Tag Archives: treatment

How I Discovered I had Breast Cancer

As part of the original team of BBC Breakfast Time, from 1983 – 1987, I was a symbol of health and fitness for the nation in my campaign “Get Britain Fit” wearing my trademark shiny green leotard and tights!  It came as a complete surprise to me that I had breast cancer.  I was feeling as fit as a fiddle at the time and there was no indication that anything was wrong.  I was 47 when I was diagnosed and was at the peak of my fitness.

I was menopausal at the time and went to the menopause clinic to see if I would be a suitable candidate to take hormone replacement therapy (HRT).  As part of a series of medical checks they carried out a mammogram.  Later that week they called me back and suggested I went to the Royal Marsden Hospital in London.  When I got in to see the consultant the mammograms were up there and I said to him “you’re going to tell me I’ve got breast cancer aren’t you!”  And he simply replied “yes you have”.  He told me it was in its early stages and that the cancer was in situ, which means it was contained in both the breasts.

My reaction was one of utter disbelief, and then as the consultant talked it over with me my feelings were of intense fear and then intense anger and I thought “what have I done wrong?”  I knew nothing at all about breast cancer, and back then in 1988 nobody talked about it.  I looked for books about the disease and information, but it was to no avail, there was nothing at all, not like there is today.

My treatment was to have both breasts removed – a bilateral mastectomy – which is sometimes referred to as “the cruellest cut” for a woman.  Although breast cancer patients look and appear fine from the outside, we are all of us somewhat scarred inside.  It is an onslaught to our femininity.  The consultant talked about re-construction but to be honest I hadn’t got a clue what they were talking about.  All I knew was that they had cut the cancer away and because of that I thought there was no further treatment.

I hated the hospital I had gone to for the operation.  I went into the Cromwell Hospital and because I needed to keep my cancer absolutely secret had booked in under my maiden name.  Only my two sons, my former husband and a close friend knew.  I was high profile at the time and I did not want the press to find out.  It’s not what you want when you are ill.

When I came home I found the press had been sniffing around because I had not been on TV.  I was off screen for about 4 months before I came back and did a four minute segment.  Nobody knew my secret nor did they know how I had to steel myself in order to do it!  I hadn’t got my stamina or mobility back and could never have done a 45 minute fitness class.  It took about a year before I could again.

During all this time I kept a detailed diary of what was happening to me because I could not talk openly to anyone about it.   9 months after my cancer the diary was published by Bloomsbury called “A More Difficult Exercise” – which it was!  When members of the family and friends found out they were very angry with me because I hadn’t told them I was ill.

Today I am fighting fit.  Being fit is important and if you are going to be hit by a thunderbolt, like my cancer was, it pays to be fit.   Fitness helps you to get through such difficult times and assists a more speedy recovery.  Until my illness I had assumed I would go on for ever and had not thought about popping my clogs at 47.  However some years later – in fact it was 12 years ago – the time came for me to face all my demons.  I had to go for counselling, I just had to find somebody that I could talk to about all my suppressed anger.  I went to the Cancer Counselling Trust because they offer help to cancer patients – even a long time later – and they can help you, your family and friends.

One of the things that are important to me is that I am still around and I feel that I have been given a second chance in life.  My message to anybody going through the same trauma as I did is to share what you are going through with others.  You must not be left feeling that you are alone, because you are not alone.  This disease affects one woman in nine.   I was wrong to have kept the diagnosis to myself.  Breast Cancer Care run a marvelous support system which can not only provide you with the latest information, but will also put you in touch with other women who have been through just what you are now going through.  Both Breast Cancer Care and the Cancer Counselling Trust have websites and free help lines.

One of the most important things to me is that I am still around and have been given a second chance in life.  It gives me some urgency.  But my sons have presented me with the gift of 4 grandchildren and seeing this continuance of your life makes it all worthwhile.

Glossary: Population and Personalised Care

This Glossary is about Population and Personalised Care the latter being  a style of clinical and general management which always considers the patients’ perspective as the most important and is committed to increasing patient Engagement, Empowerment or Involvement, which may be regarded as synonyms. Personalised care is an element of patient centred care and is the other side of the coin from population care. This is a diffuse and fast moving field with language evolving at a rapid rate. Here are the key terms and concepts.

  • Value “What is gained relative to what we give up – the benefit relative to the cost but not only to the direct cost, which is the efficiency of a service, but the Opportunity Cost, or the Opportunity Lost to put it another way and there are three dimensions to value in healthcare
    • o Allocative value, determined by how the assets are distributed to different sub groups in the population
    • o Technical value, determined by how well resources are used for all the people in need in the population
    • o Personalised value, determined by how well the decisions relate to the values of each individual

Waste is any activity in a process that consumes resources without adding value for the patient

Cost effectiveness

The relationship between the cost of an intervention and its impact.

