Getting the most out of your medical appointments: more tips from a Consultant Oncologist

 

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Meet Richard!

Following on from his last blog post about preparing to meet your oncologist, Consultant Oncologist Richard Simcock writes about the best way to start a consultation with your doctor – and ways you can follow up afterwards.

 

 

 

 


Signposting

If you go to a show you normally know what you’re going to see. Have you ever seen a film or play where you literally knew nothing at all about it before it started? You were likely to have been initially bewildered as you got your bearings. Arriving at a consultation knowing what to expect means less confusion: it allows you to get straight to the substance. It is good practice for a healthcare professional to explain the purpose of the meeting (‘Today I want to explain your radiotherapy treatment’ etc.), but that isn’t always the case.

A reasonable question to ask is ‘What are you hoping to discuss today?’ This also gives you an opportunity to highlight any areas that you know that you want to cover and leads to better time prioritisation. If a follow-up meeting is being arranged, then asking ‘what would you expect us to discuss at our next meeting?’ leads to even better preparation.

Ask for Copies

After almost every clinic consultation a letter will be written. These letters have multiple purposes: they inform the referring clinician, they may be a request (e.g. ‘please prescribe drug X’), and they also act as a record of the meeting (much better than a scrawled note in undecipherable handwriting!).

Eighteen years ago, the NHS plan recommended ‘patients should as of right receive copies of all correspondence between health professionals about their care.’ This was enshrined in the 2015 NHS Constitution. Copies of letters written about you will be sent automatically in most cases. If you’re unsure whether and how this happens, it’s reasonable to check just in case it isn’t yet routine for the doctor you are seeing: ‘Will you send me a copy of the letter you send to my doctor?’

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Try filing your own notes

Not every patient wants their letters, and if you wish not to receive a copy you should make that clear too, in case letters are sent automatically.

In my opinion, far better is a letter written to the patient first and foremost. This should avoid issues with jargon and misunderstanding, but it’s also a part of patient-centred decision-making. The Academy of Royal Colleges recently produced a report (‘Please Write to Me’)  with a  ‘How to..’ document for doctors around writing directly to patients, and I’m hopeful that this will become increasingly standard practice.

You are entitled to copies of results and reports too. This can be problematic as these are almost always written in the dense jargon of the specialty. Breast Cancer Care produces a guide to understanding a breast cancer pathology report and there are other online resources for other cancers. Asking for a summary of what the report means is very reasonable, but asking for a tutorial on the meaning of every word may not be the best use of precious consultation time. As we move to a time where patients will (hopefully) be able to access more of their own data via portals, medical specialists will need to produce more readable report summaries.

Key worker

You should be allocated a ‘key worker’ – this will most often be a clinical nurse specialist (CNS). Many CNS are highly expert in their field and will know answers to all the common questions, and most of the complicated ones too. They can be invaluable in helping you navigate what is happening before, during, and after a consultation. They will often help patients ‘debrief’, particularly if a clinic meeting has been complicated or upsetting. Key workers are there to act as your advocate and help you to get the best, most personalised care. If you know that you have a lot of questions to ask, then first flag this with your key worker before a meeting: your key worker will be able to answer many questions for you, as well as prepare the doctors in the clinic and potentially organise a longer slot.

Macmillan helps to support over 4300 CNS in the NHS and yet we know there are still inadequate numbers. This means not all patients will get the CNS/key worker access they need or deserve. It is always reasonable to ask ‘Do I have a key worker/CNS? And how can I get hold of them if I have questions?’

Occasionally, a doctor-patient relationship is not good.  Communication will be poor as a result. Every doctor can have a bad day when they perform less well, but if you think you are not able to have a good meeting with a doctor attached to your care then this is an issue that your key worker should be able to handle sensitively. Key workers can often help by arranging another member of the team to see you where possible.

Second (and third and fourth) opinions

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Your case is reviewed by multiple doctors

It is standard within the NHS that all newly diagnosed cancer cases are discussed by a multidisciplinary team of professionals. I attend two of these meetings a week. In the Head and Neck cancer meeting, I sit with two other oncologists, a consultant radiologist and pathologist, three specialist nurses, three dieticians, two speech and language therapists, a consultant dentist, a specialist radiographer, and six consultant surgeons and trainees. We discuss every case, and multiple different approaches to the patient’s problem. Later in clinic we will meet the patient and present a summary view. The ‘first opinion’ is often the combination of multiple expert opinions.

You might want to ask ‘Has my case been discussed at the MDT and were any other options discussed?’. This might be particularly important if there are different possible treatments.

Records of the MDT discussion are also available.

Despite these multiple opinions you may still feel that you would like another team to consider your case. A second opinion can be arranged by your treating team (hospital to hospital) but the mechanisms by which hospitals get paid mean that it is often preferred if the request for another opinion comes from your GP. Transferring clinical information and the masses of data contained within scans can now usually be achieved instantly and electronically. Be aware that another opinion will inevitably lengthen the time before treatment can be delivered.

