’m saying this, I’m an old-fashioned type person, I grew up thinking if you feel ill, if you feel tired, rest, stop.  Actually, I hated sports at school and in university.  I didn’t have a physical routine in my life and actually in the last decade, I think because of being a psychologist and because the information was so profoundly changed, that everyone said exercise is vital for you both physically and psychologically.  I thought, I better check this out.  I now go for walks or occasionally a little job, but it’s a daily part of my routine now.  That’s without having gone through a cancer diagnosis and treatment myself.  I tell my children, I tell my friends, I think it’s the most important psychological tool that we have.

Joe:                 Good on you, Frances, and good on you for following on your own advice.

Frances:           I don’t always do that.  I try.

Joe:                 I love what you said about managing your energy with respect to resting even when you’re not exhausted.  I know that when I was going through treatment, my first round of chemotherapy was again counter-intuitively a lot tougher for me because I was pushing myself through exhaustion, through feeling tired and for my second and third rounds, I understood there were peaks, there were ups and downs, and I would actually take rest before that.  It allowed me to take it in a much better way.  Even in terms of seeing people, I would have friends or family come to the hospital and I knew for a fact that in the evening I would be completely smashed.  I said, if you want to come in, come in the morning.  That really helped.

Frances:           Exactly.  I love the fact, Joe, that you had worked that out, that you were also able having worked that out to express that.  Again, that’s not easy, you’ve got family, friends, people wanting to come see you.  Actually, you knew that you had to prioritise your own wellbeing, you had to prioritise and safeguard your energy levels and you were able to articulate that to them, and they were able to hear that and respect that, too.  It’s a complex process.

Joe:                 It is, absolutely.  Another thing, of course, Frances, when people say to you, relax, take it easy, sometimes it’s actually not that easy to do.  How do you actually do it?  Can you give us some specific things to help you relax?

Frances:           Thank you so much for asking that, Joe.  I happen to have to go for a few blood tests myself recently.  I may at some point actually talk to the nurses who were taking the bloods about that, because they all say, “Just relax”, but they don’t tell you what to do.  I happen to have some strategies up my sleeve, so I know how to relax.  I just keep thinking, if only the nurses, the phlebotomist, the doctors, whoever is doing the blood test or whatever intervention it is, could actually say to someone, “What I’d like you to do is make your out breath longer than your in breath.” That is a way of physically introducing relaxation.

What you do, I tend to encourage people to count their breath in.  I say, “Take a breath in for four, hold it for two, and then breathe out for seven.” The out breath taking longer than the in breath, I don’t fully understand the physiology, and I probably ought to, but it induces relaxation.  I think that’s the first and, to me, the most practical relaxation skill.  Your out breath longer than your in breath.  Find your own root, find your own way of counting.  Some people like to think about it visually.  They like to imagine breathing out through a straw or trying to keep a feather up in the air.

Anything that makes your out breath longer than your in breath.  That’s the first thing.  Secondly, there’s abdominal breathing, that’s where you put one hand on your chest, one hand on your tummy and you take a breath in.  A deep breath in.  You make your tummy, the hand on your tummy move out further than the hand on your chest.  Again, that introduces a deep level of abdominal breathing that induces relaxation.  Then the third thing, again, a practical strategy is something that I call muscle tense release.  Again, don’t get caught up in, “Have I clenched my fists and raised my shoulders?”

It doesn’t matter how you do it, just tense your muscles, clench them up, talk yourself through it.  “Okay, my muscles are tight and tense, I’m holding them, I feel it, they’re hard”, then you very slowly and gradually release that muscle tension.  You let your fists gradually open.  You let your shoulders drop down.  You reveal the release.  You actually talk yourself through.  You say, “I can feel relaxation flowing through the muscle groups that I’ve tensed.  There are a lot of apps on the phone that you can use.  You can find scripts to help you with muscle tense release relaxation.  Again, as I say, don’t get caught up in how to do it, just find a way to tense some muscles and then release them.  Then focus your attention on the relaxation flowing through.

Joe:                 That’s fantastic advice.  One of the things that helped me, Frances, especially, for example, when I was getting something in my hand, was to visualize something positive.  For me, it was an image of me playing with my son, for example.  That took my mind off whatever was happening.  It helped me relax.  What’s your take on that?

Frances:           I think that’s great, and thank you, because the relaxation strategies that I was talking about are quite physical relaxation strategies.  Actually, thank you, because it’s really important to recognise that you can also relax your mind using visual imagery.  I really do try to imagine myself on a beach and I can tell you, in Britain in February, it’s quite a challenge of the imagination, but what it does, and what I think what I would say, and I don’t know whether you did this with your visualisation, Joe, but to actually with visualisation, try to build in some of the other senses, as well, so that you’re actually thinking about, okay, so I can feel myself kicking the ball to my son.

Imagine the laughter that you’re hearing from him.  Think about what you can feel.  For me, with my imagery of the beach, I’m actually almost trying to feel the warmth of the sun on my skin, I can hear the lapping of the waves on the beach.  I can feel the sand between my toes.  I can smell the sea air.  Use your imagination and build in all of those senses.  Then you can really take yourself out of the horrible medical setting that you’re in, to a place that’s a better place for you.

Joe:                 That’s fantastic, Frances.  I love your advice.  That’s a whole different level of sophistication to that visual imagery.  That’s great.  Frances, another thing I want to talk about is sleep because that’s a problem.  Sleeping, is it before, during, or after treatment?  Why does it happen and what are some of the steps that you can follow to have better sleep?

Frances:           I think the diagnosis and then the treatment of cancer and, as I say, post-cancer treatment, sleep is incredibly disrupted for all sorts of reasons.  Obviously, I’m a psychologist, so mind racing is going to be the top of my list.  Your mind is going to be racing with all sorts of thoughts.  I think that the treatment that you go through has a gruelling affect on your body, that impacts on your body’s natural rhythms and sleep is such a habit.  Changes to the routine, cancer may disrupt your usual routines in a really profound way.  It’s not at all surprising that sleep is disrupted.  I think the other thing about sleep is that it’s at night time that I think the loneliness and the isolation, and the fears kick in again back to mind racing.  How do you manage that?  Well, in the research I did for my book, I was really interested to discover that even without a cancer diagnosis or treatment, people worry a huge amount about sleep.

They think that we overestimate how much sleep we actually need to function.  The first thing I would say is, actually, if you’re having a bac night of sleep.  Again, try not to catastrophise the: My next day is going to be ruined, I’m not going to be able to manage the next round of chemo, whatever it might be that’s going through your head.  Just reassuring yourself that you can rest, letting your body just loosen and unwind and lie down.  That in itself has a deeper effect physiologically than we realize.  That’s the first thing.  I think the second thing I would say is, is really look at your sleep habits.  Try not to let cancer diagnosis and treatment disrupt those sleep patterns too profoundly.  Try to go to bed and get up at roughly the same time each day.

If you have a disrupted night, it’s very natural to think, “I’m going to try and catch up during the day and I’ll have some naps and rests and sleep in the day.” Actually, if you can, rest but don’t sleep during the day, because then you won’t perhaps sleep or get off to sleep as well when you’re then trying to do so at night.  Look carefully at your bedtime, the time you get up, and this idea of compensating for lost sleep.  I think that can get one into unhelpful habits.  I think another thing I would say is, we can get into the habit of almost associating bed with lying awake and worrying.  If you’re aware that that’s something that you do, that you almost start to worry the minute your head hits the pillow, actually try to break that association.

Look at finding a way to maybe just have a chair in your room, near your bed, so you that instead of lying in bed, you just get up and you’re warm and comfy, in a nice arm chair, then when you think you’re about to fall back to sleep, then get back into bed.  Try to have bed the place where you sleep and not the place where you lie awake worrying.  Then, at a practical level, have a notebook and bed by the bed.  I know I often have my thoughts about, “I need to order that, or get that for my daughter, or sort something out.” Actually, just being able to write it down helps to allow me to put my mind at rest.  I think those would be the things I would suggest.

Joe:                 Yes, that’s great advice, Frances.  I definitely feel like I have to write something down or I’ll forget, and the world is going to end.

Frances:           Exactly.  The middle of the night is such a tough moment for that – exactly.

Joe:                 One thing you touched on, Frances, is cancer disrupts so many things in our lives, during treating and after treatment, as well.  That includes sex.  What would you say to someone?  How do you go about making that better?  How do you go about improving it?  You’ve got a lot to deal with but at the same time, you want this to be just a normal healthy part of your life?

Frances:           Absolutely.  I think it comes back to actually talking as a couple together.  Acknowledging fears.  I worked with a woman who was really so distressed by the fact that she and her husband had stopped having sex and she felt all the insecurities associated with that.  Actually, what happened was that eventually she did agree to invite her husband to come in and meet with us jointly.  Actually, what it turned out was that he was deeply loving towards her, still very attracted to her.  She had thought that he no longer felt any physical attraction to her.  That wasn’t the case at all.  He was absolutely terrified of hurting her.  She’d had a mastectomy and he was really anxious about touching her.

He also had found some really wrong site that said that after chemo, a woman’s risk of having a heart attack during sex could be increased.  There was no basis to this.  I don’t even know whether that was actually what he had properly read.  That’s what he had taken from this.  He was just really frightened about initiating physical contact at all, let alone sex with his wife.  We talked that through.  Then what we did, they hadn’t had sex for months, if not for a bit more than a year.  What we talked about what just not to go straight back into sexual intercourse, but to find a way just to resume intimacy together.

I’m really conscious that people going through treatment, and some of the treatments, there’s no getting around, that some of the treatments do have an impact on sexual function.  As a couple, I think it’s about finding ways to talk about it and finding ways to maintain a loving, physical intimacy with each other without or despite the impact of the cancer.

Joe:                 That makes so much sense, Frances, because ultimately, yes, like you say, intimacy is so much more than sex, and this is what we all think, this is what we’re all looking for to be understood, to be loved, to be cared for, and for our partner to show that in the right way.

Frances:           Exactly.  I do think it is so hard for the partners who may have been with you through those most intimate but awful moments of treatment and side-effects.  It can, for some couples, change how they feel about each other’s bodies.  I think the point is, exactly as you’re saying, to look at the breadth of love and how one can express love and intimacy, and not to get caught up with it.  It has to be intercourse straight away.

Joe:                 That’s right, not to get caught up in the mechanics or that it has to be a certain way.

Frances:           Exactly.

Joe:                 Fantastic, Frances.  I’m sure there are things that get overlooked by people when they’re going through cancer or after cancer.  What would you say are one of the biggest things that tend to get overlooked?

Frances:           I think the biggest thing is actually being kind to yourself and really looking at the expectations that you have of yourself.  I think people expect themselves to be strong, skilled, competent, confident, not all the time, but a lot of the time through this whole process.  I think that there’s something about just recognising the inevitability of psychological ups and downs, in the same way that you will have physical highs and lows.  I think if I could train oncologists and oncology nurses, I just think, just talk to people about the fact that they are going to find this hard.  That they will go through it.  Those deep moments of doubt, anxiety, anger, fear, depression, and just acknowledging that, you don’t get caught up in it so much.  Nor do you start to add in self-punishment, guilt, all of those extra emotions on top of that.

Joe:                 Absolutely.  That’s fantastic advice, Frances.  What would you say to someone, what is the best advice you can give to someone after cancer?

Frances:           After cancer, I want to celebrate with someone, I want to join in with that excitement, that achievement involved with all of that.  I think that the thing that I would add to that wonderful news is that it’s the start of a new chapter rather than the end of the story.  I know that sounds a bit trite and not very practical.  I think it is really important.  From my experience, what a lot of people do is they actually, the treatment is so gruelling, and they just have to keep putting one foot forward.  They find a way to get through the treatment.  I think, for many people, it’s only after treatment and the successful complement of treatment, that they actually begin to process emotionally what they’ve been through.  I think not everybody does this, but I think the majority of people do.  I would just like that to be just acknowledged and highlighted for people at the end of treatment.  Celebrate but also be aware that there may be more complex emotions than you expected.

