INFO CANCER


                                                                

"individuals who approach life with an attitude that all of life is a gift will be more likely to find the good in bad life circumstances. They are more likely to move forward following a catastrophe. In fact, they may be more likely to label such an event a gift."

It seems a common thread -- the fact that cancer makes us all stronger in one way or another. It's one of the silver linings, I think. Cancer can be a gift. We just have to regard it as one and look hard for its hidden treasures.

WHAT CANCER CANNOT DO


Cancer is so limited,
It cannot cripple love,
It cannot shatter hope,

It cannot corrode faith,
It cannot destroy peace,
It cannot kill friendship,

It cannot suppress memories,
It cannot silence courage,
It cannot invade the soul,

It cannot steal eternal life,
It cannot conquer the spirit,

anonymous


P.A.V.E.L. HELPLINE  for young cancer patients: 0800 800 421


European Code Against Cancer

Any recommendation made to reduce cancer occurrence should not be one which could lead to an increased risk of other diseases. The recommendations which comprise the revised European Code Against Cancer should, if followed, also lead to improvements in other aspects of general health. It is also important to recognise from the outset that each individual has choices to make about their lifestyle some of which could lead to a reduction in their risk of developing cancer. These choices, and the rationale underlying their recommendation, are presented below.

Certain cancers may be avoided and general health improved if you adopt a healthier lifestyle:

- Do not smoke; if you smoke, stop doing so. If you fail to stop, do not smoke in the presence of non-smokers 
- Avoid Obesity 
- Undertake some brisk, physical activity every day 
- Increase your daily intake and variety of vegetables and fruits: eat at least five servings daily. Limit your intake of foods containing fats from animal sources 
- If you drink alcohol, whether beer, wine or spirits, moderate your consumption to two drinks per day if you are a man and one drink per day if you are a woman 
- Care must be taken to avoid excessive sun exposure. It is specifically important to protect children and adolescents.
- For individuals who have a tendency to burn in the sun active protective measures must be taken throughout life 

- Apply strictly regulations aimed at preventing any exposure to known cancercausing substances. Follow all health and safety instructions on substances which may cause cancer. Follow advice of national radiation protection offices

There are public health programmes that could prevent cancers developing or increase the probability that a cancer may be cured:

- Women from 25 years of age should participate in cervical screening.This should be within programmes with quality control procedures in compliance with European Guidelines for Quality Assurance in Cervical Screening
- Women from 50 years of age should participate in breast screening. This should be within programmes with quality control procedures in compliance with European Union Guidelines for Quality Assurance in Mammography Screening 
- Men and women from 50 years of age should participate in colorectal screening. This should be within programmes with built-in quality assurance procedures 
- Participate in vaccination programmes against Hepatitis B Virus infection
 
This study was supported by the Europe Against Cancer programme of the European Community
http://www.cancercode.org/code.htm




                               

SAINT SILUAN* WARNING SIGNS FOR CANCER IN CHILDREN

               *Saint Siluan was a Russian monk who died on Mount Athos in 1938. He prayed ceaselessly for all humanity.

  Dissemination of the Saint Siluan warning signs is an initiative of ICCCPO in cooperation with SIOP.




 Facts about Childhood Cancer


    When adequately treated, approximately 70% of childhood cancers are curable. However, today only 20% of the world's children benefit from advanced medical care.
    
    Children living in the underdeveloped countries account for 80% of the world's population of children. Some of these children have cancer and are currently denied the right to hope for a cure.
    
    The ICCCPO exists so that the parents of these children have access to the information they require to make educated decisions about their child's treatment.
    
    Please remember, when searching for information on the internet...    

    - that every child with cancer regardless of financial or social class, race or native origin deserves access to the best possible treatment and medical care,
    - results may include links to information related to adult cancers; these are often quite different to childhood cancers even though they may have identical or similar names,
    - results may include information intended for different audiences; for example information for ocologists often assumes a great deal of prior knowledge and specialist education,
    - the search term may include a word that is spelt differently in American and UK English (eg. Leukemia vs. Leukaemia, tumor vs. tumour),
    - the quality of information on the Internet is variable; users should be aware of source reliability issues.

    Parents are strongly advised to discuss their information requirements with their doctor, who knows their child's specific details.

    
                            Children with cancer need everyone's help!



                 


                  
                 


The global cancer burden

Cancer is largely preventable and the most curable of major life-threatening diseases today.
By applying existing evidence-based knowledge it is possible to prevent at least one-third of the estimated 11 million cancer cases that occur globally each year and with early detection and treatment, it is possible to cure at least another third of cancer cases.
However, in spite of the unprecedented understanding of the root causes of cancer, the gap between what is scientifically feasible and what is being applied continues to widen.

In 2005 alone, almost 7 million people died of cancer and close to 11 million new cases were diagnosed. Cancer claims twice as many lives worldwide as AIDS. In fact, more than 12% of all deaths every year are caused by cancer. That’s more than AIDS, tuberculosis, and malaria put together.
In industrialized countries, cancer is the leading cause of premature mortality, and evidence points to the emergence of the same trend in developing countries.

