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Rad Chat is a forward-thinking global knowledge hub where healthcare professionals can advance their knowledge and expertise in radiotherapy and oncology by utilising the award winning, first therapeutic radiographer led oncology podcast and social media channels.
We're empowering healthcare professionals worldwide by providing free, CPD-accredited radiotherapy and oncology education, by sharing real-world experience, expert insights, best practice and patient perspectives, we're helping healthcare professionals’ advance cancer care and improve patient outcomes.
Dani Binnington (00:48)
Hello everyone, I'm Dani, the host of the Menopause and Cancer podcast.
Naman Julka-Anderson (00:52)
Hi everyone, my name's Naman, one half of Rad Chat, and I'm joined by fellow host Jo McNamara.
Jo McNamara Rad Chat Host (00:58)
Hi everyone.
Naman Julka-Anderson (00:59)
So this is our episode 193, Dani How was it for you?
Dani Binnington (01:04)
Wow, this is amazing. I'm well over 180, gone out every Wednesday and I'm so excited to be co-hosting this episode with you guys. I've got loads of questions. How are you both today?
Jo McNamara Rad Chat Host (01:16)
Good, thank you. Excited. We've been anticipating this recording for a long period of time, and I think it will be really interesting to do it this way. We've never done a co-hosted style podcast episode, so we're hoping everyone listening will really enjoy it.
Naman Julka-Anderson (01:17)
Yeah, okay.
Dani Binnington (01:39)
Yeah, great. So for all of my listeners, what can people learn from your show?
Naman Julka-Anderson (01:44)
I think we have a good mix between Jo and I. So we have kind of four series or themes if you want. So the main thing is to champion the patient voice. So living with them beyond cancer, but also we mix in things around equity, diversity, inclusion, leadership, education, workforce development. But I think it always started off, didn't it Jo, being mainly around education for radiotherapy and oncology.
Jo McNamara Rad Chat Host (02:06)
Yeah, absolutely. When you go into a radiotherapy department, there's certain things that you know could be improved or, you know, that patients maybe struggle with from a patient experience perspective. And ⁓ as someone who kind of works clinically still, but not every single day, you kind of go in going, could we make these changes? And sometimes it's pushed back with resistance because of time, money.
⁓ You know, we've always done it this way is a phrase I hear quite often coming from NHS employees. And ⁓ actually using the podcast, we've seen real changes to practice. So people have heard patients, they've heard the experiences that they've gone through, or they've heard from experts in their field. And that's then initiated people to think, I don't want to continue to do it this way. I want to make a change. So I think that's definitely a reason why.
We are so passionate about utilising Rad Chat in that way.
Naman Julka-Anderson (03:05)
What about you Dani, how did it start for you?
Dani Binnington (03:07)
So the Menopause and Cancer podcast really aims to just educate on that intersection of cancer and menopause or what happens when cancer treatments make you menopausal. And it really started at a time when I knew my surgically onset menopause was coming personally. So it was a personal curiosity. At that time, we had all of these amazing menopause campaigners campaigning outside the Houses of Parliament. They're in the papers, they're on the telly.
Talking about normal menopause education and actually saying menopause could be a problem. And I was thinking, wow, but they want to take my ovaries. Is this going to happen to me? And so I kept asking my doctors how they could support me. And I wasn't really given the information I needed then. And so I thought, well, I'm going to go and look for some of those doctors. And there are many incredible experts. And so I just made it my mission to give them a microphone,
and interview them on the Menopause in Cancer podcast. And it's been every single Wednesday since I started the podcast, I found brilliant people from oncologists to surgeons to menopause specialists, to nutritionists to really educate us how we can navigate menopause when it's been a result of your cancer diagnosis. And I've brought patients on and a bit like you said earlier, Jo, I think it's been an incredible tool to actually
create change. When I first started, I had to ring people saying, can I send you some leaflets? Will you listen to me? This is a problem. Can I tell you what our community are experiencing? And I, you know, there was a lot of hesitation and there was a lot of like, oh, who are you? And why do you want to talk about that? This week alone, and it's not even the end of the week, we've had 50, five zero requests from hospitals and Macmillan centers for leaflets and
And so I think the podcast has been a vehicle for change. And I think every conversation contributes to that change like ours today.
Naman Julka-Anderson (05:10)
I think going back to what Jo said and probably what you've alluded to, there's still that responsibility, isn't there? Like, you are a spokesperson now, you've challenged people in a positive way to bring about positive change, but there's always that week on week. I think maybe not so much now, coming up to four years. Jo, you might agree or not agree, but I think at the beginning I was always like, I need to revise for every single episode, every single guest that was coming on, know all the facts, but actually now, exactly as we said before, it just needs to be organic and it isn't really about us.
but we still, well, I feel like I always get a controversial question in don't I Jo.
Jo McNamara Rad Chat Host (05:43)
Naman loves a controversial question. think it's a guest expect it now. Absolutely.
Naman Julka-Anderson (05:46)
I think it's because other people are probably thinking it and they want to know and I'm like, I'll just do it.
Dani Binnington (05:52)
love it.
And I usually get the word vagina in. There you go. I've said it. We're not even three minutes in. That's a good one. ⁓ But I would love for you as podcast host, take me a little bit back to what is or what was your real job. So you are clinicians and why did you think, okay, let's do a podcast. Like that's not so conventional.
Jo McNamara Rad Chat Host (05:57)
⁓ you've said it. So I love that.
Dani Binnington (06:19)
And take me back to a little bit of your professional experience, if you don't mind. So all of our listeners can really understand why do these two amazing people, you who have busy jobs, who have busy lives, decided to set up Rad Chat.
Jo McNamara Rad Chat Host (06:33)
So I am in my day-to-day job, a senior lecturer, and I'm really fortunate because I get to work alongside amazing colleagues and help train about 32 % of all therapeutic radiographers in the UK, which is a huge proportion of people. And just in terms of kind of my educational role, we have to be innovative about how we educate people. And, you know, back in the day, was an OHP, you would put it...
put on these OHPs and draw certain things and then you talk about things and then you move on and you get PowerPoint and you start doing more didactic stuff. Then you move into simulation. And I definitely see podcasts as another educational resource and tool to essentially be able to help educate people. So really selfishly, I probably utilize Rad Chat quite a lot thinking I'd love to teach people about X, Y, and Z.
