The dawn of a new dao: writing about cancer survivorship
My presentation included the story of ‘Ann’, a breast cancer survivor with lymphoedema, who suffered (needless) discomfort for eight years before thirteen acupuncture treatments turned her life around. Little did I know that over a decade would elapse before my book Acupuncture and Cancer Survivorship: Recovery, Renewal, and Transformation was published.
Ann – not her real name – participated in research I conducted to explore using acupuncture and moxibustion to improve wellbeing and quality of life for people living with cancer treatment-related lymphoedema. She is the one patient who taught me the most – about acupuncture, cancer survivorship, and lymphoedema. Her story has been a constant inspiration and support to me. I had to tell her story to the world – this imperative triggered my dawn of a new dao.
My vision
My book needed to do more than tell Ann’s story. I envisaged a book that would be a bridge between professional communities – acupuncturists, biomedical healthcare professionals, academics, and researchers, as well as cancer survivors.
This book should inform acupuncture professionals about the challenges of cancer survivorship. It should increase awareness amongst other communities that acupuncture is a powerful tool that can improve wellbeing and quality of life for cancer survivors. It would explore cancer survivorship from many perspectives – biomedical, East Asian medicine, the evidence base for acupuncture, my clinical experience, and the cancer survivor’s perspective. I set a high bar for myself, inspired by Giovanni Maciocia’s texts, which were the mainstay of my acupuncture training and professional life.
I discussed the idea with my partner, and on obtaining his support, arranged a sabbatical from my NHS post as Research Acupuncturist at Mount Vernon Cancer Centre. And I set out to find a publisher.
Publishers
‘Just don’t take 11 years to write your book, like “x” did,’ warned my first publisher after I missed numerous deadlines for delivering a manuscript. I confess I ‘wore through’ two publishers – both went into retirement – before eventually successfully delivering a manuscript to Singing Dragon. All my publishers were helpful, supportive, and meticulous in their feedback on my work. Above all, they were incredibly patient.
Working with a publisher begins with writing a proposal. This detailed plan lays out every aspect of the proposed book: purpose, target audience, layout, proposed chapters and their summaries, a survey of existing works in the field, the author’s qualifications for writing the book, etc. It baffled me that as well as the estimated word or page count, I needed to specify the number of tables, figures, and illustrations, and even the number of references. At this early stage, I had little idea of how many of these would be needed.
On acceptance of the proposal, the contracting process begins. In the two rounds of proposal writing and contracting that I underwent, the process was more complex and stringent with my second publisher, possibly because they were a larger publishing house.
Contracts are a dizzying whirl of legalese, covering aspects that I found utterly baffling and beyond my ken. Fortunately, I followed advice from a published colleague to join the Society of Authors. This UK trade union for writers offers members advice on legal matters, which certainly helped me navigate the complexity of the contract with my second publisher. However, when it came time to sign, I was still uneasy about what I was signing up for – and what I might be signing away.
Once the contract is signed, the publisher lays out their house style and expectations for how the manuscript will be delivered. And then, writing begins in earnest.
Throughout the entire book writing process, I sought advice from already published colleagues. One advised me to consider self-publishing, as it would provide greater financial return on sales. One look at what is involved sent me scurrying back to the arms of a publishing house. For a start, I did not need to add acquiring book design skills to my already overlong to-do list.
Furthermore, a good publisher adds value – as well as their expertise in book design, they ensure that all legalities are addressed. The rules for writing a book for profit are different to those for writing academic papers, for which referencing is sufficient. My publishers steered me clear of many pitfalls about which I was unaware.
Publishers also ensure quality control, take care of printing, distribution, and sales, and assist with marketing and PR. I pay handsomely for this expertise, and I am quite happy to do so.
Identifying gaps and finding my voice
Soon after attempting a first draft, I identified limitations to achieving my goal. My experience with cancer survivors thus far was limited to breast and head and neck cancers. I needed to expand my range to encompass more cancer types.
Through my NHS role, I was fortunate to be able to access charitable funding to support a four-year project working alongside an oncologist specialising in gastrointestinal and colorectal cancers. Simultaneously, I was involved in a study with prostate cancer survivors.