Knowledge about the prevention and treatment of cancer has significantly increased, but the numbers of people diagnosed with cancer each year and those who eventually die from it are growing dramatically. Worldwide cancer control can only be effective if it is given priority at the highest decision-making levels. Complacency and inaction on the part of the international community will effectively contribute to more than 10 million deaths annually by the year 2020.

In developing countries, 80 to 90 percent of cancer patients already suffer from advanced and incurable clinical complications at the time of diagnosis. Transfer of knowledge must actively be promoted between peoples of industrialized economies and those who live in resource-limited settings. Best practices and lessons learned on cancer-control strategies need to have a regular forum. Clever science in tandem with sound policies based on evidence can lead to a reduction in the global cancer burden.

Cancer knows no boundaries. It not only affects the quality of life of the person living with the disease but also adversely impacts the psychosocial welfare of entire families. Its effects can be wide-ranging and a downward spiral can result with huge economic implications. Cancer is capable of inflicting a massive and often irreversible shock on the most vulnerable: young children, adolescents as well as persons whose families depend on them for basic survival.

The fight against cancer is at a turning-point. In close partnership with patient and survivor support networks, and national cancer societies, the International Union Against Cancer (UICC) is in a unique position to pool resources and expertise to contain the further spread of this deadly disease.

The time to act is now !

http://uicc.org/fileadmin/about/global.pdf



What is cancer?

Cancer is a disease that affects many people. Many people are frightened when they hear about cancer. This fear some times discourages people from becoming informed and doing what they can to help prevent cancer. Learning more about cancer is a way to cope with the fear of cancer.
Cancer is a group of many diseases that are due to abnormal functioning of the body cells. The human body is made up of billions of these tiny cells. These cells form all parts of the body, skin, bones, heart, lungs, and other organs. Normally, these cells reproduce themselves to support the growth and repair of the body parts.
When a cell begins reproducing or dividing without the normal order, pattern or purpose, we call this a tumor. A tumor may be benign (not cancerous) or malignant (cancerous). A benign tumor may grow larger, but it does not spread to other parts of the body. It may cause serious problems, a blockage or appear unusual, but it usually can be removed and does not grow back.
A malignant tumor is cancerous. The tumor invades nearby parts of the body. It can spread to other parts of the body forming new tumors (this is called metastasis). In a malignant tumor, the cells are growing completely out of control.
In some cases, even when the original tumor is removed by surgery, the disease may continue to grow where it began or in other parts of the body if cancer cells already have spread.

What causes cancer?

Cancer occurs when there are changes in the part of the cell that controls reproduction or division of the cell. These changes can be caused by infection, like Hepatitis B, or by exposure to smoking. Scientists agree that people develop certain cancers through repeated or long term contact with one or more cancer causing substances called carcinogens. Carcinogens cause body cells to grow abnormally. Examples of carcinogens include some pesticides, radiation, chemical toxins, and tar in cigarettes. In addition, smoking cigarettes too much may cause
you to have lung, throat or bladder cancer. For some cancers, such as colon, prostate, breast or brain the causes are not clear, and we do not know why patients with these types of cancer get the disease when other people do not.
Treatment of hepatitis (liver disease), avoiding sunburns, or quitting smoking will reduce the chance of getting cancer from these causes. Early testing (screening) to look for cancer early (when it is small and has not spread to other parts of the body) can allow for treatments which will cure the cancer, preventing death from cancer.
Some of the infections that may cause cancer can be contagious, but cancer itself is not contagious. You won’t get cancer by being around someone who has cancer.
Some types of cancer, like breast or colon cancers, run in the family. The risk of getting these types of cancer may be higher for you if other relatives in your family had that type of cancer before. You can help yourself by getting tested early for the types of cancers that are common in your family.

Warning signs of cancer include:
 -  Losing a lot of weight without trying
 -  A cough that won’t go away and that is not TB
 -  Coughing blood, vomiting blood, or passing blood in the stool
 -  Blood coming from the vagina that is not menstruation
 -  Unusual changes in moles or skin
 -  Skin wound that will not heal
 -  Feeling very tired and weak without reason
 -  Lumps or growths
 -  Unexplained pain

Having these warning signs does not mean you have cancer. The signs may be caused by other things. If you have one or more of these signs, check with a doctor to know why.

Preventive health care and cancer treatment – Doing things to keep healthy Preventive health care is very important. It is necessary to eat the right foods, exercise and pay attention to your body if you want to be healthy. It is also very important for you to see your doctor as soon as you find any of the cancer warning signs, or any other health problems. Your doctor may recommend a test to find
cancer early before you have warning signs and, when a cancer is easier to cure.
Your doctor may find that you do not have cancer, but finding the disease at an early stage improves the chances of cure or control.
There are many different kinds of cancer. Some cancers are easier to treat than others. The treatment of cancer is improving. Old cancer treatments caused lots of side effects and were very difficult for patients. Now, there are many new and more effective cancer treatments. If cancer is found early, doctors can use these new treatments which are less troublesome and easier for patients. If cancer is
found early, doctors have a better chance of successfully curing the cancer.
Having cancer does not mean that you are fated to die from cancer, or that it is God’s will that you die from cancer. People who have cancer can often be cured, so that they do not die from cancer. If you have cancer, do not give up. It is important to seek treatment because most cancers can be treated.
If you have questions about the information you see here, or if you want to learn more about cancer and early testing, contact your family doctor for an appointment. If you believe you may have some unusual signs and believe they represent early signs of cancer, you should make an appointment with your doctor.