Who do I know who's an expert in that field that I can get to come on Rad Chat? Because it's accessing people that you would never ordinarily get to access. And absolutely we can teach people everything there is to know about radiotherapy. But do you know what's missing is that holistic care, being able to offer those personalised conversations with our patients because we don't necessarily have that wraparound knowledge. You know, do we have enough
information or knowledge around chemotherapy, immunotherapy, hormone therapy, what are the side effects of all those treatments. And although we teach things, we don't go into enough detail and things change. If I think back to my education, I got taught nothing about the menopause, absolutely nothing. Whereas now students are getting entire modules in some cases on the menopause, which is absolutely incredible. But that's kind of my main passion and why I was really passionate about
you know, using Rad Chat as that educational tool really.
Dani Binnington (08:34)
And what about you, Naman?
Naman Julka-Anderson (08:37)
So yeah, I'm a therapeutic radiographer like Jo. I've always liked the review side of things. So whereas the treatment side is fun, I think I found it quite stressful at times. But then having that one-to-one contact and working in a very specialist team to look after people's side effects was always my kind of thing. And then use your communication skills and eventually learn how to prescribe medications and stuff. But I like being very busy, so I don't just do that. I work for...
Macmillan Cancer Support Charity as well as a clinical advisor. And it's quite nice not being full-time clinical anymore. I think some people might hate me for saying that, but actually I think after COVID, the pressure and like the burnout from that, I feel so much better that I don't have to worry about the clinic every single day. Although saying that I'm starting a new job, which is kind of four days, but it doesn't matter. We won't worry about that just yet. But ⁓ I think similar to Jo, we maybe had a very small amount on
menopause or surgical menopause or cancer related menopause at university. I think as a young man, I just didn't think I needed to know about it, if I'm honest. And I think when I qualified, it was more evident that if those sort of questions came up in a review or something, we'd always be directed towards more of the female staff to talk about, even if they were the same age as me. And I think having grown as a professional, realising and probably a lot through Rad Chat, actually, there's a lot of stuff you don't know. But actually, as a
healthcare professional just like we use Rad Chat for other people it should be continual professional development so I think it's always nice to learn new stuff and I am a nerd so I think it's nice to know and actually being in those situations with a patient where you don't have the answer I don't like it but it does happen obviously but then I still didn't know where to go to find more information and obviously now as you said there are more people campaigning for this talking about it more openly on social media it's not as much of a taboo in some spaces as it used to be
So yeah, that's kind of where I'm up to with it, I think.
Jo McNamara Rad Chat Host (10:41)
Dani, can I ask you, you know, if you had to explain what the menopause was, what would you say?
Dani Binnington (10:46)
My God, how long have we got, Jo? My favourite, favourite topic to really get into the nitty gritty. But actually the menopause is a moment in time. And if someone is lucky enough to live to their natural menopause age in the UK, it's around the age of 51, although that can differ. And it is the time when a person hasn't had a period for a whole 12 months.
And the lead up to it, it can almost be up to a decade, is perimenopause. And that's when hormones start to dwindle over a long period of time and they go on a bit of a rollercoaster as they do. They don't behave very well. And so often people in perimenopause struggle with symptoms and symptoms can affect people physically, mentally. And many people actually have a whole variety full of symptoms that affect them to different and varying degrees.
The difference with menopause after cancer is when cancer treatment triggers the menopause, such as chemotherapy, surgery, radiotherapy and we'll talk more about that today, and also anti-hormone therapy, so endocrine therapy for many breast and gynecological cancers, it's a lot more abrupt. So the body has not got a decade to get used to the dwindling hormone levels. I had surgery, so from one moment to the next, I came out of theater, I had no...
none of my hormones, like I was pushed off that hormonal cliff. And of course that's a huge shock for anyone's body. I wasn't even 40. But we now work with lots of people who are in their 20s and 30s and that's a shock. When people go through chemotherapy, it can be weeks, it can be months. Often people say to me, on my third round of chemo, that was it, I had no more periods. Sometimes periods may come back and sometimes they don't. So there's an extra layer of uncertainty.
that gets added to when people have chemotherapy or any type of cancer treatment. And for those people who have a hormone sensitive cancer, who might be on an anti hormone therapy, it's actually the part of the cancer therapy makes you extra menopausal. It's like menopause on speed or on steroids, we often say, and it just sucks out the last bit of oestrogen from your body. And that is
hugely hugely effective or affecting many people in how their symptoms affect them. So a menopause after cancer is always different, people explain, it can be more abrupt, symptoms can be more severe. We often have fewer treatment options depending on the person's medical history and the type of cancer they've had. And currently there is no hormonal health plan or menopause plan woven into any
cancer survivorship teams into any cancer teams, it doesn't exist. It's not, people aren't asking about it. And so there is a big void because then people finish their active cancer treatment. They are being discharged back into their general practitioner. And we are too specialist a case for most GPs to then really know what to do with us. So we fall really fall into that void. We, we often talk about the menopause void. And so I hope, yeah.
the answers. I was wondering from you, just with the radiotherapy hat on, we hear from lots of people about lots of difficult stories of menopause symptoms, especially the genital urinary syndrome symptoms of the menopause for gynaecological cancers. And can you explain a bit more about the radiotherapy and how it might affect a person's body?
Jo McNamara Rad Chat Host (14:23)
So essentially, if we are delivering radiation, it will damage any cells that that radiation comes into contact with. So the way radiotherapy works is we have really high ionising radiation. So much more powerful than when you go to A &E with your broken bone. You'll have that X-ray and it's quite a low dose amount of radiation used specifically for that X-ray.
When you get to radiotherapy, we are bringing out the big guns. We are using some seriously hardcore ionising radiation. And I think patients will straight away be fearful of that because they'll think of all the kind of scaremongering stories that people say about radiation. And that is why when we deliver our radiation, we are using very specific targeted treatments.
