Older People Living with Cancer

Peer advocates supporting older people affected by cancer

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..faced with a cancer diagnosis, feelings of isolation and confusion are only magnified..

Karen Renner, who has recently taken up post as Volunteer Coordinator at programme partner AgeUK Northumberland, gives us an insight into why delivering the Cancer, Older People and Advocacy programme is so important in Northumberland:

I started working as the Volunteer Coordinator on the Macmillan Cancer Advocacy Programme with Age UK Northumberland in September.

I have worked with volunteers in various roles in the past but I am new to advocacy.

I am passionate about the project.  As Macmillan say, ‘no one should face cancer alone’ but sadly, in the case of older people this can be all too true. Over one million older people haven’t spoken to a friend, neighbour or family member for over a month. This is sad enough but faced with a cancer diagnosis, feelings of isolation and confusion are only magnified. That’s where our project comes in and can assist in ensuring that voices are heard, informed decisions taken and quality of life maintained.

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Even those fortunate to have the support of loved ones can feel lonely.  It is not unusual for older people to keep their concerns to themselves: they don’t want to trouble anyone and they don’t ‘want to be a burden’.  An advocate can bridge this ‘gap’.

Working in Northumberland provides its own unique challenges and rewards.  The county has vast rural areas with pockets of small communities that don’t have the ready access that more urban counties have to services and professionals. Older people are typically traditional, proud individuals who like to go about their daily lives with the minimum of fuss. That’s why the project is so important.  One in three of us will be diagnosed with cancer at some stage of our lives and everyone should have support at that time.

Karen Renner

Karen Renner

I am fortunate to be working in a small team of dedicated, enthusiastic people who all feel the same way.  We are working towards the vision of OPAAL: that is, the provision of high quality independent advocacy. Our volunteers will be the key to achieving this.

Karen Renner, Age UK Northumberland/Macmillan Volunteer Coordinator

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World’s Biggest Coffee Morning ……. Again!

Juanita Williams, Volunteer Coordinator from Sandwell Advocacy’s Cancer, Older People and Advocacy (SCOPA) project paints a vivid picture of this year’s World’s Greatest Coffee Morning and what it means:

It’s September and to me that means one thing to me –  not the end of the summer, not the children and teachers going back to school – It’s the World’s Biggest Coffee Morning, raising money for Macmillan Cancer Support. 

I have been hosting coffee mornings since 2006 as my way of thanking Macmillan Cancer Support for supporting our family on my dad’s cancer journey.  I have raised thousands of pounds for Macmillan over the last ten years but I have had so much back. Every time I do something for them, another opportunity seems to come my way which enriches my life.  I suppose that’s what happens for the volunteers here at SCOPA.  They came along to give something back and in return they get a sense of achievement knowing they have made a difference to someone’s life. It’s a really positive and rewarding cycle.


I know I have written blogs about it before as have many other Cancer Older People and Advocacy projects but the events are always so different.  Firstly, every year we have a new Mayor.  This year we were joined by Cllr. Julie Webb.  She spent lots of time talking to local residents and volunteers about the work of SCOPA and Macmillan.  She is very aware of how cancer affects so many people in her ward, across the borough and the rest of the country. 

We also had a very special guest from Macmillan Cancer Support.  John Pearson is the Executive Director of Cancer Support Operations.  I met John for the first time back in 2014 when I was taking part in an “extreme” Macmillan Cancer Support cycling challenge over the Himalayas in India.  John and his wife were also cycling and camping on this really tough ride.  I think that’s what I really like about John – he works for Macmillan but he also raises thousands of pounds for the charity.  I’ve seen his Facebook pictures – he runs, cycles, sails, treks, hosts black tie events, serves water at marathon pit stops, gets up at ungodly hours to sell at car boots, barbeques, makes tea for little old ladies and sports a green afro wig with style when called for! And that’s in his spare time!