Adapted from the American Cancer Society pamphlet: WHAT YOU NEED TO KNOW ABOUT CANCER by Harborview Medical Center, AANCART and House Calls programs. Translation made possible by The Accessing Health
Information Project, funded by the National Library of Medicine.


PREVENTING BOWEL CANCER

Thousands of people a year could be saved from developing bowel (colon) cancer - if only they knew how.

Here are our Top Ten Tips - they won’t help everyone but will save many lives:

1. The wonders of walking - especially brisk walking. Daily walks (at least 30 minutes) boost the immune system, make our insides work more efficiently and help keep down fatty cells around our middle as we get older - these cells increase insulin which can encourage cancers to develop around the body.

2. You are what you eat - cut back on red meat, processed and fatty foods, step up wholemeal bread/pasta, oily fish, fruit and veg and you’ll really improve your chances of avoiding bowel cancer.

3. Older & wiser - most people who get bowel cancer are over 50 so the older you are, the more aware you need to be. Screening is the best way to catch it early. From April 2006 the over 60s will be offered free bowel cancer screening - it’ll be wise to accept

4. Weight watchers win - being fat increases your risk. Even if you’re fit and fat, you’re still at increased risk of bowel cancer. Big breakfast, middle sized lunch, small dinner, only fruit as snacks between meals - with exercise, it’s the best way to lose weight

5. Ask your granny - if there is any bowel cancer or other cancers in your family. Having close relatives affected can dramatically increase your risk - click on Family History to find out more

6 Know your onions - veg from the allium family (onion, garlic, leeks ..) are thought to protect the gut against cancer and it’s good advice to eat lots. Latest research looks good for watercress and broccoli too.

7 Think alternatives to aspirin - research shows aspirin can stop early cancers developing but get your doctor’s advice before you take it. A great alternative - organic green veg: they develop natural aspirin (salicylic acid) to help fight off plant diseases

8. Smoking & drinking - no surprise that smoking and heavy drinking, especially beer & spirits, can increase your chances of getting bowel cancer. To stop smoking, try the Quitline 0800 002200. Exercise helps to cut cravings; serious drinkers, contact www.al-anonuk.org.uk - serious smokers Quitline 0800 002200

9. Listen to your insides - ulcerative colitis, Crohn’s disease, inflammatory bowel disease, a history of polyps - bowel problems like these can lead to bowel cancer, especially if you developed them young or have had them a long time. Make sure your GP gets you monitored

10. Don’t sit on symptoms - millions of us have bleeding from the bottom and changes in our bowel movements every year. Get to know which are important and how to test them to see if serious before going to your GP - ring our 24-hour recorded symptoms hotline - 0870 24 24 870 or get our Step by Step guide, free from Lynn’s Bowel Cancer Campaign, address below. Pick up symptoms earlier and you might live longer.

“Bowel cancer is the commonest cancer in Europe and the second highest cancer killer in the UK, affecting one in 10 families. I want people to know that although being told you have cancer can be absolutely terrifying, it is not necessarily a death sentence. “This certainly applies to bowel cancer as it is one of the most treatable, curable and beatable cancers. Be aware of the symptoms and don’t be embarrassed about speaking to your GP. Being able to spot important symptoms might save your life.”
Margaret McMahon

http://www.bowelcancer.tv/cgi-bin/page.pl?page=HowToPrevent&accessability=no


PATIENTS' RIGHTS


The Rights and Educational Needs of Sick

Children and Adolescents

1.  Every sick child and adolescent has the right to tuition within hospital or at home.
2. The aim of tuition for sick children and adolescents is the continuation of education, enabling them to maintain their pupil-role.
3. The hospital school creates a community of children and adolescents, and normalizes everyday life. Hospital education shall be organized as class, group or individual teaching and at the bedside.
4. Hospital and home tuition must be adapted to the needs and abilities of the child or adolescent in co-operation with the home school.
5. The learning environment and facilities must be adapted to the needs of sick children and adolescents, and communication technologies shall also be used to prevent isolation.
6. A variety of teaching methods and resources shall be used. The content encompasses more than formal curriculum learning. It includes subjects related to special needs arising from illness and hospitalization.
7. The hospital and home tuition teachers must be fully qualified and receive further training.
8. The teachers of sick children and adolescents are full members of the multi-disciplinary caring team and are the link between the hospitalized child or adolescent and the home school.
9. Parents must be informed about the right to schooling and the educational program of their sick child or adolescent. They shall be recognized as active and responsible partners.
10. The integrity of the child or adolescent shall be respected including medical confidentiality and private convictions.