Finding my voice was another challenge in those early drafts. As a researcher, I had many publications and had fully assimilated the style of the scientific paper. My first attempts at the book chapters were formal, stilted – and I was hesitant to express my own views and experience. It took a long time to find my voice and develop the confidence to express myself in my own way.
Procrastination, displacement, or the creative process?
Discovering my own creative process also took a long time. Although I intended to start writing at 9 am and finish at 5 pm, I wasted much time and constantly felt guilty. I cleaned the house, gardened, got my tax returns in, played far too many computer games – anything to avoid constructing those dreaded sentences.
Two years before manuscript submission, Angela Hicks introduced me to her model for the stages of learning. The first three of the six stages described what I was struggling with:
- The intention stage – characterised by procrastination and guilt.
- Preparation, a messy/fuzzy stage where everything is unclear.
- Impasse, the stage of feeling completely ‘stuck’ whilst remaining in a fuzzy/messy state, and in which huge frustration and upset can build.
Impasse is compared to the ‘transition’ stage of labour, and is the sign that things are about to change to stage 4, the active phase.
This was a revelation. I began to understand and accept my own processes, to be able to name the stage I was in, and to work with it constructively. Eventually, I realised that my ‘time at the desk’ started at 3 pm and I would then put in a good three to four solid hours of writing.
My mornings were not wasted. I realised that the activities I had previously regarded as displacement were important times when my subconscious whirred away, developing the thoughts, arguments, and structures that would take form later in the day. I stopped feeling guilty. I got on with the task. Finally!
The joy of the pandemic
While there are few reasons to be grateful for the pandemic, the moment lockdown was declared I decided to FINISH THAT BOOK! My first publisher and I agreed to part company, and I embarked on finding a new one.
Mine would be the first acupuncture book Handspring had taken on. This wonderfully supportive, artisanal publishing house introduced me to new, more complex possibilities and processes. Best of all, they took the unusual step of assigning me a development editor from the start. Susan Stuart and I worked together closely for nearly two years.
To ensure delivery, I instituted a monthly reporting system, wherein I kept Susan posted of all developments and issues arising during the month and set out my goals for the coming month. Even then, completion took longer than anticipated, and Handspring’s owners would retire and sell on to the publishing house Hachette – of which Singing Dragon is an imprint – before my manuscript was delivered. Nevertheless, this was positive. I was making progress at last!
Getting support
Writing is a lonely occupation, and a demanding discipline. From the outset, I knew I needed support, and I am obliged to the members of my supervision group for their willingness to hear about my struggles and review my chapters as they slowly emerged.
At a meeting for BAcC fellows in 2018, I took the courageous step to ask Isobel Cosgrove to be my mentor. Happily, she said yes, and her combination of academic, writing, acupuncture, and mentoring experience perfectly matched my needs. She in turn suggested I approach Angela Hicks for additional support, and I am indebted to Angie for our regular mutual mentoring sessions.
That was still not enough to fill the infinite void. Jacqui Jensen attempted to help me out of a block with her invitation to write a page a day and send it to her. Although that didn’t quite work as planned, I am grateful for the helping hand and proposed strategy.
Dr Jane Buckle, my long-standing friend and author of an acclaimed, prize-winning book on clinical aromatherapy, was my constant cheerleader. Endlessly generous with her support and her conviction that this would be a good book, she rewarded me with one of her wonderfully witty and funny poems every time I reached a milestone.
How things change!
Novelists often talk about how their characters assume lives of their own, taking a shape originally unforeseen by the author. The characters of my book – the main consequences of cancer treatments – also grew in a way that I did not foresee. Looking back at my first book proposal, it is interesting to note that the seven chapters now comprising Section II were initially planned as two chapters! Fatigue, hot flushes, lymphoedema, pain, dry mouth – these ‘characters’ demanded full attention be given to their roles in the lives of cancer survivors.
Taking my cue from Dr Buckle’s book, I also invoked a peer-review process. Peer-review is the evaluation of scientific, academic, or professional work by others working in the same field. I wanted to ensure that my coverage of biomedical details was correct, so I approached experts in the respective areas for validation and feedback.