Joe:                 Yes, that’s fantastic advice, Frances.  I know that with cancer, things will never be the same, but at the same time, like you just said, life after cancer is a new beginning and a chance to do things in a different way.  That, in many cases, is doing things in a better way and starting things that you may have missed out on.  Now, every day is really a present that you receive and it’s up to you with what you do with it, isn’t it?

Frances:           Absolutely.  I think you described that perfectly, Joe.  The only little thing I would add in is that there will be days when you wake up and you don’t think it’s a present.  It’s a bad day.  You’re in a bad mood.  That’s okay, too.  I completely agree with you.  It’s about what you make of this new chapter in your story.

Joe:                 Exactly.  If we are to take this present analogy even further, I would add to that that maybe those bad days is one of those times when you got a present you didn’t want, so maybe you can put that to the side.

Frances:           Exactly.  Yes.

Joe:                 We probably exhausted this analogy about the present.  Frances, I loved your book, I think it’s fantastic.  If someone wanted to check it out and check out your other books, what is the best way to go about it?

Frances:           Thank you so much.  I really appreciate your kind words about the book.  Also, the chance to tell other people about it.  In Britain, I believe that the publisher, we sent a copy of the book to all of the public libraries in Britain.  Whether they’re still there, I don’t know.  Obviously, Amazon is probably the easiest place to get hold of the book.  What I would also say is, if people feel comfortable in talking about it with their medical team, if you can check whether the medical team have their own little library of resources for their patient group.  That would be a wonderful way of seeing if you mentioned it to them, if they have the funds to buy a couple of copies.  Then lend it out to people.

That would be a great way of getting the book.  I think it is known about, but it’s a little bit haphazard.  Anything that tells people, look, there is this particular resource, I’m very appreciative of.  As I said, it’s on Amazon, it’s in paperback.  It’s not hugely expensive.  I think it’s about £8.00 in the UK.  I’m afraid I don’t know what it costs in the other countries.

Joe:                 That’s nothing, Frances.  I liked what we talked about, you should use every tool that you can find.  This happens to be a fantastic tool.  Thank you so much for your time, Frances.  That’s been incredibly insightful.  Thank you for your practical advice and for the fact that you clearly still care about this area and you care about the outcomes for people.

Frances:           Joe, I can’t thank you enough.  It’s been just a delight.  I was a little bit nervous at the start.  I just reminded myself, thank you.  I do feel very passionately about it.  I love the chance to talk, so thank you for that.

Joe:                 Thank you, Frances.  I appreciate it.

When it comes to cancer, we are so focused on the specialist who’s treating you, and rightly so because your oncologist or surgeon or your urologist is absolutely crucial in getting you through it. But what about the general practitioner, the family doctors, what role do they play and how can they help you in your fight against cancer?  Right now, you’re going to hear from Jon Emery, the professor of primary care cancer research at the University of Melbourne.  Jon will reveal why the GP is your best ally in your war on cancer and is going to set the record straight on cancer and how it relates to primary care, including:

Jon Emery Academic Profile

Australian Cancer Survivorship Centre

Better Health Channel

Cancer Council Victoria

Episode 009: Why The Oncologist Is Your Guide Through Cancer

Joe:                 Jon, first I really want to ask you, the family doctor, the general practitioner, this is really the first line of defence against cancer.  It’s up to him or her to understand what’s going on, to send you for tests, to forward you to the right specialists.  How can primary care physicians pick up cancer early?

Jon:                 There are two ways, really, to think about earlier detection of cancer.  One is through screening tests.  These are tests that are offered to people without symptoms and then they are obviously trying to detect people when they present with symptoms that may be due to cancer and investigating those symptoms.  Maybe if we just start by thinking about screening tests.  There are three national screening programs.  They are the programs that the government funds because they’re very strongly based on evidence and they’re the screening programs for cervical, breast, and bowel cancer.

The GP has an important role in ensuring people are up to date with their screening tests.  Particularly promoting some of the tests which are not being very well-used at the moment.  The bowel cancer screen test is probably the most relevant in that context.  At the moment, it’s sent in the post once you hit 50 and only 39 percent of people actually bother to do it.

Joe:                 Wow, that’s pretty crazy.

Jon:                 Yes.  GPs can play an important role in reminding patients that the test will be coming soon and encouraging them to do it.  It’s a very effective test and ensuring that your patients are up to date with those screening tests are an important strategy in early detection.  The bowel screening test is the one that’s least well-used, it’s probably got the strongest evidence for it in terms of detecting cancers early and preventing early deaths from those cancers.  If you think about symptoms, this is where it’s more challenging.  The majority of cancers, even for those where we have a screening test, they present with symptoms.

Most of the patients, when they develop the symptoms, they go to see their GP.  It’s challenging because the symptoms of most common cancers are also symptoms of much more benign, non-cancerous conditions.  That’s where it becomes very difficult.  In medicine, we talk about something called, “Red flag symptoms”.  These are the symptoms that you really need to think about cancer is a possible cause of them.  Things like obviously a breast lump, rectal bleeding, coughing up blood, blood in your urine, losing weight is particularly in the context of other symptoms.

Those are symptoms that should make you think about a possible cancer diagnosis and investigate.  In general practice, those symptoms are actually quite common, most of the time, they’re not going to be due to cancer, so if you cough up blood, then you have a less than five percent chance of that actually being due to lung cancer.  It’s much more likely to be an infection, but it’s a really important symptom to recognise.  That’s true for some cancers, but some cancers present with these red flag symptoms.  Other cancers present with much more subtle symptoms.

If you think about pancreatic cancer, that presents often with a bit of indigestion, bit of back pain, a bit of tummy pain, but quite intermittent, so a loss of appetite.  As single symptoms, as a GP, you’re not immediately going to think about pancreatic cancer as a cause.  Most of the time, it’s going to be due to something completely different.  That’s why it’s the challenges of balancing out when to investigate somebody against waiting too long.  Obviously, perceive delays in diagnosis.  It’s difficult.  Some of it’s about ensuring that you have strategies that patients know to come back if their symptoms get worse or they develop new symptoms, that’s something called, “Safety netting.” Some of it’s around using some simple blood tests to begin with.  As it might, again, give you some clues that this is potentially a more serious cause for those symptoms.  Sometimes it’s about giving some initial treatment, again, ensuring that patients know to come back if their symptoms persist.  At that point, that might prompt you to think again and raise the likelihood that it might be actually this is an underlying cancer and therefore, you would go and investigate.

We know some cancers are harder to recognise early than others.  They’re the ones that have these more non-specific symptoms signatures.  Things like pancreatic cancer, myeloma, ovarian cancer, these are the ones that are harder to pick up early because their symptoms are not quite such red flag symptoms.

Joe:                 Yes, got you.  Absolutely.  That makes sense.  Jon, in terms of technology, can it help us to pick up things quicker and if so, how?

Jon:                 Yes, there’s a lot of interest in new diagnostic tests that might allow us to investigate people with symptoms or as new screening tests, even.  If you think about there are different ways that this might be done, sometimes it will be a new blood test that’s picking up early markers of cancer in your blood and there’s a lot of research going on in these types of biomarker tests.  Not many yet have been shown to have been specific enough to actually use them in general practice.

You get a lot of false positives.  There’s a lot of funding going into blood-based tests, then there are new imaging tests, so ultrasounds and CT scans, PET scans, and better uses of those tests might allow us to detect things.  Then there are even more interesting things, so there are these things called, “Volatile organic compounds”, these are things that you breathe in and out.  Some colleagues of mine are working with a group in Cambridge who are developing a breath test for cancer.  It picks up patterns of chemicals that come out in your breath that are potentially associated with a number of cancers in your lung but also in your digestive tract.

There’s some really interesting work.  Still a bit early days’ yet to be using it in general practice.  That’s another test that’s not invasive but might actually be a really interesting way of picking up both gut cancers and lung cancers a bit earlier than currently.

Joe:                 That’s fantastic.  What about things like artificial intelligence?

Jon:                 Yes, that’s a really good question.  The other thing is looking at large data that exists already.  There’s been some early work around looking at large data sets from general practice, and electronic records in general practice and starting to mine those to look for patterns of symptoms, abnormal blood tests that might allow you to have recognised a cancer earlier on.  We’ve been doing some early work in that area of diagnostic algorithms based on patterns of these tests that might prompt a GP to consider a cancer diagnosis sooner than they would.

Our brains are fallible, and we have various cognitive biases when we’re thinking about diagnosis.  We think that this approach to using computerised algorithms are rising from artificial intelligence mechanisms might in the longer term pick up earlier signals based on symptoms and blood tests, particularly in these cancers that are harder to diagnose because of their non-specific way that they present, that just might prompt GPs to think sooner that this is a possible cancer diagnosis, and somebody might need an earlier investigation.

Joe:                 Absolutely.  You know, Jon, as somebody who was really going through cancer, myself, and as you can imagine, I’ve done a lot of tests, and so I always imagine that there is obviously a person on the other end who’s looking at those tests with blood markers.  Whether they are CT scans or x-rays or whatever it might be.  How does that process work, and can technology perhaps help in that as well to pick up certain patterns?

Jon:                 Yes, again, that’s another big growth area in artificial intelligence, is automated image analysis in radiology.  There’s some interesting work, for example, in mammography, and using automated analysis to pick up early signs of breast cancer that might have been missed by a radiologist.  Again, another growth area of use of AI to more systematically analyse subtle changes on a CT scan or a mammogram or so on, that might detect early changes sooner than a radiologist might.  Thinking about from a GP’s point of view, that may eventually lead to some automated image analysis of low-cost ultrasound machines.

A GP might have their own ultrasound machine and have automated analysis of that, as an example.  The other interesting area in automated analysis is in skin cancer, and automated analysis of images of the skin using things like a domestic scope or even a mobile phone.  AI is a really big growth area in terms of another key strategy to detect cancer earlier.

Joe:                 Would that help, also, with going for periodic check-ups and notifying people earlier about things that could potentially could be red flags?

Jon:                 Yes, so potentially, and there’s an interesting area in self-monitoring apps.  Again, we’ve been doing some work in skin cancer about using apps on the phone to monitor changes in your moles as an early marker of change for melanoma.  Similarly, there are these symptom check apps that you can use that, again, have symptom-based algorithms behind them to prompt patients to go and see their doctor if they have certain important symptoms.

Joe:                 Yes, that’s fantastic, especially for a hypochondriac like myself.

Jon:                 That’s the danger, of course, that they can cause too much anxiety and generate a lot of unnecessary worry, because we all have symptoms most days if we think about it.

Joe:                 Yes, absolutely.  It makes it a really tough job for the GP, because how do you get the right balance between not jumping the gun and not leaving it late?

Jon:                 That’s right and that’s part of the skill of being a GP and they take into account a lot of other factors.  Obviously, in the context of cancer, cancer is more common as you get older.  You count for certain risk factors, as well, that you know put people at a higher risk of cancer, whether it’s their family history or if they smoke and so on.  You use all of that information, obviously, the examination as well.  All of these factors are used to help a GP weight up whether they should be investigating somebody sooner than others.  It’s a difficult balance.

Joe:                 Yes, absolutely, because I guess when you’re dealing with cancer, you’re also in between test results and treatment options and you’re working with different specialists.  What do you believe is the role of the GP, of the primary care physician in all of this?

Jon:                 Once a patient has had a diagnosis of cancer and they’ve started what is often a complex series of treatments, seeing lots of different specialists, it can be very overwhelming.  Often, patients lose touch with their GP at that point.  Actually, there’s still an important role we think for the GP during cancer treatment.  They can help try and make sense of what is happening with that patient.  They can provide a lot of important psychological support during their treatment.  They’ll often be managing their other health conditions, a lot of patients with cancer will have other chronic conditions, as well.

The GP needs to be kept informed of what’s happening from a cancer point of view, from a specialist team, and to be aware of the side-effects that the patients might be experiencing.  The impact that might have on some of their other chronic conditions, too.  GPs can play an important coordinating role in showing that you’re seeing the right specialists that are managing some of the common side-effects that people might be experiencing.  Providing that important support for both the patient and their family and then managing their other health problems at the same time.