So there are lots of different types of radiotherapy and I think it's important to maybe go into that first. We typically think of radiotherapy as being external beam radiotherapy delivered using a linear accelerator. And that's maybe what a lot of people associate with radiotherapy treatments, but there are also other types of radiation treatments, including stereotactic radio surgery for brain conditions. There's internal types of radiotherapy.
Some parts of the world use intraoperative radiotherapy. So there's lots of different types of radiation treatments, but also ⁓ different kinds of radiation. So there is photon radiation and there's also proton radiation. So a lot of people will kind of do a bit of Googling and get confused about what types of radiation they're actually having. But a lot of the general public will have external beam radiotherapy using external.
linear accelerator to deliver that. Now, depending on where we are treating in the body, we are only focusing on the tumor or where the tumor was if that person has had chemotherapy or surgery previously. And so we are only trying to aim the radiation at that area with a slight little margin. Okay. So we're being extremely precise. And as a consequence of that,
we are going to cause some damage to that area, but only to that area. So it's not like chemotherapy, which is a systemic type of treatment that you administer it, and then it will go all throughout the body. And any cell that is then rapidly dividing will be affected by that chemotherapy drug. Radiotherapy is slightly different in the fact that the beams have to pass through those cells for them to be affected. So typically,
the x-rays will go in or the photons will go in through the body and they will damage either the DNA of the cells or it will damage the cell itself, which will then consequently then have an effect on the DNA. And so any cancer cells will be irreversibly damaged, hopefully.
Whereas our normal healthy cells could also be damaged. And that's where potentially we are causing permanent damage and affecting people's fertility. But we have to be in that area. So ⁓ if you were having breast cancer treatment and we were treating the breast or the chest wall area, that is essentially where we are damaging those cells. So that in itself would not cause the menopause.
cause people to go through infertility. However, if we were delivering radiation treatments to the pelvic area or to an area that actually controls hormones, so like the pituitary, then that would also potentially create the menopause or affect fertility. So we have to kind of consider where we are treating and whether or not those areas are in the treatment field or whether or not we're
delivering a treatment for say breast cancer, but that patient is also having hormonal therapy. And that then can cause menopause or chemotherapy as well.
Naman Julka-Anderson (18:35)
And there's obviously lots of different symptoms that we can cause because of, yeah, causing either the menopause to come on, whether it's an early menopause, but some people, I think what we've seen or spoken to or I've seen in clinics, they say that the symptoms vary from mild to more severe at times. But the list obviously, it's not as bad as maybe a chemotherapy list of side effects, but there are lots of things that can happen. So affecting your skin, your confidence, weight gain, mood swings.
pains anywhere in the body, but a lot of these problems, obviously, as they start, when people are having radiotherapy treatment, they could also be symptoms from the treatment itself, especially in the pelvic region. And then when we get into the region of late effects following treatment, that's also masking some of the symptoms and it becomes which are you trying to kind of manage or look after at the same time. I think the one that I've found the most with maybe people who are younger in their 20s or 30s is the loss of confidence. So they're feeling that loss of confidence in their body as it is.
They know that they're potentially now infertile. They're to be going through a menopause or the symptoms of it. And then with the lack of body confidence and going back out into the world post-treatment, they just don't have any idea of how to approach those conversations around dating or things like that. I think that's one thing that just recently as well that we've seen come up quite often.
Jo McNamara Rad Chat Host (19:54)
From my own experience, it affects absolutely everything, doesn't it? know, Naman talking about how we feel as a human is affected by the menopause. And I don't know, Dani, if that's something that you see a lot with the people that you talk to in your community.
Dani Binnington (20:13)
There isn't really anything that isn't affected when we are pushed into menopause because of our cancer treatment. And there isn't really necessarily always an end to it. And I think that's something I wanted to get across today. If anyone is listening and they would say, are the insights of your community that you can share? And it's that feeling that for many people with a primary cancer diagnosis, very much
sort of gear themselves up towards getting to the end of the active cancer treatment. And it's that time when everyone is kind of like, well done. And you come to the end and you can now start to rebuild your house. And it's a really tough time mentally for many cancer survivors. It's also the time when many people then start to realize, my gosh, have I actually, am I not in the menopause? Are these menopause symptoms? Are there menopause? Is it chemo brain? Is it brain fog? So it's.
confusing as well and it's often months and years after that people come and find us and then say, no one's ever told me, I wasn't warned. No one really told me that the menopause was going to be such a big problem for me post cancer diagnosis. And they're still turning up with all of these symptoms. so joint ache, fatigue, insomnia, hot flushes, night sweats, low mood. These are really, really common symptoms. Anxiety, like you said.
And also if people have brain fog, it doesn't seem like much, but if you want to return back to work and if you've got hot flashes and if you can't remember what you tried to do or you're not as quick and you've got a lack of concentration, a lack of focus, then that really, really knocks our confidence back as well. You know, we know anxiety is a really common menopause symptom for healthy perimenopausal menopausal women.
and then compounded by everything our community have been through, compounded by the fear of recurrence. On top of that, the low hormone levels can make a lot of these symptoms worse. For many people who are on hormone blocking medication, for example, the GSM symptoms that I mentioned earlier, the genitourinary symptoms, they are really debilitating. So it's a dry vagina, it's itching, it's painful.
upon intercourse, there might be bleeding, tearing, tearing off the skin, the vulva, the skin of the vulva becoming very thin. Some people explain that they can no longer go for the smear test because they're so dry and so tight down below and they haven't had the treatment that perhaps is appropriate for them. And so I think it's important to think, wow, okay, we've got all of these physical symptoms, but we've also got a whole cohort of mental symptoms.
and often people are affected in different ways. And I want to say to people they're not stuck because from having worked and listened to probably thousands of people now over the last many years is people aren't stuck. So many symptoms do come and go, they will change. There are many treatment options that are very safe and some symptoms will need to be treated for them to be improved.
like vaginal dryness, for example, that's often in a lifelong treatment for people. And so, yeah, I think it's those symptoms that people need to be aware of, that they can be menopausal symptoms, because it's good for people to understand what's going on with them. Because if they don't understand, they just keep thinking, is it me? Maybe it's just me that hasn't recovered from active cancer treatment. Everyone else seems to be doing so much better. They're bouncing back at work and I've got
all of these things still going on with me. And that is often a time where we don't have access to incredible people like yourselves anymore, because we don't see you, we've been discharged perhaps. And so it's an isolating part of a survivor's journey as well.
