After undergoing chemotherapy and multiple surgeries between 2010 and 2011 to treat stage 3 testicular cancer, Chad Barlan thought the worst was behind him — that is, until the medical bills poured in and the debt collectors started calling. The then-31-year-old single father from Buford, Georgia, was shell-shocked to discover he owed more than $80,000 to the various centers and doctors who treated him. “I chose a basic insurance policy because it was the most affordable.

I was young and fit at the time and never imagined how quickly my situation would change,” says Barlan.

Medical bills were only partly to blame for Barlan’s financial woes. The treatments, plus harsh side effects that sent him to the hospital, meant lots of missed workdays from his job with a lawn care company. Eventually, Barlan went on disability. When his employer terminated him, Barlan lost both his paycheck and his health insurance.

Even after he was in remission, Barlan struggled to return to work and pay his bills. “I entered a dark place of depression and anxiety. It took about six months before I felt physically and mentally strong enough to seek employment again,” he recalls. During that time, the past-due notices and collection agency calls didn’t stop. At one point, Barlan considered filing for bankruptcy. “I felt like a horrible human being for not being able to repay the people who worked so hard to save my life,” he says. “I wanted to do my part, but I simply didn’t have the financial means at that time.”

Barlan’s situation is not unique. Up to a third of survivors say they incurred significant debt while undergoing treatment; half of them accumulated debt of $10,000 or more. A 2016 study conducted by the Fred Hutchinson Cancer Research Center in Seattle found that people are 2.5 times more likely to file for bankruptcy following a cancer diagnosis. What’s more, these bankrupt patients are nearly 80% more likely to succumb to their disease. There’s even a name for this phenomenon: financial toxicity. “The psychological and emotional stress of accumulating so much debt while struggling to afford critical medical treatments, as well as cover basic needs, is incredibly harmful — that’s financial toxicity,” says Salene Jones, a clinical psychologist and a member of the Fred Hutch public health sciences division.

Depending on the cancer type, severity and associated treatments, costs for care vary wildly, with patients quickly racking up tens to hundreds of thousands of dollars of debt. It’s a crisis bordering on a national emergency, says William Goeren, a licensed clinical oncology social worker and director of clinical programs for CancerCare, the leading national nonprofit organization dedicated to providing free, professional support services that helps people manage the emotional, practical and financial challenges of cancer. “As cancer treatments continue to advance and become more specialized, their costs have significantly increased,” he says. The average monthly cost for some novel cancer treatments, such as immunotherapy, has more than doubled over the past decade to $10,000 per treatment.

Insurance costs are also on the rise. A recent nationwide survey conducted by the Kaiser Family Foundation (KFF) and the Los Angeles Times found that annual deductibles for job-based health plans nearly quadrupled over the past decade to $1,350 per family member. At the same time, insurance premiums rose at more than double the rate of inflation. To manage costs, health insurers have started charging higher premiums and passing costs onto patients who pay more out of pocket for deductibles, copayments, coinsurance and other expenses. “Insurance policies today offer less coverage at higher costs, which puts the onus back on people who are already struggling with the emotional and physical toll of a cancer diagnosis,” says Goeren. “It’s a double whammy.”

In 2014, Hanover, Pennsylvania, resident Melanie Thompson underwent multiple rounds of radiation and chemotherapy — at a cost of $10,000 to $15,000 per treatment &mdash; for inoperable stage 4 squamous cell carcinoma of the tonsil that continued into the following year. Even after meeting her nearly $7,000 deductible, Thompson was on the hook for 10% of the treatment costs, which quickly added up to thousands of dollars.

At a time when Thompson needed the money most, she was unable to keep up with the demands of her job and forced to resign.

Then there are the additional hits that pile on debt, such as travel and hotel expenses and items like medical equipment, altered clothing, wigs and cosmetics. Half of the KFF survey respondents said that, due to lack of money, they delayed or skipped medical care or elected not to fill a prescription — decisions that diminish treatment success and jeopardize survival. Not surprisingly, people with cancer and other serious, chronic medical conditions, such as heart disease and diabetes, are the most financially strapped among the ill. “Thanks to new therapies, people with cancer are living longer, fuller lives. The downside is that they are left with treatment-related debt that can be difficult if not impossible to dig out from under,” says Goeren.