Research and Trials

Research in cancer is vital to drive innovation and improve survival. Clinical centres that engage in research may produce better results (this has been shown in recent radiotherapy trials), perhaps through more detailed systems of quality assurance.

You may be offered the opportunity to take part in a clinical trial, but if you are not then a good question to ask is ‘Are there any clinical trials for my situation in this hospital?’

If there are no local trials then looking at the National Cancer Research Institute website and their Portfolio Maps for a specific cancer will show what important questions investigators have about treating that disease.

If trials are not available locally it is helpful to ask if there are other accessible centres that are running relevant research. This information will usually be available to your team although you will have to consider carefully if the promise of a trial justifies the burden of travel to a centre further away from home.

Conclusion

There is a whole science devoted to analysing different styles of doctor-patient communication and ultimately doctors want the meetings with their patients to be effective, efficient, and friendly.

‘Communication’ has a double meaning – it can also mean a connection between places, a route or a bridge. Good communication should be able to take you somewhere new: bring you to a new point of awareness or knowledge. I hope these tips help you make the best use of those vital minutes, so you have maximum opportunity to arrive at the best possible destination of understanding.

Richard tweets as @BreastDocUK. He is a Consultant Clinical Oncologist at the Sussex Cancer Centre. 

Living with incurable cancer: talking to my children

In this guest blog post, Shine community member Beth writes about her story of living with incurable bowel cancer, and shares her experiences of talking about her illness with her young children.


 

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Meet Beth

My name is Beth, and I was diagnosed with bowel cancer in 2016 at the age of 37. I was working as a Paralegal, and about to start the final year of my law degree. This diagnosis could not have come at a worse time, just when I was finally pursuing the career of my dreams and becoming a solicitor. However, it was not my career that came to mind, but my family: my husband and my babies.

In 2017 things went from bad to worse. I was told that the cancer had spread to my lungs and was now incurable. I was given six months to three years to live. My son Joseph was nine at the time, and my daughter Abigail was just seven. How was I going to tell them? What was I going to tell them? How much should I tell them? How much would they understand? How could I make sure I was always a part of their lives? What could I put in place for them emotionally for when I was gone?

I had a lot of questions – mostly about my kids, not medical questions for the doctors. Who to ask? I found charity leaflets about talking to children about cancer, but they were very generic; I felt that there was a lack of support for parents and children in this situation. I wanted to speak to child psychologists, parents who had been through this, adults who had lost a parent as a child – anyone who could give me insight into the best things to do for my children. in the end I found help, ideas and support from my followers on my Facebook page. I asked if anyone had lost a parent at a young age and if so, what had helped them. Then the ideas came flooding in.

When I was first told I had cancer, we told the kids that I had some bad cells and the doctors were going to take them out, meaning that I would be in hospital for a bit. After my initial operation, we explained that I would need to have some medicine to kill off any tiny bad cells that the doctors could not see and help prevent any more bad cells growing. We explained that the medicine might make me feel ill. The progression of my cancer meant that I needed to break the news that the bad cells were back, the doctors could not cure me and – the bit I still needed to get my head around – I was going to die (but we had no idea when).

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Beth and her family

I talked to Richard, my husband. We planned to sit the children down and talk as a family, but not about time frames. Unfortunately, we never did get to sit down and do this. Life has a funny way of taking these things out of your hands.

I did tell Joseph and Abigail, but it was one afternoon when I was snuggled up on the sofa watching TV with them. An advert about cancer came on and Joseph turned to me and said ‘you had cancer didn’t you, Mummy? But you don’t have it anymore.’ My heart sank. We had never used the ‘cancer’ word, but he knew. Yet that was not what got me. Yes, I was going to have to shatter their world, and it would have to be now because I could not lie to them. The conversation went something like this:

 

Me: Well, you know that medicine to try and stop it coming back?

J&A in unison: Yes, Mummy.

Me: It looks like the medicine didn’t work as well as we thought, and I do still have cancer.

A: But Mummy, cancer can kill people.

J: But the doctors will make Mummy better, Abi.

Me: Unfortunately, the doctors can’t cure me, but they are going to do whatever they can to keep me here with you for as long as possible.

A: Are you going to die, Mummy?

Me: We all die one day, but I will probably die sooner than we would like. You know that if there is anything you want to ask me, you can. We can talk about anything.

There were lots of tears and cuddles, but oddly no questions – well, not then. A few weeks later my daughter, who is very matter-of-fact, asked ‘Mummy, will you last until Christmas?’. I am still not sure if she was more concerned about her presents – the man in a red suit does not get all the credit in our house…!

Both children made us promise that we would tell them whenever we got any new information. Joseph wanted to know about scan results and treatments. They seemed reassured by being included in what was going on. Just over a year on, we still have no idea how long I have left, but we take each day as it comes, and do everything we can to make as many memories together as possible.

