Advocacy pays off!

In 2014 we set out with the vision of an equitable and sustainable breast cancer policy for all. This policy was approved in April and was officially launched in East London on Friday. This is indeed an achievement! This means that our advocacy pays off.

Even though the policy was approved – the policy is by far not complete as there are still gaps in the policy. The decision was to focus on Phase 1 to ensure that the treatment aspects are in place before focusing on the community awareness and clinical breast examination as well as the supportive care and palliative care aspects. Other gaps are the provisioning of lymphoedema and prosthetic services. We need to make sure that these aspects get the attention that they require in the future.

The policy will be implemented first in five treatment centres: Groote Schuur in Western Cape, Helen Joseph/Charlotte Maxeke in Gauteng, Frere and Livingstone in Eastern Cape and Universitas in Bloemfontein. All of these were selected as they are already in line with the breast policy.

The Breast Cancer policy is at  http://www.health.gov.za/index.php/shortcodes/2015-03-29-10-42-47/2015-04-30-08-18-10/2015-04-30-08-24-27?download=2300:breast-cancer-policy-2017.

You may also be aware of the Tobeka Daki Trastuzumab Access Campaign. Trastuzumab is included in the policy and subsequently added to the Essential Medicines List. This in itself is also a win as there was quite a resistance from the EML Committee to add traztuzumab due to cost. This has opened the case for trastuzumab to be included as a PMB for private sector clients. There are already some patients that are approaching their respective funders.

Access to trastuzumab in the public sector in particular depends on the successful completion of negotiations for an acceptable price, as explained in the BDLive story  (here as “fair use”).

The reality of this is that at this stage there is only one company – Roche – that has a registered drug. Mylan and Amgen are both busy with clinical trials. Mylan has already applied to register their product, however their product is still under review by the FDA and our our MCC still need to get their systems in place for the approval of biosimilars. If the Department of Health want to procure this drug then they must follow the tender route and that would mean that only Roche would effectively be able to tender and these tenders last for two years. The reality is further that even though it is part if the policy, the provinces are responsible for the implementation of the policy and therefor provide the budget for the drug. Some of the treatment centres have already indicated that they would not have the budget for trastuzumab irrespective of price. It would therefor seem as of our advocacy effort will have to take on these access issues as well at a later stage.

For your information the updated cervical cancer policy 2017 is at http://www.health.gov.za/index.php/shortcodes/2015-03-29-10-42-47/2015-04-30-08-18-10/2015-04-30-08-24-27?download=2299:cervical-cancer-policy-2017. The main changes in this policy is

• Taking cognisance of  new technologies namely Liquid Based Cytology
• Test and treat on site at the health facilities
• Guidelines for a full continuum of care

It is worthwhile that organisations also study the content of this policy as the global movement is to focus on women’s health.

The Palliative Care Policy is not yet available

Grieving mindfully

For many of us, the ‘festive season’ is anything but festive as it reminds us of loved ones lost, or of easier, healthier times. Clinical psychologist Marc Lipshitz has written three blog posts that will help you through the grieving process. This is the first.

Grief is a personal journey never the same for any two people, and as unique as your life and your relationships.

Grief may be the experience of continuing to love someone after they die, of longing for a loved one’s presence, and yet knowing that is no longer available. However, grief is not limited to loss through death. Every time you lose a relationship or are faced with uncertainty, you grieve the loss of a predictable and safe world. You experience grief when you move to a new town, lose a job, or go through a divorce. You experience grief when you are diagnosed with a life-changing illness, or when you are separated from a loved one by circumstance. You experience grief when you experience any change in your relationship with yourself or to the world.

Paradoxically, it is often when you try to resist the intense emotions of grief that they linger, and even hurt more deeply when they inevitably surface. Grieving is the process of using your emotional vulnerability not to suffer greater distress, or to intensify your pain but to redirect this pain toward your growth as a human being.

Engaging in this process begins when you come in full contact with yourself and learn to ride the waves of grief. Your thoughts, your feelings, your identity during a life-threatening illness or after loss of a loved one all become vehicles for your own evolution.

Grieving can be understood as making the decision to allow yourself to mourn, and to fully experience the lessons of grief with the goal of living life better. The terrible emotional pain of grief tends to have a life and process of its own. Allowing the process to unfold does not remove all distress but it can soften the sharp edge of pain. To allow the process means to allow yourself to feel and experience each day on its own terms; we cannot assume that we know what tomorrow will bring.

