GMC Number: 4500281

Specialty: Pathology

GMC Number: 7073631

Specialty: Medicine

GMC Number: 7379323

Specialty: Urology

GMC Number: 4331359

Specialty: Neuropathology

GMC Number: 6102072

Specialty: Neurosurgery, Spines & Pain

Receiving a diagnosis of cancer is different for everyone and affects each person in an individual 
way. However, research and patient experience indicate that it can be common for people to feel a 
variety of emotions that may include fear, anxiety, low mood, confusion, anger, sadness, denial, 
relief.

In the same way that the emotions people experience upon receiving a cancer diagnosis are unique to each individual, the ways in which people access support and the strategies they find helpful can 
vary too.

This leaflet brings together a variety of suggestions for helping and supporting individuals 
through difficult and challenging periods in their lives, as well as information on the support we 
offer here at North Bristol NHS Trust.

It is important to remember that professional help and support is available. Talking to your doctor 
or nurse to access support in your area may be the first step. Many areas also offer ‘buddy 
systems’ or have support groups.

Remember, if you encounter difficulties related to your cancer or treatment, even if it is some 
time after treatment ends, you are still able to access support.

For a list of options for support we provide at Southmead Hospital, please see below.

Physical Activity

Physical activity is any form of exercise or activity involving movement that uses your muscles. It 
helps to improve your physical and psychological health. Being fitter and stronger will really help 
you to manage your daily activities, as well as increasing the level of feel-good chemicals 
(endorphins) in the body. This can be a positive way of coping with the sometimes overwhelming 
intensity of emotions.

Physical activity is recommended by the National Cancer Institute and the British Association of 
Sport and Exercise Science. They advise that physical activity is safe and effective before, during 
and after cancer treatment.

There is research evidence that physical activity can help in the following ways:

• Reduce side effects of treatment such as fatigue
• Improve quality of life
• Reduce the risk of cancer coming back
• Help look after your heart and manage other health problems
• Reduce anxiety and depression
• Help maintain a healthy weight
• Strengthen your muscles, joints and bones
• Improve your flexibility and help keep you supple
• Increase your confidence

The Macmillan ‘Move More’ pack is an excellent resource that covers all of these points in more detail and also advises how to become more active at the different stages of cancer, how much activity is recommended and how to get started. It guides you through exercises that can be done at home and includes lots of everyday activities like walking, housework and gardening. This is available from the Macmillan Wellbeing Centre.

The Energise exercise programme is also available to introduce people to a supported environment to begin exercising. You can self-refer or you can be referred by your nurse specialist or another 
medical professional. Full details of Energise and other physical activity programmes near to you 
are available at the Macmillan Wellbeing Centre.

Diet

Eating well can sometimes prove challenging following a cancer diagnosis, due to the physical 
side-effects of certain cancers and their treatments. Optimising your intake to achieve the most 
balanced diet possible can have many positive health benefits, including improved immune system 
function, better energy levels and improved mood. Specialist dietary advice may be provided 
following a cancer diagnosis/ treatment, which should always be adhered to.

Recommendations from the World Cancer Research Fund for living well following a cancer diagnosis encourage you to:

• Consume more; fruits/vegetables/beans (aim for a minimum of 5 portions per day)
• Choose wholemeal/wholegrain cereals where possible
• Limit red meats to <500g per week
• Avoid processed meats
• Reduce salt to less than 6g/day
• Avoid/minimise alcohol
• Be a healthy weight
• Avoid nutritional supplements unless they have been recommended by your medical team, or a registered Dietician

If you would like further nutritional information, comprehensive literature can be obtained from 
the NGS Macmillan Wellbeing Centre.

For further support, please complete a self-referral form to see our Specialist Dietician for a 1:1 
consultation. Referral forms are also available from the centre.

