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VISION, JANUARY 2017

Train to be a cancer ‘buddy’

vivors and caregivers, but it may not be suitable for patients currently undergoing treatment.

Registration has opened for the introductory cancer buddy training course in Johannesburg on 18 February 2017 to be run by CanSurvive Cancer Support.

The seminar covers all cancers; the various types of treatment; the emotional aspects, relationship building and need for recognition, as well as hospital etiquette. It also addresses palliative care.

Hosted by Netcare at their Auditorium in Sandton and the goal of the course is to train a group of volunteers to be able to assist cancer patients, helping and supporting them through their cancer journey.

Basic communication skills, positive language and non-verbal communication, listening, empathy and observation around a ‘patient active’ approach are also included.

The intention is to educate interested people about the disease and provide them with greater self-awareness and the required communication skills needed in preparation for talking to and visiting patients. Volunteers learn how to become tools to support those going through a crisis. Applications to attend the course are invited from any cancer sur-

CanSurvive buddies distributing Christmas gifts at the Charlotte Maxeke chemo clinic

Guest speakers from other organisations and an oncologist have been invited to talk to course members. Requests for an application form or any queries can be directed to Bernice Lass at bernicelass@outlook.com. A fee of R100 will be charged to book in order to cover lunch and other refreshments, but will be refunded if the application is not accepted. Applications close on 11 February.


VISION, JANUARY 2017 Another wonderful Wings of Hope Christmas Party with songs by Granville Michaels, ballroom dancing, great food, raffles and a wonderful audience of more than a 100 people. Happy new year to everyone.

Look good when dealing with cancer convenient access to ports. And short sleeves allow for easier blood drawing.

While makeup assistance is sure to be appreciated, clothes can cause the biggest issue. AWhatNexter mom writes about the alltoo-common issue of extreme weight loss during treatment. “I’ve already dropped more than 20% of my normal weight (from 121 lbs to just 94 lbs) … nothing I own fits anymore.”

Other WhatNexters advise that black yoga pants are the essential wardrobe item. “Basic black yoga pants and athletic wear can go a long way because of the stretch,” she writes. Pants with waist bands also work well, provided that they don’t put too much pressure on your middle and exacerbate nausea.

There is one small upside to this problem: it means you have to go shopping. Another member from one of the forums recommends a trip to the thrift store to get a minimal basic wardrobe with an emphasis on comfort.

One of today’s stranger fashion trends is young women wearing pajamas outside of the house. This means that cancer patients have an opportunity not only to dress comfortably, but still be up with the latest trend of the moment. One patient writes that she decided that “this is the best time to wear what I am comfortable in and say, ‘hey, I have cancer, so I have an excuse to go to the corner store in pjs and slippers and a coat if I feel like it.”

And while many women would not believe it, even male cancer patients can benefit from a shopping spree (contrary to popular belief, not all of us are born slobs). WhatNexter, Hussy, found that after diagnosis, her husband had a “knack for finding all the 90% off” items at clothes. As a result, she writes, “he looks and feels better in clothes that fit.”

It’s important to wear what makes you happy. When cancer arrives, the usual fashion rules go out the window. But when you can manage to dress well and stay comfortable in spite of the disease, those occasional looks in the mirror will give you a much needed boost and put the spring back in your step.

It’s important to find clothes that not only look good, but that are practical. This can mean certain tweaks to your usual style that you may not have considered. For example, clothes with buttons are easier to put on and take off than pullover tops. They also can provide easier access to doctors who need to administer IVs or tend to chemo ports. However, since chemo treatments can sometimes cause loss of feeling in the finger tips, you might want to opt for clothes with large buttons.

Tell VISION how you have kept your style and beauty during your treatments. What tips can you offer? This article is published by courtesy of What Next.com and more interesting articles can be found at www.whatnext.com/blog

Tops with larger neck openings – like boat necks – also provide

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VISION, JANUARY 2017

It’s time to revisit the right to assisted suicide and euthanasia

Collective South African

Voices for Cancer www.canceralliance.co.za

by Neil Kirby,director of healthcare and life sciences law at Werksmans Attorneys

The Cancer Alliance is a collective group of cancer control non-profit organisations and cancer advocates brought together under a common mandate, to provide a platform of collaboration for cancer civil society to speak with one voice and be a powerful tool to affect change for all South African adults and children affected by cancer.

There is a popular belief that one may, when unfortunate health circumstances present, choose to end one’s life. In certain countries that process is recognised and supported by law. In South Africa, however, the choice is not as simple. The withdrawal of treatment at a patient’s request is an instruction that is binding on healthcare providers pursuant to the provisions of the National Health Act(http://www.gov.za/documents/nationalhealth-act). But any other instrument, in circumstances where a patient is unable to make a decision, is not binding on them. Therefore, the concept of a living will is one that is without legal force in South African law.

the patient’s wishes as expressed when he was in good health should be given effect to.

A living will is traditionally a written document executed by a person while lucid, that indicates an individual’s choice or decision to end his or her life in circumstances where he or she is unable to make decisions for him or herself medically.

The next significant decision concerning assisted suicide was made by the Pretoria high court in Stransham-Ford vs Minister of Justice and Correctional Services. The applicant in this matter, suffering from advanced cancer, sought an order declaring that the medical practitioner who was to assist the applicant with a lethal agent in order for the applicant to take his life would not be held accountable and would be free from any civil, criminal or disciplinary liability.

Living wills are useful instruments to assist a patient’s family to make decisions on the patient’s behalf where the patient is, for medical reasons, unable to do so for him or herself.

The applicant achieved success in the application.

There is certain utility in having a living will but it remains legally inert.

The decision may provide useful precedent to another ailing individual who is incensed by the indignity of a suffering death, but euthanasia is by no means a legally endorsed procedure available to all.

Granting a death wish: South Africa’s euthanasia debate Matters of assisted suicide were first addressed in the high court in Cape Town in 1975. In the matter of S vs Hartmann, the high court was tasked with dealing with an appeal in respect of a doctor who had administered morphine to the deceased in circumstances where the deceased was suffering from a terminal carcinoma of the prostrate.

The primary issue that emerges from the Stransham-Ford judgment is the lack of legal architecture to deal with euthanasia, even though the right to die is constitutionally endorsed by the rights to life and dignity. Therefore, the question that the judgment leaves us with is not whether the Bill of Rights endorses euthanasia or the right to die but rather what we, as a society, must now consider as appropriate.