We talked about making memory boxes, something they would have to keep their memories of me and our lives together as fresh as possible. The children put things into their boxes that remind them of something we have done together. It could be a photo of us together, anything that means something to them. I hope these boxes will help them to connect to me through physical things they can hold, touch, see, and smell.

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Dreaming about holidays

I am also doing things that the children do not know about: for example, I have written their birthday cards all the way up to the age of 21. This was tough and I cried a lot, but it was important to me. I set up an email address for each of them and I send them emails. I include a summary of something we have done together, what I enjoyed most, and a picture or two. I bought some books that ask questions about my life, and about their lives. I am in the process of completing these books and trying to answer all the questions.

I plan on recording videos and writing letters for special occasions. My husband can give them if he feels appropriate. The most important thing, though, is to be there for them right now and make the most of the time we do have together.

I am currently on a holiday booking spree…

 

You can learn more about Beth and get in touch with her via her blog, Facebook page, or Instagram/Twitter: @bowelwarrior. 

If you would like more support about talking to children about cancer, you can…

 

Great Escape: reunited!

2018 Escapee Caroline shares her experience of our Great Escape Reunion, a one-off event celebrating five years of weekend retreats for young people with cancer.


I was lucky enough to be able to attend the 2018 Shine Great Escape (read my fellow Escapee Rosie’s blog about it here), and I was invited to the Great Escape Reunion almost as soon as I had accepted my place on the Escape itself!

It turns out that 2018 was a year worthy of celebration: the Great Escape that I attended was the fifth weekend away for young adults with cancer that Ceinwen Giles and Emma Willis had organised since Shine began. In March, Shine organised a reunion event in London, inviting all of those who had attended a Great Escape to come along and celebrate the anniversary with them.

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Some of the 2018 Great Escape attendees reunited!

The afternoon began with tea, cake, and conversation, which gave us time to chat with our fellow Escapees and meet those who had attended in previous years. While it was a great opportunity for many to catch up, for the 2018 attendees it was also a chance to get to know each other better. Although we all feel a strong bond with our ‘tribe’ as a result of the Escape, there are still so many things that we want to learn!

Once we’d warmed up and helped ourselves to a piece of flapjack or four, the Reunion continued in true Escape style – with Sharpies, crafts, and collages. Although some Escapees remain defiantly unartistic, everyone took part in creating collages to show how the experience had affected their lives. It was amazing to see how much one weekend away could change our perceptions about cancer and our attitudes towards living with the disease.

After the activities came a potted history of the Shine and the Escape from Ceinwen and Emma, including stories about how they’d manage to convince friends and friends of friends to sign up to voluntarily spend a weekend at a hotel in Bournemouth with a group of young people with cancer – hardly the most glamorous of mini-break ideas! We are all overwhelming grateful that they pulled it off, as the next portion of the afternoon showed. Representatives from each Great Escape gave short presentations about their experiences and gave us an insight into what everyone had been doing since their Escape. This part of the afternoon was emotional for many reasons. It was fantastic to see photos of weddings, exciting trips abroad, and new babies, which gave us optimism for our futures beyond cancer. However, the moving tributes to those who have sadly passed away since attending their Escape reminded us all about what it is that brings us together. After the presentations, we raised a glass not only to Ceinwen, Emma, and the volunteers, but also to the wonderful Escapees who are no longer with us.

And as for the 2018 Escapees? Although we weren’t convinced that we would have much to report after only a few weeks apart, we had managed to achieve a surprising amount: a few new jobs, several dates, a couple of people returning to work, and some meet-ups already in the calendar for later in the year. And then, of course, the few thousand (!) WhatsApp messages we had exchanged with each other since leaving Bournemouth. It seems that a Shine Great Escape isn’t a Shine Great Escape without a very active WhatsApp or Facebook group!

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Fond memories of the Escape…

The reunion came to a close with a group discussion about the future of Shine, and how we could ensure that more young people are able to benefit from everything the charity has to offer, then a delicious buffet.

 

I’ll leave you with a few comments about the day from my fellow 2018 Escapees. Thank you again for everything Shine, and all the volunteers who have contributed to the Great Escape!

‘It was great to chat to previous attendees and see that they are still benefiting from the Escape and have gone on to make good progress. Also, it was nice to see that they are still good friends with each other years later. The Escape has a long-lasting impact and doesn’t just fizzle out after leaving the bubble of The Grove.’

‘I get really tearful thinking about our Escape and the Reunion. I feel like I belong with you guys, where I don’t belong anywhere else.’

‘[Our group photo from the Reunion is] my work screensaver!! I look really happy, which makes me smile, and when I have a tough day it reminds me that we’re in this together.’

What is a ‘Great Escape’? To learn more about the Shine Great Escape and how you could apply to take part, check out our website here

Introducing Kate!

Five years ago, Shine didn’t have any staff. In fact, we were really just getting the ball rolling on this young adult cancer charity whole thing. Looking back at where we started makes it even more exciting that we’ve just welcomed our FOURTH employee!