Adopted by the General Assembly of HOPE
Barcelona - 20th May 2000
web: http://www.hospitalteachers.eu


Child patient rights and responsibilities


Everyone has a right to expect quality care while in hospital. Hospital staff and parents have a special duty of care to children and a legal responsibility to protect the child’s rights, interests and wishes.
This is dependent on their age, understanding and the treatment they are having (this may differ in Scotland).
While in hospital:
A child can expect…

• to receive treatment on the basis of clinical need.
• courtesy and respect for privacy and dignity.
• treatment in a children’s hospital, unit or ward that is right for their age and medical condition, with play and education available.
• nursing care by appropriately trained children’s nurses.
• to be involved in discussions (if they are able to understand) and consideration to be given to their wishes.
• an introduction to the staff caring for them.
• their operation to be carried out by, or under the supervision of, a surgeon with appropriate training and experience in the care of children.
• anaesthetic from an anaesthetist who is trained and experienced in the care of children.

As the parent or guardian of a child you can expect…

• to be with your child during treatment, unless it puts either of you at risk, and to stay overnight if you wish.
• to choose to have a relative or friend with you during consultations and examinations.
• to be given time to ask questions about your child’s medical problems and suggested treatment and to get clear information about them (ask if written information is available).
• to be given a name and telephone number of someone you can ring if you have any other questions.
• to take part in all decisions about treatment and aftercare and to have the pros and cons, including any risks, side effects and alternative methods of treatment fully explained to you.
• to be informed day or night of any worsening in your child’s condition.
• staff to understand you may be feeling worried or nervous and this may affect the way you or your child behave.
• to be told if there is a delay when you arrive for an appointment, how long you may have to wait and why.
• to know the names, jobs and professional status of the staff involved in your child’s care.
• to have all details about you and your child treated in confi dence (except where required by law) and for your permission to be obtained before any details can be shared with anyone else.
• to have the right to see any information kept about your child and family.
• to complain if you are unhappy with the treatment you or your child receives.
• to be given an explanation and, where appropriate, an apology, if things do not go as planned.
• to choose whether or not your child may be seen by medical students.

You and your child have a responsibility…

• to treat all staff, other patients and families with courtesy and respect.
• to let the hospitals know at once if you change your address or telephone number.
• to understand that there are pressures of time and resources on the NHS and those working within it.
• to give staff full information about your child’s condition and to let the staff know if your child has any physical or learning disabilities, allergies, sensitivities, conditions or changes in their health and of any medicines they are taking, including over the counter remedies.
• to tell staff if your child is being, or has been, treated by other health care professionals that might be relevant to present treatment.
• to tell staff if you do not understand or are uncertain about any part of the diagnosis or treatment and ask for more information or clearer explanation (in writing if it helps).
• to follow the instructions given to you on the care of your child before going into hospital for an operation.
• to make sure that your child follows the advice on what to do after the operation (eg exercise, diet, etc); takes any medicine as instructed; and seeks medical advice before stopping or changing treatment.
• to think about and be aware of what might happen if you or your child refuse the
recommended treatment or do not follow the doctors’ advice and accept responsibility for those actions and the subsequent results for your child.
• to ensure that your child attends follow-up appointments and that all appointments are attended on time or that cancellation (with reasonable notice) is arranged.
• to make sure you, your child and all accompanying visitors follow all the hospital and ward rules.

JANUARY 2003
©The Patient Liaison Group at The Royal College of Surgeons of England.
Contact the PLG on tel: 020 7869 6045; fax: 020 7869 6045; or see the website at www.rcseng.ac.uk/welcome/information_for_patients_liaison/


Children Patient' s rights
England and Wales

Young people aged 16 or over but under 18 can give independent consent to their own treatment. It is not necessary to obtain the consent of a parent or guardian. A young person can be overruled by a court order.
However, if the young person is incapable of giving their own consent, for example, they are severely disabled, the parent’s or guardian’s consent must be obtained.
Children under 16 can give their own consent to treatment provided they are judged capable by a doctor, Primary Care Trust or NHS Trust, of understanding what is involved. There is no general test for assessing this capacity, and each case will be decided on its own merits.
If a child under 16 does not have sufficient understanding, parental consent (or a court order) will be required for any treatment, except in an emergency. If a child under 16 who does have sufficient understanding refuses treatment, treatment can still be given with their parent’s or guardian’s consent or by a court order.
Young people or children under 18 cannot give their own consent to experimental operations and blood donations, unless they have sufficient understanding of what is involved.
Scotland
In Scotland, a child under 16 can consent to, or refuse, any treatment if the qualified medical practitioner attending them believes they are capable of understanding the nature and possible consequences of the treatment. Parental consent should be obtained where a child under 16 does not have sufficient understanding, except in an emergency where there is not time to obtain it. If the local authority holds parental responsibility for a child under 16, consent from a parent or guardian does not need to be sought.
Northern Ireland
In Northern Ireland, a parent's consent may be required for any medical treatment for a young person aged under 16. However, in practice, if the young person understands the implications of the treatment involved, they can consent to, or refuse, medical treatment themselves.
A young person over 16, if competent, can give their own consent to treatment, although most hospitals will require parental permission to perform an operation on a young person under 18.