Joe:                 Absolutely, that makes so much sense.  We sort of touched on this, but many people go online to try to find answer when they’re in pain, maybe when they have side-effects from the treatment.  Is that a good idea and when should you go to the doctor?

Jon:                 It’s difficult knowing when to go and see your doctor.  There are some very reputable sites that Cancer Council, for example, has some very useful information about common symptoms that might be due to cancer and therefore, should prompt you to go and talk to your doctor about that and have that checked out.  The Cancer Council websites are, from a cancer point of view, are very useful sources of information around both symptoms that are important.  Also, if you’re during treatment, they have a very useful helpline, as well, and you can actually phone up and talk to one of their nurse educators and get some very useful advice from them, if they’re worried about all sorts of things.

The web is a difficult place because you can go searching and find yourself in areas where the information is not necessarily as accurate as you’d like it to be.  Going to a trusted source.  There are other trusted sources.  There’s something called: The Better Health Channel, which is a much broader health and information resource about health matters in general.  It can be useful to get a better understanding about existing health conditions.  During treatment, if you actually have cancer and your receiving treatment, then hopefully your cancer centre will actually provide you with some written information, so that you understand your treatment and the side-effects and reasons to phone up one of the cancer nurses or something, if you have problems.

I think often it’s better to rely on some of the information that you’re provided with, or to contact the cancer centre that are treating you if you have concerns, rather than go Googling.

Joe:                 Yes, absolutely.  That makes a lot of sense, Jon.  I feel like after my all-clear, any sign of trouble and I immediately think it could be cancer.  What do you think is the best way to deal with fear of cancer coming back?

Jon:                 Fear of cancer coming back is a very common thing for a lot of cancer survivors.  We know that many people will struggle with this and particularly at times when coming up to a health check with their cancer specialist is a period when you’re obviously having tests to make sure you’re all okay.  That’s a very common period where, obviously, the fear that the cancer might have returned really starts to cause problems.  It is a difficult thing to manage.  For some patients, it can become very troubling.

For a lot of patients, it’s about trying to ensure that patients are aware of the importance symptoms to look out for.  The fact that actually recurrence for many patients and cancer survivors, their risk of recurrence is quite small.  It’s partly trying to balance, so people aware that they often overestimate the risk that their cancer is going to come back.  Some of that, just better information around their actual risk and the sorts of important symptoms to look out for can be reassuring.  There have been a number of research studies that have looked at much more detailed psychological treatments.  Particularly for people who fear cancer recurring, it becomes very troubling.

Group in Sydney, they’ve been running some trials of a course of psychological therapy for patients for whom fear of recurrence and become really very disabling.  They’ve got some early results showing that this very specific theoretically-based approach to fear of recurrence is an effective strategy.  Hopefully, that approach might gradually become available through psychologists more widely, as the results of that trial become more widely known.  For a lot of patients, it is just going to see their GP and talking to them about their symptoms.  GPs can often be quite reassuring, that actually the symptoms they’re experiencing are not an important sign of recurrence.

Joe:                 That’s a great sign, Jon.  I guess a lot of the times, I never really thought about going to see my GP, even though she has been instrumental in terms of picking up cancer and supporting me through it.  That’s a great point.  Sometimes we don’t think of the general practitioner as someone who can really help get you through this.

Jon:                 Yes, I think they play a very important role in that broader support and can be quite reassuring that you don’t necessarily need to be worried about a particular symptom.

Joe:                 Yes, absolutely, continuing on the mental side of cancer, most folks go through fear and anxiety, maybe when they are going through treatment.  What’s your advice on dealing with that and if you think it might be all a bit too much, where do you turn to for help?

Jon:                 A lot of cancer centres and all GPs, as well, will have access to psychologists who can be very helpful in providing strategies to help with anxiety and depression, which we know are quite common both during treatment and after treatment for cancer.  The GP alone, they’re very experienced with dealing with mental health issues.  Again, going to talk to your GP, if you’re beginning to experience signs of anxiety or low mood, they alone can be very helpful in both assisting how severe it’s got.  Whether psychological treatments might be helpful and therefore, referring you through Medicare to see a psychologist can be helpful.  They may just provide some counselling themselves and give you some other strategies to help with your mental health.

There are some sort of broader lifestyle things you can do, physical activity is actually very helpful for a lot of reasons for cancer survivors.  Including in improving their mental health.  Getting into a regular physical activity regime can help with many of the side-effects of the fatigue, as well as the anxiety or the depression.  Meditation some people find very helpful, yoga, that sort of thing.  There are a whole range of different ways to help with some of those mental health issues.  For some, it’s about finding the ones that work well for the individual patients.

Again, it depends on how severe things become.  There are obviously some drug therapies that some people may need to go on for a period of time, particularly for depression.  Often in combination with psychological therapies, as well.  Again, a lot of this can be access through your GP, but also the cancer centre will often have a team of psychologists and psychiatrists for people with some severe problems with their mental health during their treatment.

Joe:                 Yes, that makes so much sense, Jon.  Is it common that some physicians are better than others?  Is that true and how do you find one which is suited to you and your needs?

Jon:                 Yes, unfortunately, there probably is a variation in the healthcare system, a variation in personality type, quite apart from variation in quality in general of the delivery of care.  That’s one of the things, that as a medical researcher is one of the focuses of how you reduce some of that variation.  It is a fact that we do see variations in the quality of care sometimes.  I think the issue of finding a doctor who you get on well with and trust is really important.  Particularly, finding a GP who you develop a longer-term relationship with, who gets to know you over a period of time.  That continuity of care is one of the strengths of a good general practice.

For a lot of reasons.  We know that actually that developing a trusted, long-term relationship is actually a marker of good long-term care and is associated with better outcomes.  Sometimes you do have to shop around a bit, unfortunately.  In Australia, general practice, of course, because you have the option to go and see any GP you like, recommendation is often good.  Personal recommendation.  Of course, there’s increasingly stuff on the web where you get reviews of practices, as well.  I think it is important to try and find a GP who you can talk to, who you think will listen to you, who will give you the time when you need it, and who you feel you want to develop that longer-term link with.  Sometimes it’s not always possible to see the same doctor every time.

Actually, just even being in the same practice where they’ve got your records and all the information about you from your specialist, as well, all in one place is also important.  Going to see the same practice, even if you can’t always get to see the same doctor is also another way of trying to improve the quality of the care that you receive.

Joe:                 Yes, that makes so much sense to me, Jon, that if you invest the time up front to find a good doctor and build up relationship with them.  Then it’s a preparation for eventually dealing with something like cancer.  It’s a really important investment.  I know I was lucky to have a fantastic GP and great specialists.  At the same time, Jon, I don’t think they said a word to each other.  I guess in my case, it worked out well, but I think sometimes that conversation might be needed.  How do general practitioners stay in the loop and how can we make that process work better?

Jon:                 We know that communication between different doctors is often not ideal.  There are problems getting – with our current system – of sharing information that is often reliant on a still very old-fashioned systems of dictation.  Then the letter goes off to a secretarial pool and it might take weeks before it eventually gets typed.  It sounds extraordinary that hospital systems still rely on those rather old-fashioned methods of produced letters, even, let alone we have much better methods of communicating electronically in other businesses and so on.  It is recognized that there are structural problems in a lot of the healthcare system that rely on old-fashioned methods of communication.

We know from a cancer survivorship point of view, there has been quite a lot of work around trying to improve communication between healthcare providers.  There’s been a lot of interest in what is called: Survivorship care plans.  Which are much more structured methods of communication, both to the patient and also to the GP.  The information that’s most relevant about providing care for that patient.  We’ve done some trials of providing that type of information to GPs in models where the care is more explicitly shared between the GP and the cancer specialist.

We’ve shown that that is an effective way of improving communication.  Increasingly, cancer centres are thinking about how to implement this much more structured method of communicating between the specialist, the patient, and their GP, and other healthcare providers in that more structured way, and in a timely way.  There are well-recognised problems.  There are attempts to improve both the way the information is provider in a more structured and more useful way and ensuring that GPs are better kept in the loop.  In the longer-term, there is now something called: My Health Record, which is a federally funded approach to have a single core electronic health record.

That will at least have a lot of the core information around health conditions, tests results and so on, that will be assessible to any healthcare provider.  Therefore, in a much timelier way.  That’s gradually being rolled out and from I think about August this year, the vast majority of the patients within the Australian healthcare system, even if they’re not aware of it, will actually have access to My Health Record, which is an electronic record, that will have information about the drugs they’re being prescribed, all the tests that they’ve had ordered on them and so on.

GPs will have a core role in helping patients to ensure that that record is reasonable up-to-date about their various health conditions.  That, in the longer-term, we hope is a way of improving the communication around what’s happened to a patient between the different parts of the healthcare system.  It’s got a way to go still.  We think from a cancer survivor point of view, actually having an up to date My Health Record is a really important part of trying to improve that communication between different healthcare providers.

Joe:                 Yes, that makes so much sense, Jon.  I know that medical experts can take a complicated case to a panel of experts to get their input, is there a process in place to allow a general practitioner to get a second opinion, like if they’re not sure about what is the best way to go?

Jon:                 Yes, that’s interesting.  Obviously, in cancer care, there are these what are called: Multi-disciplinary meetings, where you have different specialists who will get together and discuss what the best treatment plan is for that individual patient.  Probably in cancer, that’s been the best developed model of really having good expert input from an oncologist, a radiologist, a surgeon, and a whole range of allied healthcare specialists, as well, to really plan what the best treatment is for that individual patient.  In general practice, obviously, it’s slightly different.  The GP is often seeing patients in quite an isolated way.

Particularly in group practices, so where you have, increasingly doctors are not single-handed doctors, they work as part of a group of doctors in a practice with a whole team of nurses as well and other allied healthcare professionals.  That practice model, if we have a team of doctors, does actually allow better opportunities to seek a second opinion.  Whether it’s informally, just talking to one of your colleagues about a patient that you’re not quite sure what’s going on.  Sometimes it will be a more formal route, where there’s subspecialisation with a practice of GPs.

You might find some GP saying, “Well, actually a colleague of mine has a particular interest in this area.” You might be offered that opportunity to see another GP in the practice because that’s their special interest.  I think as general practice becomes more complex and they take on a greater role in managing a lot of chronic diseases, then we might see a bit more of that subspecialisation within a general practice and within a team of GPs, so that different GPs have different areas of expertise, so you’ve got that potential for in-house second opinions.

Joe:                 Yes, that makes a lot of sense, Jon, because I know from even personal experience that as we moved around and lived in different areas, you go and look at a website for a particular practice and you start to read about the doctors, and you can read about their different areas of interest and expertise, and you go, “Yes, that might be the person for me or for my son” or whatever.  That really makes a lot of sense to me.  Also, I know that survivorship is an area that’s really close to your heart.  What are some of the challenges that some folks have after treatment and what is the role of the general practitioner in all of this?

Jon:                 Sure, I think increasingly the GP will have a growing role in cancer survivorship, as we move more toward what is called: Models of shared care between the hospital specialist and the GP, and in much more structured ways.  This comes back a bit to what we were talking about having better showing of information, with clearer guidance to the GP about their specific role in terms of caring for the cancer survivor, knowing which tests to order, in terms of monitoring a recurrence.  Knowing how to get rapid access back to see a specialist if they’re concerned.  In terms of the core cancer survivorship care, I think we will see a growing role for doing some of what would have been traditionally offered by the cancer specialists, but actually the GP will take on a greater role there.  As well, of course, as providing that much broader holistic care from a psychosocial point of view, and also managing other chronic conditions that cancer survivor may also have.

Joe:                 Cool.  Thank you so much, Jon, for your insight and for your advice.  I really appreciate it.

Jon:                 Well, thank you very much for asking me to.  Thanks, Joe.

