Issue 128 a day in the life of

A DAY IN THE LIFE OF . . .

UPLIFTED BY MAGGIE’S: AN ALTERNATIVE ‘DAY IN THE OFFICE’ Liz Waters RD Macmillan Dietitian and Nutrition Course Facilitator Having worked for 20 years with individuals being non-surgically treated for cancer in the NHS, Liz was flattered to be asked to facilitate nutrition sessions within Maggie’s Merseyside.

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The opening of Maggie’s Merseyside1 offered me a new challenge, as I was invited to provide the nutrition sessions within the centre, which has morphed into facilitating the Nutrition Course and providing nutritional input to the Psychological Support Course entitled ‘Where Now?’ Working within Maggie’s required a shift in my usual professional role as a clinical NHS dietitian - there are no case notes to view, no blood tests to check, and there is no institution to be restricted by. The ethos of Maggie’s is to provide free practical, emotional and social support to people with cancer and their family and friends, following the ideas about cancer care originally laid out by Maggie Keswick Jencks.

Recognising that the individuals attending the course have potentially differing cancer diagnoses and treatment journeys, with their own experiences along the way, can mean that it’s challenging to get it right for everyone. The participants are usually made up of a number of ladies with a breast cancer diagnosis (with all the permutations that can bring: triple positive, ER negative, etc) and then those with other cancers, such as head and neck right through to anal, including blood and skin. The interactions between group members can result in firm friendships, or some disagreements in the sessions, so requires a recall of group management techniques on my behalf.

Week One: A varied group - ladies with breast cancer, a gentleman who has successfully been treated for leukaemia and a lady struggling with the advice being given by her dietitian following gastroesophageal surgery: “All fatty and sugary foods I don’t usually eat…but

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www.NHDmag.com October 2017 - Issue 128

my weight is still dropping.” I cover the evidence base for cancer survivors using the guidance from World Cancer Research Fund (WCRF),2 advising that although this is based on healthy eating, for some, it may suit better to think of it as ‘eating for health’ to fit their individual needs. I link this in with other guidance on healthy eating such as the NHS’s Change for Life website.3 I state that this guidance is for all, so perhaps family members or friends may change their habits too. To ensure all nutritional thoughts are captured, I hand out blank ‘thought bubbles’ asking that all queries or points for discussion are ‘captured’ when they are had, recognising the potential effects of ‘chemo brain’ on memory recall.

At the end of the session the lady struggling after surgery turns to me and says, “I’m not ready for this yet. I need to follow the advice of my dietitian.” I advise that she does; she doesn’t return the following week.

Week Two: Portion sizes, including red meat and alcohol. An eye opener for most and a bit of fun with it, as I include a practical session on comparing the calorie content of alcoholic drinks with food items. Alternative drinks are discussed and smoothies/juices only promoted within the 150ml recommendation.4 Portion sizes in relation to fruit and vegetables are debated, generally the portion of what we commonly call broccoli (green trees) compared to its correct name of calabrese. Most realise

the benefit of portion control and are pleased to be referred to the British Dietetic Association’s Food Fact sheets5 covering these topics.

Week Three: A wider discussion about healthy living and the bigger picture with potential controversies cleared up, plus weight management and how individuals are tackling this. Some supportive words come from one of the ladies who has completed the same chemo regime as another, but a few weeks ahead, whose weight has started to reduce. The advice regarding physical activity can sometimes be a challenge for those struggling to get off the couch, but allows for signposting to health and wellbeing services such as ‘swim buddies’ or walking groups.

The guidance around sun safety and the vitamin D debate results in a lively discussion, with brand names being swapped for ‘lighter’ high SPF creams being the result, ensuring that the UVA rating6 is considered as well. Last, but not least, bowel habits and the recommendations about increasing our wholegrain consumption and achieving the recommended 30g per day fibre intake.7 In previous groups, I’ve had those who continue with a low fibre diet to control symptoms, but yearn for “something brown”. A ‘no, no’ for some then, although another practical exercise about the difference in fibre content between various food items such a breakfast cereals, pasta and rice brings a few surprises. For those in need, I highlight the toilet card8 that can be used for urgent comfort stops and where to obtain them.

Week Four: Generally, the session everyone attends - superfoods and antioxidants, busting the myths. One of my first group attenders reminds me regularly how she continues to advise that “there is no such thing as a superfood”, so an eye opener for all that this is simply a marketing term and has no scientific basis. The myth busting exercise utilises Cancer Research UK’s evidence9 and this time brought about an interesting discussion regarding the complementary/alternative diets that are promoted as ‘cancer cures’ with one member of the group. This was heightened by the guidance that additional vitamin and mineral supplements10 shouldn’t be taken unless specifically advised to do so, for example, the calcium and vitamin D supplements taken by some in the group.

Week Five: Sometimes an awkward week, as the participants are realising the bonds between them are growing stronger and their knowledge has increased, but the course is nearly over. This week I aim to widen the focus to encourage the participants to move on from simply ‘nutrition and cancer’ to thinking of diet, activity and overall health, as everyone should. Clearing up the complexity of food labelling11 starts off the session with the topic winding along to ‘best before/use by/sell by’ dates, common food allergens and how these are labelled. The session draws to a close after discussing the differences between food production and storage methods, fresh, tinned and frozen in relation to growing your own and the seasonable eating message.12 Week Six: The final week, when I have invited the participants to perhaps bring along some food or drink items to share, to celebrate the role of nourishing ourselves as a social activity.

I encourage final thoughts to be submitted, perhaps drawing on those ‘thought bubbles’ from Week One and recipe swapping to occur.

Often contact details are passed between participants and I request that the evaluation forms are completed on behalf of Maggie’s.

Fortunately, these always reflect well on my delivery of the sessions, which have on occasion been referred to as ‘laughter therapy’ due to confessions regarding alcohol intake, or not knowing the difference between a garlic bulb and a garlic clove for a recipe!

Each time, the participants depart with a great sense of thanks for enabling them to have grown in their nutritional knowledge, feel empowered in their food choices and able to enjoy it as part of their lives. For others, it can be more significant - they can eat without fear that what they are consuming will harm them, believing it will make their cancer come back. Personally, to be able to make such a difference by using my dietetic knowledge, a wide evidence base, my communication skills and years of experience to benefit others, is a real pleasure. Maggie’s has provided me with the challenging opportunity to have an uplifting ‘day in the office’. I would encourage others to feel challenged and do something different from ‘the day job’. www.NHDmag.com October 2017 - Issue 128

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