Optimality;

Optimality is reached when resources or productivity create maximal benefit with the least harm. Beyond optimality there is overuse.

Programme Budgeting and Marginal Analysis;

The fundamental idea behind programme budgeting is decision making based on explicit criteria related to the wellbeing of the whole population, as opposed to decision making by compromise among various institutional, parochial, or other vested interests. Marginal Analysis consists of starting with a particular mix of services and analyzing changes in that mix. If resources can be shifted to produce greater benefit then this should be done.

Opportunity Cost;

The value of the next best alternative forgone as a result of the decision made.

Equity;

Equity is a subjective judgment of unfairness.

  • System – A set of activities with a common set of objectives with an annual report.
  • o Network – If a system is a set of activities with a common set of objectives, the network is the set of organizations and individuals that deliver the systems.
  • o Pathway – The actual care process of care experienced by each individual patient/client; also described as maps that define best practice.
  • o Quality -The degree to which a service meets preset standards of goodness in the delivery of the system’s objectives.
  • Culture – “Culture is the shared assumptions of a group that is has learned in coping with external tasks and dealing with internal relationships. Akey cultural issue is the development of a culture of stewardship.
  • Population healthcare –the design and delivery of the care with a primary focus on the population in need, not the healthcare institutions, where the populations in need are defined not bureaucratically but by the optimum population size for high value care for individuals and the group in need Population medicine or population clinical practice – a style of practise in which the clinician feels, and is given responsibility for, all of the people in the population in need whether or not they have been referred
  • Personalised Care or Personalised Medicine  –  the tailoring of care to take into account each individual’ s unique  needs, preferences and values. The term has become popularised recently to describe clinical decision making in the era of the genome but another term for clinical decision making incorporating genomic information is
    • o Stratified Medicine – decision making based on the patients degree of risk, including risk suggested by genomics and based on the long standing practice of risk stratification of elderly people based on social and medical, but not genomic characteristics
    • o Precision Medicine decision making taking into account genomic information either in diagnosis – ‘molecular diagnostics’ –or choice of drug treatment –‘pharmacogenomics’.
  • Principal and Agent – legally the patient is the principal, the clinician the agent, even if there is no money involved. Some people feel the shift in the balance of power occurred with the founding of the NHS when the patient was not charged for consulting the GP. The pendulum swung further because of
    • o Information Asymmetry – the fact that the clinician has, until the advent of the Internet much more technical knowledge
    • o Trust – Faith in another to perform a task that is not in the other’s interest
    • o Autonomy – Freedom to make decisions or act without reference to others
    • o Informed Consent – Consent to treatment given with full understanding of the magnitude and probabilities of the good and adverse outcomes
  • Empathy – In his book on Emotional Intelligence Daniel Goldman identifies three types of empathy – cognitive empathy is the ability to understand what another person is thinking   Emotional empathy is the ability to feel what another person is feeling. Empathic concern is the ability to sense what another person needs for you.
  • Evidence and Value based decision making – Decision making that ensures the patient is fully informed about the strength of evidence about the probability and magnitude of both risks and benefits of the options being considered and that the patient has been helped to reflect on, clarify and express their preferences based on the value they place on the possible benefit, the possible harm and on the risk they are taking.
    • o Health Literacy – The cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information. The term Statistical literacy – the ability to understand and communicate probabilities which is shared by both patients and clinicians, sometimes called risk literacy is increasingly used
    • o Framing –  the conscious or unconscious presentation of data in ways that influence their interpretation and decision making
    • o Shared Decision Making – is a style of decision making in which clinicians and patients are both involved
    • o Preference Sensitive Decision Making – is a style of decision making in which the patient’s preferences are explicitly elicited, to avoid
    • o Silent Misdiagnosis – namely failure to diagnose accurately the patient’s values and preferences even though their disease has been correctly diagnosed
    • o Informed Consent
    • o Patient Decision Aids – a tool to support the patient during decision making, particularly before and after the face to face consultation and they are increasingly  delivered using digital means variously called eHealth, mHealth, digital health or Telemedicine which may be regarded as synonyms
  • Patient defined and reported outcomes are objective measures using validated tools

subjective measures of outcome, including the degree to which the treatment addressed the problem that was bothering the patient most, rather than their diagnosis and the patient’s experience.

Necessary, Appropriate, Inappropriate or Futile Classification of interventions based on the probabilities of benefit and harm

Burden of Treatment – the impact of the process of care on the affected individual and their carers