Listen, I think it’s fair to say that nutrition isn’t the first thing in mind when it comes to cancer but eating well can make a huge difference in dealing with cancer, during treatment and in recovery.  Today, I’m talking to Julie Lanford.  Julie is a cancer dietitian who is going to describe your nutrition needs during cancer.  Whether you find it difficult to eat at the moment, or you maybe you’re relying too much on comfort foods, or maybe you don’t really know much about eating well during cancer.  You’re going to get tons of fantastic in-depth practical advice from Julie that you can apply right now, including:

Cancer Dietician: Lifestyle tips for prevention and survivorship

Episode 002: How Exercise Helps Crush Cancer

Joe:                 Julie, thank you so much for doing this.  I really appreciate your time.

Julie:              Sure, yes.

Joe:                 Julie, I just heard that bacon and sausages are now considered to be on the grade on carcinogen by the world health organization.  That really ruined my week.  What’s with that?  Is that even true?

Julie:                It is true, they were upgraded.  It’s been a couple of years, upgraded, whatever you want to call it.  It is a class one carcinogen, but I think it’s important to understand really what that means.  Just because something’s a class one carcinogen, you also have to have a lot of exposure before it will cause a problem.  Tobacco or cigarettes, they are also a class one carcinogen, but by smoking regularly, it increases your risk by double-digit percentages for cancer.  Eating things like bacon and processed foods, which is the sausages, they have the preservatives and additives.  It does increase your risk specifically for colon cancer, the increase in risk is small but it is something.  I always tell people, you know, I wouldn’t make a habit out of eating bacon right now.  It seems bacon is pretty popular.  I went to a restaurant the other day and it was like every other menu item had bacon on it.  I say somethings a habit if you do it three times a week or more, bacon is not something that I would make a habit out of, but if it’s something you eat once a month, I’m not too worried about it.  It comes down to how often or how much are you having at a time.

Joe:                 That’s fantastic, Julie.  I think that makes me feel a whole world better.

Julie:                Good.

Joe:                 Julie, I know you’re big on providing information that is evidence-based, can you talk about what that is and why is that important?

Julie:                Yes, so I think many people are confused about what evidence-based really means.  Just because a scientific study happened doesn’t make something evidence-based.  Evidence-based recommendations mean that there have been multiple well-designed studies showing the same results.  Enough to the point where we have consensus among scientists or medical professionals that there should be a recommendation around that particular issue.  I think where a lot of people get confused is just because a study was done, if that study was done in mice or rats or an animal model, or it’s only one study and there aren’t multiple studies going on about that topic.

It doesn’t make it evidence-based.  It might make it interesting, but it doesn’t mean it’s something that we absolutely have to change our lifestyle around.  Evidence-based means that a body of experts have gotten together, and they rank the evidence.  If there is consensus that say something like fruits and vegetables are good for us, which generally everybody agrees upon.  There’s lots and lots of data on that.

Joe:                 Yay.

Julie:                Exactly.  There is an evidence around cancer and eating more fruits and vegetables and plant foods.  I think some of the other topics are interesting, but I think we should build our foundation around healthy eating on evidence-based recommendations from reputable medical bodies.  Then if you want to layer other things on top of that, that may have less evidence, but maybe it makes you feel good, or it makes you feel like you’re doing something additional, I think that’s fine.  We definitely want to focus on the things that have the strongest evidence.

Joe:                 Yes, that makes so much sense, Julie.  How do you incorporate it into your daily practice?  Do you read research journals?  How does it work?

Julie:                Well, there are way too many research studies for me to ever read them all, because I have to actually go out and educate people and not just sit in an office and read all day long.  What I do is rely on the strong science-backed evidence-based bodies.  In the U.S.  anyway, we have the U.S.  preventive taskforce for more screening type tests.  When it comes to nutrition and cancer, I spend a lot of time with the American Institute for Cancer research.  They have great information.

Their website is: aicr.org.  They have actually an expert report where they rank evidence and they do updates, continuous update project is what they call it.  They have them around different types of cancer.  I tend to stay on top of what they are recommending and also, American Cancer Society has some good research, briefs and then the National Cancer Institute are also great places to go.  I tend to rely on people smarter than me to direct me in those things.

Joe:                 As we all do.  Absolutely, because it’s so important to really look at the real data out there.  There are a lot of myths and misconceptions around nutrition and cancer.  What would you say are some of the biggest ones?

Julie:                I would say the number one myth would be sugar feeds cancer.  People are constantly coming in asking me about that.  I call it a myth because there might be a little piece of truth that, yes, glucose is an energy source for cancer cells but it’s also an energy source for every cell in our body.  When you think about the term: Sugar feeds cancer, there’s nothing you would do about that.  It’s not like if you quit eating sugar, then the cancer cell will stop growing, it just doesn’t work that way.

The way I describe it is that every cell in our body runs on glucose, or that building block of carbohydrates, which some people term sugar.  We don’t get to pick and choose which cell gets what fuel.  From a practical standpoint, it’s not helpful of a thing to say except to scare somebody and make them very anxious about the foods that they eat.  Of course, we want to use common sense, certainly we don’t want people to eat a whole lot of sugar-sweetened beverages and desserts all the time.  There is a common-sense balance.  That’s one of the top myths.

More recently, I would say at least around the people that I see, some clients are a little bit afraid of eating meat or dairy products right now, based on some popular documentaries that are not sharing the strongest information.  I’m fine if somebody wants to not eat meat at all.  That’s a personal choice, but we don’t have good strong evidence that you shouldn’t eat meat.  You do have lots of evidence showing that you should eat lots of plants.  Whether you eat meat or not, you should still eat lots of plants.

Joe:                 Okay, that’s great.  We know that the immune systems shuts off during chemo, is it a good idea to take vitamins or minerals that can boost your immune system?

Julie:                Well, I would say there’s not good evidence to show that taking pill forms of nutrients actually does boost your immune system.  There is some evidence that shows that we don’t want people taking anti-oxidants supplements during treatment.  That it might counteract what we’re trying to do with cancer treatment.  There are mixed studies on anti-oxidants during treatment and so we air on the side of caution and we say, “If you want to eat food sources of anti-oxidants, or tea, like green tea, that’s perfectly fine.” We don’t want anyone to take really high doses of them in pill form.

Joe:                 Yes, because chemotherapy is actually pretty good at changing your taste buds.  Sometimes you’re in treatment and sometimes beyond.  What advice do you have around managing that?

Julie:                Yes.  Everybody’s experience is different, and it depends on what type of chemo and how your body reacts to it.  We do have strategies for all different types of issues that may come about when it comes to nutrition.  Specifically, around taste changes, a lot of times, we will have people, if you have a metal taste in your mouth from chemo, some people find it helpful to drink lemon water before they eat.  To not eat with metal silverware because that makes that metal taste worse.  You can use plastic silverware.

For some people, their taste buds are real muted, so they don’t taste very well, so they need to use more spicy foods.  Some people have mouth sores and spicy foods bother them, so they need to eat bland foods.  There’s no one across the board recommendation.  It really depends on each individual and what they’re dealing with.  Then we troubleshoot based on that.

Joe:                 Yes, right.  I remember there was a guy in my oncology ward who pretty much stopped drinking coffee, just because he had it during chemo and to him it was just disgusting.  Then I think he just stopped drinking it.

Julie:                Yes, a lot of people, if it’s not a good habit, then it’s a positive thing that it forces them to change their habits.  Especially around those comfort foods that you’re really used to and then your chemo makes it, so they don’t taste good, that’s like adding insult to injury.  Well, I enjoyed drinking that coffee every day and now it doesn’t taste right.  That’s one more thing that I have to deal with.  When people lose their taste buds, they start coming back, I usually recommend that they try to optimize that and take advantage of that opportunity to train their new taste buds to really like healthy foods.  If they had habits that they’d been wanting to let fall away, they can train their taste buds to like better foods.

Joe:                 Yes, that’s a great idea, Julie, because that could a conscious beginning of a new phase of life, where you eat better.  Absolutely.  What are some of the most important things to keep in mind when it comes to diet before and after treatment?

Julie:                For most people who, let’s say, during treatment they didn’t have too many side-effects that prevented them from eating normal foods.  They’re looking at after treatment and the way I say it, how can they optimize their nutrition and optimize their survivorship.  I do programs here at the non-profit that I work for, and we focus on nutrition, exercise, stress management, and then medical management, which I think all are really important pieces of optimizing survivorship.

From a nutrition standpoint, I really focus on the recommendation that cancer survivors follow the same things that we recommend for cancer risk reduction, which is essentially eating a plant-based diet, not eating too much of the sugar-sweetened beverages.  Not eating too much added salt and not eating too much of the red and processed meats.  I think what’s most important for people is to really focus on getting the nutrients that their body needs to function.  Especially as they’re healing up after treatment, where they might have had their treatment affected not just the cancer cells to get rid of those, but it also had effects on other parts of the body.

There’s a lot of healing that’s going on.  Supporting that healing with good nutrition choices, good quality sources of nutrients that come mainly from food.  When you choose food sources of nutrients, you get a lot of variety of nutrients.  You choose lots of different colours in your foods, you’re getting a variety of nutrients and they’re all really important to promote good growth of healthy cells and also supporting the immune system.  We do promote a plant-based eating, whether that includes small portions of meat or not is a choose your own adventure.  Definitely focusing a lot on plant foods and making sure to get plenty of fruits and vegetables every day.

Joe:                 Yes, also, Julie, you touched on colours and the fact that you should be mixing up foods of different colours, so how does that work?

Julie:                By colours, I mean the colours in the foods as they’re grown, not like do you have Cool Aid there?  We’re not talking about fruit punch or colours like that.  What we want from the colours are things like red in the tomatoes, red in the watermelon, orange from sweet potatoes or carrots.  Oranges, yellow from a variety of things but squash.  When you eat all of those different colours, the colours really represent the type of plant nutrients that are in that food.

You don’t have to have a degree in nutrition to figure out that when you eat a variety of foods, you get a variety of nutrients and your body will get what it needs.  We don’t want people eliminating all of one food group.  We want you to eat a little bit of every food group and we want you to eat a lot of fruits and vegetables.

Joe:                 Yes, that makes a lot of sense, Julie.  Another area where we could open another can of worms here, but I know exercise is a good, and we could probably talk about that for hours.  It’s such a huge area and exercise and diet go hand-in-hand.  What is some of the advice that you would have on that front?

Julie:                Exercise isn’t my speciality, but they do go hand-in-hand.  What I know is that people can eat all the right nutrients but if they’re not utilizing their body the way it needs to be used, your body won’t need all of those nutrients.  Especially when it comes to protein, people will say, well, should I take a protein drink, or should I use protein powder?  Well, at least in the U.S., most people eat more protein than they need anyway.  The reason you want protein is to rebuild your cells, to rebuild muscle, but a lot of people aren’t exercising and so exercise is what builds muscle.

It’s a perfect complement but your nutrition plan is only going to go so far.  Especially after treatment, a lot of their body composition has changed as a result of treatment or the fact that they were less active during treatment.  To get their body composition back to a healthy balance where we have plenty of muscle tissue and lean body mass, it really is going to require – nutrition is never going to build muscle.  Nutrition can help to build the cells when you’re exercising.

I focus a lot on helping people recognize their need for exercise.  I know exactly what types or how to do it, but especially weight bearing exercise can help build muscle.  It helps build bones, which can be a big side-effect for a lot certain types of chemotherapy are risk for bone loss.  It also just helps you feel better.  Fatigue is much better management when people are physically active.  All of those things, I think exercise is fun and also very much beneficial.

Joe:                 Fantastic.  You spoke about plant-based eating, can you talk about why that’s important and why would you go incorporate this into your daily life?  What is the best way to do it in a practical way?  Many people, myself included, may not be used to that.

Julie:                With the plant-based eating, I think that the most important thing is to think about every time you sit down to eat, that you have the opportunity to give your body some nutrients it needs to function.  For the most part, we need a lot of phytochemicals.  Phyto means plant.  These are just plant nutrients that our bodies need to function.  You need a lot of them every day.  When you sit down to eat, half of our plate should be covered in fruits and/or vegetables.  A quarter of our plate would be covered in some kind of whole grain, which is also a plant food, so that counts as part of your plant intake.