Naman Julka-Anderson (24:25)
Can I ask quickly from a healthcare professional perspective, and I don't mean this to sound like a stupid question, but there are so many symptoms to consider. And I suppose from both of your perspectives, for any of the healthcare professionals listening who aren't sure how to tackle things first, what would be something to try and consider as the first port to try and talk it through or try and manage first? Because it's obviously quite difficult to manage everything in one go and you have to try all certain things. What would you suggest that people consider first from a professional standpoint?
Dani Binnington (24:32)
There's no such a thing.
Yeah, it is a brilliant question. And especially because we're not going to magic over billions of pounds that we can feed into the NHS so that we're going to have menopause clinics within every cancer clinic, right? So that's not going to happen in my lifetime, but maybe for the next generation to come. It's three things really. And the first one is to adequately prepare people for what's to come. And so to feed
their conversation into pre-cancer treatment planning. And I don't know, and I think a really good piece of research would be to try and figure out at what point in a patient's journey is it the right time. Because when I think back to when I was first diagnosed aged 33 with three really young children, I could not have cared any less of what might happen to me in three years time. I would have taken any cancer treatment. I would have gone for it.
because I wanted to do anything to see my kids start school and see them walk through those gates in their little dresses. However, we now believe perhaps drip feeding the fact that this treatment might make you menopausal. Let's talk again in three months time at your next conversation. It's drip feeding it into more conversations because we know some people, it goes in one ear and out one the other ear when they're not ready to hear it.
But if it's drip fed into those conversations, there is a chance that people will remember. And that's, think, the first thing. there is no right or wrong, but it's having the conversation. The second thing is to actively acknowledge this can be a really difficult post cancer treatment scenario. And these menopause symptoms can be tricky. And it's acknowledging that. And the third one is then to really signpost people to support.
And I don't think everyone needs to skill up and become a menopause expert and not every breast care nurse needs to know everything there is, but it's finding someone in their team that might have the interest in learning more and skilling up. It's understanding if they have menopause specialist services as part of the hospital. It's referring them to organisations like us, menopause and cancer. It's the least we can do, I think, to...
then help people on their feet. What do you think, Jo?
Jo McNamara Rad Chat Host (27:20)
I definitely think that aspect about consent comes through all the time with patients and with experts that we talk to. So quite often patients will be informed of all of the side effects and probably at surgery and again at chemotherapy and again at radiotherapy. However, that oncologist or that surgeon or that advanced practitioner gets 10, 15 minutes to do that consent process. ⁓
Dani Binnington (27:26)
Uh-huh.
Jo McNamara Rad Chat Host (27:49)
Maybe longer if they're really lucky, but it isn't long enough to necessarily go through, this is what could happen, but this is the consequence that it could have on your life and how that will actually feel. Quite often it's a short conversation around, you might be put into early menopause. And I can say this from my own personal experience of going through IVF where I had chemical induced
⁓ menopause. And although I'd been told it would happen, nobody actually sat me down and said, this is what you will experience. And ⁓ I can honestly say, having gone through IVF a lot, ⁓ that our marriage was nearly over at the end of it. And I certainly know that it was as a result of the hormones and the effect it had on me. And I think it's that
It's that conversation that needs to happen. It's not just on a consent form of you will go through the menopause or you will have, there's a risk that you could go through the menopause. I think it's having a more detailed conversation and definitely drip feeding all the time. We say this all the time. And I think sometimes maybe research would be beneficial, but I actually think just from my own experience that everyone is different and diagnosis may be
the right time for some people, but maybe after treatment is totally finished might be better for others. And I think the key is to ask the question, you know, this is what could happen to you. Are you happy to go ahead with treatment? We can talk again at another time about the consequences of that. Or actually, as you go through your cancer pathway, every healthcare professional that comes into contact with you might talk about how are your
How are your symptoms? What are you experiencing at the moment? Are you having any difficulties? But I sometimes think that healthcare professionals are scared to ask the question because there are no resources. They maybe don't have the knowledge themselves, or they don't have the time to necessarily spend with patients talking to them about all the things that they're experiencing. ⁓ And it's really, really challenging, which I think is why
Dani Binnington (29:58)
Yeah.
Jo McNamara Rad Chat Host (30:13)
It's amazing that there are then other organisations that as healthcare professionals, we can refer patients to. It's sad that we have to do that, but it's the realities of it. I don't know, Naman, if you'd add anything to that.
Naman Julka-Anderson (30:24)
I was going to say there's also
the hesitancy, I suppose a parallel is like healthcare professionals not talking about exercise with their patients. Like I'm hopefully never going to experience menopause, but there is that hesitancy for me to try and talk to someone who's going through it because I don't know fully what it feels like. I've not seen anyone around me go through it fully to that extent that I can kind of share that lived experience. So I know like one of my friends who I said we're having this episode coming up. ⁓
She also said, well, how would you feel talking to someone in their 20s about menopause? And I still feel that hesitancy because there's someone younger than me and I don't know enough about it. I can signpost everywhere, but that empathy isn't going to be fully there because I don't have the lived experience. But again, that's where working with colleagues who can help and support is kind of beneficial, I guess.
Dani Binnington (31:12)
Yeah, I think we can't expect everyone in a cancer team to be happy to talk about all of those things and to skill up and to, you know, to learn more about it and go on CPD courses and blah, blah, blah, to really, you know, do their best. But they can find someone who is happy to have those conversations because we're all different and we're all people and we're human beings. And some will be happy to talk about sexual health and others won't be.