Sleep

It might sound obvious, but a good night’s sleep can profoundly affect how well or poorly equipped 
we feel to face the challenges of each new day. Getting into a healthy sleep routine can help us to 
feel more physically and mentally able to function on a daily basis. A healthy sleep routine might 
involve:

• Keeping regular hours - Going to bed and getting up at the same time each day and avoiding daytime naps will help programme your body to better sleep.
• Creating a restful sleeping environment - as quiet and dark as possible. Try and make sure your bed is comfortable, with distractions (e.g. TV) relegated to another room.
• Reducing stimulants (e.g. alcohol, caffeine, nicotine) in the evenings as they are known to  disrupt sleep quality. Instead have a warm, milky drink or herbal tea.
• Exercising regularly, but not too close to bedtime
• Keeping a ‘worry pad’ - before bedtime, jot down any worries on your mind. The goal is to avoid  doing these things when you’re in bed trying to sleep and spend time the next day thinking through them.
• Practising relaxation - have a warm bath, listen to quiet music or do some gentle yoga to relax mind and body.
• Don’t struggle in bed - If you can’t sleep, try not to lie there worrying about it. If after a while you realise you’re not getting to sleep, get up and do something you find relaxing until you feel sleepy again, then return to bed. This is so your mind associates your bedroom with a place for sleeping, not stress.

There is no ‘right’ way to feelHaving a positive mental attitude during and after cancer treatment can be beneficial. However, it is normal to feel a range of emotions when you are coping with treatment and recovering from it and allowing yourself to feel these without pressure to remain endlessly positive is important. Having the opportunity to talk openly and honestly about how you are feeling can be invaluable, whether this is with friends and family or through a support group or Living Well Course (see page 11).

If you feel that your mood is getting in the way of you being able to do things that matter to you 
(e.g. at home or work) then it is worth seeing your GP or nurse specialist to talk about options 
for psychological support.

Mindfulness

It’s common to find our mind worrying about the future or dwelling on the past, but this can turn 
up feelings of worry and low mood. Mindfulness techniques can help you to let go of the struggle 
with difficult thoughts and feelings and focus on the present moment. With practice, mindfulness can have a wide range of benefits including reduced depression and worry, increased sense of calm and ability to cope with physical symptoms (like pain and fatigue), as well as an enhanced wellbeing generally.

You can get information about mindfulness techniques and courses from the Macmillan Wellbeing 
Centre here at Southmead Hospital and Penny Brohn in Pill (www. pennybrohn.org.uk).

Body confidence

Experiencing cancer and treatment for cancer may have an impact on your appearance and the way in which you might see your body or feel about the way you look. Tips for dealing with changes in appearance include:

• Planning and practising ways to confidently answer any comments or questions.
• Taking steps to feel better about your appearance e.g. attending a Look Good Feel Better workshop (contact Macmillan Wellbeing).
• Physical activity and exercise can improve how you feel about your body whilst releasing feel-good chemicals into your system.
• Keeping a journal or express your thoughts, worries and anxieties in writing or in a creative visual way that allows you to help process difficult emotions.
• Talking to others and letting them know if you need more support.

It can feel difficult to adjust to, and talk about, changes in appearance.  However, keeping your 
feelings to yourself can sometimes stop you doing things you enjoy or getting the right help. It 
can help be helpful to talk about your feelings with someone you trust and who you feel comfortable or you may find it helpful to write down your questions or concerns and share these with your health professional.

Further cancer support at Southmead Hospital

Here at Southmead, we are able to offer support at any stage of your cancer journey.

We provide access to:

• Cancer information and support clinic - information session on a range of wellbeing topics relating to living well with and beyond cancer
• Macmillan Wellbeing Centre – for information, support and a cuppa!
• Living well days - information session on a range of topics relating to moving forwards
• Living well courses – see overleaf for more information
• Exercise groups
• Dietetics advice
• Macmillan Citizen’s Advice Bureau – for financial support
• Psychological support around decision making - preparing for surgery or other treatments and support with making decisions about cancer treatments.
• 1:1 Psychology - support around coping with cancer and concerns relating to this. This could include issues like fear of recurrence, body image concerns or mood.

Please speak to your Clinical Nurse Specialist or the team in the Macmillan Wellbeing Centre if you 
are interested in these support options or email LivingWell@nbt.nhs.uk.

Living Well courses

These 5 week self-management courses are now offered as part of your routine follow-up care. The courses are facilitated by a health psychologist, specialist nurse and volunteer.