Samantha Watson learned at a young age about the crippling effects of cancer-related debt. In 1999, as a 21-year-old college student, she received a Ewing sarcoma diagnosis. After undergoing a bone marrow transplant, Watson was slapped with a $275,000 medical bill. It took two years of legal wrangling with the insurance company to get the charges reduced to a more affordable amount. “Cancer and money are two taboo topics,” says Watson. “Unfortunately, if you or a loved one receives a cancer diagnosis, you’re going to have to talk about both.” Watson applied what she learned from dealing with her own medical debt to found The Samfund, which is a program of the Expect Miracles Foundation and provides grants and online finance educational seminars to young adults recovering from the financial impact of cancer treatments. “Young adults don’t have savings to tap into and often choose the most minimal insurance policy, if they have coverage at all,” says Watson, managing director of stewardship at Expect Miracles Foundation. “They’re also more likely to still be weighed down with student loans.”

Of course, financial toxicity can be devastating at any age. A 2016 Cancer Medicine study conducted by The Samfund found that “patients experiencing financial hardships may struggle with impossible decisions about which bills to pay and which to skip, whether to risk going without insurance or medications or declare bankruptcy instead.” A 2017 Cancer

 survey found that half of respondents faced with medical debt cut back on essentials like food and clothing, and nearly one-third were unable to pay bills for essentials like rent and utilities. In an attempt to stay solvent, a third of the respondents resorted to borrowing money from family or friends, and an equal amount applied for financial assistance from nonprofit organizations. In the KFF survey, 20% of participants reached for a credit card to pay medical bills, a decision that exacerbates the problem by tacking on high monthly interest charges. An increasing number of people faced with insurmountable debt are turning to crowdfunding sites like GoFundMe to alleviate some of the financial stress.

Thompson tapped a combination of resources to pay her medical bills and living expenses. Family and friends held a motorcycle charity drive and silent auction, as well as an online crowdfunding effort. Grants from nonprofit organizations helped cover utility bills. “It makes me sad — and a bit angry &mdash; that people like me who have always worked hard and lived responsibly have to resort to asking family, friends and strangers to chip in so that I can have food, shelter and appropriate medical care,” she says. “Cancer is horrific enough without these added stressors.”

In a perfect scenario, each of us would have an emergencysavings fund to cover a crisis. In reality, just half of single people and 60% of families have even $2,000 in savings, including cash, non-retirement funds and other liquid assets, according to the KFF study. In a different report from 2015, nearly half of Americans said they would have to sell something or borrow money to pay a $400 unexpected medical bill.

Thompson quickly depleted her family’s savings during her first year of treatment. Nearly five years after her diagnosis, she still shells out close to $30,000 a year to cover medications, follow-up scans, ongoing treatments and insurance deductibles. “I can never get ahead,” she says.

For those who find themselves drowning in medical-related debt, these steps can help:

Tap into all available resources. Talk with a social worker at your treatment center. “An oncology social worker can connect you with local and national resources that provide services or financial assistance,” Goeren says. A social worker can also help with mental health services to address cancer — or debt-induced depression or anxiety. Some organizations to check out:	

(CancerCare.org) financial assistance program provided more than $41 million in aid in 2018 to help over 25,000 people with treatment-related costs such as transportation, home care, child care and copayments. Contact Cancer

by phone at 800-813- 4673 or email info@cancercare.org.

(thesamfund.org) offers grants for essential expenses, such as rent, groceries, insurance and car payments, to people ages 21 to 39. The organization has partnered with Triage Cancer to provide an online toolkit, available at CancerFinances.org, for people navigating financial hurdles during and after a cancer diagnosis. To reach The Samfund directly, call 617-938-3484.

 (PatientAdvocate.org) helps people negotiate affordable access to medical care and provides arbitration and mediation to address medical debt and job retention. The organization also offers financial assistance for treatments and prescription copayments. Contact them by phone 800-532-5274 or email help@patientadvocate.org

 (cancer.org) has tips and resources for paying high medical bills and daily expenses and can be reached at 800-227-2345.

 (legalhealth.org) provides free individual consultations, advice and counseling in New York City hospital based clinics for  patients struggling with legal issues. For information about our clinics visit our website at  http://legalhealth.org/schedule/.

 Talk to the billing department. You may be able to negotiate a reduced bill or set up a monthly payment plan with your treatment center or doctor’s office.