As a very active volunteer and fund raiser himself John totally gets what it is we are doing here in Sandwell on the Cancer Older Peoples Advocacy project.  It was for this reason I wanted to invite him to meet our volunteers and some of their partners who are being supported.  I wanted him to see what a huge difference SCOPA and Macmillan can make to an area like Sandwell.


We opened the event at 10.00am.  It was an early start for myself and my friend Jenny who works at Sandwell Irish Community Association where we host the event.  Jenny does all the work over at the venue, making sure the room is booked, hiring materials to dress the room and sourcing prizes for the raffle.  I couldn’t do the event without her support.  The SCOPA staff team arrived next and set about making sure everything was ready for our guests to turn up.


Next to arrive was my mom, Cath.  Mom spends her leisure time crafting and always puts on a fabulous stall full of handmade gifts.  She has learned that it’s never too early to start selling Christmas items and this year’s creations included knitted handbags, felt flower brooches, Steam Punk boxes (you will have to Google that one as it’s too difficult for me to explain) and fairy houses.  The Mayor is always brought to the event by the Sergeant at Arms (chauffeurs to you and me). This year we were joined by Kennedy and he always informs the Mayor about the event prior to her arriving so she knows what to expect.


Eventually all of our guests get to sit down and enjoy a nice cup of tea and a piece of cake.  We have so many talented supporters who bring along their cakes.  The cupcakes always look splendid stacked high on the cake stands but the Victoria sponges, chocolate sponges, lemon drizzle, rocky road slabs, banana loaves and coffee & walnut cakes are equally as delicious. This year we were treated to a magnificent chocolate cake covered in soft icing and Maltesers.  Apparently there were no calories in it at all (that’s what she said!) I can honestly say that the bakers of Sandwell never let us down. 

Sandwell council sent along one of the communications team to take photographs of the event. This year we were also joined by an apprentice who spent time photographing the cakes.  These all went onto Twitter, Facebook and to the local Express and Star newspaper.  We were a bit cheeky and we asked the photographer to take a few extra shots for us to use ourselves.  We plied him with cake and he didn’t refuse.

Throughout the morning the SCOPA volunteers, board members and staff were all on hand to make sure everything ran smoothly.  Some served refreshments, others washed up and some were simply there to listen – that’s what we do – and we do it well.  This year we were joined again by some of our partners, its lovely for all of us to meet with them face to face as often we only get to chat on the telephone. It’s always good to put a face to a name and a voice.


We drew the raffle and you could hear a pin drop as people waited anxiously to hear if their number was being called.  The gifts had been generously donated to us and included orchid flowers, chocolates, champagne, toiletries and much more. In total we raised over £380.00 and this has been paid in and is on my Justgiving page.

Here at SCOPA we have built very successful relationships with our Macmillan colleagues, both on the wards and out in the community.  Their involvement is key to the promotion of our service and we really appreciate their help, likewise they value what we can do for them.  When we host a coffee morning we are able to promote the SCOPA project and get the word out to both professionals and the local community. I work with wonderful people who are all striving to make these journeys a little easier.  I can’t think of a better way to network and reach out to people – but that’s because I simply love a cup of tea and a piece of homemade cake! What a great job our SCOPA team are doing.

Juanita Williams, SCOPA

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Over time I was able to build a trusting and secure relationship with Valerie

Aneesah, advocate at our delivery partner ICANN, tells us about Valerie (not her real name) and her issues around divulging that she is HIV:

I received a referral for Valerie who had used us as a service in our previous advocacy work. She was diagnosed with breast cancer but was in the very early stages of recovery. Therefore, she was extremely emotional when we initially met. Because I already had an established relationship in our previous advocacy service Valerie felt comfortable to talk to me openly about her feelings and concerns.

Valerie’s ethnicity and cultural background played an important role in how she felt and how she mentally perceived how she should be handling her medical problems. She’s from African descent and although she was living with her sister she was of the strong opinion that she needed to be emotionally strong and expressing her true feelings and worries was a great sign of weakness. Yet equally it was clear to me that these vulnerabilities and insecurities were taking a very big toll on her and was having a far deeper rooted impact on her mental health.