You refuse treatment for your child
If you, a guardian or child refuse to give consent for treatment which a doctor thinks is necessary, the doctor is still obliged to treat the child. The action the doctor takes will depend on how urgently the treatment is needed.
When a child’s life is in danger, the doctor has the right to do whatever is needed to save the child’s life. If you or a guardian either fail to provide medical help for a child, or unreasonably refuse to allow treatment, you can be prosecuted for neglect.
Children
There may be a number of issues which you may wish to consider if your child is to go into hospital, for example, whether you can stay with your child, how much help you can give with feeding and looking after your child and what will happen to your child’s education. Action for Sick Children may be able to advise on all these issues. It also produces a leaflet for parents whose child is going into hospital for the first time.


DIET reccomendations

European Prospective Investigation into Cancer and Nutrition

EPIC: Diet nutrition and cancer prevention

According to the American Institute for Cancer Research (AICR), the world's most comprehensive cancer study being conducted in establishing the link between diet and cancer risk has been going on for over a decade and few people hear about it. Over 80 scientific papers based on the study have been published in journals such as the Journal of the National Cancer Institute, the Lancet, the Journal of Nutrition.

The study -- called the European Prospective Investigation into Cancer and Nutrition (EPIC) -- is an enormous undertaking involving 521,483 individuals in 10 different European countries. EPIC is unique because the populations being tracked are so diverse in eating habits. But this is precisely what gives the study the advantage it has in making comparisons and noting trends.

According to EPIC, a few of the emerging results found in the link between diet and cancer are:

Consumption of meat sharply increased risk of stomach cancer and esophageal cancer. For every 100 grams of meat consumed by subjects, risk for stomach cancer more than tripled. The association between meat intake and stomach cancer was considerably stronger among subjects with populations of H. pylori bacteria in their stomachs.
Two indicators of abdominal obesity, waist circumference and waist-to-hip ratio, were strongly associated with colon cancer risk in both sexes. Men with the largest waist circumference had 39 percent higher risk of colon cancer than men with the smallest, for example, while women in the study with the largest waist circumference has a 48 percent higher risk than women with the smallest waists.
Blood samples of women with breast cancer were compared to blood samples of women without breast cancer. Women over 60 whose blood was given under non-fasting conditions, high levels of serum C-peptide, that could reflect insulin resistance -- long suspected of contributing to cancer risk -- was associated with a doubling of breast cancer risk.
The risk for oral and pharyngeal cancers drop by 9 percent for every 80 grams of fruits and vegetables consumed per day.

Researchers are beginning to come to some conclusions involving the data they have to date that clearly shows that globally, diets that are high in fruits, vegetables, fiber and fish are associated with greater cancer prevention -- with obesity and sedentary lifestyles much larger factors in increasing cancer risk.


European Prospective Investigation into Cancer and Nutrition
  Introduction   
         
     The European Prospective Investigation into Cancer and Nutrition (EPIC) is coordinated by Dr Elio Riboli, Chief of the Nutrition and Hormones Group at the International Agency for Research on Cancer (IARC, which is part of the World Health Organization) in Lyon, France. EPIC received substantial financial support from the Europe Against Cancer Program of the European Commission.
      
    EPIC was designed to investigate the relationships between diet, nutritional status, lifestyle and environmental factors and the incidence of cancer and other chronic diseases. EPIC is the largest study of diet and health ever undertaken, having recruited over half a million (520,000) people in ten European countries: Denmark, France, Germany, Greece, Italy, The Netherlands, Norway, Spain, Sweden and the United Kingdom (select a country from the map).
    Within these countries EPIC research scientists are based in 23 centres: one in France (Paris), Greece (Athens) and Norway (Tromsø), two in Denmark (Aarhus and Copenhagen), Germany (Heidelberg and Potsdam), Sweden (Malmo and Umea), the Netherlands (Bilthoven and Utrecht) and the United Kingdom (Cambridge and Oxford), five in Italy (Florence, Milan, Naples, Ragusa and Turin) and Spain (Granada, Murcia, Asturias, Pamplona, and San Sebastian with Barcelona the co-ordination centre). Originally there were 7 countries involved but between 1995 and 2000 Sweden, Denmark and Norway, which were already involved in similar studies, joined EPIC and thus broadened the European cohort to include Scandinavian populations.
 Recruitment into the study, which was initiated in 1992, was principally from the general population aged 20 years or over, and took place between 1993 and 1999. Detailed information on diet and lifestyle was obtained by questionnaire, and anthropometric measurements and blood samples were taken at recruitment. The blood is stored in liquid nitrogen for future analyses. By studying very many people in different countries with differing diets, using carefully designed and tested questionnaires, EPIC should produce much more specific information about the effect of diet on long-term health than any previous study. The first results were presented in June 2001 at the European Conference on Nutrition and Cancer and the conference proceedings have been published in Riboli E., Lambert A. (eds) : Nutrition and lifestyle : Opportunities for Cancer Prevention. IARC Sci. Publ. No.156. 2002.