Read below to find out more about Kate – she’ll be supporting our 14 Shine Networks across the country. We’re still a tiny charity (with big ambitions) but we’ve grown a lot in the last few years and we couldn’t be happier to have someone new on our team!


Hello, I’m Kate!

Trying to put almost 40 years of life into a few hundred words isn’t easy AND I am not one for talking about myself, but I wanted to introduce myself and give you a bit of insight into why I do what I do.

Born in Northumberland (very proud of this!), we moved south to Bedfordshire when I was nine so my accent didn’t have a chance! Aged ten, I was diagnosed with Type 1 Diabetes which had a huge impact on my education as I missed so much school. There was an underlying cause of the diabetes which wasn’t discovered until I was 16, so it was IMPOSSIBLE to manage!KJ PP

As a young teen, I wanted to go into medicine, but all the health stuff got in the way and I wasn’t able to finish my A-levels or go to university. Then, when I lost most of my sight in my early 20s because of diabetes, I really felt that the odds were stacked against me. Fortunately, with little sight I was still able to do some studying with the Open University, which was brilliant. After hundreds of bouts of laser treatment and a month in Addenbrooke’s Hospital, Cambridge, I thankfully regained a lot of my vision and this remains fairly stable to-date.

Handling all this stuff at such a young age had a massive impact on my mental health and I really struggled with anxiety and depression, but it made me particularly interested in the impact that physical health challenges can have on our mental health. As I found it difficult to get into work, I started volunteering for a tiny mental health charity based in Luton, and before I knew it I was working with them full-time and loving it. I worked with people who had various mental health challenges, helping them to write and perform small drama pieces for health care professionals and the public to help them understand what life is like with a mental health condition. Although I was most definitely not into the drama side of things, I found it incredibly rewarding to be able to bring both sides of the coin together and to challenge perceptions, leading to changes in clinical practice. Nowadays, this would be called something fancy like ‘co-production’ – but nearly 20 years ago I don’t think that term existed!

KJ Beach 1Fast forward to today, and I have had the privilege of working for several charities including Mind, Crohn’s and Colitis UK, and most recently Cancer Research UK. My focus was volunteer management until 2015, when I took on a patient engagement role which brought patients and clinicians together at local and national levels to improve services. Over the past few months, as well as working in patient engagement, I have started to talk about my own experiences as a patient. This has been so rewarding. I have been able to get involved in an NHS Improvement initiative for patient leaders and I have also done some work with finance and insurance company American International Group (AIG), helping their managers to become more inclusive.

I am so happy to be part of Shine Cancer Support, and I feel that all the professional and personal experience that I have had fits perfectly with the role of supporting and developing Shine’s local networks. What excites me the most is working with all of you to help Shine grow and reach more people while keeping true to the Shiny vibe! What you say, what you need, and how you feel about things really matter, and together we are such a force for good. I am really looking forward to getting to know all of the network leaders, and understanding how we can work better together across Shine’s community. Without all of the amazing network leaders, Shine would simply be four people desperate to make a difference to the lives of young adults who have had a cancer diagnosis.

I get what it is like to be ill when you are just getting to grips with yourself and life: to have that rug pulled out from under you, and to have so many hopes and dreams shattered. That said, I wouldn’t change my past as it has brought me here. 2018 is a big year for me as I turn 40 in November and I am already planning the celebrations! I never expected to reach my fortieth birthday, so it really will be a big party (parties…?) and I will be more than happy to accept cake when I am out and about.

See you soon!

Taking care: How and why ‘carers’ also need support

A few years ago, the partners of a couple of Shine members approached us about starting a ‘Plus Ones’ group. Having cancer is tough, they noted – but so is supporting someone with cancer. We started our Plus Ones group online and it’s continued to grow over the years. As we’ve worked more on supporting the supporters, we’ve also learned more about the issues that they can face.

In this blog, Dr. Jason Spendelow (one of Shine’s original Plus Ones) outlines some of the issues that ‘carers’ often face when supporting someone with a life-limiting illness. We know a lot of Plus Ones don’t consider themselves carers (78%, according to a recent survey that Shine carried out!) but we hope this gives you some insight into the support that someone looking after a young adult with cancer might need.


 

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Those who provide significant levels of care to another person are more than twice as likely to suffer from poor health than non-carers.

While carers do report many positive experiences, the physical and psychological wellbeing of this group is often compromised due to the stress associated with the support they provide. Those who provide significant levels of care to another person are more than twice as likely to suffer from poor health than non-carers (Carers UK, 2004). When asked directly, the vast majority (84%) of carers said that caring had a negative impact on their health (Carers UK 2013). Carer wellbeing, then, is a particularly important topic in cancer and other chronic illnesses. Carers provide a huge amount of support to loved ones affected by these illnesses. This means it is even more crucial that we take care of the carers.