The high court found that the accused had committed murder notwithstanding the particular circumstances in which the morphine was administered to the deceased. The administration of the sentence took into account the particular circumstances in which the accused had acted and the court came to the conclusion that “this is a case, if ever there was one, in which, without having to be unfair to society, full measure can be given to the element of mercy”.

When is the right to die a right? Only in circumstances where the bearer is terminally ill, or may it be exercised by a healthy individual? Who will monitor the process, if anyone? May a third party object, and what will the status be of such an objection? How will it affect the payment of life insurance policies or potentially applicable medical scheme benefits?

The next occasion on which the South African courts were required to deal with assisted suicide arose in the Durban and coast local division of the high court in 1992, in the matter of Clarke vs Hurst NO and Others 1992.

The debate is complex but it must be carefully moderated as euthanasia, at least for purposes of South African law, is not about death and the right to die but rather the process of achieving that goal in the secure belief that one is exercising a constitutional right.

The matter concerned passive euthanasia; the patient was in a coma and unable to participate in any decision-making about his care or death. Interestingly, the patient did have a living will and the court relied on the existence of this document to assist it in coming to the conclusion to allow the passive euthanasia to proceed.

The existence of a living will does influence decisions when the patient is unable to make or participate in making decisions about his or her health and treatment.

The court examined the deceased’s quality of life prior to the onset of his medical condition, and the positions and decisions he had communicated to those around him during his lifetime in respect of his views and thoughts on euthanasia and the application to his circumstances of the provisions of a living will. The court concluded that

Perhaps it is time to dust off the Law Commission report on euthanasia and the artificial preservation of life from 1998 and reinvigorate the discussion we need to have about euthanasia and the right to die. Dying with dignity is as important as living in freedom.

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VISION, JANUARY 2017

Prejudice: first do no harm

James C. Salwitz, MD Dr. Salwitz is a Clinical Professor at Robert Wood Johnson Medical School.

Medicine is paradox. To save, we cut with sharp knives. We ignore pain, so that it will light the path to diagnosis.We give toxins to destroy toxic disease. We scold our neighbours when they neglect their health, even as we work ourselves to exhaustion, eat too much and evade exercise. We comfort the families of our patients, while ignoring our own. There is one contradiction, which by its very nature defines what it means to be a doctor. It is a foundational value on which the profession rests. We must care deeply about each person, while not caring about them at all. Doctors must be without judgement or prejudice, and must treat every person without regard to what they believe, what they have done or who they are. Murderer, mother or monster, saint, slum lord or sex offender, nurse, noble or Nazi, the physician is tasked to treat each as human and patient. This creed is not only every doctor’s calling; it is the utopian vision which Medicine offers the world.

He lectures frequently in the community on topics related to Hospice and Palliative Care and has received numerous honours and awards, including the Physicians Leadership Award in Palliative Care. His blog, Sunrise Rounds, can be found at http://sunriserounds.com I am concerned that this fundamental value may be in danger. It is not just the suddenly angry, callous, in-your-face society into which we have spun. Nor is it vicious Facebook assaults, or the increase in public acceptance of ostracising, biased, fear-laden rhetoric. Rather it is a change, perhaps the result of this furious flood of disrespectful national communication, which I sense in myself. I recently took care of a patient with advanced cancer … the type is not relevant, but the pain, loss and terminal nature is core. He grew increasingly terrified, as his life, part by body part, was stripped away. He desperately needed my help. The problem is that, frankly, I cared. I cared that he was an evil man. His life had been spent bringing abuse and hurt to others, and even though he was very sick, he continued to wreak misery upon his family. He was manipulative, condescending, hubristic and usurious. I found myself thinking that there was justice in his fear. It was hard to see any benefit or reason, let alone “good,” in helping him live even a little longer. The real horror, is that I had come to see him as “evil.” Such judgements may be rendered by family, courts, society or god. They are never the place of a physician. None-the-less, every time we met I could feel, in me, the bile of anger, frustration and sanctimonious judgement. I was sliding close to that line where prejudice would change my care, so that he might suffer more, as he so “deserved”. I am deeply disturbed by this case, because it is a gross deviation from how I have seen my patients and profession for so many years. I have learned to see, and without out judgement accept, human frailties and deviation as part of the constellation of each individual and to use those traits, even when other forums might judge, to guide and help each patient. I found myself feeling as if I might punish this man for his life, instead of returning him to it. The peril is that the shift in tolerance, diversity and compassion of our society may penetrate so deeply that it will poison even the healers. The national tumult may have affected my ability to treat this man because it gave me license to find righteous justification in anger. This is a frightening result. If this pathological societal conversation continues and spreads, if blame and hate grows, like a disease it may infect the whole of us. If its virulence is not stopped, the consequences may be catastrophic. While it is the role of all to be open, fair, accepting, and to recognize the sanctity of each person, this burden rests most heavily on the shoulders of the medical profession. It is our calling not only to care for the sick without judgement, but to teach the value of life. The altruistic voice of physicians must remind us of the beauty and potential of all persons, and we must help others see through fear in order to accept that while we may be different, we are more deeply the same. Any society which holds as less by anger, bigotry or hubris any person or people, has within it a spreading disease. Doctors must heal. They must guide and remind us that in the end, we are, one and all, human.

The value of cancer support groups Having cancer is often one of the most stressful experiences in a person's life. However, support groups help many people cope with the emotional aspects of cancer by providing a safe place to share their feelings and challenges and this is confirmed by Cancer.net. The groups also allow people to learn from others facing similar situations. Receiving a cancer diagnosis often triggers a strong emotional response. Some people experience shock, anger, and disbelief. Others may feel intense sadness, fear, and a sense of loss. Sometimes even the most supportive family members and friends cannot understand exactly how it feels to have cancer. This can lead to loneliness and isolation. Support groups allow people to talk about their experiences with others living with cancer, which can help reduce stress. Group members can share feelings and experiences that may seem too strange or too difficult to share with family and friends. And the group dynamics often create a sense of belonging that helps each person feel more understood and less alone. Support group members may also discuss practical information. This may include what to expect during treatment, how to manage pain and other side effects of treatment, and how to communicate with health care providers and family members. Exchanging information and advice may provide a sense of control and reduce feelings of helplessness. Many studies have shown that support groups help people with cancer feel less depressed and anxious. Support groups also help them feel more hopeful and enable them to manage their emotions better. However, support groups are not the right fit for everyone.