Then you have a quarter of your plate that would be protein.  That’s where you get to choose.  Do you want to have meat or dairy products on your plate for protein?  Or do you want to have more plants, which is what vegetarians and vegans do.  They get their protein from beans and nuts and seeds.  What I encourage people to do is have one cup of fruit at breakfast because most people don’t want vegetables at breakfast.  A cup of fruit at breakfast.  A cup of vegetables at lunch.  A cup of vegetables at dinner and then most people enjoy fruits and they snack on them throughout the day.

That will help add up your total and if you’re getting to four to five cups a day combined with fruits and vegetables, that’s what we’re aiming for.  The other key indicator of a plant-based diet is, are you having plant proteins every day?  Even if you’re a meat-eater, you should still be having beans, nuts and seeds at least one serving a day.  Then the other things will fall into place.  If you have fried foods occasionally or if you have desserts occasionally, that’s not a big deal as long as you’re still meeting the core of getting all of those plant nutrients, so that you can make sure that all of your cells have the tools that they need.

Joe:                 That’s great, Julie.  What about the times when you’re in treatment and eating is physically difficult, what can you do?

Julie:                When eating is hard, then we sometimes say, okay, maybe we should just find whatever we can.  Especially during treatment, if someone really cannot tolerate any of these healthy foods or plant foods, having something to eat and getting enough calories and protein is more important than anything else.  We need them to get those calories and protein in, if it’s a milkshake and that’s all that they can get in, if it’s one of those canned nutrition beverages, if that’s all they can get down, that is better than nothing.  The last thing we want is for somebody to not get enough food.

If you’re not getting enough calories and you’re not getting enough protein and you have a diagnosis of cancer and you’re going under treatment, we have plenty of studies showing that that will lead to malnutrition and that malnutrition leads to poor outcomes.  We want to do whatever we can to make sure that people get enough food in.  If they can’t tolerate fruits and vegetables and all of the healthy things that we’re talking about, then it’s time to think about, well, can we add calories with healthy foods like nuts and avocados and olive oil and heathy fats?  If we can do that, great, if they can’t even tolerate that and all it is ice cream, then it’s just going to be ice cream for a little bit of time until they get through it.

Joe:                 Absolutely.  Speaking of drinks, what’s your take on alcohol.  I know I’ve heard a lot about drinking in moderation and what is that and how can you apply it in practical terms?

Julie:                Yes, so we know that alcohol increases risk for cancer, several different types of cancer.  It increases risk.  Again, it comes down to how often and how much are you having at a time.  That’s where moderation comes in.  I find a lot of people don’t know what moderation really is.  They can’t actually define it.

Joe:                 Or can’t stop themselves.

Julie:                Yes, or they start, and they can’t seem to stop at moderation.  The definition of moderation when it comes to alcohol is one drink a day for women, two drinks a day for men.  You don’t get to save those up for the weekend.  It’s once your day is over, that’s your drink or not.  I tend to think I would not have a drink every single day.  To me, that is a habit and that’s not a habit that I want to make every day.  A drink is considered 12 oz of been, 5 oz of wine, which is like not that much.  Or an oz and a half of liquor.  Really, finding that balance is important.

Joe:                 Yes, that makes so much sense.  If we go back to food, I know you have so many great recipes on your website.  What was your favourite one when you don’t have much time?

Julie:                Yes, so I – gosh, I have a lot of favourite recipes.  There are a couple of ones that I use all the time.  I have a smoothie recipe.  It’s a green smoothie with bananas and peanut butter and spinach and it’s delicious.  I use a cup of milk and two tablespoons of peanut butter and two teaspoons or dark coco powder, a cup of spinach, and a frozen banana is really important.  That blended up is delicious.  That would be a breakfast meal.

Or if it’s a snack, I’d probably have half of it.  I also love making granola.  I have a granola recipe on my website I do a lot of crockpot recipes because that tends to be easy.  I do chilli, bean chilli, I don’t put meat in my chilli.  Bean chilies in a crockpot is something that I really like to do a lot.  I like to do curry recipes.  A lot of people ask about turmeric.

All types of herbs and spices are good for us.  Curry is a great way to include that in your foods.  You don’t have to be fancy to eat healthy.  Sometimes I just go to the grocery store and I grab a piece of fruit, I grab some carrots, I grab hummus and crackers.  Maybe a little thing of yogurt.  That’s a lunch.  It doesn’t have to be fancy.

Joe:                 That’s fantastic, Julie, because I think that’s actually misconception that it does have to be something really fancy and elaborate.  I think that puts a lot of people off, doesn’t it?

Julie:                Yes, it puts me off.  It makes me feel like, never mind.  Forget it, I’ll just go to a drive-through and get whatever I feel like getting.  When you try to lower the bar and make it simple.  At least here, I live in the southern part of the U.S., and when I moved here, people would eat peanut butter and banana on a sandwich.  It was like peanut butter and jelly, only you put banana instead of jelly.  It’s really good.  Also, it’s cheap and it’s easy.  Most people like it.  Finding those really simple things I think is the key to making healthy eating fun and also simple.

Joe:                 Yes, I think that’s an especially important point if someone’s dealing with treatment or after treatment, because you’ve got fatigue, you’ve got all of those things.  You’re really not in the mood to spend hours in the kitchen, right?

Julie:                Unless someone really likes to cook.  That’s their hobby and that’s what gives them purpose and meaning, and they like it.  Life is too short to stress out and spend half of your day in the kitchen chopping things.  We’ve got to figure out how to nourish ourselves but also allow ourselves time to do other things.

Joe:                 Yes, exactly.  There’s another stigma that comes with healthy eating, is that people think that it’s all about denying yourself food that you love?  Is that true?

Julie:                Well, it’s definitely a stigma.  I think people have a hard time figuring out that, hey, a special treat is okay sometimes.  You should have a special treat sometimes.  It shouldn’t be like, oh, I do a really good job, but I never ever treat myself.  That’s not fair.  We should be able to find that balance, but I also know people who tend to fuel or feed their emotions with food.  That’s not healthy either.  They might be eating junk food too often, like every single day, or it becomes this habit where they cope emotionally with challenges by eating certain things.  It’s hard to figure out what that balance is, but certainly we should be able to enjoy desserts and special treats on occasion.

Joe:                 Yes, exactly, it also comes together with having great intentions in mind.  Sometimes you want to do the right thing, but I guess we have trouble sticking with it.  That’s why most New Years’ resolutions go out the door a few months later.  Do you have some thoughts around how you can stay on track with and build on healthy habits?

Julie:                Yes, for a lot of people, we’re not really aware of what our habits are.  The first thing, if somebody wants to come in and see me and get some nutrition advice, I say they have to show me the money.  That’s not dollar bills, the money that I ask for is they keep a food record for a whole week.  Where I don’t want them to just write down kind of what they ate.  I need them to specifically write down what exactly they ate and how much of it and what did they drink and how much of it did they drink?  We don’t have to memorize everything that we eat.  If we’re looking at wanting to make some healthy changes, we need to do an audit.  By writing down what we eat for a week, it shows us, I don’t want people to make changes before they write it down.

I want them to write down what they’re actually doing, so that we can pick out what are the habits that maybe aren’t so good?  What are some things that we could make substitutions for or change up a little bit?  Or, maybe they have a habit, they’re eating treats too often and we just need to cut it back to a more reasonable amount.  Really, that’s the first thing I would do, is keep a record for a week, to figure out what they’re actually doing.  Then, to count up the number of fruits and vegetables they eat every day, that’s another simple place to figure out, maybe they actually need to eat more fruits and vegetables to improve their nutrition.  Those are the first things I start with, as I count up the fruits and vegetables when somebody brings me a week-long food log.

Joe:                 Absolutely, Julie.  It makes so much sense because we’re really not honest with ourselves.  If you were to ask me on the spot, I would probably immediately, like what I had last week for example, I would immediately discount all the snacks that I had and would easily half the amount of alcohol that I had.  Yes, you really do have to have a log and keep yourself honest.

Julie:                Yes, definitely.

Joe:                 Is there something that people often miss when they try to have a healthy diet, but they aren’t really getting the results that they want?

Julie:                Let’s see.  I think sometimes people skip meals or they don’t get a full meal, if that makes sense.  They would eat something at lunch, but it might not be the right combination of foods.  We want to make sure that at meal times we have fruits and/or vegetables.  We have wholegrains and we have protein.  A lot of times at breakfast, people hardly have any protein at all.  Then maybe at lunch they might have a salad, but they don’t have any carbohydrates.  They’re not balanced throughout the day.  We need them to eat consistent amounts throughout the day.

The other thing that happens is, they often ignore their hunger and fullness ques which is a big problem.  If their body is actually hungry, we want them to eat.  We also want them to stop eating when they’re full.  A lot of people eat so fast that they get through their food before their body can even tell their brain that they’re full.  Slowing down meal times, tasting their food, making sure they have a variety of nutrients on their plate.  Then really paying attention to if they’re hungry, then they should probably have a snack.  Then do not skip meals.  That’s a red flag.

Joe:                 Yes.  What are some of the books or other resources that you’d recommend for a person who’s dealing with cancer or maybe they want to build a healthy life after cancer?

Julie:                Yes, there are a few.  I think there’s a lot of really not quality books on nutrition.  I’m always cautious about that.  There are some cook books that I think are really good.  One of my favourite cook books, it’s not specifically cancer-relate but it is called: Lickidy Split Meals.  It’s a dietitian here in the U.S.  that wrote it.  Very practical.  Lots of quick and easy healthy meals.  I think people need more of that.  There are some eating well through cancer cook books that I think are pretty good by Rebecca Cats.  It talks some about side-effects but also healthy eating.  Here at the non-profit that I work for, I host a mindful eating program.  We contract a dietitian to come teach that.  The books, her favourite ones to help people get more in touch with their hunger and fullness ques and to try to avoid emotional eating is called: Intuitive eating.  It even has a workbook with it now, which is really handy.  Those are things that I really think are great tools to help guide people.

Joe:                 Yes, I love those PDFs that are very simple and clear on your website.  I’ve got one on my fridge right now that really helps guide you through making these decisions on what to eat better.  If somebody wanted to check out your products online or work with you individually, what would they do?

Julie:                Yes, the website: cancerdietitian.com has lots of recipes.  I have all kinds of different things on there.  I do have some printable handouts on a variety of different topics.  Those are available.  Some of them are free some are for purchase.  They support the non-profit I work for.  I think that’s a nice thing.  People can email me.  I usually respond pretty well.  I don’t do online consultations, but I do know some dietitians who do that, some oncology dietitians.  On social media, I’m happy if somebody sees something on Facebook and they’re wondering, is that true or not?  I get a lot of followers who will send that to me or ask my opinion.  Those are easy things to do and to engage with some of my programs.

Joe:                 Yes, that’s fantastic advice, Julie.  I think that nutrition during cancer is an area that really doesn’t get enough attention.

Julie:                It’s true.  The interesting thing is, there’s just not a lot of us oncology dietitians compared to the number of people who are being treated.  At least in the U.S.  insurance coverage doesn’t pay for it.  A lot of cancer centres might have one or two dietitians if you’re lucky for a lot of patients.  Sometimes it falls on the healthcare providers that aren’t dietitians and they don’t always know how to respond.  I always encourage, when somebody emails me, I encourage them to at least ask their cancer centre for a referral to a dietitian.  The more they hear that, the more likely they are to start staffing someone on-site to help with that.

Joe:                 Yes, absolutely, because I only found out about oncology dietitian pretty much after the fact.  I wish I found that earlier because I put on a whole lot of weight during treatment because I was on steroids.  It made me eat a lot of food and not necessarily the best food.  I think a lot of folks need advice around that.  I think it would be great to have a lot more awareness around it.

Julie:                Yes, for sure.

Joe:                 Thanks so much for your time, Julie.  I really appreciate it.

Julie:                Yes, thanks for asking me to come on.