Be direct with your doctor. Tell your provider that treatment costs are an issue. You may be able to get an equally effective but less costly option. You also may be able to skip or spread out certain follow-up tests or procedures if your doctor recommends doing so. Your physician is also in a position to know more about drug discounts and clinical trials. Thompson’s oncologist went to bat for her and secured a reduced rate with the company making the chemotherapy.

Reach out to big pharma. Many pharmaceutical companies, as well as medical device companies, offer products at reduced prices through patient assistance programs.

With the help of a Samfund grant, Barlan returned to school, earned some certifications and started his own business. In 2016, he paid off everyone involved with his initial cancer treatments, but medical bills for treatment-related complications and follow-up scans remain an everyday reality. “I’ll always be grateful for the support of family, friends, organizations like The Samfund and even strangers who helped carry me when I couldn’t manage everything on my own,” he says.

Articles

Feature

Cancer survivors who feel buried by costs during and after treatment can reach out to resources for help.

Digging Out of Debt for Cancer Survivors

Now two years post cancer, I have begrudgingly accepted the new normal that arrives in tandem with the gift of cancer survival.

In my old normal, at my 10-hours-a-day sales job, women decades younger dubbed me the Energizer Bunny. Sure, I spent a little extra time in front of the makeup mirror and an equal amount of time choosing the perfect outfit — the worse I felt, the better I planned to look. It’s a psychological trick I employ: Fake it to make it.

Old Normal barely registered everyday senses like balance and smell. It took for granted the fragrance of lavender growing outside my home and the scent of salted sea air that greeted me each day. Old Normal gave no thought to endurance or stamina, either. It loved bike rides flanked by the ocean and considered the ability to cascade down a hill or effortlessly climb a flight of stairs as life entitlements, not feats to be treasured. Every day, Old Normal would watch as I brushed and styled my long brown hair, giving no thought to its presence. Worst of all, Old Normal would quickly glance at those supported by wheelchairs and canes and, after a blip of sympathy shorter than a blink, continue to be Old Normal.

Enter the diagnosis — cancer &mdash; and the life cycle of Chemo Normal. Its balance issues required me to place a hand on a supportive shoulder. Chemo Normal’s lack of endurance meant keeping an ever-vigilant eye for the available empty chair. Chemo Normal balked at climbing stairs and gave an adamant “No!” when it came to riding bicycles &mdash; that ability was gone, completely gone. 

The saying “Once you learn how to ride a bike, you never forget”? Not true.

Chemo Normal’s response to “Wake up and smell the roses”: “Forget about it.” Forget, too, the sweet-scented floral spectrum. Instead, Chemo Normal with its sense of humor, retained for me the odor of pungent, stinky perfume but not the burning odor of pots and pans, thus making timers mandatory cooking equipment.

On the outside, New Normal, albeit with a few changes like missing eyebrows and a receding hairline, looks like Old Normal. If you, like me, practice the trick of looking your best on your worst day, the compliments you receive can backfire: “You look great” comes with the expectation that Old Normal still exists when you, on the inside, know only New Normal — the you that has to be home in bed by 9 p.m., the you that has barely learned to walk again because of balance issues, the you that turns on timers so the house doesn’t burn down, the you that relies on movie subtitles because of hearing loss from chemotherapy &mdash; all while the stranger or a friend tells you what you want/don’t want to hear: “You look great.”

To these compliments, I smile and say “Thank you” while looking around for that chair.

Our longing for what was the old us is akin to a child who is emotionally attached to Mama’s skirt — a skirt imbued with magical powers, a skirt that must be captured in a tightly clenched fist to maintain security and status quo. Once that child’s tiny fingers capture that fabric, life’s disruptions seem surmountable. I want any remnant of my old normal self that I can recapture, and I will do whatever it takes to get back any piece of fabric from my old life.

Our team helps us recapture those pieces of fabric from Old Normal and supports us in our recovery. Teams for us vary but can include a physical therapist, essential for regaining balance and strength; an acupuncturist to help ease neuropathy or issues with sleep or energy; an oncologist who props our psyches and our immune systems to keep cancer at bay; and specialty doctors for any other maladies that chemo might have brought on — related to vision or cardio or osteoporosis. Accessory items complement the team: Fitbit trackers for sleep and exercise, herbal supple&shy;ments, and on and on. No one but us knows about the adjustments made to accommodate New Normal.