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VISION, JANUARY 2017 Although this study can’t prove that mindfulness causes more authentic behavior, which in turn causes greater well-being, there’s reason to believe this might be the case. When we pursue things that matter to us - whether it’s a new career or a budding romance - we sometimes feel overwhelmed by fear or self-doubt. Mindfulness could help us recognise these feelings and work through them, rather than getting stuck and paralyzed by inaction.

Can mindfulness help you be more authentic? According to a new study, mindful people might be happier because they act according to their values. For many of us, mindfulness is a relaxation tool - a way to cultivate calm and slow down in a frantic world.

Mindfulness could also help us notice opportunities and carefully consider them - she mentioned that her company’s hiring; maybe I’d be a good fit? - rather than moving forward on auto-pilot, rarely straying from our current path in life.

But that’s not all it can do. “Sometimes when I meditate, I can’t stop smiling,” a longtime practitioner told me recently. “I just want to jump up and go after my dreams!” And she could be onto something: According to a new study, one of the ways mindfulness improves our well-being may be by encouraging us to act authentically, according to our values.

And mindfulness might give us the extra thoughtfulness we need to remember our values in everyday situations - to say no to commitments that will exhaust us, to remember to be patient with our kids, or to take care of our bodies.

A group of Australian researchers surveyed more than 800 people, mostly undergraduate students, about their levels of mindfulness, well-being, and “values-based action.”

Life is full of decisions, big and small, and they can be guided by what truly matters to us - or by fear, stress, and inertia. Mindfulness may help us stay true to our inner compass, and follow it toward a better life.

Values-based action reflects how much progress you’re making toward the things that matter to you - your goals, self-improvement, and purpose in life - and how much you get distracted or discouraged along the way. For example, if you value compassion, you would rate yourself higher if you took time out of a busy week to check on friends who are struggling. The mindfulness measured here was participants’ ability to stay focused, minimise distraction, and avoid judging their thoughts and feelings.

This article Kira M. Newman originally appeared on Greater Good, the online magazine of the Greater Good Science Centre at UC Berkeley and can be found at http://tinyurl.com/jxqap2l

CONTRIBUTIONS FOR PUBLICATION VISION is an e-newsletter for cancer patients and caregivers and we would like to be able to provide information on suitable support meetings anywhere in South Africa so please, let us have your details for 2017.

In their analysis, the researchers found that more mindful people had higher well-being - with much of this link accounted for by their acting more in line with their values. This was the case for the various types of well-being measured in the survey, including the participants’ overall satisfaction with life, how much positive and negative emotion they experienced recently, and how positive they felt about their relationships, themselves, and the future.

Your comments, articles, and letters submitted for publication in VISION are always welcomed and can be sent to the Editor at: cansurvive@icon.co.za.

In other words, one of the reasons mindfulness may be so beneficial is because it helps us translate our values into action, to live authentically.

Let’s talk about cancer! Join us at a CanSurvive Cancer Support group meetings for refreshments, a chat with other patients and survivors and listen to an interesting and informative talk. Upcoming meetings: HEAD and NECK Group, Rehab Matters, Rivonia - 2 February 18:00 KRUGERSDORP Netcare Hospital Group - 4 February 09:00 PARKTOWN Hazeldene Hall (opposite Netcare Parklane Hospital) - 11 February Enquiries: Mobile 062 275 6193 or email cansurvive@icon.co.za www.cansurvive.co.za : www.facebook/cansurviveSA The Groups are open to any survivor, patient or caregiver. No charge is made. The Groups are hosted by Netcare.

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VISION, JANUARY 2017

Finding comfort through therapeutic writing

the timing of when. Usually patients will wait until they have a confirmed diagnosis and treatment plan, and then make others aware. You may even want to jot down the reactions you received from specific friends and coworkers, as well as family members.

A cancer diagnosis can elicit a wide range of feelings, many of which can be difficult to express. Writing therapy, also called expressive writing, during your cancer experience can help you understand your diagnosis, work through those feelings and reflect on what the disease means to you, your family and your friends.

Consider asking a friend or family member to help you update others about your condition using a weekly e-mail, social media site or an online blog. These tools allow others to stay informed about your situation without feeling intrusive. They also eliminate the hassle of conveying the same message multiple times.

According to several studies, writing therapy can even help boost your emotional well-being, reduce your cancer-related symptoms and improve your physical abilities. In one clinical trial recently published in the Journal of Clinical Oncology, people with cancer who participated in writing therapy rated the severity of their symptoms (such as pain and distress) much lower than those in the control group. They also scored higher in their physical abilities (such as walking up stairs and carrying groceries). In another study, people with cancer who wrote about intensely emotional experiences for 15 minutes per day for four consecutive days made fewer illnessrelated trips to the doctor. Their lung and liver functions also improved, and their blood pressure decreased.

Maintaining your personal relationships is vitally important for your emotional health, and writing therapy is another way to keep open those lines of communication, especially when in-person visitors are not recommended. You may decide to share other things beyond medical updates, such as what books you’re reading and what recipes you’re enjoying, on e-mail or through social media. Expressing When you want to avoid adding to your loved ones’ emotional load, you can turn to personal expressive writing. Expressive writing allows you to document your emotional developments, manage your worries and doubts, and work through all of your diverse thoughts and feelings, such as hope, anxiety, sadness, fear, joy and relief. It may also help alleviate some of the unsolvable questions churning in your mind, such as “Why me?” or “What did I do to deserve this?” Keeping a private journal will allow you to write more deeply and honestly than you might in your public messages.

Effects like these are not uncommon. As a result, cancer centres in the US have started to include expressive writing programmes as a complementary therapy option to help people process their diagnoses and cope with them more effectively. Best of all, it doesn’t cost anything and it doesn’t require you to be a proficient writer either. There are many ways to express your feelings through writing therapy:

No matter what you choose to write about, never worry about perfection. Right and wrong do not exist in the realm of therapeutic writing, so simply write what you feel.

Tracking You can track your symptoms, side effects, medication adherence, pain levels and more, which will help you become a more educated and empowered patient. Share this information with your health care team, so they can monitor your progress accurately and effectively and provide additional help, when necessary. Do it each day. It doesn’t require a lot of time. Just one word and a number for your pain level for example is sufficient. It has been proven that if patients wait until a week or two and try to retrospectively recall their symptoms, they will be inaccurate.