It is planned to follow-up the study participants for the next 10 years at least, continuing to study the role of nutrition and lifestyle in cancer development and other chronic diseases. The EPIC Newsletter can be found here.

In September 2001 the 5 A Day Initiative project, under the auspices of the German Cancer Society in Frankfurt, Germany entered into a collaborative research agreement with the EPIC study.
 http://www.iarc.fr/epic/Sup-default.html


European Prospective Investigation into Cancer and Nutrition

The European Prospective Investigation into Cancer and Nutrition (EPIC) study is a Europe-wide prospective cohort study of the relationships between diet and cancer, as well as other chronic diseases, such as cardiovascular disease. With over half a million participants, it is the largest study of diet and disease to be undertaken.

EPIC is coordinated by the International Agency for Research on Cancer (IARC), part of the World Health Organization, and funded by the 'Europe Against Cancer' programme of the European Commission as well as multiple nation-specific grants and charities.

521,457 healthy adults, mostly aged 35-70 years, were enrolled in 23 centres in ten European countries: Denmark (11%), France (14%), Germany (10%), Greece (5%), Italy (9%), The Netherlands (8%), Norway (7%), Spain (8%), Sweden (10%) and the United Kingdom (17%). One UK centre (Oxford) recruited 27,000 vegetarians and vegans; this subgroup forms the largest study of this dietary group. Recruitment to the study took place between 1993 and 1999, and follow up is planned for at least ten years, with repeat interview/questionnaires every three to five years. The main prospective data collected are standardised dietary questionnaires (self administered or interview based), seven-day food diaries, blood samples and anthropometric measurements, such as body mass index and waist-to-hip ratio. Additionally, the GenAir case-control study is studying the relationship of passive smoking and air pollution with cancers and respiratory diseases.

Up to 2004, there were over 26,000 new cases of cancer recorded among participants, with the most common being cancers of the breast, colorectum, prostate and lung. Current analyses are focusing particularly on stomach, colorectal, breast, prostate and lung cancers. The different dietary patterns in the different countries should enable reliable associations to be made between particular diets and cancers. The analysis of stored blood samples should also allow dissection of genetic factors involved in cancers, as well as the effects of hormones and hormone-like factors.


Key findings
Consumption of fibre, fish, milk and cheese reduce risk of colorectal cancer, while red and processed meat increase risk
Consumption of fruit and vegetables does not affect risk of breast or prostate cancer


Meat, Fish, and Colorectal Cancer Risk: The European Prospective Investigation into Cancer and Nutrition
http://jnci.oxfordjournals.org/cgi/content/full/97/12/906


The Bristol Approach to Healthy Eating


Malnutrition is common in adults and children with cancer and evidence clearly shows that this can have a negative impact on how effective a person’s medical treatment is for them and also how well they are able to tolerate the treatment. A healthy eating plan can help to protect against malnutrition and also ensure the body receives adequate levels of nutrients that support the body’s immune and repair functions, both of which can become weakened due to the disease or its necessary medical treatments.

Scientific research highlights the powerful anti-cancer properties of many foods and indicates that a healthy diet can be very beneficial for people diagnosed with cancer. This sheet provides a general overview of our healthy eating recommendations and includes lists of foods that we encourage people to eat plenty of, the foods we suggest in moderation and those we would encourage people to minimise. These are presented alongside practical suggestions on how to add healthy foods high in anti-cancer agents into the daily diet, while gradually cutting down on or avoiding those foods containing compounds that may undermine health. Please note that those with specific nutritional needs should seek the advice of a health professional before changing their diet.

The Bigger Picture
Although what we eat and drink is very important, there are also many other changes that can be made to improve quality of life and to support health and well-being.  It is very natural that adults and children may experience increased stress levels after a diagnosis of cancer, but this stress can prevent the immune system, a most vital system of defense against disease, from working at its best.  We therefore feel that learning practical techniques to reduce stress levels is just as important as following a healthy way of eating. 

Healthy Eating for Children
Generally the diet that would be most supportive to the health of adults would also be the one most supportive to the health of children. The focus with both adults and children is on the use of whole foods, which are those with as little added or taken away as possible. While it is often assumed that children will not be happy to eat wholesome foods, there are many ways to make vegetables, fruits, wholegrains, nuts and seeds and pulses appealing to children. Ideas include fresh fruit juices and smoothies, burgers made with beans, lentils and good quality fresh meat, potato chips prepared by baking slices of fresh potatoes in olive oil, vegetable soups etc.

Parents should be encouraged to cook meals for their children that are based on a wide variety of fresh ingredients and to experiment with new foods. If children do not accept the new foods at first it is worth persevering. However, one very important point is that children should not be forced to eat foods that they don’t like as stressful mealtimes are not helpful to parents or children. The key thing is to make the foods and the eating experience as fun and exciting as possible and one way to do this is to involve children in the food preparation. Also families should be encouraged to sit down around a table and eat their meals together.