Thanks to my physical therapist, New Normal has learned to ride again and climb stairs and regained balance. Thanks to my acupuncturist and supplements, New Normal can smell lavender again but still requires a cooking timer. Thanks to my oncologist, New Normal is in touch with support services, and the writer in me is back. Thanks to my hairdresser, New Normal’s shorter, sassier style, grown out from Chemo Normal’s baldness, gives me the confidence to walk tall and stand on my own two feet — 20 minutes at a time. New Normal still wants me in bed by 9 p.m., although those “You look great” friends think I can stay out until midnight.

The gifts? When I pass the wheelchairs and canes, my eyes well up and my thoughts linger a little bit longer. I look for doors they need opened and offer my chair to someone who has it a little rougher than I do. As we age, we all meet New Normal. Those of us who’ve traveled down Cancer Road just get there a little sooner, and we choose to accept Chemo Normal or fight it with gusto. In this place of being old and new again, we are blessed with the gifts of cancer — a kind and empathetic presence, ours for a lifetime.

Voices

A survivor discusses the decision to either accept each stage of the cancer journey or fight it with gusto.

The Gifts of Cancer

What Rikki Rockett, founder and drummer of the rock band Poison, thought was a passing illness turned out to be the start of a harrowing ordeal with throat cancer.

Head and neck cancer accounts for about 4% of all cancers in the United States, according to the American Society of Clinical Oncology. Rockett learned of his type, HPV-attributed throat cancer, in 2015.

, he shared how his disease was found and describes his experience with immunotherapy — the treatment he credits for helping him achieve remission.

 How did you come to learn you had cancer?

: I thought I just had a sore throat. And the reason I didn’t suspect anything weird was because everybody in the family had a sore throat or some kind of infection that week, except theirs went away and mine didn’t. I got to week three and I thought, “What is going on here?”

I went to my ENT (ear, nose and throat specialist), and he said, “Have you ever been scoped?” I told him no. He (wanted to take) a look to make sure there wasn’t a second infection that (he) needed to be aware of. He scoped, and I could tell something was up. He sat down in his chair, took his glasses off and (said), “Listen, I really want to biopsy what I’m looking at.”

And I said, “Oh my God, what?” He goes, “There’s some&shy;thing there that shouldn’t be there, and I’m suspicious. I’d feel a whole lot better if we do a biopsy.”

I did the biopsy the following week, and it came back negative. We were like, “OK, what is it?” And he said, “It could be an inflammatory response, so let’s treat it as such for a week and see what happens.” It didn’t change. Then we did a fine needle aspiration of the lymph node, and that was inconclusive. He said there was a specialist that he used to work for at UCSD (University of California, San Diego): “This is all he does. I want you to go to him.” I went to him, and he said, “I think it’s one of two cancers, and I want to do my own biopsy because I’m not trusting it either.” It took a couple of weeks to get all the data together, and (it was cancer).

What was it like to hear “You have cancer”? 

By the time I heard that — and this sounds really weird &mdash; I was almost slightly relieved in the sense that at least I knew what the hell I was dealing with. I had thought, “What if this is something really weird (and) they don’t even know how to treat it?” The doctors made me feel like, look, especially if it’s with HPV, (I) have a really good shot with this. So I trusted that.

Your cancer is a result of HPV. Can you talk about what that means? 

There is a lot of information going around naysaying the HPV vaccine, and I know that’s a very personal thing to everybody, but at the same time, nobody wants this cancer or any cancer. And HPV is a big one that can cause it. If people are out having sex, they definitely need to be informed.

It was not fun. I had been warned by other people what it would be like. I tried not to read a lot of things, because a lot of times when you go on forums and things like that, you have to realize that those people are having a bad day. That’s why they’re (doing that). I listened to what the doctor told me. He said, “For the next three months, this is your job.” So I treated it like a job. I got up every day, I took a shower, and I put my best face forward. But, unfortunately, you have to do that three months of waiting before all the swelling from the radiation goes down in order to get proper imaging to know where you’re at. I started getting lymphedema and all kinds of stuff. I started to ask other patients, “Have you ever had lymphedema?” They said “a little bit.” Nobody else had it the way I did. I could also feel hardness in my neck, and (they told me) it was radiation fibrosis. Then I went in for a scan and he said, “I’m sorry. This is persistent disease.”