Similarly, I wanted to ensure that my acupuncture facts were correct, and that my book was accessible, usable, and informative to acupuncturists. Thirty peer-reviewers gave freely of their time and constructive feedback. Many reviewers reviewed multiple chapters – some multiple times! – and their input was invaluable. This added significant time and effort to completing the manuscript, and I am glad that Handspring fully supported this approach.
Submitting the manuscript
The deadline for manuscript submission was now January 2022. True to form, I missed it. The publishers were relaxed – they knew work was progressing. The unforeseen penalty was that Handspring’s directors retired and sold their company to Hachette in March 2022. This involved many changes – new expectations, house styles, procedures, and personnel. My development editor Susan Stuart skilfully guided me through this period of change. I kept writing…
Summer 2022 was intense. Whilst I usually seek to have a good work-life balance, that summer I worked long days including weekends. Rising at 5 am to get much-needed exercise – watering my allotment in drought conditions – I then spent the day pounding away at the manuscript.
I had over-written, so needed to edit out thousands of words; it broke my heart to cut out sentences, paragraphs, and sections that cost much time, thought, and labour. Nonetheless, needs must. I triumphantly, and exhaustedly, delivered my manuscript in August 2022. Production would take nearly another year before publication on 21 July 2023.
The production process
What to do now? There was a gaping hole in my life. It had been filled with commitment to my book for a decade. A good friend advised me just to sit with the uncertainty, to allow things to develop. That was wise counsel for what lay in wait… the production stage!
There was the saga of the cover. Colleagues advised me to hold out for the cover I wanted. My heart was set on using John Piper’s Baptistry Window in Coventry Cathedral – its beautiful modernity and representation of renewal following devastation seemed the perfect match for the message of my book. No, said my publisher, ‘this is not our style’. I endeavoured to be graceful despite my disappointment. I was rewarded by their inspired cover design – without even knowing about my passion for gardening, Singing Dragon designers created a cover that perfectly matched my own interests and conveyed the hope that is enshrined in the book’s title and message.
Beverley with Sandra Nimako Boatey (left) and Claire Wilson From Singing Dragon
Illustrations were another challenge. I learned how difficult it is to convey what I wanted in a drawing, when I have no drawing skills myself. My awkward attempts to mark up screenshots of other drawings resulted in misunderstandings and frustration for all. And then there were the genitals – I was convinced that figures in a medical text need not be presented as Barbie and Ken dolls. One great advantage of the switch from Handspring to Singing Dragon was that fewer illustrations were possible – a huge relief at this stage.
Permissions, legalities, editors’ queries all had to be addressed. Rewrites were required. Personnel were changing rapidly; things risked being missed. This was the most anxiety-inducing phase of the entire project. Then things fell silent again.
Proofs and final sign off
When proofs were delivered in February 2023, I could not summon the courage to look at them. I asked Teresa Young, my long-term research colleague at Mount Vernon, to preview them for me. It was only when I heard positive noises emanating from behind her computer screen that I dared look myself.
There is nothing like the shock of seeing material that has always been in Word format transformed into book layout. There it was, with pages beautifully laid out! What a relief. I may have cried. There was still much work to do, checking and rechecking, and we went through three rounds of proofs before final sign-off.
Publication
I certainly cried when I heard the book would not be published for another five months. The wait seemed interminable. Then one day, my partner carried a large box into the kitchen, saying ‘this arrived for you’. Thinking it was a late birthday present, I didn’t even recognise the publisher’s name on the box! Inside were ten copies of my book with its beautiful cover – containing 11 years of work. I could see it. Feel it. Turn the pages. At last. It was a reality.
21 July 2023 was the official publication date. I celebrated completion, the fifth of Angela Hicks’s six stages of learning, with a cakes and champagne party for close friends and colleagues. A late birthday present did appear at the launch party – a cake decorated to resemble my book, that was so convincing people thought it was the book. Fortunately, it was good enough to eat!
What next?