It's good to recognise that, right? And look for the right person in someone's team. We recently did a survey with over 1200 patients and many said that the menopause or navigating menopause was much harder than active cancer treatment because it's gone on. They say they haven't had the preparation. They say they haven't had the support they need. They feel that the healthcare professionals didn't have the training or expertise they needed. And so
We kind of thought it wasn't gonna be positive results, but we didn't anticipate them to be that, you know, they were quite sort of sobering really. I also know all healthcare professionals just want to do really well. That's why you go into this job, isn't it? And so the question is, how do we support everyone who is a participant in this conversation, who is an observer, who is a supporter, who would guide someone through?
How do you think you could have these conversations within your teams? How can you start those conversations?
Jo McNamara Rad Chat Host (32:49)
I love that question, Dani, because it's often one that my students say to me. They're like, Jo, I know I've got to talk to my patients about sex and intimacy. I know I've got to talk to them about physical activity, nutrition, ask them about menopause, but how do you do that? And I always say, you have to ask these open questions to your patients and ask if patients want to talk about these things.
So you're not jumping in there straight away going, how's your sex life? Do you want some advice and support from me? That's never gonna be the right way to do it. talk, yeah, of course. ⁓ But talking to patients and saying, as a therapeutic radiographer, we have lots of knowledge around oncology. And if you want someone to talk to about your relationship, intimacy, ⁓ sex, menopause,
Dani Binnington (33:20)
Yeah.
Naman Julka-Anderson (33:24)
Bit of foreplay first right Jo?
Jo McNamara Rad Chat Host (33:45)
then absolutely, please do feel that you can come and talk to me about it. If you want any questions answering, I'll do my best, but if I don't know the answer, I'll seek someone who does. And I think that's a really nice way to just open it up. That doesn't necessarily mean that patient's going to talk to you.
I think you have to develop that rapport and that trust. And it might be hard if you're only seeing that patient for say five treatments, you may not develop that kind of relationship with that patient. But at least they might go away thinking, they did mention that I could talk to them about that. ⁓ And actually tomorrow, maybe I will see that radiographer again. And maybe I will say, actually, my husband and I tried to have sex last night and it was a disaster.
Do you know why that could be? It never fails to surprise me considering women will always go through the menopause. How many women don't know about what the symptoms are of the menopause? And I would say I'm exactly the same. Going through perimenopause has been truly horrific for the last year. Naman has to listen to me constantly moaning about my hair and how it's gone curly, which
sounds really stupid, but it really affects my confidence because I always had nice straight hair. ⁓ But it's kind of going through it that really makes you think, actually, this can really affect every aspect of someone's life. And could we potentially do more to just start having these conversations? And when you think that a lot of the workforce is women in radiotherapy,
I think we should be more confident about having these discussions. And if we don't know the answers, that's fine. Sometimes it's about listening. Women want to talk about what they're going through and potentially, you know, maybe sharing some of their symptoms, going, what is this? Is this treatment related? Or is this the menopause? I think it's really important. And just having that really basic knowledge could really make a big difference to patients, I think.
Dani Binnington (35:54)
Thank you, Jo, for sharing your personal story with perimenopause, but also with your fertility treatment and really acknowledging that. And also, Naman what you said earlier about being a bloke and not personally affected, you know, it does open, I think, a conversation for all men going through prostate cancer treatment. At one point, when I have a little bit more energy, I think there will need to be work put into that area because men are...
not very good at talking. know in most of our cancer charity centres in the UK, for example, and I know listeners are worldwide, so it might be similar in other areas, it's more ⁓ people with ovaries that use charitable services and less men walk in and get the help. And we know that treatment for prostate cancer, for example, it's almost similar to what happens to women for breast cancer treatment and
their testosterone is really removed from them and it comes with a lot of side effects and people really struggle. And if we just look at people with breast cancer, because that's sort of the biggest cancer ⁓ or the the biggest group we have in our community, up to 70 % of those will have had a cancer that is hormone receptor positive. So they will then be stripped of all of that oestrogen from their body as part of their cancer treatment, often for up to five to 10 years.
And only about half of everyone who is started on these endocrine therapy drugs gets to the end because the menopause side effects are too severe and they haven't perhaps had the help to plough through or to support them to stay on that treatment. And so I think we have a responsibility to do better in helping people with these late long-term side effects of cancer treatment. It will help some.
people stay on their active and long-term cancer treatment and that will improve survival rates. And so I think if people think, this, we just talking about survivorship and quality of life and improving how people survive cancer? Absolutely not. We have also many people in our community with suicidal thoughts. You talked about your relationship, of marriages, absolutely not making it, of people not being able to be intimate, experiencing pleasure, not having a sex slave.
And so it's a lot more than just a bit of quality of life. It can really save lives. And we actually need to include everyone into this conversation, Naman because you'll have enough women around you that will go through the pyramid of whores, right? And it will affect you. Because if they haven't had the help, your life is going to be a misery, may I say
Jo McNamara Rad Chat Host (38:34)
⁓
Dani, I love that point because ⁓ a big shout out to my husband, he'll cringe because he'll be downstairs hearing that. But Lee works in the corporate world and I am so proud of him because he is a real menopause champion. And actually wherever he has worked, he has implemented training for men and women about the menopause. ⁓
because he knows working in an industry years ago, they used to have big factories and those factories were predominantly male workers. And he knew that there were a lot whose partners wives were going through the menopause and they were just at a loss of, have no idea. She hates me. I don't, I don't know why, but our relationship is in tatters. And he implemented this whole course and it was just.
eye-opening because, you know, it's not necessarily something that they can control. It's everything that their partners or wives are going through. And it's thinking about, what can I do to kind of acknowledge that actually I'm there to support you whilst you are going through this? You know, if someone broke their leg, you're not just going to be like, go on, go up and sort yourself out. I'm not going to help you cook the dinner or...
I'm not going to do any childcare. It wouldn't happen. So it does. It makes me laugh just how much it can affect people's lives, both from the person who's experiencing the menopause and also their partner and husband as well. And it's often something that's not necessarily talked about.
Dani Binnington (40:11)
Mm.