Mental & Physical Health

We have an increasingly large pile of research available on carer wellbeing. From this, we know that psychological issues are among the most commonly reported difficulties amongst carers (Stenberg et al 2010). An important concept here is ‘carer burden’, which refers to negative emotional experiences that occur from providing care. The level of carer burden varies from person to person, with higher levels of burden being linked to female carers, living with the care receiver, spending large amounts of time caring, being socially isolated, under financial stress, and having no choice in becoming a carer (Adelman et al 2014).

Carers can experience a range of psychological difficulties. Some of the most common issues tend to be low mood and depressive symptoms, elevated levels of stress and anxiety, and lower quality of life (see for example, Braun et al 2007; Pinquart 2017, and Easter, Sharpe and Hunt 2015). Rates of depressive and/or anxiety disorders are higher amongst adult carers when compared to the general population. These figures do not mean that you are destined to develop such psychological issues, but carers are clearly more vulnerable. In late 2016, Shine carried out a survey of Plus Ones and found that 58% had experienced stress, and 77% had experienced anxiety.

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Shine’s first Plus One workshop covered how to cope with anxiety.

In addition to psychological difficulties, carers can experience decline in their overall physical health. Physical health problems vary and range from fatigue to insomnia, headache and gastrointestinal issues (Jassem et al 2015).

Positive Experiences

Despite the physical and psychological challenges discussed above, many carers can also identify positive aspects of their experience. Some of the reported positive experiences included being able to give back to someone, knowing the person is being well cared for, improved relationships, personal growth, and an enhanced sense of meaning or purpose (American Psychological Association 2018). Finding meaning and purpose is an experience reported across several groups of carers (Carers UK 2004). Being able to help is a source of satisfaction for many carers, while ‘giving back’ to someone and having an equal or reciprocal relationship are other positive outcomes (Spendelow, Adam and Fairhurst 2017; Buchanan et al 2009), Ribeiro and Paul 2008). The relevance to wellbeing is that experiencing positives from caring help people to cope better with the stress that comes their way.

Taking care of yourself

Your wellbeing is influenced by many factors. Believing that just one ‘thing’ is the cause of any experienced psychological difficulties is usually inaccurate and unhelpful. Attempts to improve your wellbeing, therefore, usually involves taking several factors into consideration. Look, I could bang on here about all the things you know you should be doing already: getting plenty of sleep, exercising, and eating vegetables. Yes, this is all true and fundamental to your health. But I won’t repeat the same advice given millions of times already.

Perhaps a more useful strategy is to ask ‘What barriers stop you from taking better care of yourself?’ and, more importantly, ‘What can you do about these barriers?’. Some barriers are physical: for instance, you don’t think you have time to look after yourself. Other barriers are psychological. For example, some carers feel that it is selfish to prioritise themselves over the loved one they support. Asking what barriers exist (and why) helps work out what might have gone wrong with previous failed attempts to take better care of yourself. These barriers need to be directly addressed, otherwise it doesn’t matter how many times you are told to go for a walk and eat some broccoli.

It may be that you need to discuss this issue with a sensible person that you trust in order to make progress with your wellbeing. Having said this, here are a few questions you can ponder to get you thinking more about barriers to better self-care:

  • What emotions might you experience if you put more time into self-care?
  • Why do you think you would experience those particular emotions?
  • What do these emotions say about your attitude to self-care?
  • What would have to change in your life to result in more time given to your wellbeing?
  • How might the wellbeing of the person you support be negatively affected if you spent more time looking after yourself?
  • What would be the worse thing someone could say about you as a carer? How does that influence your self-care?

 The Bottom Line

Carer wellbeing matters, both to the quality of life of the carer, and the wellbeing of the loved one that the carer supports. To cope with the huge challenges brought about by cancer, you need to be thinking of self-care strategies that are positive and sustainable over the long-term. If you fall over, both you and the person you care for will find things even tougher. Thinking about barriers to self-care can be a useful way to better understand your current approach to your health, and how you can improve it.

Jason is a clinical psychologist with a special interest working with people and their carers affected by chronic illness and disability. He also supported his wife through cancer. He runs his practice in Surrey. See more at www.jasonspendelow.com

To join our Shine Plus One Facebook group, click here. To join the mailing list for Shine Plus One events, please email plusone@shinecancersupport.org.

 

How I told my five-year old I had cancer…

In this post, Shine member Steph tells us how she talked to her son about her diagnosis. What are your experiences of talking to young children about cancer? Please share this post and add a comment if you like.


When I was diagnosed with cancer in July 2016, my first thoughts were ‘I just need to get through this for him’ – ‘him’ being my nearly five-year old, Theo. We’d arranged a fantastic party for his fifth birthday and all I was concerned about was being there for it.

As it happened, the first part of my treatment was booked in for a week after the party. This was such a relief. The sun shined brightly that day and it couldn’t have gone better.

I knew, though, that I had to tell him about my cancer because there were going to be things he’d see, and things that would come as a surprise to him. Perhaps everything he was used to might change. Who knew at this point?