Listen, I don’t know about you, but for me, honesty has become such a rare commodity these days because it’s so hard to accomplish – you have to set aside your ego, you have to put your worries aside about how other people see you, but it also gives you this incredible power of clarity.  Honest – that is how I would describe Matt Featherstone, our guest today.  Matt is for real.  Matt doesn’t screw around. He takes his honesty and he turns it into insight, into how you can shift your focus during cancer, into how you can manage your energy.  Who is going to stay with you through cancer? Matt is going to share some fantastic advice for dealing with cancer, including:

Cancer Connect

Joe:                 Matt, thank you so much for doing this, and I’m really looking forward to this.

Matt:                Yes, very happy to help.  It’s a worthy cause.

Joe:                 Yes, absolutely.  First, I want to ask, how did you react when you first found out that you had cancer?

Matt:                Yes, I remember it distinctly, it’s one of those big life events, isn’t it?  I suppose I was very similar to many blokes.  We’ve got 19 things going on in our heads at once, and I got a call from my GP and I remember coming into the office and actually in the office with my wife, and saying, “Sweetie, I’ve got some bad news, we’d better put aside some time to talk.” I didn’t drop everything.  I think it took me quite some time that evening before I even stopped work and went into the other office and said, “Look, we’ve got a problem that’s got nothing to do with the business, we’ve got a problem here.” I guess the short answer is, I was a bit numb, actually, I wasn’t expecting it.  I think it was, as I say, quite some hours, then, of course, seeing her face really made a very big difference to my evening.  We literally turned the entire office off and just went and sat down and had a cup of coffee and went, “Well, we weren’t expecting that, what are we going to do?” It was a bit of a shock.

Joe:                 Yes, exactly, like you said, I felt shocked, I felt numb, and I felt the whole world stopped and came to a close, like everything slowed down.  The whole sound was muffled.  It was just a really bizarre feeling because it’s unexpected, right.

Matt:                It is, it’s a very unusual experience.  I suppose one of the positive things is, Joe, that since then, I guess like most people, we’ve had other things that have happened out of left field, not expecting them.  Sometimes it’s nothing to do with health but just things in the family.  I must admit, we, as a family unit, now we’re better at taking unexpected bad news and doing something with it than we were before.  There was an upside.

Joe:                 Yes, absolutely.  That’s a positive take on it, Matt.  I think that’s because you’re confronted with it, you’re forced to deal with it.  You have to find a way.

Matt:                Yes, that’s right.  You’re exactly right, Joe.  It’s almost like there’s a moment now that you can’t go back on.  The die is cast, and you need to do something.  You’re right.  It’s a very specific type of life event that you’ve just got to deal with in a sense, yes, you’re right.

Joe:                 Absolutely.  Your family, your friends, you just mentioned your wide, she obviously was in a shock, but how did they react, and did they support you in a way that you wanted to be supported?

Matt:                That’s a great question.  Firstly, I would say that some of my friends didn’t make it through the experience of being a friend with my while I had cancer.  At the time, I think I was a little disappointed, I think, would be the honest way of describing that.  I must admit, now that I’ve come through five years of cancer-free.  Joe, that was a great celebration, I must say, that was a big party.  I now look back on the new group of friends, but at least the refresh group of friends that I have, let’s put it that way.  I must say, the friends that I have now, they have more of an alignment I think with the way that I view the world and cancer.  I think that’s a very good thing.

I think that’s a very positive thing because I still occasionally find myself thinking about cancer and some of the issues that I had and the way I responded and this newer group of friends of mine are very useful, if I could use that word.  They’re very supportive, that’s a better word.  They’re very supportive.  Sometimes I say, “I kind of want to talk about something that happened when I had cancer.” I now think it was a positive experience in terms of my friends.  In terms of my family, yes, my immediate family were very good.  I guess because they’re right there with me.  They’re in the same house as me, and at the time, anyway, our kids have grown up now, but at the time, they were here.  They couldn’t remove themselves from the situation at all.

They responded very well, my wife and my immediate family.  My extended family, you know, I’m talking about parents and brothers and look, that was variable.  Without naming names, but I had some issues there with people that found it very difficult to come to grips with this.  The way they dealt with it was to keep their contact with me to a minimum.  I get why, I do, I understand why.

Joe:                 Yes, why?

Matt:                In summary, I had a type of cancer that is partially hereditary, in the sense that you’re genetically predisposed to it.  That meant that males in my extended family started thinking obviously about themselves, I get that.  I totally get it.  That meant that part of their response was less because they were thinking about themselves.  I totally get that.  If I were in their shoes, I’m sure I would have thought to myself, “I’m going to get tested.  I better make sure this is not going to happen to me.” One of the members of my extended family did find a very high indicator.  I get it, I get why.  I guess I may have had an unrealistic expectation around my extended family and how they would react.  That took a little bit of an adjustment for me.

Joe:                 Yes, so thank you for your honesty, Matt, because it’s such a hard topic to talk about, but I think it’s very necessary because I think people need to hear this stuff.  The more people I talk to, I find this over and over again, that this happens to people.  These patterns come up, time and time again, you know?

Matt:                Yes, you’re right.  Although, we can rationalize it, like I just did, I think, Joe, that it’s fair to say, when it actually happens, it’s a little bit more emotional than the way I just described.  Certainly, I did, I don’t think I acted terribly well in the moment to somebody that wanted to go and find out whether they may have had an indicator rather than asking me about how I was going.  I think I probably overreacted a bit.  I think it’s fairly human to do that, because the fact that we’ve got it.

Joe:                 Yes, sorry.  I think it’s really great that you processed a lot of this negative stuff and moved on.  I really want to go back to your friends for a second.  I think it’s incredibly encouraging that you found what you referred to as a refreshed group of friends.  In terms of friends, because that would be different from your extended family, I want to try to understand what your perspective is because I went through it more recently.  Who is going to stay with you through cancer? To me, still, it’s pretty painful.  I don’t understand why the people that I expected to be there for me, why they pretty much just dropped out completely or just pretty much disappeared.  When I really expected them to be there.  What sort of process did you go through to think about that?  Are there any explanations that you found, yourself?

Matt:                Yes, look, I do, I have two things that helped me rationalize and understand why some of my previous friends didn’t come through the whole journey.  I think the first thing, Joe, is when you get diagnosed with cancer, some people find it extremely hard to properly understand how long the journey is going to be.  They perhaps think it’s like you’re going in to get some surgery done and then a week or two’s time, you’re going to be okay.  Of course, you and I both know that that’s not the case.  The first thing I’d say is that some people can’t understand the length of the journey.

We’re going through a five-year journey and sometimes more.  Since they don’t understand that, they drop away.  They literally go, “I don’t know what to do?  I’ve been there to the hospital, I’ve talked to him, and I don’t really know what to do.  Do I come back and talk about the same thing?” I think that’s kind of one reason.  I think the second reason is that some people just aren’t good with illnesses.  One case, I remember, in my own set of previous friends, they’re not good with illnesses, they think illness is a little bit of a weakness.  Someone’s just giving the cancer illness too much time.  They think, why give something like that so much of your time and effort.

Of course, they don’t realise that’s entirely what cancer is going to do, it’s going to take up just about every moment of your waking life, right?  For quite a while.  They don’t get that.  It’s almost like they think it’s the flu, like, get on with it.  I think that’s probably a male thing, Joe, I’m not sure it’s a female thing.  I’ve got female friends.  I think it was more my male friends who were a little bit wanting to see me come out the other end more quickly and less time talking about cancer than I did.

Joe:                 Yes, I think you’re absolutely right, I think it’s that different modality of cancer.  Even if I take just the nine weeks of chemotherapy that I went through, my entire paradigm had shifted.  I became an entirely different person.  For them, it was just business as usual.

Matt:                Yes, I think you’re right, Joe.  We start changing the way we’re interacting with our illness and they don’t because they don’t understand that.  They’ve observing it, but they don’t really get it.  I think you make a great point there.

Joe:                 Yes, Matt.  What is it that’s different about man facing cancer?  Do we have different needs?  Do we express things differently?

Matt:                I think so.  I’ll give you two reasons for that.  I think the first thing is that generally speaking, we, as men, don’t tend to ask other people for help as much as our female friends do.  What happens, I think, a little bit, is, to be brutally honest, we don’t address things that we should do, we don’t ask for help, so things get a little worse than they need to be.  Again, the example, in my case, I had a bad reaction to one of the general anaesthetics.   I had three operations and I got no word of whether it was a ratio to gas or whatever it was, and I ended up in ICU.  I wasn’t really helping myself terribly much.

I wasn’t being a very nice patient, to be honest.  I wasn’t communicating properly with the nurses and I wasn’t trying to help myself, by asking for help.  That just made, when I look back on it, it was a silly thing to do, it made my stay in ICU a lot longer than it needed to be, and I probably had some ramifications of that.  If I had been a little bit more sensible and asked for help, I probably wouldn’t have had some of the other problems that I had post to the operation.  I think that’s the first thing, we need to ask for your help a bit more than we naturally do.  I think the second thing is the expressing.

I think you ask a very good question there.  I think as men we tend to express things in terms of a logical, if you like, way of expressing something, rather than the emotional way of expressing something.  We tend to say, here’s my problem, what do you guys thing?  Rather than, here’s my problem, this is how I’m feeling about it, what do you guys think?  Because we don’t kind of talk about our feelings as much, we tend to get back a very logical response, “Well, have you tried this?  Have you tried that?  Have you tried that?  Why aren’t you doing this?” Of course, some of those things mightn’t be a terribly good idea, given how we’re feeling at the moment.

I’ll give you a simple example, in my particular case, I was very sick after one of the surgeries I had.  Someone that said, Matt, how are you going today?  I said, “Well, I’d love to go for a cup of coffee, but I can’t, have you got any other suggestions?” That was a bit silly of me, I should have probably said, “I’d love to go for a cup of coffee, but I feel sick.  I’m going to throw up if I have a cup of coffee, do you mind if we go and just have a wander around the garden and talk about something else?” I should have said that, if I had said that, then the person that was there in the room at the time would have gone, “Well, I understand the way you’re feeling, that’s alright, how about we do this?” Yes, I think you made a great point, I think we probably need to explain a little bit more about how we’re feeling, the emotional side of things, and try to ask for more help rather than try to do it ourselves.

Joe:                 Yes, I completely agree with you because as men, we tend to want things to make sense.  When it comes to cancer, a lot of things just simply don’t align.  A lot of them simply don’t make sense.

Matt:                Yes, you’re right, particularly in terms of the medical profession.  I think one of the biggest learnings I had was to spend the time in waiting rooms, actually reading up about procedures and what can be some of the side-effects of the procedures and what some of the frequently asked questions are about the procedures.  That really did help me to then interact with the medical profession in a way that enable them to give me a much better answer.  I think what happens is that they’re so busy that they tend to answer questions in a very short way because they’ve got patients waiting, and all of that sort of thing.

I noticed when I said, “Well, actually, I’ve read this study and it says this, and I’d like to ask you what your view is on that and how I can stop having that problem later on in life.” They would then reset and go, “Okay, this guy actually has some background, I’m going to give him a much better answer.” That was, of course, much better for me.

Joe:                 Absolutely.  It’s better to ask informed questions when you know what’s going on.

Matt:                Exactly.

Joe:                 Also, Matt, I think that also it’s very important for us men to take a step back a little bit, because I feel that quite often we want to be in control of things, we want to be in charge, we want to know exactly what’s going on.  Quite often, that’s not really what happens with cancer, sometimes we have to let things take its course a little bit.

Matt:                You’re right, Joe.  As blokes, we find that pretty hard to do.  We’re wired a bit to try to at least take control, whether we can or not is a different matter but we try to and you’re right, there are a lot of things in that journey in cancer where you can’t take control, it’s going to take as long as it’s going to take, I remember, Joe, saying that to myself a few times, “Matt, there’s nothing you can do to speed this up, let it go, let it go for as long as it’s going to go.  Try to learn as much as you can about this while you’re waiting.  Just try not to do their job for them.” I remember being quite pointed with myself just to stop doing that.

Joe:                 That makes so much sense.  Matt, I know that your daughter was also diagnosed with cancer, that is absolutely the worst thing that I can imagine.  It’s crazy, but also understand that all of these crazy events have brought your family together.  How did that come about?  What is your advice to someone about bringing in your family together on this cancer adventure?