These feelings of guilt and shame were exasperated as she had also been diagnosed as HIV positive some years ago. Due to Valerie’s concerns she felt that this was another medical condition that needed to be keep hidden. What came through in our conversations was that although fortunately she had a very good and trusting relationship with her consultant the diagnosis of breast cancer meant that she had to constantly disclose the fact that she was HIV positive to other medical health professionals, particularly during the period she was undergoing chemotherapy as the requirement was to have regular blood count checks. Because she was highly conscious and anxious about her diagnosis of HIV coming to light, she found the whole treatment procedure very tense and traumatic.

By the time she established contact with me she had many unexplored and suppressed worries. Her main reason for contact was an approaching benefits assessment. Valerie felt she was forced into a situation where she would have no choice but to discuss medical issues she was highly uncomfortable with.

In our meetings which followed over a couple of weeks I was able to talk and reassure her that she should not feel shame or guilt towards her condition. As time went on we met regularly and Valerie was able to make the vital step of being able to talk about her condition without supressing her true feelings. I was able to reassure her that for the purpose of the benefit assessment it was vital to disclose both of her medical conditions in depth as her eligibility would depend on this.



Over time I was able to build a trusting and secure relationship with Valerie and this really helped me to advocate on her behalf. Consequently when we were in the assessment she was able to depend on me to talk on her behalf on occasions when she found things difficult to explain to the assessor or when she became uncomfortable.

As a result, Valerie was successful in receiving the benefit and the experience allowed her to recognise that professionals in general work using the ethic and principles of being impartial and non-judgmental. The experience clearly demonstrated to her that although she felt that by disclosing her medical conditions she would be judged and perceived in a negative and possibly prejudiced way, this in reality was clearly not the case.

As a result of this experience and advocacy support we were then able to arrange specialist focused counselling services as a more long term plan to deal with her anxieties.

This particular experience demonstrated to me and to Valerie that by working on her emotional insecurities and coming to terms with her health condition it was going to enable her to consciously make the effort to attend future appointments in relation to regular health checks at the hospital. Ultimately advocacy support empowered her to be in control of her health, which hopefully now will contribute to improving her quality of life.

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Clinicians and Patients: Balancing the Conversation

Today Jen Rimmer, advocate from Dorset Macmillan Advocacy and Dorset Advocacy, looks at the barriers to patients being more involved in decisions affecting their care:

BBC Radio 4’s Inside Health (listen here: http://www.bbc.co.uk/programmes/b07vs2p0) reported on NHS Wales’ new initiative ‘Choosing Wisely’ which is attempting to challenge the general atmosphere that doctors know best and encourage patients to engage more actively in the decision making process around their tests and treatments.

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Dr Paul Myers, Chair of the Academy of Medical Royal Colleges in Wales who is leading the new initiative was interviewed on the programme. He explained that the NHS is, “often too quick to offer patients treatments and interventions that don’t always benefit them and may even harm them…up to 10% of interventions in healthcare are inappropriate and perhaps even harmful”

To tackle this, patients are being encouraged to ask 4 key questions of their clinicians:

  • What are my options?
  • How likely is the treatment to benefit or harm me?
  • Do I really need it?
  • What can I do to help myself?

In tandem there is work going on to ensure that the clinicians are more receptive to patient questioning in an NHS culture dominated by time constraints and clinical decision making processes increasingly driven by guidelines and protocols.

Dr Myers describes findings that patients, “continually express that they’d like to be more involved in the decisions made about them” but at the same time many patients state that they have difficulties having conversations with their clinicians.

The Choosing Wisely initiative acknowledges that failing to understand patients’ needs and wants often leads to high levels of patient dissatisfaction and that spending time in the initial consultation listening and identifying the concerns, values and preferences of the patient pays dividends later down the line.

But what are the barriers to achieving this and how can these be addressed? Well for those of us who already work in healthcare advocacy, one useful strategy is clear!