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Steph and Theo

I read a book that was written to help you tell your children about a cancer diagnosis, and I was genuinely saddened by it. It talked about the family getting angry and the diagnosis not being the child’s fault, and about parents getting cross but telling the child not to blame themselves. Then there was a picture of utter chaos: dad was in the kitchen in his pyjamas, there was a knife in the fish tank, the dog was eating the kids’ cereal and the kitchen floor was flooded. It was absolute carnage – it simply looked to me like daddy wouldn’t be able to cope. This was not at all what I wanted Theo to see or understand. The book and the tale it told just really didn’t work for me.

A different approach

I wanted something that said, ‘no matter what happens, Mummy is doing her absolute best for you, and doing everything in her power to be OK’. So I decided to write a poem. I needed it to be personal to Theo to help him understand that the future might look different for a while, and that Mummy wasn’t going to be well.

Dear Theo,

Mummy has written this for you, it’s a rhyme, 

And wants to read it to you from time to time.

For now, mummy does feel a little sick,

But a cuddle from you would do the trick.

Sometimes mummy will stay in hospital for the night,

The nurses will take good care of her, she’ll be alright.

You know you take medicine from a spoon,

Mummy has medicine too which’ll make her better soon.

The doctors are doing all they can to make her well,

Why not even wish her a get well soon spell?

Mummy is trying her absolute best,

But sometimes she needs a little rest.

You are all she thinks about day and night,

And dreams about you and her flying your kite.

As always be the loving person you’ve always been,

You’re the bravest boy mummy has ever seen.

Theo’s reaction

The first time I read it to Theo, he smiled and said ‘wow, it rhymes!’. I knew, though, that he’d heard the underlying messages. I was lucky too that when Theo was with his dad, he’d read it to him as well. Theo heard the poem over and over again, and even asked for it sometimes. I think it prepared him for the next few months and taught him that there was likely to be a fair amount of change coming.

As changes were on the horizon, I told him when they were going to happen: a stay in hospital, surgery (and therefore he’d have to be extra careful and not jump on me) and losing my hair. Theo never really asked any questions and dealt with it all very matter-of-factly – a little like me, I think.

Theo really didn’t like my wig though and wanted me to just ‘be me’ and not hide behind it. My hair is growing back now, and the other day he asked if I could shave it again as that’s what he preferred! It struck me that no matter what, children love you unconditionally – and even if I’m feeling different or unusual, to him I’m normal and I’m his mummy.

I also visited Theo’s school as I didn’t know how he would be affected by my illness and if it might come out in class. The school were fantastic: they set up an Emotional Learning Support Assistant for Theo, with whom he had a chat with once a week. It seemed that no matter what was happening, I was still his mummy, and he simply told them what was going on at that point in time. It gave me a great peace of mind to know that the staff were looking out for him when I wasn’t able to do so.

Looking back

I find my poem hard to read now as it brings back so many difficult memories. At the time, my priority was to make sure that Theo would be okay, and that I got through everything as easily as I could for him.

I’m so glad that I didn’t go in all guns blazing with that book, and that I took some time to think about what was right for us.

If you like the poem or think it would work for you, too, then feel free to read it to your children.

If you’re affected by any of the issues that Steph has discussed, you can join our private Facebook group and find peer support.

If you’re free on 19th May, join us at Shine Connect 2018, our annual conference. We’re having a session specifically for parents going through cancer who want to support their children. More information at shineconnect.co.uk.

You can also look at the list of useful organisations on our website

Looking for a job after cancer

In the second of two blog posts on looking for work after cancer, recruitment consultant Ash Holmes answers some of the questions that were put to him via our private Facebook group. If you’re looking for work, make sure to check out his original post too. And good luck!


 

How should I deal with gaps in my CV? I don’t want the time I took off for treatment etc. to be seen as a red flag to an employer.working after cancer

This is probably the hardest question to answer as there are so many variables, and it will depend on your individual circumstances and how open you wish to be.

If you’re returning from a career break, no matter how long or short, it is best to at least address it in some way on your CV. Don’t leave it up to the individual reading your CV to wonder and draw their own conclusions.

Depending on how open you plan to be, simply putting ‘career break due to personal reasons, happy to discuss during a call/interview’ could be enough to stop a potential employer from wondering and instead focus on the rest of your CV and application.

Wording here is very important! As a reader, the difference between ‘personal issues’ and ‘personal reasons’ is huge. Try to think carefully about any language you use and avoid sounding negative. Ask for a second opinion, and get someone else to read through your CV.

If you do not want to talk about your reasons for having a break, then simply putting ‘career break’ with the relevant dates is still better than leaving a gap. By being transparent and addressing any empty spaces head-on, it stops any reader from trying to guess what’s happened. This is your chance to ‘control’ the reader’s impression.

Most recruiters and hiring managers will make a quick judgement about a CV, and finding an extended gap between dates is often one of the first things that they will want to ask about. Bearing that in mind, it’s important for you to be able to provide a reason for the career break, even if you are not going to talk about cancer. People take career breaks for a number of reasons, including: concentrating on family/a hobby or passion, feeling they have achieved everything they wanted and needing time to consider the next step, the end of a contract, or a change in circumstances (professional or personal) that meant they did not want to rush into a new position.