When you have completed your acute treatment, go back to the beginning of your expressive writing and read over the parts of your cancer journey you chose to write about. You may even choose to continue to do journaling as you take the next step of transitioning into short term then long term survivorship. For those with advanced metastatic cancer, expressive writing is also very therapeutic. It gives you perspective. Again what you choose to share is your personal decision. Consider however if you want to also write to specific family members and friends about the importance they have had and will continue to have in your life, while you are still here and even after you are gone.

Reflecting Reflecting involves looking back on your experiences and analysing how they made you feel, how they fit together and what you can learn from them. You can focus on philosophical questions, such as “How did this happen?” and “What does it all mean?” Or you can focus on smaller, more direct questions, such as “Should I try to get more exercise?” and “Am I adhering to my medication schedule?” “What can I do to reduce my risk and my family’s risk of getting cancer in the future?”

Reprinted with permission from Patient Resource LLC. Copyright 2017, Patient Resource LLC. www.patientresource.com. Editor’s note: When diagnosed with cancer, my reaction was to collate as much information as I could about surviving and spread it around to other survivors and caregivers. Hence VISION was born.

Sharing What you share is up to you. Remaining completely silent about your cancer diagnosis and treatment experiences can make you feel isolated and may force others to speculate about your condition, so sharing some information is recommended. But, you don’t have to be an open book. It’s up to you to decide what information to share and with whom, as well as

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VISION, JANUARY 2017 should either not be removed or, if absolutely necessary, be removed only with a clipper.

WHO Guidelines:

Shaving is something that has "long been assumed was necessary to facilitate skin exposure," Dr Kelley said. However, after extensive review of the evidence and lengthy discussion, the expert panel concluded that "hair removal can actually increase the risk of causing microscopic cuts or traumas to the skin, and the evidence tells us there is clear benefit to not removing the hair or simply clipping it if it absolutely needs to be done," Dr Kelley said.

29 ways to prevent surgical site infections New guidance on preventing surgical site infections (SSIs) from the World Health Organization (WHO) recommend that patients bathe or shower before surgery but that they not be shaved, and that antibiotics be used immediately before and during surgery but not afterward.

The guidelines also spell out the best way for surgical teams to clean their hands, what disinfectants to use before incision, which sutures to use, and the best approach to the use of drapes and gowns for preventing SSIs.

The Global Guidelines for the Prevention of Surgical Site Infection were developed by a panel of experts who reviewed the latest evidence on preventing SSIs. They include 29 concrete recommendations to be applied in the pre-, intra-, and postoperative periods.

Although the guidelines are intended for surgical patients of all ages, some recommendations do not apply to the pediatric population, owing to lack of evidence or inapplicability. This is clearly stated in the guidelines.

The guidelines are valid for any country and are suitable for local adaptation. They take into account the strength of available scientific evidence, cost and resource implications, and patient values and preferences, the WHO says. The guidelines complement the WHO Surgical Safety Checklist by providing more detailed recommendations on SSI prevention, the agency says.

"No one should get sick while seeking or receiving care," MariePaule Kieny, PhD, WHO assistant director-general for health systems and innovation, said in a news release. "Preventing surgical infections has never been more important, but it is complex and requires a range of preventive measures. These guidelines are an invaluable tool for protecting patients."

The new guidelines, if implemented, will save lives, reduce harm, cut costs, and limit the spread of antibiotic resistance, the WHO predicts.

"I really welcome on behalf of doctors this set of guidelines," Dame Sally Davies, MD, chief medical officer, United Kingdom, told reporters at the briefing. "It's WHO at its best ― evidence-based, normative guidelines that are straightforward and simple to use. We all know that we've got to use our resources carefully, and you tell us when to use them and when not to use them in this, and that's terribly important," she added.

Huge burden, highly preventable SSI is an issue that "concerns everyone," Ed Kelley, PhD, WHO director of service delivery and safety, said during a press briefing. "There are no reliable estimates or global database or registry tracking exactly the number of surgical site infections that occur every year, but WHO estimates that millions of patients are affected by surgical site infections annually," he added.

http://www.medscape.com/viewarticle/871312?nlid=110510_184 2&src=WNL_mdplsfeat_161108_mscpedit_wir&uac=98558SG&sp on=17&impID=1230745&faf=1

SSI is "highly preventable," Dr Kelley said, and the new WHO guidelines are "the most extensive set of global guidelines ever produced on this subject."

PSA and male cancer support group

Until now, no international evidence-based guidelines had been published, and there are inconsistencies in the interpretation of evidence and recommendations regarding existing national guidelines, the WHO notes. The guidelines were published online in November, 2016 in two separate articles in the Lancet Infectious Diseases.

Monthly support groups are held at the

The guidelines say it is "good clinical practice" for patients to bathe or shower before surgery, and they recommend either plain soap or an antimicrobial soap.

Boardroom at MediClinic, Constantiaberg, Plumstead

With regard to the timing of the use antibiotics, there is evidence that antibiotics given before surgery can prevent infections for certain surgical procedures, but there is no evidence that use of antibiotics after surgery prevents infections, the guidelines say.

For more information contact: Office: 021 782 9113 or 021 761 6070. Helpline: 076 775 6099

The recommendation is to administer surgical antibiotic prophylaxis within 120 minutes before incision and that consideration be given to the half-life of the antibiotic. "Obviously, the selection of the antibiotics, the exact appropriateness of the antibiotic for a given patient is up to the clinician," Dr Kelley noted.

Email: info@can-sir.org.za. Web: www.can-sir.org.za Our grateful thanks to Medi-Clinic for providing a home for our activities and refreshments for our members. It is much appreciated by us all.

No Shaving The guidelines "strongly" discourage shaving at all times, whether preoperatively or in the operating room. The guidelines say that hair

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VISION, JANUARY 2017

CALENDAR

CONTACT DETAILS

January 2017 11

CanSurvive Cancer Support Parktown Group, Hazeldene Hall, Parktown 9:00

28

Wings of Hope, Netcare Auditorium, Sandton. 10.00

30

Cancercare Support Group, Rondebosch Medical Centre, Look good, feel better - appearance does count.

