Extra help tips if you are recovering from cancer

Almost everyone who has ever had cancer recognizes it. The fear that you will get sick again or that the disease will get worse. Even when doctors claim that everything is completely fine, something still gnaws. Tilly Overbeek knows that feeling. Ten years ago she got colorectal cancer. ‘Fortunately, I have been cancer-free for years now. Yet it remains somewhere in the back of my mind: as long as it doesn’t come back. The investigations are always exciting. At the same time, I am very sober. Fear should not rule my life. I want to look ahead.’

Not everyone is as optimistic as Tilly. ‘Unfortunately, the body does not have a button that you can press to get certainty’, says psychologist Coen Völker of the Helen Dowling Institute, which provides psychological support for cancer. He has to deal with people on a daily basis who find it difficult to deal with their fear. “Sometimes fear takes over your life.”

Five Steps Against Anxiety

Together with psychologist and ex-cancer patient Jan Verhulst, Coen Völker wrote the book Angst na cancer (2018). Fortunately, there is something that can be done about fear, says Völker. ‘There are five steps, summarized in the acronym ‘HOPPA’.

• The H stands for recognizing the symptoms: how do you know you’re scared? After your illness, you may be more irritable and angry at the slightest. Often you are actually not so much angry, but afraid. You worry about the future. Once you know that, you can continue working on it.’
• The next step, the O, is examining the fear. Völker: ‘What exactly are you afraid of? You can use help from your environment here. Give people the opportunity to ask questions about how you deal with your uncertainty, what concerns you have. After all, you can feel very different from what you show on the outside. What you feel and what you fear can be different for everyone.’
• The first P stands for talk. ‘Some people find it difficult to talk to their partner’, says Völker, ‘but you can also talk to someone in the immediate vicinity, if necessary an outsider or social worker. It’s really a relief when you can confide in someone. On the internet you will find all kinds of lists with tips for a good dialogue or a comforting conversation.’
• The second P stands for trying. Coen Völker: ‘The best method for dealing with fear and uncertainty differs per person. So try out what suits you best. For one it helps to do more sports, the other needs medication or a therapist. Remember, there’s nothing wrong with seeking help if you can’t figure it out on your own.’
• Finally, the A stands for acceptance. ‘That turns out to be very difficult for many people. But fear can be lessened if you accept that it is there. Yes, there is an insecurity that makes you vulnerable. Yes, you have less control over your life than you always thought. But that uncertainty is there, so you better take advantage of it. Make that fear an ally. See fear as a bodyguard who tries to protect you, even if it often bothers you.’

Anxiety and stress are there for a reason, says Völker. “Your body makes stress hormones because it’s trying to take care of you. Without fear you would take too many risks, drive way too fast, you would not jump aside in time when a car suddenly arrives. The fear tells you to be alert. That is why patients check their bodies more often and go to the doctor more quickly if they feel something is not right. Extra alertness isn’t bad at all. Also trust your own resilience. People turn out to be capable of much more than they had previously thought.’

Eat when you’re not hungry

Nutrition is very important in cancer recovery. ‘Due to the disease and the treatment, the body mainly needs extra proteins,’ says Harriët Jager-Wittenaar. As a lecturer at Hanze University of Applied Sciences Groningen, she has been researching malnutrition for years. “These proteins are needed to build muscle mass. But at the same time, your metabolism is disrupted. We call this metabolic dysregulation. Your body is not utilizing the nutrients properly. In addition, your brain tells your body that you are full. So you have to eat a lot to be able to recover when you’re actually not hungry.’

In some patients there is an additional problem: nausea. Jager-Wittenaar: ‘That means you eat less. This is not without danger. If you are deficient in calories and protein, you will lose weight. That may sound positive, but it isn’t. Because you don’t lose so much fat, you mainly lose muscle. You then have less muscle power and less brain power. This means that you are more tired and can also become depressed or anxious.’