Naman can I ask you a question? So it's really interesting because we speak to a lot of clinical nurse specialists and they're really happy to have the conversation about maybe someone's sexual health, for example. We know over 88 % of cancer survivors after breast cancer, for example, will struggle with sexual health related symptoms. In your patient group, you'll see a big amount of people or a big proportion of your patients as well.
that struggle. It's quite awkward to have the conversation though, right? I just want people at home listening, thinking, I don't think I could talk about it. You are a bloke, you will look after female patients. We know they will struggle. It's kind of like also understandable that people don't ask, isn't it? Because it's a bit awkward, really.
Naman Julka-Anderson (41:12)
I think it is awkward, I think culturally growing up in India you don't really talk about sex. Marriage is a marriage, arranged marriage sometimes, so that's always the vision I had growing up, like being born and raised in India. But then I think when I qualified and started to work, realising it's a normal thing, I'm, you know, I was a teenager once, I know how it starts, how it goes, what happens, it's not that awkward, you have to talk about it, patients need that help and actually...
I think what really, where it really started for me was patients who are having cervical radiotherapy. So to have the dilators and stuff afterwards, actually it's not just about intercourse, it's about ensuring they can have vaginal examinations later on. I think that's where it clicked to me just to think, yes, it's awkward, but the more I do it, the less awkward it becomes. And exactly as Jo said, it's not about starting the consultation by saying, so how's your sex life? I mean, some people are happy to do that and there are some sex and wellness.
experts we've had on the episodes with us on Rad Chat who are happy to do that, but actually it's more about opening that space in a proper way. I can't remember what it's called. Lorraine talked about that when she came on, there's a specific way to open up and give them space to talk about it, but I can link it with the show notes, but it's, some patients sometimes are, or have experience of vaginal dryness. Is this something that you've experienced? And then it allows them to say yes or no, and then you...
go into it more often. And actually the more you learn about it and I think working with Macmillan and the Love Honey partnership, which, yep, some people found controversial, but actually I thought it was amazing because it just took all the taboos away and it just said, it doesn't really matter what you're into. At the end of the day, we know it's a problem and this is how we're to do it. And I was part of it in the background. So, but ultimately it is part of our job and we all have agendas when it comes to a consultation that I need to ask X, Y and Z. But in the proforma, like I have a
Dani Binnington (42:42)
Me too.
Naman Julka-Anderson (43:01)
in a Word document that I use for different site specialisms etc. But I always then added in sex and intimacy, so I knew I had to talk about it. And I think now I'm more confident. I've had some very interesting conversations. The oldest person was a 99-year-old, and he had a 60-something-year-old partner. And I talked to my wife about this recently, and I helped him get Viagra, and then he was happy to talk to everyone about his young girlfriend again. Well, then I've talked to someone in their early 20s going through brain treatment who had a...
Dani Binnington (43:08)
Yeah.
Naman Julka-Anderson (43:30)
a GBM quite late stage but just wanted to go out and party like she didn't have cancer and then talking about that like that's the breadth of our conversations in Radio therapy and I think the more you do it the easier it becomes it still feels a bit awkward but I once you get through the awkwardness and shyness it's actually quite a nice conversation about intimacy rather than just sex
Dani Binnington (43:50)
That's amazing because we do have to break through a lot of cultural barriers, right? There are lots of myths. You spoke about India, our black community has other myths and they really deal with cancer very differently to other sort of minorities. And so it's really important to recognise where we all come from. And I think I see that when people want to know what can I do about my menopause symptoms? you know.
what you said very, very at the beginning of the conversation, Jo, about the responsibility of having these conversations and running a podcast like we do. I have taken that responsibility really to heart. You know, I started out thinking I'm going to try and figure out what I can do and invite all of these amazing doctors onto the podcast and see how I could manage my menopause after my particular type of breast cancer. But it very quickly, it
became something very different and it's like I don't, you it's not about me at all anymore. It's about everyone's story that I've heard and all these people wanting more help. So what happened for me is that people listened to the show and I had so many emails in the first six months of people saying, I love your conversations. It's amazing. I've never heard anyone talk about this before, but I still don't know where to go for help. And that responsibility weighed really heavy with me.
So heavy actually that I then back in 2022 decided to set up Menopause and Cancer, the not-for-profit organisation, and we support people really globally, but also very much in the UK with all of our free and accessible support services. And since then, we want to provide active support that is evidence-based. And when people come and say, Dani, what can I do about these symptoms? Those are my symptoms. What can I do?
Initially I always thought, I'll lay all of the ideas out, everything that doctors told me what they can do, whether it's non-hormonal treatments or hormonal treatments or whether it's ⁓ exercise or diet, like whatever it is. But actually I've really changed my mind off that. My first question now always is a bit like you just said, Naman, is what are your belief systems? What do you want to do? What do you think is gonna be helpful for you?
because I have had so many conversations with people where I think, my God, they have these symptoms. And I thought, well, I wonder if they saw a menopause specialist now, whether they would maybe prescribe one of the non-hormonal treatment options that we have evidence for, for some of their symptoms. But that person will look me in the eye and say, Dani, I have had so much chemotherapy. I have had radiotherapy. I had so many drugs pumped into my body. I'm not touching any more medication, at least for the next little while.
And so I know it's irrelevant what is out there, all of these treatment options. The only thing that matters is what that person is willing to do and what's right for them and their belief system is really, really, it's a big point in that. Do you talk about that when you teach your students, Jo, that how you can have all of these amazing treatments out there, but every patient is so different? that, must be so hard to be a doctor.
I'm so glad I'm not one. You have a difficult job.
Jo McNamara Rad Chat Host (47:00)
Honestly,
my students roll their eyes at me talking about personalised care all the time, because I think it's so, so important to really appreciate what does someone want? What's important to them? Is this symptom giving them such grief that it's affecting their quality of life, or actually can they cope with it?
⁓ there's an amazing image that if you just Google, ⁓ kind of personalised care, it always comes up, but it's two dogs and they're standing in the mud. One of, one is a tiny little like Chihuahua style dog. And then there's another one that's a Labrador, lot bigger. And they're both standing in the mud. And obviously the tiny little Chihuahua is there totally covered in mud and just the, the little bit of the legs of the Labradors covered.