CanSurvive Cancer Support Groups - Parktown and West Rand : CanSurvive Head and Neck Support Group, Rivonia, Johannesburg Contact: 062 275 6193 CancerCareSupport Group, 4th Floor, Rondebosch Medical Centre. Contact: linda.greeff@cancercare.co..za or phone 0219443700 for more info GVI Cape Gate Support group: 10h00-12h00 in the Boardroom, Cape Gate Oncology Centre.| Contact: Caron Caron Majewski, 021 9443800

February 2017 1

CanSurvive Cancer Support West Rand Group, Netcare Krugersdorp Hospital, 09:00

4

Bosom Buddies Support Group, Hazeldene Hall, Parktown at 09:30 for 10:00

6

CanSurvive Head and Neck Support Group, at Rehab Matters, 1 De la Rey Rd. Rivonia at 18h00

8

CanSurvive Cancer Support Parktown Group, Hazeldene Hall, Parktown 9:00

18

CanSurvive buddy training day, Netcare Auditorium, Sandton from 08:00 to 17:00. Email bernicelass@outlook.com for enrolment form.

23

Cape Gate Oncology Group, Oncology Centre 10:00. Nutrition during treatment.

27

Cancercare Support Group, Rondebosch Medical Centre, Giving back as part of healing.

1

CanSurvive Cancer Support West Rand Group, Netcare Krugersdorp Hospital, 09:00

6

CanSurvive Head and Neck Support Group, at Rehab Matters, 1 De la Rey Rd. Rivonia at 18h00

11

CanSurvive Cancer Support Parktown Group, Hazeldene Hall, Parktown 9:00

11

Wings of Hope, Netcare Auditorium, Sandton. 10.00

23

Cape Gate Oncology Group, Oncology Centre 10:00. Cancer and depression. Bosom Buddies Support Group, Hazeldene Hall, Parktown at 09:30 for 10:00

GVI Oncology Somerset West Group for advanced and metastatic cancers. Contact person: Nicolene Andrews 0218512255 Can-Sir, 021 761 6070, Ismail-Ian Fife, info@can-sir.org.za Helpline: 076 775 6099. Cancerbuddies@centurion: Marianne Ambrose 012 677 8271(office) or Henriette Brown 0728065728 Pastoral Counsellor More Balls than Most: febe@pinkdrive.co.za, www.pinkdrive.co.za, 011 998 8022 Prostate & Male Cancer Support Action Group, MediClinic Constantiaberg. Contact Can-Sir: 079 315 8627 or Linda Greeff 0825513310 linda.greeff@cancerbuddies.org.za Wings of Hope Breast Cancer Support Group 011 432 8891, info@wingsofhope.co.za

March 2017

25 27

PinkDrive: www.pinkdrive.co.za, Johannesburg: febe@pinkdrive.co.za, 011 998 8022; Cape Town: Adeliah Jacobs 021 697 5650; Durban: Liz Book 074 837 7836, Janice Benecke 082 557 3079 Bosom Buddies: 011 482 9492 or 0860 283 343, Netcare Rehab Hospital, Milpark. www.bosombuddies.org.za. CHOC: Childhood Cancer Foundation SA; Head Office: 086 111 3500; headoffice@choc.org.za; www.choc.org.za CANSA National Office: Toll-free 0800 226622 CANSA/Netcare Support Group 10:00 Clinton Oncology Centre, 62 Clinton Rd. New Redruth. Alberton. Second Friday each month. CANSA Pretoria: Contact Miemie du Plessis 012 361 4132 or 082 468 1521; Sr Ros Lorentz 012 329 3036 or 082 578 0578

Cancercare Support Group, Rondebosch Medical Centre, Coping with family when going through cancer treatment.

Reach for Recovery (R4R) : Johannesburg Group, 011 869 1499 or 072 849 2901. Meetings: Lifeline offices, 2 The Avenue, Cnr Henrietta Street, Norwood

April 2017 1

CanSurvive Cancer Support West Rand Group, Netcare Krugersdorp Hospital, 09:00

6

CanSurvive Head and Neck Support Group, at Rehab Matters, 1 De la Rey Rd. Rivonia at 18h00

8

CanSurvive Cancer Support Parktown Group, Hazeldene Hall, Parktown 9:00

20

Cape Gate Oncology Group, Oncology Centre 10:00. Living with pancreatic cancer.

22

Wings of Hope, Netcare Auditorium, Sandton. 10.00

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Cancercare Support Group, Rondebosch Medical Centre, Nutritional focus after treatment maintaining your health.

Reach for Recovery (R4R) : West Rand Group. Contact Sandra on 011 953 3188 or 078 848 7343. Reach for Recovery (R4R) Pretoria Group: 082 212 9933 Reach for recovery, Cape Peninsula, 021 689 5347 or 0833061941 CANSA ofďŹ ces at 37A Main Road, MOWBRAY starting at 10:00 Reach for Recovery: Durban, Marika Wade, 072 248 0008, swade@telkomsa.net Reach for Recovery: Harare, Zimbabwe contact 707659. Breast Best Friend Zimbabwe, e-mail bbfzim@gmailcom Cancer Centre - Harare: 60 Livingstone Avenue, Harare Tel: 707673 / 705522 / 707444 Fax: 732676 E-mail: cancer@mweb.co.zw www.cancerhre.co.zw

May 2017 1

CanSurvive Cancer Support West Rand Group, Netcare Krugersdorp Hospital, 09:00

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VISION, JANUARY 2017 of breast and pancreatic cancer, according to the study. Chemotherapy drugs are usually administered to cancer patients every few weeks at a high "maximum tolerated" dose. Though this approach kills the majority of tumour cells, it often spares a small number of tumour-initiating cells (TICs) that subsequently give rise to new tumours. Moreover, these recurring tumours are often more aggressive and able to metastasise to other tissues, in part because high doses of chemotherapy drugs also affect cells in the stromal tissue that surrounds tumours, including immune cells and blood vessel endothelial cells.

News in brief Preventing C. diff in patients with blood cancer undergoing bone marrow transplant Clostridium difficile infection, commonly known as C. diff. is the most common and costly infection for hospitalised patients undergoing bone marrow transplantation for the treatment of blood cancer. However, a recent study found that the standard antibiotic treatment for the infection, oral vancomycin, may be able to prevent the occurrence of C. diff.

Khttp://www.medicalnewstoday.com/releases/314350.php

Tobacco companies target African kids Despite tobacco companies’ commitment not to promote cigarettes to children, they are doing exactly that in Africa.