Matt:                Great question, yes.  Our daughter was diagnosed a week after me, so we just had one of those perfect storms that happens sometimes in life.  The that brought us together was, because I was one week ahead of, and it doesn’t sound a lot of time, but you and I both know that in that one week, you’re really getting started.  You’re on the phone to people, you’ve been to medical appointments, you’ve got tests done, you’ve done quite a bit in that first week because you have to.  What happened to us, Joe, was that because I’d had that experience, I had already found quite a few people who had been through the type of cancer I had.

I got them to come and talk to me, and in some cases talk also to my wife, we started to be able to understand how that was going to affect the family, because we could hear their stories.  Some of those stories were great, by the way, so it was about how we’re going to avoid some of the problems that other families had.  Some of them were really good stories about how, for example, one family we heard about had some rules that they were not going to use highly emotive language when they were talking about the cancer.  They were going to take five and if they couldn’t talk about their feelings in a constructive manner in the family, they were literally not going to say anything.

We found those little tips to be extremely useful, because we could start to say, “Well, look, why don’t we do that in our family?  Let’s have that rule.  That sounds like a great rule.  Why don’t we do that?  We’re going to go away this weekend, we’re going to forget about cancer for a weekend.” We did a whole stack of things that we’d learned from other families had been useful, that would work in our case.  That helped a lot to deal with my cancer, but also our daughter’s cancer.  She was obviously an awful lot younger, obviously.  She was 17, so she was quite young.  That brought its own challenges and we really needed to speak to some people in their family who had someone with cancer at that age.  I think really, Joe, that was a very big learning, was to educate ourselves by talking to others who had been there before.

Joe:                 Yes, that’s the biggest thing, isn’t it?  How did you find those other families to talk to and find those rules, some of them, that you could incorporate into your life?

Matt:                Well, the first thing we did, was we went out our extended family.  My family and my wife’s family and we said, “Hey, this is happening to us, you’re going to need to give us a little bit of flexibility in terms of what we’ve committed to do?” Like, we won’t be going to dinner at this date, we’re not doing this birthday party and all sorts of things we had to decommit on because now we really had to focus on this.  Of course, it’s a bit like six degrees of separation.  Some of our extended families came back and said, “Actually, I know somebody, would you like to talk to them?” Of course, we said yes, can you put them in touch.  We also got quite a number of people from my GP and my surgeon and from our daughter’s surgeon.

They sent out, we were quite lucky, quite a number of patients who were willing to talk about their experiences.  They didn’t know us, but they were very kind to take a phone call and we could ask them questions and they’d talk to us about what they did in their families.  Of course, there’s cancer counsel, and they have a number of ways of connecting families in who are either experiencing cancer themselves or caring for someone with cancer.  They’ll put you in touch with these people and you can ask them questions.  We actually found we had a very great number of people we could talk with.  We did a lot of that in that very first week of being diagnosed.

Joe:                 That’s fantastic, Matt.  You really tackled it early.  I love your concept of little C.  Can you talk about what that is and how that’s helped you tackled cancer?

Matt:                Little C, Joe, came about because in a waiting room, one evening, I had an iPad and I started saying, what am I worried about?  I just started writing, what am I worried about?  I just dumped a whole stack of issues and questions and anxieties onto this page in my iPad.  Then I went back, and I looked at that and I went, “My goodness, cancer itself is actually not the biggest worry that I’ve got at the moment.  My biggest worry is what happens if I don’t come out the other end?  What happens if this is it for me?” That was a much bigger issue than dealing with cancer.

Then the second biggest issue, again, more important than cancer, what was going to happen to my family?  How was my potential demise, not to put too fine a point on it, what was going to happen to me?  Have I got my affairs in order?  Then I came up with this idea, that I’m going to call it little C, from the perspective that there are much bigger issues that I need to address at the same time, and I need to get that square around my head, I’m not going to dump that on people.  I’m going to get my own thoughts together on what’s going to happen to me if I die.

I found that by putting it in perspective with those bigger issues, that it became the little C.  Now, that didn’t mean that I didn’t think it wasn’t important.  As I say, it’s very much in parallel, I was giving time to what was going to happen to me if I did die, and they said, “Sorry, we’ve tried everything and you’re not going to make it out the end” , then I knew how I was going to react to that and I had my affairs in order.  In parallel, I knew I was still going as fast as I could to get to all the appointments and get the bookings done on the tests and get myself into hospital and get myself fit and all that sort of thing.  It was going on in parallel, but it did mean that cancer itself took a little bit of a smaller sort of priority over some pretty larger questions.

Joe:                 That’s fantastic because it’s such a positive reframe.  It really puts cancer in its place.

Matt:                That’s right, it is a reframe, I’ve never thought of that.  You’re right, Joe, it is a reframe, yes.

Joe:                 I don’t know about you, but I have a lot of advice to share with the old me who was diagnosed with cancer and going through treatment, I really had no clue about what was going on.  Is there anything that you could have done differently in retrospect?  I know there’s no such thing as hindsight, but if you had that chance, would you have done anything differently to make it easier for yourself?

Matt:                Yes, I would have, for sure.  The first thing is, I wouldn’t have kept working.  At the time, we had a mortgage and kids in school and it was a pretty tough time, but I do remember after one of the operations, I think I might have been out of hospital one or two days.  It was a very short period of time at home resting, then I flew down to Adelaide for a day’s work, for our business.  I was a mess that day.  I think I slept the entire way down in taxis, trains, planes.  I just was slept.  When I got there, I wasn’t on my game and coming back, I did the same thing.  Then I had physical ramifications the next day of just pushing myself too hard.  I think the first thing I’d do is find a way of stopping work for a bit, not permanently, but dropping back to part-time or something or other.

Running your own business, it’s actually a lot harder to do that than it looks, because you’ve got to bring the business in, you’ve got to deliver the business, you’ve got to build the business.  You’re doing it all yourself.  Now, we’ve got staff, but you’ve still got to run the ship.  My silliness was to try to keep doing that rather than just say, “Do you know what guys?  This week, forget about it, I’m not here.  I won’t be able to do a thing.  I’m not picking up the phone, I’m not doing my emails, I’m just doing nothing.  I’ve just got to go and get better.” It would have been better for me to do that the three times that I went to hospital.  That was a mistake.  I shouldn’t have done that.

I think the second thing, Joe, that I’ve learnt is that the ramifications of some of the treatment are not to be underplayed either.  I thought I was reasonably fit and I had come out the end with a smaller number of ramifications on my health than I did.  Therefore, my recuperation was a lot longer than what I thought.  Mentally and physically, I took four years out of the five years in my particular case before I actually started feeling at all well, to be honest.  To be brutally honest, I did not feel well mentally or physically for four years.  That became a real drag, Joe.  It was a drag on me, it was a drag on my family, on the business, because I just wasn’t feeling well.  I think that was a mistake.

I looked back over some of my notes and people were talking, that mental fog, for example.  Joe, you remember this, I’m sure.  That mental fog, that took a long time before that dissipated.  Then I had another procedure and I’d get it back again for a period of months.  I think I was a bit silly in thinking I would be coming out the end of the mental and physical implications of these treatments fairly quickly.  You don’t know until you’ve done it.  I would have been much wiser if I had gone, “I don’t know, I’ll see how I feel, then I’ll plan my way forward.” I didn’t do that, and it was stupid, you know?

Joe:                 Of course, you sometimes feel like you just want to break on through and sometimes that may not be the best way to go.

Matt:                Yes, that’s right, exactly right.  That’s well put, Joe.

Joe:                 Matt, what are the top three things that helped you deal with cancer on a daily basis, physically, mentally, emotionally?  What comes to mind?

Matt:                A great question.  Let’s take all of those three things.  Physically, I was very fit before the first of the three operations I had.  I’m very glad I did that.  In fact, one of the guys who I’m currently talking with through Cancer Connect, as a peer support person, I did make a big point of this, and it was interesting that the person I was speaking with said, “Well, as a matter of fact, I don’t think I’m that fit.  Maybe I do need to spend a lot more time getting fit, I don’t know.” I’ll tell you, I thought I was super fit, and I struggled getting through three operations in a period of 12 months, it just knocked me about.  I think getting fit physically is definitely one of the top three things.

I think mentally, and it may not suit everyone, Joe, but certainly my case, I needed to get real very quickly in my head about what this thing was all about.  I didn’t paper over it, I didn’t say, “It’ll be fine.  I’m sure the medicals, they know what they’re doing.  The hospitals are good, the treatments are proven.” I didn’t say that to myself.  I went, “Okay, I’m going to find a stack of problems in here.  I need to be realistic about this, it’s going to be a difficult process.

I need to get myself mentally ready to wrestle with this process and interact with it and make sure that I drive an outcome out of this that’s good.” I didn’t let it happen to me, I guess that’s the way, Joe, that I’m trying to express.  That I tried to get into the situation and drive it.  I think that helped a lot mentally.  It wasn’t happening to me, as opposed to me managing it.  If that makes sense?

Joe:                 Yes.

Matt:                I think the third area is around financially, yes, that’s a great question.  We had income protection, when I say we, the business and myself, so on the days where I just couldn’t work, I just couldn’t get out of bed and just mentally not there or physically not there, I had income coming in.  What I don’t think I did that well, which I’d probably change, if it ever happened to me, and touch wood it won’t.  That is that I needed to get my head into the space of, okay, I’m going to go backwards financially.  We’re going to owe more money at the end of this than we did.  Okay.

There’s nothing I can do about that.  I can’t be superman and try to work and do this thing at the same time.  I think if I released some of the pressure off me to keep some of the financial trendline going, so that we’re still making our savings target and still putting money towards that and doing those things.  I think if I’d been a little bit more realistic about not trying to do that, and just accepted the financial consequences for a period of time, I think that would have been a lot better.  It did cause some issues that were just unnecessary, in terms of clashes of dates, you know?  I can’t go into hospital that week because I’m going to be in New Zealand, so I’m going to do it the week after.  Stupid things like that.  I’ve been getting my head around, we’re going to go backwards.  I’m not going to be put so much pressure on me, let’s get this thing done at the optimum time.  Let’s not put it off, let’s go.  I think that would have been a better way of going, actually.

Joe:                 Yes, for sure, Matt.  I think one of the things that keeps coming through for me from what you’re saying, and I think that’s true for all of us guys, is that we just put so much pressure on ourselves to be this or that and it just takes us back, really.  It’s not helpful.

Matt:                You’re right.  It causes issues physically, emotionally, and financially that are unnecessary.  You’re right, you made a great point.

Joe:                 Yes, Matt.  Can you please talk about what Cancer Connect is?  I know you’re doing some fantastic work around that.  How does it work and why did you get involved?

Matt:                How does it work?  It’s one-on-one peer support, but it has a very important aspect of it.  That is that only first names are used, and we don’t share our phone numbers or anything about where we live.  Now, why that’s important is it enables two strangers to just talk about the facts, without worrying about anything.  I’m just Matt.  They don’t know who I am, where I live, what my phone number is, and I can just say – because they’re not going to ever work out who I am.  This is my experience, boots and all, this is what happened to me, and take from this experience whatever you can in terms of your own situation.  It enables a great deal of honesty.

I think that’s why it works.  To answer the second part of your question, Joe, why I got involved, it’s because it’s there.  It’s there.  I came across it, as you know me, because it was one of the organizations that I turned to in those early days of educating ourselves.  I thought, well, if they’ve got an opportunity there and I can help someone with my experience, then I’ll do it because it’s there.

Joe:                 Absolutely, and it’s one of those things that I only found out about it after the fact.  I found a brochure somewhere and I went like, “Why didn’t I know about this when I was going through treatment?”

Matt:                Yes, you know, in Australia, with only one exception, which is Darwin at the moment, and I’m sure the territory up there is working hard to address is, there are a lot of resources available in each of our capital cities.  We’re actually very blessed that way.  Most of the population has got a huge amount of state and federal help that they can get for very little costs, if not no cost at all.

