Cancer - Where are we going wrong? | Mid-Life Cancer Crisis

A guest article by Beata's husband John, offering ten suggestions for improving cancer care in the UK.
21st April 2015

This article has been sent with a letter to all the main political party leaders in the UK urging them to Do More for Cancer.

Introduction

There can be no doubt that significant advances have been made in preventing, diagnosing and treating cancer, but after decades of massive investment, education and policy development, the outlook for cancer patients remains very bleak and progress in finding a lasting cure for cancer seems painfully slow. Cancer is the number one fear of the UK public, ahead of debt, knife crime and other worries [16] reflecting the fact that cancer has such a devastating effect on so many lives; there can be few people whose lives have not been touched by cancer in some way.

Around half of us are now expected to get cancer at some point in our lives [1], up from one in four in 1975. While this increase is partly explained by the fact that more of us are living to an older age, where the risk of getting cancer is higher, the scale of the increase suggests that other factors are also contributing to the rise. This is also evidenced by increases in cancer rates among young people, which rose by around 20% between 1994 and 2010 [2].

Around half of us are now expected to get cancer at some point in our lives, up from one in four in 1975...only half will survive more than 10 years.

For those who are unlucky enough to get cancer, only half will survive more than 10 years and many of those that do will need extensive treatment over this period, with at least a quarter of patients being left with distressing long-term health problems or disabilities as a consequence [8]. Those that don’t fare so well can expect a gruelling treatment programme of toxic drugs, radiation and surgery, prolonging their lives but deferring the inevitable at the expense of reduced quality of life.

Average 5 and 10-year survival rates have improved slowly but steadily over the last 40 years [6] but there is a huge variation in survival rates for different cancers and recently survival rates for some cancers have got worse [7]. While improving survival rates is generally good news (putting aside for a moment the need for ongoing treatment and its side effects) this does not directly translate to improved life expectancy, as part of the improvement comes from earlier detection. So, if a cancer is detected earlier, a person could still technically ‘survive’ for longer even if the treatment failed to extend their life, as the survival period is measured from the point of detection. Obviously early detection is a good thing, as it should result in improved chances of being cured, but as there is no foolproof method of confirming that someone has been cured of cancer, we have no way of knowing how many people have truly beaten the disease.

When it comes to funding our treatment, while most of us are grateful that we have a public funded health service to rely on in the UK, cancer can also still result in significant financial difficulties for many, further adding to the burden on cancer patients. Cancer charity Macmillan identified that on average, 80% of cancer patients are hit with an average cost of £570 a month as a result if their illness [3]. And, as public funded treatments have to be rigorously tried and tested to demonstrate their effectiveness and value for money to the tax payer, the dependency on public funded health care often results in limited or delayed access to newer, more leading edge treatments that may be available in the private sector.

the UK lags behind other European countries of similar wealth and performs worse than average

There is also much to be dismayed about when we consider the UK’s performance on cancer survival compared to other countries. Research has shown that the UK lags behind other European countries of similar wealth and performs worse than average. In January 2011, the government set out a long term strategy aimed at improving the UK’s performance in a paper entitled “Improving Outcomes: A Strategy for Cancer” [4]. The strategy’s target is to bring the UK’s performance up to the average level for Europe by 2015, which it estimates will save an additional 5,000 lives a year.

The NHS spends around £7bn a year on cancer, more than any other condition except for mental illness. This is expected to grow significantly over time as more and more people are ‘living with cancer’. An estimated 2.5 million people in the UK are now living with cancer, up by 20% in the last 5 years [5]. This increase is largely due to improvements in survival and detections, meaning that people are being treated for longer.

an estimated 2.5 million people in the UK are now living with cancer

A lot of excellent work is being done by scientists, doctors, charities and politicians to improve the situation and the outlook is improving, but more and more patients are living with the side effects of long-term treatment and the escalating financial cost to the Tax Payer of treating increasing numbers of patients for increasing periods of time is unsustainable. The lack of real progress in overcoming cancer after decades of research and billions of pounds of investment is frustrating – cancer patients want and deserve better and policy makers should do more to examine why progress is so slow.