C. diff causes diarrhea and can lead to severe inflammation of the bowel. The infection is uncomfortable and can result in other severe medical complications, along with longer hospital stays and increased treatment costs. Last year, the American Journal of Gastroenterology published a paper that calculated the average costs of C. diff to range from $8,911 to $30,049 per patient.

Tobacco companies are aggressively marketing cigarettes to African school children in an attempt to expand their markets. This is according to the African Tobacco Control Alliance (ATCA), which surveyed 79 schools in five countries and found a high density of cigarette sellers on the doorsteps of primary and high schools.

In the trial, which was conducted at the Abramson Cancer Centre at the University of Pennsylvania, researchers gave vancomycin to 73 patients on a preventive basis - twice daily from the day of admission until the day of discharge. They focused on patients with blood cancer undergoing allogeneic stem cell transplants. These patients have their immune systems repressed so as not to reject the bone marrow from the healthy donor. However, this leaves patients at a high risk of life-threatening infections.

School children were also able to buy loose cigarettes and “childfriendly” flavoured cigarettes aimed at encouraging new smokers. There was also open advertising of cigarettes by shops and hawkers

US cancer deaths are dropping

Of the 73 patients who received vancomycin prophylactically, none of them developed C. diff within their stay at the hospital - an average length of 33 days. Of the 55 patients studied who did not receive the vancomycin, 11 (20 percent) developed the C. diff infection. This result is on par with the national average of between 20 percent and 30 percent.

The cancer death rate in the United States has dropped 25 percent from a peak in 1991, mainly due to a steady decline in smoking and advances in early detection and treatment of tumours, new research released Thursday shows.

“This is the first study to evaluate this preventative strategy in stem cell transplant recipients, and the results are encouraging. This may become the standard of care at Penn among patients receiving allogeneic stem cell transplants,” lead author Alex Ganetsky, Pharm.D., clinical pharmacist in the Blood and Marrow Transplantation Program at Abramson, said in a statement.

The rate decrease means there were about 2.1 million fewer deaths between 1991 and 2014, according to an annual report by the American Cancer Society (ACS). "The continuing drops in the cancer death rate are a powerful sign of the potential we have to reduce cancer's deadly toll," ACS chief medical officer Otis Brawley said.

Ganetsky added that this strategy could potentially be used in other populations, for example, patients with acute leukaemia who are being hospitalised for other types of treatments could potentially be the next to be evaluated.

The decreasing death rates were most pronounced for patients suffering from four major types of cancer - lung, breast, prostate and colorectal. Lung cancer deaths among men plummeted by 43 percent between 1990 and 2014, and by 17 percent among women between 2002 and 2014, according to the research published in CA: A Journal for Clinicians.

However, researchers want to be sure to pinpoint the best use of this drug through further study, to avoid overuse and antibiotic resistance. http://tinyurl.com/jokwo5b

The breast cancer mortality rate for women decreased by 38 percent between 1989 and 2014.

Low-dose chemotherapy regimens could prevent tumour recurrence in some cancers

The drop is even more dramatic among men suffering from prostate cancer - 51 percent between 1993 and 2014 -- and in colon cancer deaths among both sexes, which plunged 51 percent between 1976 and 2014.

Conventional, high-dose chemotherapy treatments can cause the fibroblast cells surrounding tumours to secrete proteins that promote the tumours' recurrence in more aggressive forms, researchers at Taipei Medical University and the National Institute of Cancer Research in Taiwan and University of California, San Francisco, have discovered. Frequent, low-dose chemotherapy regimens avoid this effect and may therefore be more effective at treating certain types

Cancer remains the second most prominent cause of death in the country, behind cardio-vascular ailments.

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VISION, JANUARY 2017 Developing new drugs, however, is a very lengthy and expensive process and many promising drugs fail clinical trials because of unanticipated toxicity and side effects. Thus, finding new targets for drugs already in use to treat other diseases, in other words drug repurposing, is an emerging area in developing anti-cancer therapies.

near the schools despite tobacco marketing restrictions in many countries. “There were 47 cigarette outlets outside a single primary school in Benin,” ATCA executive secretary Deowan Mohee told journalists at the release of the report, ‘Big Tobacco, Tiny targets’ .

Identification of anti-hypertension drugs as potential therapeutics against breast and pancreatic cancer metastasis was a big surprise. The targets of these drugs were not know to be present in cancer cells and therefore no one had considered the possibility that these drugs might be effective against aggressive cancer types, says Professor Ivaska.

Schools in Nigeria, Cameroon, Burkina Faso and Uganda were also surveyed, and at most schools there were outlets selling cigarettes within sight of the schools’ premises. “The sale, advertising and promotion of cigarettes outside schools is a well-orchestrated strategy of the tobacco companies,” said Mohee. “They are trying to hook school kids in an environment away from their parents where there is peer pressure. They are trying to create a reservoir of replacement smokers.”

http://www.medicalnewstoday.com/releases/314832.php

According to ATCA research, 21 percent of young African men and 3 percent of women use tobacco products. The World Health Organisation estimates that tobacco smoking will become the leading cause of death on the continent by 2030 unless there is a serious effort to curb the promotion of smoking. “African governments need to enforce laws banning the sale, advertising and promotion of cigarettes and tobacco products around schools,” said Mohee. https://www.health-e.org.za/2016/12/09/tobacco-companies-target-african-kids/

Depressed patients are less responsive to chemotherapy

Ovarian cancer drug given fast-track approval The anti-cancer drug Rubraca (rucaparib) has been granted accelerated approval by the US Food and Drug Administration to treat advanced ovarian cancer. The approval is limited to cases where the cancer is caused by specific gene mutations known as "deleterious BRCA." BRCA genes normally repair damaged DNA and are designed to prevent tumour growth, the agency said in a news release. But mutations in these genes could lead to cancer. Rubraca is designed to inhibit a certain enzyme that's produced by a damaged BRCA gene.

A brain-boosting protein plays an important role in how well people respond to chemotherapy, researchers report at the ESMO Asia 2016 Congress in Singapore.

More than 22,000 women are projected to be diagnosed with ovarian cancer this year, and more than 14,000 are projected to die from the disease, according to US National Cancer Institute estimates cited by the FDA.

A study has found that cancer patients suffering depression have decreased amounts of brain-derived neurotophic factor (BDNF) in their blood. Low levels make people less responsive to cancer drugs and less tolerant of their side-effects.