Where can I find good examples of CVs for different types of jobs?

For all CVs, there are core principles to be followed:

  • Make it clear and easy to read (do not try and fill every bit of white space with boxes of text)
  • Be concise (the ‘two pages’ rule is a good guideline, but it’s only a guideline!)
  • Make sure the content is relevant to the position you are applying for (you might need to create a few different versions of your CV)
  • Make sure key information is clear and well positioned (name and contact details at the top)
  • Don’t be afraid to use bold, underline, italics, or bullet points to emphasise information
  • Triple-check for grammar and spelling – and ask a friend to check it
  • If you are speaking to a recruitment consultant, ask for their advice

It’s useful also to consider the standards in your industry. A web designer might create their own website with examples of their previous work, for example, or a graphic designer might have a portfolio.

If you have recommendations on LinkedIn, you might want to include a link to your profile in your CV. If you are wondering how to ask for recommendations on LinkedIn, one of the most effective ways is to complete a recommendation for someone else. Once accepted, they might complete one without asking. Alternatively, explain that you are returning to work and that you would really appreciate a recommendation.LinkedIn

Professional CV writers do exist, but I would be very wary about paying anyone money. You will likely receive similar advice to that which you can already find online. The majority of job boards also have blog posts and CV templates readily available.

You can find a sample of my CV at the end of this blog.

Should I mention my cancer in an interview? What’s the best approach to mentioning time off without scaring employers?

First of all, it’s important to note that you are not obliged to disclose a cancer diagnosis and it is actually illegal for an employer to ask about your health in an interview. Once you’ve been diagnosed with cancer, you’re covered by the Equalities Act 2010 which provides legal protection against discrimination relating to employment, including during the recruitment process.

Having said that, whether you want to mention your cancer diagnosis is your choice. Personally, I think you need to focus on why you are the right person for the job, what you can bring, and how it will be beneficial for the employer/hiring manager. If you are going to discuss your illness, it is probably better to bring it up in person, during a later stage interview. Here, you can gauge a potential employers’ reaction and reassure them of your capability to do the role – and by this point, you already have your foot in the door. You can also control the conversation by providing relevant information and answering any questions.

When your cancer experience is relevant to your job and could be beneficial (in that it provides a useful perspective), how should you bring it up? I don’t want to present a sob story!

Dream jobIf you feel something is relevant and it will help you to be better at your job… mention it! Sell your strengths/experiences. Here is where a cover letter on an initial application might be the right approach. Just saying ‘I’ve had cancer’ isn’t enough: you need to explain why and how that will make you better at the job.

If you think your cancer experience could provide you with a ‘competitive advantage’ over other candidates, then maximise it! Don’t discount your experience and what you’ve learned through it.

Should I Google myself when I’m looking for work? Will an employer do this? What kind of stuff do they look for?

Some employers will carry out a Google search and social media check, and some won’t. It will often depend on the type of role and industry. Is the role public-facing, for example? Does it involve work with young or vulnerable people? It is always best to be on the safe side and use common sense. Here is where a professional profile, such as LinkedIn, can help you to present the best impression.

For some roles, employers will carry out police background checks, but they must ask your permission before doing this.

If you are concerned about your online image, there are often ways to make your social media profiles private. Do a quick Google search to find out how to do this for each specific platform. Many teachers, for example, change their name on social media to make it harder for pupils or parents to find them.

What’s the best way to look for a new job? Should I go online? What can a recruiter offer me?

The best approach is to combine online and offline activity. Reach out to former colleagues, friends, and acquaintances – anyone in your network who may be able to help. Hiring managers are more willing to talk on the phone or offer an interview after a personal recommendation, and if you talk to people you know then you may also hear about jobs before they have been advertised online. The process can feel less formal and more relaxed, helping you to demonstrate your skills and ability.

A huge part of the recruitment process is online, with a drive to make the process automated in many industries. Job boards are the best place to start. There are several main boards that cover a number of industries and experience levels (Indeed, CV Library, Total Jobs, Jobsite, Reed, and Monster). Alongside these are more specialised job boards. Do a Google (other search engines are available) search to find yours.

A large proportion of recruitment agencies and employers are now posting their roles on LinkedIn, so make sure you set up an account and take look.

Remember that applying via a job board or careers website is just the first stage. To stand out, it is important to follow-up via a call or email. Don’t be afraid to use social media to your advantage: if you know the hiring manager’s or recruiter’s name, add them on LinkedIn. Or ask the company for an update via Twitter!

Unfortunately, now that we have automation and most recruitment processes are online, receiving a generic rejection email is common. From May 2018, the General Data Protection Regulation (GDPR) comes into force. This means that you can request any application to be reviewed by a human instead of through automation.