Protein keeps you going

How can you best counter this? Harriët Jager-Wittenaar: ‘Proteins, proteins, proteins. These can be found in meat, fish, egg and dairy products. Don’t you like a sandwich anymore? Just eat the topping. And add some yogurt. Dairy products with extra proteins are for sale in the supermarket. Those extra proteins are also in special diet foods; it comes in all kinds of flavors. This can be reimbursed by the health insurance. Ask your doctor or nurse about this. They can also refer you to a dietician.”
Eating enough sounds easier than it is. The side effects of the treatment and the disease do not make it easy to get enough. Jager-Wittenaar: “It helps if you regularly eat a block of cheese or a slice of sausage in between. And what milk does in your coffee. Don’t focus on fruits and vegetables. Extra vitamins will not help you, and if you eat a lot of vegetables or fruit you will feel full sooner.’

Which also helps: eat different flavors than you are used to. Tilly Overbeek has also experienced this. During her chemotherapy for colorectal cancer, she preferred to eat things with a strong taste. Jager-Wittenaar: ‘Because of the disease and the treatment, your brain can transmit different signals when you taste or smell something. This gives the food a different taste or smell. This differs per patient, but it can happen that you find something you liked very much before the treatment, then suddenly find it very dirty. That makes it even more difficult to get enough nutrients. But the reverse also applies. If you used to think buttermilk was sour and dirty, it can now suddenly taste wonderfully fresh.’

Try out new things, advises Harriët Jager-Wittenaar: ‘Think outside the box. You can suddenly find surimi sticks very tasty – and surimi contains a lot of protein. Also try out unusual combinations. I know someone who suddenly loved macaroni with frikandellen. Above all, choose something that you like yourself.’

Sports in cancer

In addition to diet, exercise is also important in cancer recovery. Many patients think it is best to take it easy in the week before their treatment, so that they can go into surgery rested. But physical activity can actually help you. ‘The fitter you go into treatment, the fitter you come out of it,’ says Martijn Stuiver. He is a lecturer at the Amsterdam University of Applied Sciences and conducts research into how cancer patients can best recover physically. ‘Sport and exercise play a central role in cancer recovery,’ says Stuiver. “Recovery actually starts before the treatment.”

Exercising when you have cancer: it seems too much of a task. Tilly Overbeek followed such an exercise program after her heavy treatment for colon cancer. “I didn’t like sports at all,” she says. ‘I walked at most half an hour a week. Now I suddenly had to go to the gym, run on the treadmill and work with all kinds of equipment in the gym. It seemed terrible to me. There were all people like me in the group. It was sometimes confrontational when someone couldn’t keep up. People from the group also died. But you could talk about it, that was very important. And even though the chemo made it almost impossible for me to stand on my feet, I still believe that it eventually helped me get back on my feet. In fact, I still exercise.’

Every step is good

Not only before and after, but even during cancer treatment, exercising helps. Researcher Martijn Stuiver: ‘There are indications that structured exercise during treatment can limit the harmful effects of that treatment. More and more studies confirm that picture.’ What does he mean by ‘structured movement’? Stuiver: ‘Let me state that every step is good. Every extra step already yields a profit. So my most important tip is: no matter how tired or bad you may feel, try to avoid inactivity. Of course that is easier said than done. However, you will notice that fatigue or nausea decreases if you exercise more.’

Stuiver recommends that you exercise ‘moderately intensive’ for at least 150 minutes per week as soon as possible after the treatment. ‘That can be running or cycling, but also a brisk walk. It depends on how fit you are. Also do strength and stretching exercises so that you stay limber and strengthen your muscles. At least as important: do something you enjoy. This can also be a team sport, for example. That way you last a lot better.’

For extra motivation and the right advice, you can visit specially trained physiotherapists, which can be found at www.onconet.nu or www.nvfl.nl. Many hospitals also offer personal exercise programs.

This article originally appeared in Plus Magazine October 2018. Not yet a Plus Magazine subscriber? Becoming a subscriber is done in no time!