So my options came down to (undergoing) chemo, which would buy me time; (having) surgery, after which I wouldn’t be able to speak; or trying immunotherapy. They put me on the trial, which was awesome, and you go through nine weeks of infusion and two pills a day — that’s how my trial was &mdash; tons of blood tests and every test in the world. And then I went in for my imaging &mdash; any time I had a PET (posi&shy;tron emission tomography) scan, it was always bad news, so the anxiety was so high. The nurse said, “We got your PET back.” And I asked, “How bad is it?” And she said, “Well, actually, it’s pretty good.” The doctor walked in the door seconds later and said, “Did she tell you? It’s like 90% gone. Everything except a little tiny bit on your primary is gone. It’s like almost miraculous. We need to keep going with this. Are you on board? And I said, “Of course I am.”

We did another nine weeks, and it was entirely gone. No more chemo, no more radiation, no surgery, nothing. It was just the immunotherapy for another seven months and then (treatment) stopped. I have been in remission for three years.

What advice would you give to someone who has recently been given a diagnosis? 

I don’t know about every cancer, but if they had 

, I would abso&shy;lutely at least look into immunotherapy clinical trials or any trial that is in second or third phase and see what their success rates are. Because if you could do that treatment and not have to have radiation, not have to have surgery, not have to have standard chemo, your side effects and the morbidity are way, way, way less.

To hear the interview with Rikki Rockett, check out our podcast “

Poison’s Rikki Rockett discusses the immunotherapy clinical trial that led him into remission.

Drumming Out Head and Neck Cancer

It’s no surprise that cancer care comes with a large price tag. However, it’s not always obvious at the time of treatment how much the disease, its management and the lasting effects will financially affect someone well into survivorship.

Drug prices can skyrocket from $10,000 a month or higher for more advanced therapies, such as immunotherapy. And patients must consider out-of-pocket expenses for side effect management and travel, among other costs. Factor in a person’s financial situation prior to cancer — existing debt, single-person income &mdash; and it all adds up.

® readers of their money hardships, such as trying to recover from the piles of medical bills, being unable to work after cancer and even losing their home because they were drowning in 

In our cover story, we focus on cancer’s financial toxicity, sharing the stories of two survivors who found a way to get back on their feet. We offer advice on how to get started yourself, perhaps with a phone call to a social worker or a nonprofit organization. You are not alone as you try to regroup from the disease and its financial toll.

Also inside, Katie Couric opens up about losing her first husband and sister to cancer, recovering after her world turned upside down and taking steps to keep her two young daughters as “healthy and whole as possible.” As a cancer advocate, Couric also discusses the new initiative that she is working with to help connect patients, survivors and caregivers with others who are facing a similar experience.

Finally, our Taste for Wellness section steps into “The Living Kitchen.” Meet the two women behind a new cookbook that offers healing recipes to boost recovery during and after cancer. We share three recipes that can help beat side effects, including a chocolate mousse dessert with an unexpected ingredient.

: hypnosis for pain relief, the use of complementary therapies, opioid trends in cancer survivors and why attitude can make all the difference.

We hope you find both practical information and everyday inspiration, and, as always, thank you for reading.

From the Chairman

Closing the Door on Cancer Care Debt

many titles — news anchor, wife, sister, mother. But her role as caregiver-turned-advocate more than two decades ago became a new challenge that’s left a lasting impact.

Her first husband, Jay, died of colorectal cancer just nine months after learning he had the disease, and Couric found herself trying to pick up the pieces for her two young daughters. A few years later, she faced the same nightmare — this time with her sister Emily, who was diagnosed with and died of pancreatic cancer.

Since then Couric has worked to help fund research for cutting-edge treatments and raise awareness about all cancers. In an interview with 

, she opens up about her losses, a new cancer initiative and the advice she would give her younger self.

: How did you cope with the deaths of your first husband and your sister? What was that like for you? 

When both my husband Jay and sister Emily died of cancer, it was devastating for our families. Jay passed away first from colorectal cancer. Our daughters were 6 and 2 at the time, and it’s really hard to describe the kind of heartbreak that ensued after he passed away. Our hopes and dreams, what I thought was going to be a long and happy life together, just vanished into thin air after his nine-month battle. And it was a shock when my sister called me just a couple of years later, and said, “I have pancreatic cancer, and it’s spread to all over my liver.” I think that it’s hard to describe for people what it’s like unless you’ve been there, and you have to rebuild your life. Thomas Jefferson once said that the earth is for the living and we’re all terminal. So I wanted to try to have a full and happy life, even if it meant doing so without my husband. I had two little girls who were depending on me. I didn’t have the luxury or the time to put the covers over my head and give up. I think people find a way to go on because they have to go on. They have no choice but to go on.