As a carer of someone suffering from ovarian cancer, a cancer with very poor outlook and few treatment options, I have no medical experience but I do have firsthand human experience of living with someone with cancer. Based on this experience, I believe that opportunities are being missed and cancer patients are losing out as a result. I would like to suggest ten weaknesses with the current system for managing cancer in this country; issues that, if addressed, could I believe make a material difference to the prospects for all cancer patients:

Only ‘Big Profit’ Drugs Get Developed.
‘Aim Low’ Cancer Strategy Unlikely to Achieve Breakthrough.
‘Prevention Strategy’ not part of ‘Treatment Strategy’.
Culture of Defensiveness and Superiority.
Inadequate Focus on Environmental Causes of Cancer.
No Central Process for Access to Clinical Trials.
Excessive Burden of Proof for Harmless Treatments.
Flawed Measures of Success.
One-Size-Fits-All Treatments.
False Abandonment of Hope.

Each of these is explored in more detail in the following sections, with an explanation of the perceived problems and possible solutions.

Issue 1 - Only 'Big Profit' Drugs Get Approved

Problem

For a new drug to be licensed and funded for use in the UK, it has to demonstrate that it is clinically effective, safe and also cost effective. This ensures that the NHS budget is allocated to drugs that are most likely to work, given the expected costs and benefits.

To demonstrate that a drug meets these criteria, it needs to go through extensive research and clinical trials to produce the evidence required. This can be a very costly process and drug companies invest hundreds of millions of pounds to bring new drugs to market. The pharmaceutical industry claims that the average cost of bringing a single new drug to market is £1.2bn [9] but others claim that the true figure is only around £50m [10]. However, whatever figure you believe, no commercial organisation is going to risk this level of investment in research and development for a new drug unless it can guarantee market exclusivity for that drug if it gets approved, so that it can name its price and get an adequate return on its investment. This is achieved by filing patents for the drugs, which enable the drug companies to stake exclusive claim to them.

only substances that can be patented, and therefore can produce a guaranteed return on the investment, end up being developed into new drugs

The consequence of this is that only substances that can be patented, and therefore can produce a guaranteed return on the investment, end up being developed into new drugs. Any substances that have clinical potential but no or limited profit potential, fall through the gap.

There are numerous substances which have been identified as potential candidates for cancer treatments, but which have not been developed for use as they cannot be patented. These include existing low-cost drugs used for treating other conditions (off-label drugs like artesunate [14 and metformin [15]]) and other natural and chemical compounds like high-dose vitamin C [11], ginger [12] and dichloroacetate [13].
There seems like an enormous missed opportunity here and cancer patients are being let down by a system which depends too much on commercial motives rather than clinical opportunity. This seems morally incomprehensible given the number of people who are suffering and dying from cancer every year.

Potential Solutions

the problem could be addressed either by much greater public funded independent research or by new incentive structures that reward the private sector for investing in non-patentable treatments

It is for policy makers to find solutions to this issue but the problem could be addressed either by much greater public funded independent research or by new incentive structures that reward the private sector for investing in non-patentable treatments. Increased public investment in R&D would also provide greater competition in drug development, resulting in more cost reflective drug pricing and greater opportunities to bring more drugs to market.

In addition, the Government should look at overhauling the whole process of conducting clinical trials, as the high cost of putting a drug through clinical trials represents a significant barrier to entry for new drugs. While it is important to have robust evidence, it is counter-productive if the sheer cost of producing this evidence results in the exclusion of drugs that have clinical potential but are unlikely to generate sufficient income to recoup the costs of the trial process.

Issue 2 - 'Aim Low' Cancer Strategy Unlikely to Achieve Breakthrough

Problem

The UK Government has recognised that the UK’s performance in managing cancer is well below par compared with other European countries and it has developed a strategy to improve cancer outcomes. The Strategy aims to improve survival periods by focusing on measures to help prevention, earlier detection and improve treatment. This is all very laudable and worthwhile but it is simply not enough.

The strategy focuses only on incremental improvements with a mediocre target of bringing the UK up to the average performance for Europe. By doing so it hopes to reduce cancer deaths by 5,000 a year within 5 years; that is an improvement of just 3% in 5 years. There will be no prospect of a breakthrough in the battle against cancer while our aim is to do no better than other countries are already doing! And meanwhile, other countries will have invested more, set more ambitious targets and forged even further ahead of the UK.