The FDA simultaneously approved the FoundationFocus CDxBRCA diagnostic screen. This screen detects the presence of deleterious BRCA mutations in the tumours of women with ovarian cancer, the FDA said.

Lead author Yufeng Wu, head of oncology, department of internal medicine, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China, said: "It's crucial doctors pay more attention to the mood and emotional state of patients. "Depression can reduce the effects of chemotherapy and BDNF plays an important role in this process."

Rubraca was evaluated in clinical studies involving 106 women with BRCA -mutated advanced ovarian cancer. Fifty-four percent of participants given Rubraca had a complete or partial shrinkage of tumours, lasting an average of 9.2 months, the agency said.

Low mood is common among cancer patients, especially the terminally ill. BDNF is essential for healthy brain function and low levels have already been linked with mental illness. This study aimed to discover how depression influenced outcomes for people with advanced lung cancer. http://www.medicalnewstoday.com/releases/314840.php

Certain high blood pressure drugs block cancer invasion By screening already approved drugs, a team led by researcher Guillaume Jacquemet and Professor Johanna Ivaska has discovered that calcium channel blockers can efficiently stop cancer cell invasion in vitro. Calcium channel blockers are currently used to treat hypertension, also known as high blood pressure, but their potential use in blocking cancer cell metastases has not been previously reported. Cancer kills because of its ability to spread throughout the body and form metastases. Therefore, developing drugs that block the ability of cancer cells to disseminate is a major anti-cancer therapeutic avenue.

The most common side effects of the drug included nausea, fatigue, vomiting, anemia, abdominal pain, unusual taste sensation and loss of appetite. The drug was also associated with bone marrow problems, acute myeloid leukemia and harm to a developing fetus, the FDA warned. http://tinyurl.com/zaus5rh

Why are apricot kernels considered good for fighting cancer? Some people regard a compound called amygdalin, which is found in apricot kernels, as a secret weapon to attack cancer cells, eradicate tumours, and prevent cancer. Amygdalin is a naturally occurring substance found in apricot kernels. Amygdalin is also present in other seeds of fruit including apples, cherries, plums, and peaches. Amygdalin can also be found in plants such as clover, sorghum, and lima beans. When amygdalin is eaten, it converts to cyanide in the body. Cyanide is a fast-acting, potentially deadly chemical. Cyanide prevents the cells in the human body from using oxygen,

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VISION, JANUARY 2017 which kills them. As the heart and the brain use a lot of oxygen, cyanide is more harmful to those than other organs. Research suggests that 0.5-3.5 milligrams of cyanide per kilogram of body weight can be potentially lethal. It is estimated that eating 50-60 apricot kernels would deliver a lethal dose of cyanide. Cyanide poisoning can occur at much lower levels, however. Web sites that promote the consumption of raw apricot kernels recommend between 5-10 kernels per day for the general population and up to 60 apricot kernels per day for people with cancer. People who follow these dose recommendations are likely to be exposed to cyanide levels that cause cyanide poisoning. The European Food Safety Authority (EFSA) warned that a single serving of three small apricot kernels or one large apricot kernel could put adults over the suggested safe levels of cyanide exposure, while one small kernel could be toxic to a toddler. The EFSA advise that no more than 20 micrograms of cyanide per kilogram of body weight should be consumed at one time. This limits consumption to one kernel for adults. Even half a kernel would be over the limit for children.

Taxol, then, takes those cells that are likely to be cancerous because they are mis-segregating their DNA a little bit, and pushes them over the edge. That finding will help Weaver learn how to identify those patients who will benefit from Taxol. "Because we don’t know how to predict a benefit, each case that is eligible to be treated with Taxol is, and there are side effects,” Weaver said. “We can now start to look for biomarkers of tumours that are prone to mis-segregating their DNA, and that will allow us to identify the 50 percent of patients who will benefit from Taxol treatment.” So why did it take three decades of Taxol use to begin to understand how it works and who will benefit? Weaver said she was able to elucidate the clinical mechanism of action because of a defining feature of the Carbone Cancer Centre: lab researchers working in partnership with clinical experts. “I needed a clinical trial to get breast cancer samples from patients at the right time during Taxol treatment,” Weaver said. “I cannot design one myself, and I can’t run it, so we really need these collaborations between physicians and basic scientists.”

AMERICAN INSTITUTE FOR CANCER RESEARCH

http://www.medicalnewstoday.com/articles/314337.php

The difference between an antioxidant and a phytochemical

Divide and conquer strategy for fighting cancer

Antioxidants are substances that prevent damage to cells from highly reactive, unstable molecules called “free radicals.” A balance between antioxidants and free radicals in our body is important for health. If not kept in check, free radicals lead to cell damage linked to a variety of chronic diseases. Phytochemicals are naturally occurring compounds in plant foods such as fruits, vegetables, whole grains, beans, nuts and seeds. In laboratory studies, many phytochemicals act as antioxidants, neutralising free radicals and removing their power to create damage. Some nutrients, like vitamins C and E and the mineral selenium, seem to block free radicals directly not only in the laboratory, but within the human body, too. When it comes to phytochemicals, however, lab test results don’t accurately depict effects in the body. In fact, many of the phytochemicals that show high antioxidant scores in lab tests can't even be absorbed from the gut. However, healthful bacteria in the colon may break down many of them, forming other compounds that can be absorbed.

For more than three decades, Taxol has been the most widely used chemotherapy drug to treat a variety of cancers. Still, it only benefits half of patients treated with it, and no one really knows why. “We knew in a dish in the lab that cancer cells treated with Taxol were getting stuck in mitosis, or when they were trying to divide, and preventing cells from dividing is one way to stop cancer,” said Beth Weaver, PhD, a faculty member at the UW Carbone Cancer Centre and McArdle Laboratory for Cancer Research who studies how DNAcontaining chromosomes separate during cell division. “We assumed it was working in patients the way it was working in the lab.” Through a collaboration with UW Carbone Cancer Centre medical oncologist and researcher Mark Burkard, MD, PhD, Weaver obtained samples from breast cancer patients who had been treated with Taxol. She found that the idea of the past 30 years was incorrect: the concentration of the drug tested in the lab was much greater than the amount that entered a patient’s cancer cells. She needed to study lower, clinically relevant concentrations to understand how it benefits cancer patients.