Dr Margaret McCartney, a regular contributor to Inside Health, highlights some of the issues – time constraints in appointments and the problem in assuming that every patient is able to take in and process the information given to them in such a way as to reach an informed decision.


Jen Rimmer

As advocates, we see this all the time. Ensuring that a person with a known cognitive impairment or learning disability is supported to digest information and come to the decision that is right for them is a given but we also see usually assertive and self-advocating individuals floored in the face of important and stressful medical decision making processes. This can be due to the emotional and psychological shock they are feeling or simply being unfamiliar with the medical domain. Advocates have both the time and the skill to support patients to make decisions and, as we have seen here in Dorset, both cancer patients and clinicians report positive outcomes as a result of Independent Advocacy involvement before, after and at appointments.

It is great to see initiatives such as ‘Choosing Wisely’ and similar programmes are set to roll out across the UK later in 2016 but if the NHS fail to consider how Independent Advocacy could support this, they might be missing a trick!

Jen Rimmer, advocate, Dorset Advocacy & Dorset Macmillan Advocacy

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“Advocacy kept me going”

Today we hear from Helen Vernon, advocate at programme partner Sefton Pensioners’ Advocacy Centre about Peter, one of the older people affected by cancer she has supported:

Peter referred himself to the Cancer Older People and Advocacy project after a diagnosis of cancer in June 2015. He had recently been told he was palliative.  He had spent 16 months in hospital with a collapsed lung.  Peter had moved in 2014 but regretted the decision due to some issues with the housing association. 

Peter had discovered that there was an electrical cupboard/water tank next to his flat.  His bedroom wall was on the other side of this cupboard and he found his sleep was severely disturbed.  We looked into the option of rehousing but Peter felt that since his diagnosis was terminal he didn’t want to spend the time he had left on a waiting list or moving house. Instead we asked that remedial work be carried out to alleviate the problem.


I negotiated with the housing association who had put in a request for the job to be completed, but it had been delayed because a surveyor hadn’t been to the flat.  The housing association actioned the job immediately.  I then continued to liaise with the housing association to make sure the job took place and that Peter was satisfied.  

In addition to this I contacted the Department of Work and Pensions to ensure that Attendance Allowance had been started and I explained to him when the payments would take place.

Peter’s family all live abroad and he felt strongly that they should be allowed to live their lives without worrying about him.  He spoke to me at length about his life and his feelings about the cancer. 

When the case was closed I asked Peter what he had thought about the advocacy process.   He said “(Advocacy) gave me a lot of hope that things would improve and they did improve, it (advocacy) kept me going”.

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Helen Vernon

I recently contacted Peter again and he has asked me to revisit him as there are now some issues around his hospital care.  He would like me to write to the hospital on his behalf and to attend appointments with him.  A new case will bring new challenges as his health is declining, but with advocacy support Peter’s wishes will be represented and his voice heard.

Helen Vernon, advocate, Sefton Pensioners’ Advocacy Centre

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We too experience loss in our roles as advocates and can sometimes be so focused on supporting others that we do not recognise the loss that we experience ourselves

Today’s post is a really thoughtful piece from Emily Brown, Volunteer Manager at Dorset Advocacy, part of the Dorset Macmillan Advocacy partnership:

It is a sad truth that the people we support at Dorset Macmillan Advocacy have been diagnosed with cancer or are caring for their loved one who have cancer.  It is not unusual then that we come into contact with people who have experienced a great deal of loss in their lives or may experience loss during the course of the advocacy partnership. We, as advocates, often find that we are supporting people though some of the most difficult times in their lives and so it is not surprising therefore that we find ourselves personally affected by their circumstances.  This is particularly true of our Macmillan Advocates as they themselves have had experience of cancer, and so are likely to recognise parallels at times, with those people they support.  As well as supporting people who are bereaved we too experience loss in our roles as advocates and can sometimes be so focused on supporting others that we do not recognise the loss that we experience ourselves. 