Potential Solutions

The Government needs to set far more ambitious targets that reflect the growing impact that cancer is having on millions of lives

Research shows that cancer is the number one fear of the UK public. This needs to be reflected in the priority it is given in the Government’s plans. While it is good practice to improve the way we do things now, we also need to find new ways of doing things. The Government needs to set far more ambitious targets that reflect the growing impact that cancer is having on millions of lives. It needs to give cancer a much higher priority, invest more and develop a strategy that could make a material difference by tackling cancer from new angles and examining what is blocking progress, rather than simply making a marginal improvements to existing processes. There is clearly a mismatch between government priorities and public opinion when the UK Government declares its ambition to become a world leader in driverless cars but only has an ambition to be an average performer in Europe for preventing and treating cancer.

Issue 3 - 'Prevention Strategy' not part of 'Treatment Strategy'

Problem

hospitals offer patients sugary drinks, sweets and salty snacks while patients are having their chemotherapy; feeding the cancer at the very moment it s being treated

Decades of research have shown that there are many factors within our control that cause or promote cancer. We know this now more than ever. Lifestyle choices we make, our diets and how we take care of our health in general have all been shown to contribute to a biological environment conducive to cancer growth [17]. The Government and cancer charities spend large amounts of time and money educating us about measures that we can take to reduce our chances of getting cancer but, in my experience, none of this good advice finds its way into the treatment plans for patients. It’s as if the team working on improving ‘cancer prevention’ have no communication with the team working on ‘cancer treatment’. Most cancer patients are desperate to do what they can to help improve their prospects but at no point during the treatment consultations that my wife and I had did anyone offer us any advice on lifestyle and diet choices that could be taken, which might discourage cancer growth. As a blatant example of how incongruent the strategies for Prevention and Treatment are, hospitals offer patients sugary drinks, sweets and salty snacks while they are having their chemotherapy; feeding the cancer [18] at the very moment it s being treated! This is clearly a case of left hand not talking to the right.

Potential Solutions

The first thing that needs to change is to recognise that many patients want to play a greater role in their treatment and do things that may improve their prospects. We cannot expect to handover our medical dilemmas to doctors and for them to solve them all for us. We have to take responsibility for our own health too and many patients are keen to do this, given the chance and a little help.

Professor Robert Thomas, a consultant oncologist and Cambridge University lecturer, has written a book called “Lifestyle and Cancer“, which summarises lifestyle and diet choices which have shown solid evidence of their impact on cancer [19]. A good start would be to take these recommendations and turn it into practical handouts for patients. This would cost very little and give patients somewhere to start. But a longer term strategy would be to move towards more Integrative Cancer Treatment that combines conventional treatments with other synergistic strategies to support physical and mental health into personalised treatment plans that result in the doctors and the patients working as a team towards a shared goal.

Issue 4 - Culture of Defensiveness and Superiority

Problem

There seems to be an unwavering belief that existing processes can’t be bettered and that the NHS has the best treatment available for you, regardless of what may be on offer privately, through alternative medicine or from hospitals and clinics in other countries

The slow progress towards finding a lasting cure for cancer can partly be attributed to the difficulty of the challenge but it is also a symptom of a lack of innovation. Lord Saatchi recently described current cancer treatments as “the endless repetition of a failed experiment” [21], with only 5.6% of UK cancer patients receiving an innovative treatment. His attempt to introduce a new law to improve innovation in medical treatment (the “Medical Innovation Bill” [23]), was thwarted by people convinced that the status quo was better.

Lack of innovation often goes hand in hand with a culture of defensiveness, prejudice and reluctance to change and even as someone on the periphery of the medical system, it is not difficult to see that this is very much the case in the UK. There seems to be an unwavering belief that existing processes can’t be bettered and that the NHS has the best treatment available for you, regardless of what may be on offer privately, through alternative medicine or from hospitals and clinics in other countries. No amount of evidence can overturn this belief unless it has come from official NHS approved sources.

All this is despite that fact that the UK has a healthcare system that performs less well than many other advanced countries. Commenting on the British Medical Journal report “How the NHS Measures Up to Other Health Systems”, one commentator says of the UK “How is it that the population most confident that it will receive treatment of the highest possible standard, featuring the latest medical advances, actually has the worst survival rates in precisely those diseases that require the most up-to-date treatments?” [22].

Potential Solutions

Making any sort of change in culture is a long and difficult job but it must start by senior government officials accepting that there may be different and better ways of doing things. This message needs to filter down through policy makers, senior management and doctors and into new laws and regulations that encourage and support innovation.

There also needs to be greater freedom and autonomy for doctors to make recommendations based on information and evidence outside of the NHS. Doctors should be apprised of international developments, clinical trials and treatment options, so that this information can be passed on to patients. During our treatment consultations we were never advised abut treatment options that may exists outside of the NHS. With so few treatment options available in the UK we wanted more information about clinical trials and studies into new treatments abroad.