The courses include:

• Adjusting to the shock of a diagnosis
• Dealing with treatment and challenging side effects e.g. hair loss, disrupted sleep, managing cancer-related fatigue
• Dealing with changes in confidence and self esteem
• Managing uncertainty and worries about your future health
• Issues around recovery, such as return to work
• Difficulties in dealing with other people’s reactions e.g. family and friends distress, grief, and understanding
• Building confidence, including taking steps towards personal goals

“I came to the Living Well course in 2014/15. Depression hit me after my treatment ended and the course was a shining light in the darkness; a safe space where I could spend time with supportive women who understood what I was going through. I cannot recommend this course highly enough; I learnt so many techniques for coping with the aftermath of treatment, which I continue to use.

Quote from Cathy, who attended a Breast Living Well course

Support networks and helplines

Having a good support network can help ease what can often be a challenging journey for people who are living with a cancer diagnosis. There are many different of forms of support that may be more helpful at different times for different people who are trying to cope with the impact of a cancer diagnosis. Support that might prove useful includes:

Family and friends

It may feel difficult talking to family and friends about your fears and anxieties, but it can 
often be helpful for both of you to ask for what it is you need from them in terms of support.

Hospital and medical staff

These staff (e.g. your Clinical Nurse Specialist and Doctors) are there to provide both medical 
care for you and to answer any questions or concerns you may have about the treatment you have 
received.

Helplines / websites

There are a number of both general and specialist cancer helplines and websites dedicated to 
supporting people with cancer. These include:

• Macmillan Cancer Support

www.macmillan.org.uk

0808 808 0000

• Penny Brohn Cancer Care

www.pennybrohn.org.uk

0303 3000 118

• healthtalkonline.org

Contact us

If you have any further questions, please visit the Macmillan Wellbeing Centre at Southmead 
Hospital, for information, support and a cuppa! Or you can call and book an appointment with one of our support workers for a Holistic Needs assessment so that you can receive personally tailored 
information and support.

NGS Macmillan Wellbeing Centre
Beaufort House Southmead Hospital Westbury-on-Trym Bristol
BS10 5NB

Email: wellbeingcentre@nbt.nhs.uk
Phone: 0117 414 7051

© North Bristol NHS Trust. This edition published June 2022. Review due June 2025. NBT003065

Holistic Needs Assessments: what are they and how do they affect my care?

Holistic is a term that is used to describe all the needs that you might encounter as an 
individual. We know that cancer can affect many areas of your life and as a result your individual 
needs may change. As part of your ongoing care we offer you an assessment to ensure that, wherever 
possible, all your concerns and needs are being addressed. This is what we call a Holistic Needs 
Assessment (HNA).

A HNA gives you a chance to think about your concerns and discuss possible solutions. It has three 
parts:

• A simple set of questions to identify any concerns you may
• have.
• A discussion with your health professional or Cancer
• Support Worker.
• Development of a written care plan.

The questions may be answered on paper or electronically and will take around ten minutes to 
complete. You can choose to be sent the check list of questions in advance or you can fill one out 
at the time of the appointment.

You will then meet with the health care professional to discuss the issues you have and help you 
consider possible solutions. Together you will agree on a plan of action to address your concerns. 
This is then written down as your care plan. You will receive a copy of this plan to take away, or 
a copy will be sent to you. Alternatively you can choose to hold the care planning discussion over 
the telephone and your care plan will be sent to you.

A HNA is designed to look at your individual needs and you can decide what is included.

Benefits of having a HNA:

• You can get information and support with any concerns you
• may have.
• It can help you to prioritise your most important concerns.
• It can help you feel more in control and involved in your
• care.
• Your healthcare professional can refer you to other services, if this would help.
• It can help you to plan ahead from diagnosis through to treatment and life after treatment.

The discussion may include concerns such as:

• Physical symptoms (for example weight loss, appetite or
• eating and tiredness).
• Emotional concerns (for example worries about the future
• and relationships).
• Practical issues (for example sorting out housework and where to get equipment that can help).
• Job, money or housing worries (for example balancing work and treatment, and benefits or 
• financial advice).
• Spiritual concerns (for example your faith or beliefs, and
• any impact this may be having).

You will be contacted by telephone to arrange an appointment. You are welcome to bring a family member or friend with you when the discussion takes place.