Contacting a recruiter can be a great way to learn more about market conditions, industry-specific job boards, suitable roles, realistic earning potential, and which employers are more flexible with employees than others. The key to building a relationship with a recruiter is to do your research and make sure that they are working in the relevant industry to you.

A word of caution though: recruiters are sales people. Some will be very helpful and answer your questions, but others won’t – especially if they do not feel that they will be able to place you into a role.

Feel free to contact me on LinkedIn to see if I can recommend a recruiter based on your career goals/background.

Ash Holmes has spent the last seven years working in the recruitment industry. As well as working with thousands of candidates, Ash has created and delivered employability training to college students and individuals who are not in work, education or employment.  Ash has placed candidates with organisations as varied as Red Bull, Olympus KeyMed, Tottenham Hotspur, and Red Gate Software. He is more than happy to answer any follow-up questions and connect on LinkedIn.

Here’s a sample CV – Ashley Holmes

Borough, London, SE1

E: example@e.com. M: +44 (0) 00000 0000000

L: http://linkedin.com/in/ashholmes14

An experienced operations and marketing professional with over 7 years’ experience within the recruitment industry. Looking for a role and organisation to be able to continue my development, expand my experience and match my ambition. I have recently returned from spending a month in North America and am now looking for a new role.

I bring a wide range of experience and skills to the role including:

  • Strategy
  • Communication
  • Change management
  • Systems and process
  • Project management
  • Marketing & social media, including ress
  • Internal recruitment
  • Third-party management (suppliers, etc.)
  • Sales & account management
  • Training

As part of my personal development I completed a Level 6 Diploma in Professional Marketing from the Chartered Institute of Marketing in January 2017. The Diploma has helped me to understand the role that marketing plays within business, study key business-focused modules including Change Management, and to view marketing from a much more strategic position.

Employment History

Etonwood Ltd. (UK)

September 2017 – November 2017

Operations Director

Brought in to put in place the systems, process, and policies to help the organisation double in size. Implemented:

  • Trainee & senior attraction & interview process
  • On-boarding process & creation of ‘Welcome to Etonwood’ book
  • Mapped career progression & formalised job descriptions
  • Put in place appraisal process based on the above
  • First stages of GDPR policy
  • Created brand guidelines
  • Created social media strategy & reached over 100,000 LinkedIn impressions from 0
  • Put in place all health and safety policies

Raw Talent Academy Ltd. (UK)

May 2011 – August 2017

Operations, Marketing & Recruitment Manager

Joined as first full-time employee. The role evolved as the organisation grew to include marketing, operations, and finally managing the recruitment team.

Key Responsibilities:

  • Member of the Senior Management Team providing input on company-wide strategy
  • Creation & implementation of Marketing strategy to drive B2B lead generation & candidate attraction in line with company objectives
  • Marketing & Operations budget
  • Management of team of three recruitment consultants & one administrator – increased delivery from 73% (H1 2016) to 123% (H2 2016)
  • Account-managed two key accounts
  • Project-managed rebrand and launch of new website (launched 2017)
  • Project-managed development of a Digital Recruitment Assessment tool (SiD Digital)
  • Management of IT & processes, including: CRM/ATS, Office365, Data Recovery, IT support
  • Managed key external/supplier relationships (CRM, developers, graphic design, video creation, job boards)
  • Contracts, terms and policies (employee contracts, Health & Safety, etc.)
  • Press releases & award entries – existing relationships with recruitment industry journalists and publications, as well as some national publications.

Key Skills:

  • Microsoft Office
  • Adobe Photoshop, InDesign
  • iMovie
  • Basic HTML

 

MarketMaker4 (UK)

Technology Company

March 2011 – May 2011

Consultant

 

Travelling in Australia

January 2010 – February 2011

 

RightNow Technologies Inc. (Australia)

International Information Technology Company

April – December 2009

Assistant to Marketing Manager APAC / Business Development Representative APAC

Key Responsibilities:

  • The building and purging of customer and prospect databases to ensure the correct contact is listed along with correct contact details
  • Arranging and organising events for, and in partnership with, the Marketing Manager to ensure customers and prospects have a positive customer experience at the events
  • Helped in the development of and provided feedback regarding Marketing campaigns so that they have the maximum impact and highest response rates
  • Engaging with customers and prospects in the run-up to company events to encourage attendance
  • Identifying and contacting prospect and target accounts to create business opportunities

Foodnet Ltd. (UK)

International Food Trading and Production Company

June 2008 – March 2009

Purchasing and Sales Admin

Education

The Chartered Institute of Marketing (UK)

November 2015 – January 2017

Level 6 Diploma in Professional Marketing

Modules; Strategic Marketing, Marketing Metrics, Driving Innovation

Chesham High School (UK)

September 2006 – April 2008

3 A-Levels A-D

Amersham School (UK)

September 2001 – June 2006

9 GCSE’s A-C

Interests

Sport and music are my two main passions. I am a keen runner and have completed three marathons to date (London, Paris and Nice to Cannes). I also regularly attend live music.

References available on request.