In a world where people can communicate and move freely across the globe, it is no longer acceptable to ignore or discount treatment options that people may have internationally or in the private sector simply because they are not recommended by the NHS. Other healthcare providers could, and often do, offer better solutions and the NHS should not blindly discourage any treatment outside of the NHS.

Issue 5 - Inadequate Focus on Environmental Causes of Cancer

Problem

many cancer causing agents are permitted for everyday use and form part of the products and services we regularly use

Cancer is not just an individual problem and responsibility. It is right that we should take personal responsibility for choices that we make that affect our health, but we depend on the Government, regulatory bodies and employers to protect our health where choices are made for us. How clean the air is, how healthy and safe our food and water is, how much stress we are put under at work – all of these things are environmental issues that influence cancer but are things that individuals can do little to affect. It may be surprising to some, but there is a list of cancer causing agents, or carcinogens as they are known [20]. Lab tests have proven that all of these things cause cancer. So, it is hard to believe that many of these cancer causing agents are permitted for everyday use and form part of the products and services we use every day.

With cancer incidence rates rising by more than can be explained by increasing life-expectancy, it seems highly likely that environmental factors are playing an increasing role in causing cancer, but the finger of blame is almost always pointed at individuals, citing smoking, obesity and alcohol as the main issues, despite improvements in some of these areas. The finger of blame is rarely pointed at governments and businesses to encourage them to regulate for, use and generate fewer cancer causing agents.

Potential Solutions

More research should be carried out into the use of and generation of carcinogens through manufacturing processes and by the products and services we regularly use, with a view to implementing increased regulation to better protect the public from harmful effects outside their control.

Statistics should be analysed to determine how much environmental factors are contributing to overall increases in cancer incidence rates, so that the problem can be understood and managed.

Issue 6 - No Central Process for Access to Clinical Trials

Problem

Cancer patients with very limited treatment options are often forced to consider trying new drugs that are being tested in clinical trials. Such new drugs offer the possibility of improved outcomes but come with greater risks as their effectiveness and side-effects are less well understood.

In the UK there are dozens of clinical trials going on at any one time across different hospitals and patients can apply to participate in trials anywhere in the country, not just at their nearest hospital. This fact alone is not well understood by patients.

When a patient has few options, they need to know about all the options available to be able choose a treatment plan that is best for them. However, there does not seem to be a centralised system for supporting patients in making this decision and doctors do not seem to be fully aware of all the trials taking place at other hospitals.

Patients have to do their own research to try to identify trials that they may be eligible for in other parts of the country

Patients have to do their own research to try to identify trials that they may be eligible for in other parts of the country; a task which is difficult for even the most medically literate of patients. We identified a clinical trial that my wife qualified for at our local hospital, although were not told about this by the hospital where she was being treated. There does not even seem to be a centralised website listing all clinical trials available in the UK; at first glance the Cancer Research UK website appears to offer this but we were advised by my wife’s oncologist that some trials may be excluded as the website only covers trials supported by the Cancer Research UK charity.

Potential Solutions

The NHS should develop and provide a centralised, independent system for doctors and patients to identify and select relevant clinical trials within the UK. This should include all trials being undertaken as well as those which have been approved but not yet started. Patients should be told how they can get access to the information about all clinical trials available to them.

Doctors should investigate all the clinical trial options available across the country before making recommendations to a patient. Where patients have few options or only options that offer little chance of success, doctors should also research relevant clinical trials that are taking place internationally and the Government should consider providing assistance to patients seeking to participate in clinical trials abroad.

Issue 7 - Excessive Burden of Proof for Harmless Treatments

Problem

There are many natural or non-prescriptions substances which carry little or no risk to patients, but which have shown some evidence that they could help with treating cancer. The internet is littered with accounts of patients who have successfully treated their cancer with nutrition, harmless supplements and lifestyle changes alone [26]. While these are anecdotal accounts, unsupported by robust statistics, clearly the evidence points to the fact that such methods can, in some circumstances, help people – as the saying goes, there is no smoke without fire.

harmless, low-cost dietary supplements with cancer fighting potential have to undergo the same rigorous and costly clinical trials as a highly toxic new drug; so as a consequence, none are ever recommended, as nobody is willing to fund the cost of producing the evidence