© North Bristol NHS Trust. This edition published Nov 2021. Review due Nov 2023. NBT003095

Clinic appointments

Following completion of your treatment for breast cancer you will not need to be seen for regular follow up appointments. This is because research informs us that returning to hospital for appointments can cause many people unnecessary worry and anxiety. Research also indicates that very few problems
related to breast cancer recurring are picked up by attending routine follow up appointments.

Instead of routine follow up appointments, you will have an ‘open appointment’ with us. This means that at any time in the future you develop a concern or problem that you feel may be related to your breast cancer or its treatment you can call us to book an appointment to see a doctor. Therefore you have open access to our clinics. You can either phone our clerical team to book an appointment on 0117 414 7000 (pick option 1) or if you wish to discuss your concern with your breast care nurse first before making an appointment please telephone her direct.

Mammograms

You will be booked into our mammogram follow up service. You will be called for a mammogram one  year after the date of your surgery and then each year until you are five years from surgery. If at that time you are you are under the age of 50 you will continue to have yearly mammograms until you reach screening age (47 - 50). If you are aged over 50 years you will then be able to access mammograms through the NHS Breast Screening Programme. During the time that you are having mammograms via our service you should not attend the NHS Breast Screening mammograms (although they will continue
to call for you).

How to help yourself

Self-examination

We would ask you to check your breasts regularly for any changes. Some women find it emotionally difficult to do this so please contact your breast care nurse for advice/support if you wish to talk this through with her.

If you have had surgery as well as radiotherapy to your breast you may find this is firmer and ‘lumpier’ than your other breast. This is due to both the radiotherapy and surgery. Your first self-check will then make you aware of what is ‘normal’ for you and you will be more aware of any new changes.

This may be a new lump in the breast tissue or any change in shape. If you have had a mastectomy (with or without reconstruction) be aware of any new lumps or nodules on the skin.

The department has a number of different leaflets to help you on what changes to look for. If you notice changes you can either ring to discuss your concerns with your breast care nurse or telephone our clerical team to book an appointment (0117 414 7000). We will always ensure that you will be seen
in the next available clinic.

Other symptoms

If you experience any of the following problems it may be useful to telephone the Breast Care Centre to book an appointment to see a doctor.

• An increasing pain for more than three weeks in a bone that does not ‘come and go’ but gets steadily worse over time. The pain may be a dull persistent ache that often gets worse at night when the muscles are relaxed
• Loss of appetite or weight loss as well as feeling really tired (lethargy)
• Increasing breathlessness and/or a continuing cough
• A new lump or change in your breast(s)
• If you have had a mastectomy any new lumps/nodules in the skin
• A swelling by your collar bone (clavicle)

It is very important to remember that any of these symptoms or any others you are worried about does not mean this will be cancer. Bone pain can be arthritis, strain or injury. Breathlessness can be caused by a cold or flu. If you come to the clinic it is not uncommon for you to be advised to have tests such as a bone scan or CT scan. This will be done as quickly as possible to minimise the ‘worry time’ for you.

Medication

If you have been prescribed any of the breast cancer tablets and experience any problems with these your doctor will be happy to see you in clinic to discuss your concerns.

If you have been prescribed Tamoxifen, which is a drug used to reduce the risk of breast cancer in women before they go through the menopause. This can be changed to a different drug if you become post-menopausal (this would be when you have not had a period for at least 12 months). If this happens to you please ring the Breast Care Centre to book an appointment with your doctor on 0117 414 7000 (pick option 1).

Emotional support

Breast cancer treatment can be an emotional ‘roller coaster’ and coming to the end of treatment can be a relief but also can feel frightening. Please do not forget that your breast care nurse is able to help with supporting you through this time and the patient support group Bosom Buddies always welcomes new people.

© North Bristol NHS Trust. This edition published June 2022. Review due June 2025. NBT002955

Our NHS People

In addition to the internal staff wellbeing programme available to all NBT colleagues, national support is also available to all of our workforce, including free access to apps, staff common rooms and dedicated support lines for staff.

Support is also available nationally for Black, Asian and Minority Ethic colleagues including culturally sensitive apps and staff common rooms.

To find out more visit NHS England » Supporting our NHS people.