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One of the coordinators on our Macmillan advocacy project felt that inviting volunteers at Dorset Advocacy to come together and share their experiences and feelings on the subject of bereavement might help us to recognise these emotionally difficult times and use them to identify ways of protecting and looking after ourselves.

Initially it was thought that this would be specifically for Dorset Macmillan peer advocates, but through the course of discussions about the training we found that the issues raised were likely to affect all of those volunteers who support vulnerable people across the county and that paid advocates too could benefit greatly from this training, so we decided that it should be opened up a wider group at Dorset Advocacy.

Kate Woodhouse (trained bereavement counsellor) facilitated this training on a sweltering hot summer’s day in late July and a dozen or so of us crammed in to the sauna that was Dorset Advocacy’s training room.  There was a mixture of advocates from our volunteer base and paid advocates, all of whom work/volunteer for Dorset Advocacy projects. We spent some time chatting over lunch and sharing ideas and experiences before we reorganised ourselves and sat in a circle.  This was a no-barriers style training and so we were not behind tables with note pads: we were sitting opposite our colleagues, ready to listen and to share.  Kate ensured that we felt safe within this space and asked us to be considerate and respectful to those who spoke as well as those who chose not to.


Despite the heat it felt as though those who attended were comfortable enough to explore the sensitive subject of bereavement/loss and what it meant to them.  We took turns to choose and present objects that represented our own experiences of loss.  Many individuals in the group used these objects as a means through which to explain a loss they had experienced and reflect upon it.

We were also encouraged to relate personal experiences, worries, anxieties and difficulties to marbles and add them to a jug of water prompting us to consider how we as people can only cope with so much before we run out of capacity. We explored ways that we, as individuals, can look after and protect ourselves alongside offering support to others so as to ensure that we are in a position to give support.

What this training highlighted to me was the importance of having a free and safe space to enable advocates to speak honestly and openly about their experiences.  All of the people at the training had different experiences and had been affected differently by them.  We must remember this and ensure that those people who are offering support and sharing the weight of worries and emotions with others are, in turn, able to share theirs and are encouraged to take time and recognise when to focus attentions on themselves.

Emily Brown, Volunteer Manager, Dorset Advocacy

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Advocacy on the edge

Today Rhonda Oliver of Cancer, Older People and Advocacy delivery partner Advocacy in Barnet tells us of her newfound understanding of advocacy:

I have to declare straight away that I am new to advocacy. I joined Advocacy in Barnet in May 2016 and since then have had more of a learning roller coaster than a learning curve!

barnet logoAdvocacy – it’s a funny old word and it has become clear that many people, including health professionals, do not really understand what it means. It has a faint whiff of Rumpole of the Bailey – something legal and a bit scary – but of course it is nothing of the sort and that is a big challenge we all face: to communicate better what we do. I guess this was a factor in the advocacy service in Oxfordshire re-branding itself as “Getting Heard”? Is this something we should all be considering I wonder or should we stick to our “advocacy” guns? Getting heard is only part of the advocacy story. At Advocacy in Barnet we say to the people we help “You talk, we listen, life changes” and it is life-changing aspects of our work that I find so inspiring.


Rhonda Oliver

The simple definition of advocacy is the act of speaking on the behalf of or in support of another person, place, or thing. So far so easy, but what I had not realised was that it would encompass so many dark and threatening sides of the human condition. All human behaviour is represented from the highest altruism to the meanest type of exploitation of vulnerable people and downright cruelty.

Some of the cases I have heard about in the last couple of months would make your hair curl – financial abuse, people being excluded from their own homes by greedy relatives, people being abused and bullied or ignored. I had no idea when I joined of the tough cases that would cross our desks.

This why I have developed so much respect and admiration for our volunteer advocates – nothing phases them. They remain professional, competent and non-judgemental at all times. Their steely determination to do the best for the people they help is amazing and nothing seems to deter them from achieving the most positive outcomes.

Volunteer advocates everywhere – I salute you.

Rhonda Oliver, Project Manager, Advocacy in Barnet