Phytochemicals and the compounds that form from them seem to act in a variety of ways to protect health. Some can increase cancer cells' tendency to self-destruct; others may stop carcinogens before they have a chance to begin the process of cancer development. They may also block the development of new blood vessels tumours need. Some fight inflammation.

Instead of getting stuck and not being able to divide, it turns out that the cancer cells are dividing, but their DNA is mis-segregating and going in all the wrong directions. “At clinically relevant concentrations of Taxol, most cells divide into two cells as they should, but the DNA is dividing in three or four or five directions,” Weaver said. “Those two daughter cells did not get the right set of DNA.”

Many phytochemicals also seem to support our body’s ability to balance antioxidants and free radicals. The human antioxidant defense system includes a complex network of enzymes and other compounds working with one another and with antioxidant nutrients supplied by food. The important take-home message from today’s research is that we need a wide variety of plant foods in our diet to get the full spectrum of phytochemicals available to protect our health. Loading up on any one phytochemical or antioxidant just isn’t the same.

This notion of aneuploidy, where cells have incorrect amounts of DNA, has long been thought to be a hallmark of cancer, particularly the more aggressive ones. Weaver’s research is confirming but also challenging that thought. “We found previously that aneuploidy is weakly tumour promoting, but it can also suppress tumours,” Weaver said. “A little of it is good for the cancer, but a lot of it is bad.”

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VISION, JANUARY 2017

Probe may aid in complete removal of cancer tissue during surgery An optical fibre probe can distinguish cancer tissue and normal tissue at the margins of a tumour being excised, in real time, by detecting the difference in pH between the two types of tissue. This has the potential to help surgeons avoid removing too much healthy tissue during surgery and also avoid performing additional surgeries later to remove any cancer tissue left behind, according to a study published in the journal of the American Association for Cancer Research. “We have designed and tested a fibre-tip pH probe that has very high sensitivity for differentiating between healthy and cancerous tissue with an extremely simple experimental setup that can already be used in a fully portable configuration,” said Erik P. Schartner, PhD, a researcher at the School of Physical Sciences and the ARC Centre of Excellence for Nanoscale BioPhotonics (CNBP) at The University of Adelaide in Australia, working in collaboration with the Breast, Endocrine & Surgical Oncology Unit at the Royal Adelaide Hospital. “Because it is cost-effective to do measurements in this manner compared to many other medical technologies, we see a clear scope for broader use of this technology in operating theaters,” he added. A major issue with current surgical techniques to resect cancer is the lack of a reliable method to identify the tissue type during surgery; therefore the surgical procedures rely extensively on the experience and judgement of the surgeon to decide on how much tissue to remove around the tumour margins, Schartner said. Because of this, surgeons often perform what is called cavity shaving, which can result in the removal of excessive healthy tissue. On the other hand, many patients do not have the entire tumour removed during the initial surgery, and will need a follow-up surgery to remove residual cancer tissue. “This is quite traumatic to the patient, and has been shown to have long-term detrimental effects on the patient’s outcome,” he added. http://tinyurl.com/hc3egoh

Incidence of metastatic prostate cancer in older men Increases The incidence of metastatic prostate cancer in older men is rising after reaching an all-time low in 2011, according to new research from Weill Cornell Medicine and NewYork-Presbyterian investigators. The findings suggest a correlation between the increase and a change in prostate cancer screening guidelines recommending against routine prostate-specific antigen (PSA) testing. In their study, published December in JAMA Oncology, the investigators used a national cancer database to identify 400,000 men over the age of 40 who were diagnosed with prostate cancer between 2004 and 2013. They found that in men over 75, both the incidence of metastatic prostate cancer and the proportion of men

with aggressive cancer increased since 2011. The researchers say their results may reflect the downstream effects of the US Preventative Services Task Force’s (USPSTF) recommendations against routine PSA tests, and underscore the need for healthcare policy leaders to reevaluate their approach to prostate cancer screenings. “It’s what most of us would have predicted, although somewhat sooner,” said lead study author Dr. Jim Hu, the Ronald P. Lynch Professor of Urologic Oncology at Weill Cornell Medicine and director of the LeFrak Centre for Robotic Surgery at NewYork-Presbyterian Weill Cornell Medical Centre. “There was a decrease in prostate cancer metastasis and death after the advent of PSA testing. Remove the screening and the rates of serious disease rise again.” http://tinyurl.com/jy3m9po

Amendments on usage of dagga for medical purposes only, warns SAMA The South African Medical Association (Sama) has warned the public that the proposed amendments to allow for the medical use of dagga would be implemented along strict guidelines. “On 23 November, Parliament’s Portfolio Committee on Health announced that the Department of Health would soon regulate access to medical cannabis for prescribed health conditions,” said SAMA chairperson Mzukisi Grootboom. “The public, and healthcare professionals, should note, however, that the Medical Innovation Bill seeks to allow cannabis for medical purposes only. The bill, and the regulatory framework to be introduced by the Health Department, do not apply to cannabis for recreational purposes, which remains illegal in South Africa.” Grootboom said the difference between recreational and medicinal dagga (cannabis) “created worldwide confusion”. A process by the World Medical Association (WMA) to develop a position on medical dagga, emphasised the need to make a clear distinction between recreational and therapeutic use, he said. The range of conditions for which medical dagga was used varied from country to country and was informed by varying degrees of scientific evidence. “As a professional medical body with prime concern for patient safety and protection, SAMA subscribes to the principle of evidencebased healthcare and maintains that policy decisions on medical cannabis should be based on high-quality scientific evidence,” said Grootboom. He added that regulations needed to adequately provide for the safe prescription and dispensing of dagga and that medical prescription of the drug should only be dispensed at a pharmacy. “Even with careful regulation of medical cannabis, experience from other countries shows that the risk of counterfeit ‘patients’ abusing cannabis medication for recreation, or for profit, remains a problem.” http://tinyurl.com/j9q5xqz

DISCLAIMER: This newsletter is for information purposes only and is not intended to replace the advice of a medical professional. Items contained in Vision may have been obtained from various news sources and been edited for use here. Where possible a point of contact is provided. Readers should conduct their own research into any person, company, product or service. Please consult your doctor for personal medical advice before taking any action that may impact on your health. The information and opinions expressed in this publication are not recommendations and the views expressed are not necessarily those of CanSurvive or those of the Editor.

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2017 VISION January newsletter