Introducing Dietary Changes
Enjoyment - the most important thing to remember is that food should always be a pleasure. The way we feel emotionally as we eat has a significant impact on the way we digest and absorb the food and we should try, if possible, to eat in a relaxed environment. Feelings of stress due to a dislike of the food will undermine the nourishment we are receiving and it is therefore important not to feel too pressured by thoughts of what should and should not be eaten.

Experiment at the same time that it is important to enjoy the diet, it is vital to include as many of the healthiest foods as possible on a regular basis. We encourage people to experiment and find ways of preparing and cooking food that is healthy and delicious.

Step-by-step changes - when introducing changes to the diet, do so in a step-wise fashion. It is important not to make lots of changes at once as it is easy to become overwhelmed, which can lead to helplessness and a desire to give up on the healthy eating plan altogether.

Varietyit is essential to eat a varied diet not only to ensure a balanced intake of all essential nutrients but also to avoid becoming bored with the eating plan.

Foods to Eat Plenty Of
·    Organic foods – use organic foods whenever availability and budget allow in order to limit exposure to potentially toxic pesticides and hormones.
·    Whole foods – whole foods are those with as little added or taken away as possible. Stick to foods that are unprocessed, i.e. no ‘ready meals’, and unrefined, i.e. use whole grain products such as wholemeal bread or pasta rather than the white variety.
·    Fresh vegetables and fruit – choose those that are in season and locally grown if possible. You should aim to have 8-10 portions per day (7-8 portions for children) with at least 5 portions of vegetables and 3 of fruit. Eat some of these raw and either lightly steam or bake the rest. Eat a variety of vegetables and fruit in a rainbow of colours.
·    Whole grains – include whole grains and whole grain products in the diet on a regular basis. Examples include barley, rye, wheat, rice and oats.
·    Pulses – include a variety of cooked and sprouted beans, peas and lentils.
·    Healthy fats – use cold pressed vegetable oils for salad dressings and extra virgin olive oil or coconut oil for cooking. Olive oil can be drizzled over bread or toast in place of spreads. If this is not acceptable use non-dairy margarine free from hydrogenated/trans fats. Nuts and seeds plus oily fish are good sources of the essential fatty acids.
·    Juices - freshly prepared juices are a great way of boosting nutrient intake. Use mainly vegetables with a little fruit to sweeten.
·    Water - drink lots of water aiming for around 1.5-2 litres per day (around 1 litre for children). If possible, aim to use spring or mineral water or water that has been filtered.

Foods to Eat in Moderation
·    Poultry – chicken and turkey (organic, if possible).
·    Eggs – chicken, duck or quail (free range and organic, if possible).
·    Fish – choose non-farmed, deep-sea white fish such as cod and haddock and the smaller oily fish such as sardines, pilchards and herring.

Please note: we suggest people consume small portions of animal products, about the size of the palm of the hand, around 3 times per week, or every other day. For children we would recommend a piece of meat, fish or an egg every day. We also strongly recommend buying the best quality products whenever possible, ideally organic. People who choose not to eat animal products should be very careful in ensuring they consume adequate protein from a plant-based source and to help we would recommend they seek the advice of a nutritionist.


Foods to Minimise
·    Red meat – e.g. beef, pork or lamb.
·    Dairy products - milk, cheese, cream or yoghurt (non-dairy alternatives are available).
·    Smoked and salt cured foods
·    Barbequed, char-grilled or burnt foods
·    Refined sugars – avoid all sugary foods and use fruit (primarily fresh but also dried, if desired) to add sweetness to the diet. Honey or maple and fruit syrups can be used occasionally, if necessary.
·    Processed foods  - e.g. pre-prepared meals and convenience foods.
·    Caffeine
·    Alcohol
·    Table salt – use small amounts of tamari sauce or rock/sea salt instead.
·    Hydrogenated or trans fats – found in many convenience foods, vegetable oils and margarines. Use cold-pressed vegetable oils and margarines free from trans fats.

Hints and Tips
·    Begin your dietary changes by increasing your intake of fresh organic vegetables and fruit. Follow this with an increase of the whole grains, pulses and nuts and seeds so that plant foods form the bulk of your diet.

·    A good way to ensure you are eating a variety of vegetables and fruit is to aim for a ‘rainbow diet’, i.e. a range of richly coloured foods. The bright colours will also makes a meal look particularly appetising.

·    Gradually replace dairy products with alternatives such as rice, nut, oat or soya milk. This does not mean that you have to do without creamy food as nut based products are good for creams and puddings. Large amounts of soya products (more than once per day) are not recommended.

·    Juicing is a great way of getting the goodness and nutrients from a wide variety of vegetables and fruit into your diet. Nutrients in fresh juices are easily absorbed and therefore juicing is useful for those with poor digestion.  To avoid high levels of fruit sugars, use mainly vegetables with a little fruit to sweeten.

·    If you are unable to obtain organic vegetables or fruit, use non-organic but make sure you wash them properly. To help remove surface pesticides, soak them for 15 minutes in water mixed with one tablespoon of vinegar before use.