However, the NHS position on complementary and alternative treatments is to reject them all due to lack of evidence - nothing is recommended to a patient unless there is substantial evidence to support it. Of course the lack of evidence doesn’t prove that they don’t work, only that nobody has found the money to prove whether they do or not. Even harmless, low-cost dietary supplements with cancer fighting potential have to undergo the same rigorous and costly clinical trials as a highly toxic new drug; so as a consequence, none are ever recommended, as nobody is willing to fund the cost of producing the evidence (as there is no commercial benefit in doing so). So, promising complementary treatments that could help a patient are never recommended, even though they may involve very low risk and cost to the patient and the NHS

Potential Solutions

Harmless and low cost treatments should not be subject to the same onerous burden of proof as expensive and toxic drugs with lots of side effects. Patients should be told about treatments that have shown some evidence of helping with cancer, as long as it has not been proven that they don’t work. Doctors should also avoid using the “no evidence” justification for rejecting complementary and alternative treatments out of hand, as many do have some evidence of success, just not the quantity and quality of evidence currently sought before recommending a treatment.

There is already a recognised list of cancer causing substances (carcinogens) [20], broken down into categories based on the amount of evidence that exists supporting the fact that these substances are in fact carcinogenic. A similar list could be produced for low risk, low cost cancer fighting substances; natural and non-prescription substances where there is some evidence that they can help to treat cancer. This list would cite varying levels of confidence depending on the amount of evidence available e.g.

Substantial evidence
Some credible evidence
Reasonable to believe
Some limited evidence

Issue 8 - Flawed Measures of Success

Problem

When politicians and healthcare managers quote our performance as a country in tackling cancer they tend to look for a headline measure of success. The most commonly used measure of success for cancer treatment is the 5-year survival rate. This measures the percentage of people diagnosed with cancer who live at least 5 years after being diagnosed.

There are several problems with this way of measuring overall success:

it does not measure how many people have been cured, only how many live for 5 years
increased survival periods don’t necessarily equate to increased life expectancy, as earlier detection can simply mean that people are living with cancer for longer, not necessarily living longer
it ignores the consequences of ‘success’ – the negative effects on patients’ quality of life
it is too short term – most people would not view living for 5 years as “success”
it masks the wide variation in survival rates for different cancers
patients needing treatment for longer than 5 years risk being seen as less of a priority
it places a disproportionate focus on diagnosis and treatment rather than prevention as it ignores increases in the number of people getting cancer

There is a saying in business management that if you are not measuring it then you are not managing it. It is very true that what we measure is what we focus on, so with the 5-year survival rate as our headline measure, we inevitably focus most on increasing the percentage of people who live 5 years or more. This isn’t a bad thing on its own but it means that we are not focussed enough on finding a lasting cure for cancer; we are instead focused on finding treatments that will extend lives in the short-term, regardless of the consequences.

Potential Solutions

A more appropriate headline measure of success is long-term remission or cure. There is currently no reliable means of determining if someone has been cured of cancer. Current detection techniques are inadequate and fail to detect minute cancer cells that can remain after initial treatment, which can lead to a cancer reoccurring. This probably hampers progress towards developing a cure, as it cannot be proven that someone has been cured.

headline cancer statistics should measure longer survival periods and take into account the impact treatments have on patients’ quality of life

As a long-term initiative, the Government should consider investing more money in developing better detection and diagnostic techniques, which are able to confirm with greater certainty that a cancer no longer exists.

In the short-term, alternative headline cancer outcome statistics should be considered, which use longer survival periods, that better reflect patient’s aspirations, and which include a weighting or adjustment to reflect the impact treatments have on patients’ quality of life.

Issue 9 - ‘One-Size-Fits-All’ Treatments

Problem

The current clinical trial system for testing new drugs validates a new drug’s effectiveness by checking it works for a group of people with the same type of cancer. Once this has been confirmed and the drug has been approved and funded, it will be made available to people with the type of cancer it was tested against.

As clinical trials are very expensive, it is usually not possible to conduct narrow tests of specific sub-types of a cancer, so patients with the same cancer are usually put into the same group and an average response rate is determined for this group. This results in the development of one-size-fits-all treatments for people with that type of cancer, with the ‘best’ treatment being offered as standard (often called the ‘Gold Standard’) for that type of cancer.

although the average response rates across large numbers of people are reasonably predictable, there can be wide variations in response rates across different patients

In practice, when the treatments are given to patients, although the average response rates across large numbers of people are reasonably predictable, there can be wide variations in response rates across different patients; some patients respond to a treatment less well than others and in these situations another treatment could have been a better for them than the ‘Gold Standard’. This suggests that there are other factors that influence how effective a treatment is and that research needs to focus on smaller sub-groups of a cancer or even personalised treatments based on the tumour profile of individual patient.