As you are experiencing this process, you will feel that very natural pull to escape or numb yourself from the pain. However, by being aware of grief rather than ignoring or denying it, and by working to understand what drives this pain, you can release yourself into the person you are and the person you want to be. In other words, you can move closer to the people in your life who matter the most, and begin to change habits or beliefs that have been keeping you from living fully.

Just as love depends on the courage to share yourself with another person, grieving depends on the courage to accept your own feelings.

We have a tendency to associate grief and distress with something being wrong. Loss and grief is a part of life. It will happen no matter what we do. If we view grief as a problem, we will think of one of the most natural parts of life, and love, as a pathology or “disorder.” But grief has always been part of the order of things, and it always will be.

“Talisman”: Of Luck, Love & Life

In this image of Tracey Derrick with her two young daughters, she managed to capture so much more than mere words are able to convey… What did your heart bounce back to you when your eyes beheld this trio of warriors?

---

TAKEAWAY: “How To Tell Your Young Children You Have Breast Cancer”

via LatinaMomTV

What is normal?

Let’s normalise a few things right now:

• There is no “right way” to make sense of what a cancer diagnosis means in anyone’s life
• We can’t expect everyone to react in a similar way, or say the same things as anyone else – each person is unique and of course their response to their cancer treatment will be individual as well;
• It’s very common for people to feel confused, disbelieving or angry when newly diagnosed, but this is not true for everyone;
• Sometimes our bodies even respond to the stress and shock with physical responses – headaches, nausea, diarrhea, sighing, poor sleep patterns etc; and
• Often people look forward to the end of treatment, but sometimes folks feel fearful, uncertain, or more emotional than they did during the treatment.

Blog by Clare Manicom, Oncology Social Worker

The importance of psycho-social care

First up, let’s be clear that our precious family members and our special friends cannot be our therapists.  The honest ones among them will tell you that they really don’t want to be our counsellors either – they just want to be their normal selves – mom, friend, cousin etc.

Then, while we’re being honest – most of us try to protect the people we love from the ugly, ungrateful, hurtful, or dark thoughts that we have around the topic of cancer, its treatment or an uncertain future.  Which makes it hard to truly share with any one person exactly what we’re thinking or feeling.

• We edit what we share
• We filter what we hear
• We are selective about what we remember

So suddenly it’s very clear that actually, it’s pretty tough chatting through our deep emotions with people who are important to us.  We might not have the words to say what we’re feeling, we might not know what to think.  We usually don’t even know where to begin with our emotional “stuff” that we’re told we have to “deal with”.

And that, very simply, is why it is so helpful to meet with a neutral, objective, trained and skilled person when you’re feeling scrambled, low, overwhelmed or plain pissed off.  It is a huge relief to offload on someone whose job it is not to judge you, but to listen to you.  Their job is to calmly provide a safe space where you can say what’s on your heart, cry or rant without hurting anyone’s feelings.

There will be times when that professional needs to challenge your opinions or perceptions, or may need to provide you with clear information that will help set you on a better path.  There are times that your listener may probe a little deeper, or may ask you questions that make you think and reflect more carefully – all this is part of your healing journey.

Seeing someone for emotional support might mean having a few sessions to examine different issues or concerns, or practice new skills in between sessions.  You will not always come away from a session smiling and jumping for joy – sometimes we need to have a “heavy session” that may include tears or rage, as a catharsis.  What you should feel every time is that you have been heard and acknowledged as an individual.  Often you will feel a sense of relief or lightness that you’ve been able to speak your mind – you’ve been brave and honest enough to express yourself and that is an important beginning point…

A social worker with medical or oncology experience will be able to provide emotional support with an understanding of the psychological impact of cancer and its treatment, as well as having insight into some of the practical challenges that people face.  Most State oncology departments employ social workers, and some private practices offer this service as well – ask your oncologist and ask again if you’re not given names to contact!

Some people are keen to join a support group when facing their illness and treatment.  As these groups are run in different ways by different organisations, ask your local clinic about what may be available in your area.  Remember that groups run for the purpose of sharing information are not designed to provide in-depth emotional support, so make enquiries about the purpose of the group, and about who runs it to help you decide whether it’s a comfortable place for you to be or not.

Social media may also be a source of general support but it’s advisable not to risk your in-depth personal emotions in a public forum, or to take advice from people who may not have the professional skills or training to provide psychological support.