·    Try not to rely on wheat products too much. Instead experiment with the other more unusual whole grains such as rice, corn, buckwheat, rye or barley.

·    Use the following to add flavour to dishes without the use of salt: herbs (fresh and dried), spices, lemon and lime, tomato paste, tamari sauce, garlic, ginger, dried mushrooms and dried tomatoes.

·    If possible, cook in bulk and then freeze individual portions for when you are busy or don’t feel well enough to cook.

·    Main meals can take a little planning, especially if you are cooking for a family.  Ensure that you have a few good healthy-eating cookbooks to inspire you.

·    If you are not used to eating meals that are free from animal products, start slowly by having one meal of this type a week. Gradually include more of these meals as you build up your repertoire of recipes and your confidence in cooking this way. 

·    Grow your own sprouts from pulses (lentils, peas and beans) and seeds. It is cheap and easy to do, and the sprouts are highly nutritious. They can be eaten raw or lightly steamed or stir-fried.


Meal Planning
Changing the way you eat can feel a little daunting at first. To help you plan your new menu here are a few ideas for breakfast, lunch and dinner, as well as ideas for snacks.

Breakfast – fruit salads using fresh or cooked dried fruits; wholegrain toast with sugar-free fruit preserve, nut butters (e.g. almond or hazelnut), scrambled egg, tomatoes or mushrooms; porridge or muesli with fruit and nuts and seeds, made using non-dairy milk; fruit smoothies (a particular favourite with children).

Lunch – mixed salad using a variety of fresh raw vegetables and fruit; fresh soups; jacket potato or wholegrain sandwich with beans, hummous, lentil pate, nut butters, sardines; cooked grain salad using barley, bulgar wheat, buckwheat, brown rice etc.

Evening meal – vegetable casserole; vegetable curry; lentil cottage pie; tofu stir-fry, fish or organic chicken with vegetables. Burgers made with beans, lentils and good quality meat or white fish coated in bread crumbs and baked are good ideas for children.

Snacks – nuts and seeds; fresh or dried fruit; chopped raw vegetables plus hummous or avocado dip; oatcakes, rye crackers, rice cakes or wholegrain toast plus lentil pate.


Supplements
Supplements provide nutritional back-up to a good diet but the focus of a nutritional approach should always be the foods, as supplements can never replace a healthy diet.

The key supplements that we recommend for people with cancer are listed below with the reasons why they are important:

·    Multivitamin and mineral – it is particularly important to supplement minerals as soil levels of these vital nutrients have declined significantly over the past few decades due to intensive agricultural practices. Formulations designed for children are readily available.

·    Antioxidant – antioxidants help protect the body against excess free radical activity, which is implicated in cancer development and progression. Many different nutrients possess antioxidant activity and it is advisable to take a supplement containing a range of these nutrients such as vitamins C and E, zinc, beta carotene etc. as they have synergistic actions working together more powerfully as a group. Formulations designed for children are available, alternatively half the dose of an adult formulation could be used for those under 12 years.

·    Fish oils – fish oils are rich in essential fats called omega 3 fats, these are very supportive to health, in particular for people with chronic diseases. Children under 12 years should take half the adult dose.

·    Probiotics – these are bacteria that are beneficial for the health of the gut. They help ensure digestion and absorption of nutrients is efficient and they promote health in other ways including supporting the immune system.

It is recommended that people stop taking all supplements 2 days before they have a dose of chemotherapy and restart them 2 days after their dose of chemotherapy.

Recommandations from BRISTOL CANCER HELP CENTRE, got for Association P.A.V.E.L., by: Dr. Luiza Dihoru, Dept. of Civil Engineering, University of Bristol
19 Martie 2006

Processed meat consumption results in 67% increase in pancreatic cancer risk, says new research!!!
http://www.newstarget.com/007024.html

USEFUL LINKS


Right to Health 
      



* CESCR General Comment No.14 on the Right to Health
    http://www.ohchr.org/english/bodies/cescr/comments.htm

* UN Special Rapporteur on the Right to Health, Paul Hunt
   http://www.ohchr.org/english/issues/health/right/index.htm

* The Right to Health: A Resource Manual for NGOs; By: Judith Asher
    http://www.huridocs.org/poprthea.htm

* The Right to Health as a Human Right in International Law; Brigit Toebes, School of Human Rights Research Series, Volume 1, Hart Intersentia, Antwerpen- Groningen-Oxford, 1999

* The ‘Right to Health’ in European Union Law, in: Economic and Social Rigths under the EU Charter of Fundamental Rigths, Hervey and Kenner eds., Hart Publishing, Oxford-Portland Oregon, 2003

* International Federation of Health and Human Rights Organisations
    http://www.ifhhro.org


The Lymphoma Coalition
The Lymphoma Coalition is a non-profit network organisation of lymphoma patient groups, which was established in 2003.  It is a global initiative, which currently has 27 members worldwide, dedicated to increasing awareness of lymphoma, and promoting the well-being of people affected by lymphoma worldwide. 
http://www.lymphomacoalition.org/main.php?lang=English