There is also a presumption that all patients being offered the Gold Standard treatment are happy with the risks and benefits of the treatment compared with the risks and benefits of other treatments that performed less well on average. It could be that a patient is prepared to consider a treatment that is less likely to work but if it did is more likely to have a lasting effect. These sorts of patient interests are not considered in the one-size-fits-all treatment decisions.

Potential Solutions

To make drugs more personal to the patient and improve consistency of response rates for drugs within their target audience, drugs should be tested against narrower sub-types of cancer. This is probably not financially feasible given the high costs of the current clinical trial system for testing new drugs, so would depend on changes to the clinical trial system to facilitate cost effective research of new drugs aimed at smaller target audiences.

There should be a progressive move towards more personalised treatments, taking into account the individual tumour profile of the patient

There should also be a progressive move towards more personalised treatments, taking into account the individual tumour profile of the patient. Tumour sensitivity testing in the lab can determine how well a person’s tumour may respond to different drugs and should be used to help in selecting the best drugs to use. This is already common practice at some cancer clinics in other parts of the world and while there is no guarantee that lab-testing results will mirror real-life results, this data is at least personal to the patient and over time results can be accumulated to gain greater confidence in using personal lab-testing as a predictor of drug success.

Issue 10 - False Abandonment of Hope

Problem

Breaking the news to someone that they have cancer is not a job anyone relishes but sadly over 250,000 people a year in the UK have to be given this devastating news every year [27]. However, it is important that a cancer diagnosis is communicated for what it is, simply a diagnosis, and not a death sentence. All too often we read or hear about people being told they have “x months to live”. My wife was told this shortly after she was diagnosed – she was told she probably had between 3 and 5 years to live, but 8 at the most.

abandonment of all hope is inhuman and unjustified

Putting a short finite time limit on someone’s life effectively robs them of any hope for the future – it is unfounded and inhuman. A recent European Court case into whole-life jail terms without review, ruled that to remove any prospect of release from prison was inhuman and degrading [24]. Why is it therefore acceptable for a cancer patient to be told that there is no prospect of survival?

While patients deserve to be given the facts about their prospects, it is vital that doctors communicate clearly what the statistics mean and don’t overstate their meaning. Average statistics from the past can be quoted as a guide to possible future outcomes but abandonment of all hope is inhuman and unjustified. There have been many cases of people claiming to have recovered from incurable cancer – miracles can happen and no doctor should tell someone when their life will end.

In Australian Aboriginal culture there is a practice called “pointing the bone”, where people believed that if a Kudaithca, a ritual executioner, pointed a bone at you then you would die. So strong was this belief that it caused an emotional response that did indeed trigger some form of psychosomatic death. While this may be an extreme example, when someone you trust and respect tells you are going to die, this can have a very powerful effect on you.

Potential Solutions

Better guidelines should be given to doctors on communicating a cancer prognosis, particularly where the prognosis is bleak. While people shouldn’t be given unrealistic expectations, it is critical that doctors never put a finite time limit on someone’s life, as this is effectively imhuman and is only likely to accelerate the patient’s demise. Miracles can happen [25] - there is no such thing as false hope, only false abandonment of hope.

About The Author

My name is John Piears and this article is based on the experiences of me and my wife Beata.

I met Beata, in 2011 but in 2012 our happiness was cruelly snatched away from us when Beata was diagnosed with advanced ovarian cancer. She was only 38 at the time, much younger than the average age of 63 for this type of cancer.

Unfortunately there are very few treatments available for women with advanced ovarian cancer and Beata was told that the treatments on offer through the NHS could only extend her life by a few years at most. She has already had major surgery and twelve months of gruelling chemotherapy but her cancer is still growing and has now become resistant to some of the drugs.

Over the last two and half years, I have supported Beata as she has battled her disease and this article attempts to provide thoughtful observations and practical recommendations based on the cancer care we have experienced, both in the UK and abroad.

Beata is still battling her disease and is currently raising money for innovative treatments available in specialist cancer clinics abroad that are not covered by the NHS. You can find out more about Beata’s story and her fundraising appeal at www.MidLifeCancerCrisis.com.

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