And the analogy is the fact that actually, you know, looking at it, you'd think, that poor little dog covered in mud, horrific, really in the thick of it, really not going to be enjoying that. Whereas actually, when you get to know them, the Labrador hates the rain, hates mud, hates being dirty. You know, that is for them their worst experience. Whereas that Chihuahua is loving life and, you know, loves being in the mud and will actively roll around in it.
And I think that is absolutely the key to personalised care. You need to ask people what's important to them. What would they like to improve their quality of life? And obviously with the menopause, there are so many symptoms associated with it, but some people will hate the brain fog because they're in maybe a job that requires them to communicate or write board papers or whatever it is and that is affecting them.
Whereas, you know, it might be the fact that, you know, they're wanting to work out and they're aching all the time. And that for them is really what's, what's affecting them. So I just think it's about opening up the conversation. ⁓ Definitely from that perspective. Dani, can I ask you about kind of maybe treating some of the symptoms? So I know when I first went to my GP.
With perimenopausal symptoms, the first thing that I was prescribed was antidepressants ⁓ because they were just like, well, you know, maybe you're too young to go through perimenopause and maybe, you know, some of the symptoms you're experiencing can absolutely help with prescribing you antidepressants. Do you find that a lot of people kind of reach out and are maybe kind of quite heavy-handedly given?
treatment that maybe isn't suitable for them.
Dani Binnington (49:56)
my god, this is such a good question, Jo. There is really so much to unpack. And obviously I am not a doctor, I'm not a medic. And when I share about medical treatments or complementary therapies, I have gone and found amazing doctors and institutions that helped me find the evidence-based solutions. And I've really kind of like just made it my mission over the last few years to sum it up. So I can sum up, but obviously for everyone listening to understand I'm
you know, not a medical person. When we talk about navigating or managing menopause after cancer, we've got to forget everything you have been taught for how to navigate menopause as a healthy perimenopausal woman, because in the healthy perimenopausal world, we know hormone replacement therapy is the first-line treatment option, and perhaps you should have not been prescribed the antidepressants, or maybe you should have, you know, I...
don't know anything really about you. But we now know that perhaps in the last 10, 15, 20, 30 years, too many people have been prescribed antidepressants where really hormone replacement therapy should have been discussed with them as an option. And we know that wasn't always the case. Now, when you think of a cancer patient and we know how cancer treatments now have pushed him into the menopause, we've got to forget all of this about the normal persons.
treatment journey. It's almost like you're barking up the wrong tree. Get that out of your head and start from scratch. The first question should always be, is systemic hormone replacement therapy an option for you? And the second question is, is local hormone therapy an option for me? So local vaginal oestrogen. And even though if people think their doctor has said they can't ever have oestrogen because maybe they've had an oestrogen receptor positive cancer,
that does not necessarily mean they can't have local oestrogen. And so I want people to know there is a big difference between local and systemic. And just because they've been told you can't have oestrogen anymore doesn't mean the local one isn't an option. So it's really important to do that. The reason why we start with that question or we encourage our patients to ask their doctors what their options are is because we have so many people after different types of cancers, bowel cancers,
brain tumours, and they had maybe stem cell transplants for leukemia, for example, blood cancers. And after many types of cancer, hormone replacement therapy is a very good and safe treatment option. But we need to start bringing that conversation into a patient's pathway and into their care plan. And what we do know at the moment, it's only when patients do a lot of self-advocacy and it sometimes takes them up to two and a half years.
to start the hormone replacement therapy. And really they should have been on it as soon as their treatment started or ended. And so we need to shorten that time that people get on the treatment they have. And when someone has been told hormone replacement therapy is not the first-line treatment option for many breast cancers or some gynaecological cancers, we've got an enormous toolkit that does include antidepressants. The problem we've now got, Jo, is that many people say,
I have heard Davina McCall says antidepressants aren't good for menopausal people. I've been prescribed them. My doctor thinks I'm depressed. But for some people, especially after hormone sensitive cancers, they can be an incredibly valuable tool in someone's medical non-hormonal toolkit. There are certain ones that work better for different menopause symptoms, so many doctors know. Some are contraindicated when people are on tamoxifen or other drugs. Again, your doctor will know.
And they're often prescribed in much lower doses than for someone who's clinically depressed. And at those lower doses, they work very well for things like, well, I'm saying very well, know, no drug comes for free and just with benefits. There's always a trade-off ⁓ and there might be side effects, but they can work for overall quality of life, for sleep, for low mood, for anxiety. They can work for some of the menopausal symptoms. And alongside of those,
SSRIs, there are also other prescribable options that a doctor can prescribe for you. We then have so much evidence for complementary therapies. Like we have plenty of evidence for acupuncture, for yoga, for mindfulness, for many other things. For example, cognitive behaviour therapy and cognitive behaviour therapy for insomnia has the best, absolutely best rate for helping and treat and cure insomnia, up to 70 % of success rate.
That's incredible. There are also some newer medications for insomnia, but CBT is absolutely brilliant. And then of course, diet and exercise are really, really, really, really important. There are certain ways of exercising for a certain amount of time a week to help with certain symptoms. It's prescriptive. It's like a prescription. Different ways to exercise for anxiety and different ways to exercise for low mood or other symptoms. So it's...
really important that we know there is a huge toolkit out there and it really needs to be as bespoke as someone's symptoms and someone's wishes and I will always say it's not a this or that approach. It's not either you do the medical route or the hormonal route or the natural route. All of that doesn't exist in our conversation really. It's like here is everything we can do. Where do you want to start? Because most times people have to muddle through
and try a variety of approaches to see what sticks, to see what they can do. And there is also no hierarchy in where they start. We sometimes have people who are so exhausted, they cannot exercise and eat a healthy and balanced diet, even if they try it. You know, they feel so achy, so low, they've got no energy. And maybe they need to start with a non-hormonal prescription, for example, to help them.
become a bit more active to maybe help them get out the house. Or maybe it's the other way around. Maybe it's someone starting with the lifestyle and the exercise and then maybe adding a bit of acupuncture and really thinking this is fluid. You're going to muddle your way through. You're going to try a little bit of this and a little bit of that. And to never rule out that hormones are always an option just because there may not be the first line treatment. Everyone deserves a conversation.