Emily and Katie Couric grew up in Virginia. Katie gave the eulogy following Emily’s death from pancreatic cancer at age 54.

As you mentioned, your daughters were both very young. How was the discussion with them? Have you had discus&shy;sions about cancer with them now as adults? 

I did a lot of reading about how talk to your children about cancer, and, according to everything I read, it was important to be honest and to not guarantee that everything was going to be OK. I remember Ellie asking me, “Is Daddy going to be OK?” and I said, “Gee, honey. I really hope so. The doctors and nurses are trying so hard to help him, and he’s trying so hard to get better.” I just didn’t want to raise expectations that he was going to get through this when the prognosis was so bleak at the time he was diagnosed.

I was really focused on making sure that my daughters got through this horrific ordeal as healthy and whole as possible. So I called Cancer

, an organization that really helps cancer patients, and I remember saying, “I need some advice. I need some help.” And they told me that kids that age don’t want to feel different from other kids when they’re young. Someone from Cancer

came to Ellie’s first grade class, and they did an exercise called the Worry Cup. They put a cup in the middle of the room, and they all sat in a circle. They had those big, fake gemstones, and everybody took turns putting a gemstone in the cup and saying what they were worried about. Her teacher later told me it was the most profound experience she had ever had in her class&shy;room. Of course, Ellie said she was worried about her dad. I think it was designed to make sure Ellie knew she wasn’t the only person who was worried about something.

After Jay died, I made sure Ellie went and talked with someone. I think because she was so young, it meant mostly playing games and role-playing. I don’t think it was tradi&shy;tional therapy. But I don’t think anyone ever regrets going to get help. They regret not going to get help. I wish I had done more for Carrie when she had turned an age where she could understand a little bit more. But Jay had died several years before, so I think you take cues from your kids and get professional help. But talking to them and keeping their dad’s memory alive was important to me. Now they are 27 and 23, and I think they worry about cancer, and I’m going to make sure they get the proper screening they need, given our family history.

Katie Couric with her first husband, Jay, and their daughters, Carrie and Ellie. 

What was the most challenging part of being a caregiver? Were there any rewarding moments? 

It’s incredibly challenging, difficult, painful and traumatic to see someone you love get sicker and sicker. Every day was a challenge. I felt like I had a vise around my heart every single day. It started to affect me physically. I had a lot of pain in my back. I didn’t sleep well. I ended up going to a therapist, and I was prescribed antidepressants for situational depression, which is brought on by some kind of traumatic incident.

I guess the positive is — and I don’t know if there is a positive, honestly &mdash; that your sense of being present is heightened and every moment seems so important. You almost form a mental snapshot in your mind when you spend your days together, whether it’s playing with your kids, going to the garden, taking walks, driving or listening to music &mdash; everything seems to take on more importance and significance, which I think is a good message for all of us when we’re not sick.

We often talk about the new normal for patients. Is there a new normal for a caregiver? 

The new normal while Jay was sick was that my entire focus was on him. I remember I was still on the “Today” show, and those two hours just felt like such a helpful escape because those were two hours in the day where I wasn’t focused on him, how he was doing, if he was going to get better, were there more treatments I didn’t know about, was there a clinical trial going on that he could enroll in. It was just all-encompassing and overwhelming. But that’s OK because that’s how I wanted it to be.

People

Katie Couric reflects on life and lessons learned after losing her husband to cancer.

Katie Couric's Advice to Her Younger Self Before Serving as a Cancer Caregiver

Cooking fish in a miso sesame marinade is super easy and has the most magical results. This recipe is well loved by many of our clients and requires very little effort to make — ideal on treatment days, when you need something quick but tasty. Not only does miso offer a complex flavor that is salty and slightly sweet, and will make your taste buds sing, it also provides naturally occurring healthy bacte&shy;ria that will support your digestion and immune system. Cooking the fish at a low temperature will help maintain a soft, tender texture that practically melts in your mouth, which is helpful when you’re dealing with a sore mouth or throat.