Blog by Clare Manicom, Oncology Social Worker

A voice for the voiceless

 

My name is Martie Westraad. I am 53 years old and live in Suiderberg, Pretoria.  I was worried and concerned about my breast as I could see something terrible was wrong with my one breast. I first went to CANSA in Rietfontein. They referred me to Pink Drive, who immediately referred me to George Makhuri Hospital in Ga-rankuwa.  I was diagnosed with stage 3 advanced breast cancer in March of 2016 after all the required test were done and started with chemotherapy in June 2016. My next appointment was scheduled for 12th July 2016, however on the 8th July I received a phone call from the breast clinic to inform me that my appointment had been postponed as there was no chemo stock available for my treatment. They said I should phone again in August to determine whether they have received stock of the specific treatment. This was very stressful for me as I realised that I cannot miss one chemo treatment and if I do I have to start all over again. My colleagues at work offered to help me financially to pay for the treatment if we could buy it  privately, and if it could still be administed. This was a dead end as well, and to crown it all the staff at the hospital were very rude to me. I decided to phone the Pink Drive as I knew that this is not supposed to happen. I was asked to send an email with all the details, which I did and the next moment the emails started pouring into my inbox from ALL the various organisations that started fighting on my behalf. I sat back and read …. I did not even know that they all exist. I did not even know that this is possible.  That was Friday 8 July. On Monday 11th July I received a personal phone call from the acting CEO of the George Makhuri Hospital, Dr Freddy Kgongwana, to inform me that I must come to the hospital for the scheduled chemo treatment on the 12th July as they have received their stock. I went – and yes I was able to get my treatment on time. THANK YOU to The PINK DRIVE for initiating this CALL for HELP and to ALL the members of the Advocates for Breast Cancer who got on board and voiced their concern about this. You really are the “Voice of the Voiceless”. Thank you to the Department of Health for dealing with this matter so speedily – is certainly good to know that we can depend on you in our time of need!

Introducing… The Breast Health Foundation

The Breast Health Foundation was launched in 2002 to raise awareness of breast health among women through a series of community based education projects and creating awareness via community health facilities.

The projects currently employ six women, themselves breast cancer survivors, who give talks at churches, places of employment and public clinics about breast health, breast self-examination and the importance of early detection.  Fourteen years on and there has been a noticeable increase in the number of women being diagnosed early.

Over the years the organisation has, through expansion, based itself in the Vaal/Sedibeng area, Cape Town and Durban. The women based in those areas facilitate educational talks, counselling and patient navigation. These educators are also at the regional breast care centres to assist the patients that have been referred and provide counseling if diagnosed.

To date our community educators have directly impacted 72 811 women through community education projects and have made 291 clinic visits. In total, 2913 women have been navigated and 376 diagnosed with various stages of breast cancer throughout all our active areas.

Bosom Buddies (BB) was established as a project of the BHF, a support group for survivors and their family and friends. The group aims to provide emotional and informative support to all individuals diagnosed with breast cancer and is run by survivor volunteers. The ‘buddies’ provide support to people affected by breast cancer at point of diagnosis and during treatment. BB hosts public meetings in Johannesburg every seven (7) weeks and speakers are invited to share knowledge and experiences with the buddies.

Buddies for Life, a bi-monthly lifestyle magazine, is published by Word for Word Media on behalf of the Breast Health Foundation. In sustaining the aims of the Breast Health Foundation. All of the persons involved with Buddies for Life are either medical or healthcare professionals, and they have been affected by breast cancer themselves or have been inspired by a breast cancer survivor. Each issue of Buddies contains a section dedicated to the early detection of breast cancer.

The Breast Health Foundations purpose is to:

• increase the awareness of breast health;
• promote education and treatment and
• provide support in respect of breast health.

Our mission is to

• create breast health awareness in the community,
• ensure individual access to information,
• potentiate access to appropriate healthcare resources,
• create an ongoing audit of operational effectiveness and
• offer emotional and informative support.

 And through our projects, we have succesfully managed to realise great results.

You can connect with us on a daily through our social media pages:

:

BHF: https://www.facebook.com/BreastHealthFoundation/

BB: https://www.facebook.com/groups/31260668033/?ref=br_tf

Buddies For Life: https://www.facebook.com/BFLMagazine/?fref=ts

EBC:  https://www.facebook.com/groups/903665216386353/

BHF: @BreastBhf

Buddies For Life: @BFLmagazine

This post was written by R.Vanessa Mthombeni for The Breast Health Foundation

 

 

 

Creamed root gratin

Another recipe for the tough times. This is pure comfort food for when you feel like nothing else.