And I think in general, it's weighing up your risks and benefits. And I guess when you think about your IVF journey, even if I may bring that up, Jo, it's like nothing just comes with benefits, right? I mean, maybe exercise, maybe exercise just comes with benefits, right? But in general, anything comes with, here are my hopes that this treatment, whatever it is, is going to do me good and give me a better quality of life. And here are my worries of what the side effects may be.
Each one of us needs to decide how we want to balance that scale. And it's not for any doctor really to decide either. I want to give the agency to every person to go, I'm going to go for what is right for you now, because we know that's what you're going to do as well, right?
Perfect. So after learning more about both of you on our shows, which has been absolutely, absolutely brilliant, do you have some top tips for any listener who might be going through radiotherapy, who might have finished their treatment?
what can patients do to empower themselves? And then one tip and maybe one tip also for healthcare professionals if they've listened to this conversation.
Naman Julka-Anderson (57:54)
I'd say for patients, don't be scared to ask your professionals. Exactly as I've said, it is our job to help you. Even if we don't have the answers, we'll try and do the best we can to make sure we get you the answers, whether it's if you want it there and then or by an email or something later on. I think for professionals, especially maybe young male professionals like me, don't be scared to learn about this. We do need to know about it. But also at the end of the day, you you're in this position in this role as a privilege to help people living with and beyond cancer.
Don't be scared to learn about things like this.
Dani Binnington (58:25)
Amazing. Anything to add Jo?
Jo McNamara Rad Chat Host (58:26)
I would definitely, yeah,
probably for healthcare professionals. If patients are experiencing things that you can't support them with, educate yourself. ⁓ I fully appreciate that workloads are heavy and time is restricted, but referring a patient is all well and good, but that patient may have only opened up to you on that one occasion about what it is that they're experiencing.
And if you can give them some helpful advice or tell them that you're going to refer them somewhere or that actually you don't know the answers at the moment, but tomorrow you will be able to provide that information, then I think it's our duty of care to do that and not just think, ⁓ another healthcare professional will deal with that at a different point along your cancer pathway because that doesn't necessarily happen. So I think that's really important.
And think for any patients listening, advocate for yourself. And I don't mean that in a kind of aggressive way, because actually sometimes as healthcare professionals, we don't necessarily ask you all the questions and you telling us something prompts us to go, ⁓ that patient's asked that. ⁓ let's follow that up. So absolutely mention away, ask away.
It's really important for us because it helps us build a rapport with you, but also it makes us feel good because we're able to do something to support our patients. So please don't ever, ever be afraid to ask those questions. We've seen and heard most things ⁓ and if we haven't, then it's one to add to the list, isn't it? ⁓ So absolutely, please feel free ⁓ to ask what any questions you may have.
Dani, I have got some questions that are like funny end questions. Do you mind if we do like a rapid fire Q &A? They're fun. So we're hoping you out there listening. If menopause were a weather forecast, what would you say yours looks like today?
Dani Binnington (1:00:19)
Go for it. ⁓
Go for it.
Crazy thunderstorms.
Jo McNamara Rad Chat Host (1:00:38)
Is that because you've just done a podcast with us?
Dani Binnington (1:00:39)
in all honesty.
It's just because everything happens at once. You don't know where they're coming or going. It's like another symptom, another day, where I'm, you know, it's just full on and it's loud and it's big for people usually.
Jo McNamara Rad Chat Host (1:00:53)
Okay, if hot flashes had a theme song, what would yours be?
Dani Binnington (1:00:59)
my god. Has to be a Dolly Parton song. Any Dolly Parton... It's got to be.
Jo McNamara Rad Chat Host (1:01:03)
⁓ I love Dolly.
Okay. What's your go-to comfort food or treat during a rough patch?
Dani Binnington (1:01:11)
Cup of tea, nothing, everything is better with a proper cup of tea. And people would have thought, where is she from? I'm Austrian, so my mother tongue is German. But when I came to the UK at the age of 19, I have pretty much very quickly learned that everything is better with a cup of tea. So it will be always that.
Jo McNamara Rad Chat Host (1:01:31)
what tea brand do you drink Dani? This is a very important question.
Dani Binnington (1:01:36)
Yorkshire. ⁓
Jo McNamara Rad Chat Host (1:01:38)
Yes!
Obviously living in Yorkshire, I'm slightly biased, but yeah, absolutely. ⁓ What's the most ridiculous menopause symptom or side effect of cancer that nobody warned you about that you just wish people knew?
Dani Binnington (1:01:53)
Itchy skin and burning tongue.
Jo McNamara Rad Chat Host (1:01:56)
Really good ones. And did you ever try a wacky remedy or wellness trend?
Dani Binnington (1:02:05)
yeah, there is nothing I have not tried as a cancer patient myself. Jo, Dr. Google at three o'clock in the morning was my best friend for a very long time. I had the cabbage leaves on my lymphoedema. I ate the raw garlic. I cut out every food group that there was. I don't know what I ate in the early days. So I've tried it all. I've had cupboards full of supplements. And at one point my lovely family even sent me on a cooking course. I think they wanted to put some sense back into my body and brain.
Jo McNamara Rad Chat Host (1:02:06)
Yeah. ⁓
Hahaha
And last but not least, if you could invent one product to make the menopause or even the cancer side effects easier, what would it be?
Dani Binnington (1:02:44)
⁓ it would be...
cancer treatments, not having the impact on ovaries.
Jo McNamara Rad Chat Host (1:02:50)
amazing. It would be amazing.
Dani Binnington (1:02:50)
be a good one, that would be a really good one. Come on everyone listening,
researchers, medicine makers, get on with it.
Jo McNamara Rad Chat Host (1:02:57)
Yeah.
No, I love that, Dani. Thank you so much for joining us. I personally have absolutely loved doing it this way. We've never done a podcast episode like this, but I loved it. And Dani, I could probably talk to you all evening.
Dani Binnington (1:03:13)
I'm sorry it's so late. Look at the time on the clock. Everyone, thank you everyone for listening.
Naman Julka-Anderson (1:03:19)
Thanks everyone.