4 chives, finely chopped, 2 teaspoon sesame seeds, handful of sprouts

Preheat the oven to 350 degrees F and line a baking sheet with parchment paper. Place the cod on the baking sheet. Mix the miso, sesame oil and ginger together in a small bowl. Spread some of the mixture over each piece of cod and bake in the oven for 15 minutes. You’ll know it’s ready when the flesh gently flakes with a fork. Top the cod with chopped chives and sesame seeds and serve. You can keep leftovers in the fridge for up to four days and reheat them when you are ready to eat.

There are different types of miso. The dark&shy;er the color, the saltier and stronger the taste. Lighter misos are less intense, so we recommend you start with these if you haven’t used miso before. You can find different varieties at health food stores and online. If you can’t eat soy, look for miso that’s made with chickpeas or other types of beans.

Avocados are not just for guacamole; they are versatile chameleons. Spread them on toast, blend them into smoothies and even use them in desserts. This recipe was our first introduction to using avocados in desserts, and it’s been a winner ever since. Here, avocado is the secret ingredient — this mousse is so chocolaty, soft and silky, you will never know that it’s not made from real cream. Try it if you experience dry or sore mouth, or if you suffer from depression and anxiety.

Berries or fruit of your choice; unsweetened coconut flakes; 80% dark chocolate chips; chopped raw pecans, walnuts or almonds; cacao nibs; hemp seeds; goji berries; mint leaves; cinnamon; raw cacao powder for dusting

Soak the dates in a bowl of warm water for five minutes. Once they’ve softened, drain the water. Blend the dates, avocados, dairy-free milk, cacao powder, vanilla extract and salt in a food processor until the mixture becomes creamy and smooth. If you have trouble getting the mixture to blend, gradually add a bit more milk, one spoonful at a time. Divide between two bowls, garnish with whichever toppings you like and enjoy! Store in the fridge for up to two days in an airtight container.

: The omega-3 fatty acids in avocados support your immune system and maintain healthy cells. Avocados can help you gain weight if cancer or treatment has made you lose it.

Sipping a hot, frothy cup of tea is a wonder&shy;ful way to start off the day or to unwind in the afternoon. But we recommend limiting caffeine during treatment. We understand this can be a real challenge if you’re a caf&shy;feine lover, so we’ve come up with an alter&shy;native for you. Matcha, made from ground green tea leaves, contains some caffeine (but a lot less than coffee), and might just do the trick if you want something with a little kick of energy. Enjoy this vibrantly col&shy;ored green tea that’s naturally sweet and earthy, and that tastes so smooth whisked into dairy-free milk. It offers benefits, such as help with swallowing and may be a way to fight exhaustion and fatigue.

6 drops of liquid stevia (or more if you like it sweeter) or 1—2 teaspoon honey

Add the milk to a small pot on the stove. Heat gently on medium until just below boiling. Meanwhile, whisk the mat&shy;cha powder with 1 tablespoon of hot water in a mug until there are no clumps and it’s a smooth mixture. Once the milk is hot, pour it into the mug with the matcha. Pour the matcha and milk mixture into a blender and add the coconut oil. Blend for 30 sec&shy;onds, or until the coconut oil is emulsified into the liquid. This will help make the milk frothy. Pour into the mug, add stevia or honey to taste.

You’ll need a whisk to blend the mat&shy;cha powder into the liquid. You can find a matcha tea whisk at any tea shop or on the internet. If you don’t have a tea whisk, you can use a regular small whisk.

Matcha tea is rich in epigallocat&shy;echin-3-gallate (EGCG), a compound that researchers have linked with preventing cancer. It’s best to buy organic matcha, even if it seems expensive, as you’ll want the higher-quality tea to get the most health benefits.

are certified nutritionists and the founders of Living Kitchen. They offer private chef, consulting and meal planning services to clientele throughout Toronto, bringing nutritional support, education and food to patients with cancer and caregivers, as well as people maintaining a healthy lifestyle.

“The Living Kitchen” is available in stores and online at outlets such as Amazon, Barnes & Noble, Target and Walmart.

Excerpted from The Living Kitchen by Tamara Green & Sarah Grossman. Copyright © 2019 Tamara Green & Sarah Grossman. Photography by Daniel Alexander. Published by Appetite by Random House®, a division of Penguin Random House Canada Limited. Reproduced by arrangement with the Publisher. All rights reserved.

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Authors of “The Living Kitchen” share meal options packed with flavor and health perks.

Summer 2019

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The Gifts of Cancer

Drumming Out Head and Neck Cancer

Closing the Door on Cancer Care Debt

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