You may remember a post I wrote last year where I discouraged you from discussing your diet with your oncologist on the basis that you are likely to be told it’s a waste of time. This is tricky territory, and I have felt a little uncomfortable with it. I remember from my own progress through treatment that I put my oncologist on a pedestal, and I certainly want to encourage you to be open and honest with your medical team at all times.
But if they fail to track any lifestyle factors and show no interest in supporting you to look after yourself beyond treatment, what are your options?
The Professional Standards Authority (PSA) published a report last week stating that registered practitioners of newer and/or complementary professions such as Nutritional Therapy are as competent as other traditional healthcare providers, and that they can make a difference as part of a multidisciplinary team under NHS commissioning. The report goes on to encourage doctors to be confident in forming new teams to offer different approaches to care. That’s great news, and makes for exciting future developments.
If you’re in the middle of treatment right now, though, you may not want to wait for that recommendation to filter through to the coal face. So how can you take advantage of the new thinking? How can you have a constructive discussion with your oncologist about your diet, for example?
This question was raised during the last cancer workshop and I’ve been giving a lot of thought to how to approach it in a way that respects both parties. I’ve always felt awkward advising anyone to duck the issue, but I’ve never wanted to encourage cancer patients seek approval for something that is just not recognised. When your oncologist dismisses your efforts to be more healthy, it can be highly demotivating.
Now, with this new report comes hope. The PSA have recognised the competence of nutritional therapy professionals who are registered with BANT and the CNHC, and they are actively encouraging doctors to recognise them too. This provides a great opener for a discussion.
How might it work?
YOU: I’d like to discuss some other angles I’ve been exploring to help me get better. I’m particularly interested in the role of nutrition. Are you aware of the new guidelines from the Professional Standards Authority about the complementary health care professions?
YOUR ONCOLOGIST: Tell me more.
YOU: In their report they stated that registered practitioners of the newer or complementary professions are just as competent as traditional health care providers, and they recommended that doctors and nurses include them in multidisciplinary teams. I was pleased to see that they included registered nutritional therapists in that recommendation.
YOUR ONCOLOGIST: Oh yes, I think I did read something about that. But we haven’t got anyone here so how can I help you?
YOU: Well, I’ve found a practitioner, registered with BANT and the CNHC, who has a particular interest in diet and cancer and I was thinking of going to see her. Would you have any specific concerns about that in relation to my treatment plan?
YOUR ONCOLOGIST: (Yes/No.)
YOU: I’m also aware that nutritionists sometimes recommend supplements. Are there any particular supplements I should avoid on my treatment plan?
YOUR ONCOLOGIST: (Yes/No/List them/Promise to look into them.)
YOU: And is there anything else that you can tell me that would be helpful for me to know and discuss with my nutritional therapist? Any safety issues around diet that would concern you?
YOUR ONCOLOGIST: (Yes/No)
YOU: Would it be helpful for me to discuss my nutrition recommendations with you after my appointment?
YOUR ONCOLOGIST: (Yes/No.)
The important thing about a conversation like this is that you are minimising his/her opportunity to just sweep your ideas away as unimportant. You are asking to be taken seriously and you are asking him to cooperate with you in your desire to help yourself using a broader approach to your health. This is directly in line with what the PSA report recommends is done on an NHS-wide basis so there should be no professional conflict.
You are not asking him to comment on the competence of nutritional therapists – the PSA report has already done that and recommended we are included in the healthcare debate – you are simply asking how the two different types of therapy might interact.
In seeking your oncologist’s advice before changing your diet you are looking for evidence rather than approval: is there any research that suggests it could be damaging? Questions like these move you clearly into an equal footing doctor/patient relationship rather than the parent/child dynamic that tends to prevail in oncology department.
Of course, as with any sort of change, you may find that your oncologist is uncomfortable with the conversation, maybe even out of his depth. But he is not going to let professional pride stand in the way of you exploring your options for future health, is he?
If you find that the conversation does not open up in a constructive way, or that there is an insistence on undermining the competence of complementary health care professionals, or discouraging your desire to explore more ways to be well, then it’s likely you’re up against beliefs rather than evidence. It may well be that your oncologist is less aware than you of the latest developments in complementary therapies. And who can blame him? Most oncologists don’t have time to kiss their kids goodnight, let alone keep up to date with anything beyond the medical approach to cancer.
Remember that you are not asking for your oncologist’s blessing, you just want the facts. It’s a perfectly reasonable approach, and one you can be sure other patients are using. Don’t be intimidated and stick to your line of enquiry. Doctor Bernie Siegel is very clear that the so-called ‘awkward’ patients have a much greater survival rate than those who just sit back for the ride, so there’s an incentive!
As ever, I want to be clear that I have the greatest respect for medical practitioners and I look forward to the time when they return the favour. Until then, my mission is to help you get the advice and care that you need to survive, even if you have to step on a few toes.
If I can help you in any other way, let’s talk.