500g potatoes, peeled and chopped
a generous cup of celeriac, peeled and chopped
1 small parsnip, peeled and diced quite small
1 small chopped onion
1 clarge carrot, peeled and very thinly sliced
1/2 teaspoon ground nutmeg, and the same of black pepper
1 teaspoon low salt stock powder
Soya milk to cover

Bring to the boil and simmer until the vegetables are very soft. Drain and mash or blend to a smooth puree.

Pile into an oiled, overnproof dish, splash with a little olive oil and soy sauce and bake in a hot oven (200 deg C) until golden.

Serve hot, sprinkled with parsley or chives.

Yummy!

THANKS TO DR ROSY DANIEL, WHO HAS GENEROUSLY SHARED THE CANCER LIFELINE RECIPES WITH US. THIS RECIPE IS FOR THE TOUGH TIMES, FOR USE WHEN YOU ARE VERY ILL, DURING TREATMENT, WHILE THE APPETITE IS POOR AND THE WEIGHT LOW.

Targeted biological therapies

Approximately 20% of breast cancers are known as HER2 positive. This means that a gene mutation has caused the cells to have an over expression of HER2 receptors and this protein signals the cancer cells to grow and divide.

The HER2 receptor can be tested for by:

1. Immunohistochemistry (IHC)- which shows how much of the protein is on the cell surface
2. In-situ hybridisation (ISH)- which tests the number of copies of the gene inside the cell..

HER2 positive breast cancers tend to be more aggressive than HER2 negative cancers.

Trastuzamab (Herceptin) is a biological therapy that has been designed to specifically target the HER2 receptor in HER@ positive breast cancer. It reduces the risk of recurrence and death in women with HER2 positive breast cancer and prolongs survival in women with HER2 positive metastatic breast cancer.

Lapatinib (Tykerb) is another “HER receptor blocker” that is sometimes used in combination with Herceptin

Side effects:

Although Herceptin has been shown to have greatest benefit when used in combination with chemotherapy, it is not in itself a chemotherapy treatment. Chemotherapy treatments affect all rapidly dividing cells whether they are cancer cells or healthy cells.

Herceptin, however, targets only those abnormal cells with increased display of the HER2 receptor and it spares the healthy cells.

For this reason the side effect profile is substantially less.

Its main possible side effect is on the heart and the use of Herceptin in some patients may require baseline and periodic cardiac function tests. This side effect is usually reversible. In some cases hypersensitivity or allergic reactions can occur and for this reason it should be given in an appropriately equipped facility by staff who are trained to manage a possible reaction. Other less common and mild side effects may include fever, throat irritation and runny nose.

It is an intravenous therapy administered via a peripheral drip into a vein ideally every 3 weeks for one year.

However, it is unfortunately extremely expensive, not yet available in State hospitals and not covered by many Medical Aid schemes.

For those who can afford it, or those whose medical aids will cover it, Herceptin has significantly improved the prognosis and survival of patients with HER2 positive breast cancers to the extent that the outcomes are even better than some patients with HER2 negative breast cancers!

This blog was kindly supplied by Ronelle de Villiers at http://www.capebreastcare.org

 

Buddies for life!

Buddies For Life is a bi-monthly lifestyle magazine, published by Word for Word Media in association with the Breast Health Foundation, for breast cancer patients, their families and friends. It was launched in June 2011, and 22 issues have been published to date with many more to come.

The glossy print and online magazine aims to educate, encourage and provide support. An array of medical professionals and experts write supportive and educational articles for the magazine on topics such as treatment, health and wellness, diet, fitness, sexuality, new advances and psychological advice that will assist those affected by cancer to understand the disease and treatment.

The content is essential reading written in a style that simplifies terminology. Super Survivor is featured on the cover of every issue and the breast cancer survivor’s story is told. On the Chemo Couch is another platform for survivors to share their unique story.

In keeping with the aims of the Breast Health Foundation, each issue contains a section dedicated to the early detection and awareness of breast cancer.

Oncology Buddies, supported by CANSA, is a new section within the magazine catering for other cancer awareness, early detection and various support groups.

Buddies For Life is available in print at hospitals, private clinics, oncology practises, mammography units, radiology centres and support groups. Medipost courier the distribution of the print magazines to all the various distribution points.

A digital version is also available on www.buddiesforlife.co.za and yearly subscriptions are offered.

 

The Breast Health Foundation is one of the partner organisations in the Advocates for Breast Cancer (ABC)