Joe:                 Yes, you’re spot on, Matt.  I think there’s absolutely nothing like hearing about cancer experience from someone who’s been there, from someone who went exactly through what you’re going through, who’s been through this journey.  I know I spent a lot of time on forums online and I think that’s a good way to go, because it really gives you perspective of people who’ve been down that road before, right?

Matt:                Yes, exactly right.

Joe:                 Matt, I know that one thing that comes up for me and I think everyone going through cancer is the fear of it coming back.  Did that happen to you?  If so, what would you recommend to someone in terms of dealing with it in a better way?

Matt:                This is a really good question.  If you’d asked me that question a month ago, I would have given you a different answer than the one I’m going to give you tonight.  Actually, in the last 24 hours, I’m starting to have some symptoms that I had five years ago.  Now, I know they can’t be related to the same thing because I had that taken out of me.  I know that that’s not in my body anymore, that particular cancer, but because they’re the same symptoms, my emotional reaction is quite hard to manage.

It’s almost like my heart at the moment is overriding my head and I’ve already been to see my GP today and had a bit of a conversation about, let’s see what we can do here, just to allay some fears that are starting to come back.  It’s a big issue and I’ve noticed talking with others, that you don’t really ever get over this, you’re kind of on the watch, if I can call it that, forever.  You’re looking at the same symptoms, you’re thinking about what could be happening, you can’t turn that channel off.  It really comes down to, Joe, what can I do to manage this little emotional channel that’s going off all the time?  I certainly have found it very good to take up a particular type of sport.

Now, everybody’s got their preferences, but what I’m getting at is, you need to choose a sport that is a very mental sport as well as a physical sport because you’ve got to stop the thinking for a little bit.  You’ve got to give your mind a little bit of a break.  Now, you can do that in different ways, some people tell me they can do that with meditation.  They can actually turn their heads off and not have this emotional reaction when they’re meditating, great.  For some reason, I can’t do that, my brain just keeps going, I can’t stop it.  I find that this particular sport that I took up five years ago, which is surfing, tends to be very good for us blokes, because you can’t surf and think about something else at the same time.

You literally can’t.  It’s a bit like soccer, I’ve heard other blokes say, that’s interesting, it’s the same with soccer, you can’t play soccer and think about something else because you’re going to miss the ball or whatever.  I think my short answer to you is, you’re right, Joe, it’s a big issue, it’s a lot bigger than it looks and that we need to find this bloke something to do to turn off that emotional channel for a little bit and give ourselves a mental break from it.

Joe:                 Absolutely.  Do you find that something like doing things like Cancer Connect, where you’re doing something that is almost in a way bigger than yourself, do you find that that helps you, as well?

Matt:                That’s a great question.  Personally, I find it very rewarding to talk with someone who is full of questions and sometimes, talking it out can be a really good thing, as we often don’t do that, as you and I have been talking about already.  I find it very rewarding to just listen and go, yes, that sounds right, that sounds par for the course.  Just that thing where somebody feels like they’re being listened to and I’m not providing advice because that’s not what we do at Cancer Connect.  I also find a nice to be able to say to someone, if I think you’re in danger to yourself at the moment, I’m going to strongly recommend you go and get some help, because it’s not something to be trivialized.

I find that quite useful and just on occasion last week, not through Cancer Counsel, but another forum, I actually did take action on behalf of someone, I said, look, I just don’t think you’re coping and I think you need to talk to someone, I’m going to get someone to ring you.  You can make your decision on whether you’re going to want to take that call or not.  I found that was just a really rewarding thing to be able to do.

Joe:                 Good on you, Matt.  That’s such a fantastic thing to do.  I know that you have your own business with your wife and you mentioned that it was a challenge to keep it going.  What was it like and how did it all work out?  What did you learn along the way?

Matt:                Great question.  The first thing I noticed was not to tell people that I had it.  I noticed that the dynamic you get between yourself and a client when you divulge that you’re going through cancer is not what you expect.  I get it.  I totally get it from their perspective.  They need a service provided to them, they’ve used us before, they’ve got a very good outcome and they want the same outcome again.  They’re got a short period of time and there you are saying, “Look, as a matter of fact, I can’t do that today because I’m going into hospital.” Why are you going into hospital?  “Well, as a matter of fact, I’ve got cancer.” Then there’s this complete silence, Joe.

I learnt not to talk about it with clients, which is a bit unusual for me, I do like being open and transparent.  I just go and that’s not a good idea, I just simply said I wasn’t available.  The second thing was, we did need to get a lot more help in the business because I just wasn’t able to do what I normally did.  That cost us money and other bits and pieces.  It was a brutal reality.  We’re just not going to get through this unless we get some more help in here, that might mean that we don’t make as much profit, but so be it.  At least we’ll continue out the other end.  I think the third thing is, that my wife and I put in place rules about what we’re not going to talk about over dinner.

One of those things was actually me saying, “I don’t want to talk about cancer over dinner” and my wife would say, “I don’t want to talk about business over dinner.” We were not having very much to talk about at some points.  What I’m getting at is, she wanted to talk about cancer and I wanted to talk about the business.  We had a bit of a tense time there at the start.  Well, how are we going to do this?  I understand you want to talk about cancer.

When are we going to do that?  Vice versa with me wanting to talk about the business.  We found ways of doing that with morning walks and getting coffees and things like that.  Look, it’s a difficult thing, there are may more positives than negatives about working with your wife in the business, I think.  That’s when business is business as usual.  When you’re also dealing with cancer and you’ve got a business, yes, it puts a lot of extra stress on things.

Joe:                 Yes, I can imagine.  I know, Matt, you do a lot of work around coaching and to enable people to get to where they want to be in terms of their success.  Has cancer changed your perspective on that?  Is your approach now different?

Matt:                That’s a great question.  The answer is yes, but for an unusual reason.  As a professional workplace coach, we are, and I am, driven very much to get and outcome on behalf of our client, we’re there to support them in order to achieve their goals and the way they want them and, in the time,-frame they want.  Of course, sometimes, Joe, you know, in the process of supporting them, they didn’t do what they said they were going to do, or they didn’t do it in the time-frame, or sometimes they even changed their goals radically.  I think what my experience of coming through cancer has allowed me to do is go, alright, that’s alright, that’s okay, we’re human and sometimes what we set out to do is not what we’re ultimately going to do, or we’re not going to do it that particular way, or we’re not going to do it in that particular time-frame.

That is okay.  I’ve noticed that that’s a little counter-intuitive and some of my coachees are doing, “Well, that’s very refreshing, that’s really great.” Other times, my coachees have said, “Well, that’s weird.  Aren’t you supposed to continue keeping me up and making me accountable for my actions and so forth.” I was saying, well, actually, if you want to change your direction, and you want to change your timeframe, you want to change your goal, you want to change what you’re doing, that’s perfectly okay for me, my job, as your coach, is to support you.

It’s actually helped me a lot to reflect back on those times through cancer and the missteps that I made and the delays and all that sort of stuff, because now I’m able to apply it and it seems to actually help my coachees quite a bit.

Joe:                 Yes, that’s fantastic.  That’s really a completely different perspective.

Matt:                Yes, it has, indeed it has.

Joe:                 Matt, I know for me, cancer has really forced me to completely change my priority.  Probably forced is not the right word.  I chose to have completely different priorities in life, well, not completely different, but the way I look at life is definitely now different.  Did you go through a similar experience?

Matt:                I did.  I did.  I’m glad you’re asking that question because I want to say that before cancer, for me, the concept of work/life balance is just something you said in order to get a tick on the box, to say that you were aware of it.  I remember my GP every year going, how is it going with your work/life balance?  Yes, I’m going really well, this is what I’m doing.  I was paying lip-service to that, Joe, I must say.  Absolute lip-service to it.  I wasn’t taking it serious at all.  As soon as I got sick and had to deal with some of the implications of the illness, I started to get serious real fast about things like physical health and spending proper time each week maintaining my fitness.

Not just when I could fit it in, I was actually fitting my work-life around making sure I was physically fit.  I really turned it around.  The same thing with my mental health.  On those days when I had that fog, and I remember once, Joe, and maybe you had a similar experience, I was in a meeting with a client and we were adding up numbers to do with my proposal, or our proposal and looking for ways to get agreement on price, you know?  I was adding two numbers together going, “What?  That doesn’t even add up.” I just totally lost the ability to add two numbers together.  That’s a mental health problem.

That’s a real-life issue.  I do the same around that now, I actually never deprioritize the time that I need to ensure that my mental health is optimized.  I’ve got a little phrase that one of my coachees gave me the other day, which I thought was really very instructive.  She called it: De-speeding.  In other words, take the speed and the pace out of what I’m doing, so that I maintain optimal mental and physical health.  I think that’s a really beautiful little word.  It encapsulates what I’ve been doing.  I’ve bene de-speeding.  I actually don’t try to do as much as I used to do.  That’s had some pretty wide-ranging implications, you know?  I’ve decided there are certain types of clients that I don’t want to serve.

I don’t want to have as my clients and I’ve said no and turned away business.  That’s actually been a fantastic thing for my physical and mental health, because I’m under less stress and I have more time to maintain these optimal levels that I’m talking about.  The same thing with business partnerships.  I’ve decided there are certain types of partnerships that were just destructive.  There wasn’t a benefit in them.  We just stopped those partnerships, we just terminated them.  That was a very good thing to do.  To answer your question, prioritizing physical and mental health has now become an actual thing, rather than we just talking about it.

Joe:                 Yes.  You almost eliminate things by nature.

Matt:                Yes, exactly, right, Joe.

Joe:                 Matt, recently, I heard Brendan Beshad, who’s my favourite expert on self-improvement, I heard him talk about the perfect day and that most people don’t really know what it looks like for them.  They never really experience it.  You know what?  I’ve had so many perfect days since cancer because I started appreciating everything that I took for granted.  Every day.  I was actually conscious about how I was designing my day.  What’s your take on that?

Matt:                I think you’re right.  In fact, just listening to you then, I can think of a couple of examples today where I just paused and said a silent, “How grateful am I?” To myself, about what’s happening.  I’m much more aware of the good things that are happening, and I want to spend a little bit of time during my day actually celebrating that and going, “That was great.  That was really good.  As opposed to, oh no, look at my to-do list that’s three pages’ long.  I think you make a great point.  I certainly caught myself doing that.

Joe:                 Matt, if you had a minute with someone who recently got diagnosed with cancer, what would you tell them?

Matt:                I think I’d tell them two things, first of all, go and educate yourself as best as you possibly can and spend as much time as you can understanding what treatment options you’ve got, what the implications of them are, how long it’s going to take to recuperate and ask as many questions as you possibly can with the medical people you’re interacting with, to ensure that you know what you’re about to do, and that you can actually manage your own situation from a logical perspective.  The second thing I’d say is to do the same thing with your emotions.  Work out what types of emotions you are likely to feel by talking to people who have been through it, is it fear?  Fear of what?

Is it going to be the fear of the unknown?  I try to really be brutal about confronting the emotions that you’re feeling.  Here’s my thing and if you think you need help, you should go and get help to manage your own emotions.  The system, or the process, if you like, you’re going to go through, medically, is not going to help you at all in terms of self-management.  You’re going to have to look out for yourself and be ready to tell people how you feel and most important, if you just don’t think you’re doing it, you’re not managing yourself very well, then to stop and go, “Okay, I need some help, someone give me a phone number, I’m making a phone call right now.

I’m going to talk to someone about getting some help right away.  Someone gives me a phone number.” You’re going to have to do that because the process you’re going to go through is not really designed to help you manage yourself.  Does that make sense?

Joe:                 Absolutely.  That’s great advice, Matt.  I really want to thank you for your time and for your honesty, because that’s not easy, and for being able to articulate this incredible complexity that comes with cancer.  Thank you so much, Matt.  I really appreciate it.

Matt:                It’s been a great pleasure and, Joe, keep up the good work, you’re going a really good job just bringing this stuff to people’s consciousness.  Well done, you keep doing that.

Joe:      Thanks, Matt.  I will.