‘Now your book is finished, you must have time on your hands,’ say colleagues and friends. But now that my book is finished, I am busier than I have ever been. Integration – the sixth and final of the stages of learning – is a more than full-time job.
Much of the focus is on PR, and while Singing Dragon support anything I set up – they produce beautiful marketing materials – it is up to me to network, establish contacts, and arrange events. Having invested so much time in creating the book, I want to ensure its message is conveyed far and wide.
To this end, I hired a PR consultant. I had previously worked with Katie Osborne of Osborne Communications on the BAcC film To the Point – I am indebted to her assistance with developing a strategy and materials to promote the message about acupuncture and cancer survivorship.
To my surprise, I have become adept at the dreaded social media, and I seem to have transitioned from an introvert writer to an extrovert author. I am busy with conferences and teaching and do more writing now than I did when I was working on the book!
Let’s talk money
Contrary to popular belief, there is no advance for a book like this, and revenues are not generous. On reviewing my publishing contract, the Society of Author’s legal counsel commented regarding royalties that, ‘almost certainly the sums will not be vast – so as mentioned you need to consider what other benefit publication will bring’. In fact, for each copy sold at the recommended retail price of £45, I receive less than £3 pre-tax.
The benefits that publication brings
Mine is the first evidence-based, peer-reviewed book to discuss acupuncture and cancer survivorship. Presenting perspectives from biomedicine, East Asian medicine, acupuncture research, my clinical experience, as well as numerous case studies, it provides a 360-degree view of the topics discussed. Case studies were developed with the people whose story they tell, thus communicating the authentic voice of cancer survivors and their experience of cancer and of acupuncture. An entire chapter is dedicated to Ann’s story, which brings together many strands covered in the book.
Signing my first book – a gift to ‘Ann’
It is gratifying to receive positive feedback from readers who report the book is helpful and informative, while being easy and pleasurable to read. For me, the book is not the end of a project, but the platform for new projects.
I am pleased to have opened the first acupuncture clinics in the UK that focus on using acupuncture to address the issues experienced by cancer survivors – those who have completed their main cancer treatments and are facing the challenges of dealing with the ‘new normal’. Details of these clinics, in central London and in Uxbridge, Middlesex, are on my website beverleydevalois.com
In summary
My mission is to increase awareness of the challenges cancer survivors face after completing treatments for cancer – surgery, chemotherapy, radiotherapy – and to promote awareness of how acupuncture can help. It’s important to spread the word that acupuncture is a safe, evidence-based, effective, non-pharmacological option that can be offered to cancer survivors experiencing the consequences of cancer treatment – no matter how long ago that treatment ended.
Being able to do this work is very satisfying, and I am thankful to that inner voice that prompted me to create a book. And to Ann for her inspiration and her commitment to spreading the word about acupuncture and cancer survivorship.
Acupuncture and Cancer Survivorship: Recovery, Renewal, and Transformation can be purchased online direct from Singing Dragon or ordered from other major booksellers.
You can also watch these excellent YouTube videos produced by the BAcC:
Acupuncture and Cancer Care
Acupuncture and Lymphoedema Patient Experience
This last is an excerpt from a 30-minute video To the Point
Beverley de Valois PhD LicAc FBAcC MBLS has been a proud Fellow of the BAcC since 2011. In 2024, she celebrates 25 years since qualifying as an acupuncturist after studying at the College of Integrated Chinese Medicine, Reading. She also celebrates 25 years working at Mount Vernon Cancer Centre, part of the East and North Hertfordshire NHS Trust, where she has conducted many pioneering research studies exploring the role of acupuncture in the supportive care of people living with and beyond cancer.
Beverley’s PhD investigated using acupuncture to manage breast cancer-treatment related hot flushes. She has many publications in scientific journals and lectures internationally. She is an Honorary Research Fellow, Bristol Medical School, University of Bristol. She is a past chair of the British Lymphology Society (BLS) Scientific Committee and is currently a council member of the British Society for Integrative Oncology (BSIO).
For more on Beverley’s latest book read our Acu. online review by Sylvia Gulbenkian
Has acupuncture taken you to places you weren’t expecting? We’d love to hear about your dawn of a new dao story
