In Brain News

Here, brainstrust co-founder and head of policy and services Helen Bulbeck discusses why it’s OK to not be OK, and the dangers of toxic positivity when living with a brain tumour.

At brainstrust we want you to be better than OK. Our support will take you to a space where you feel more resilient, less alone, better resourced, more involved with your care and part of a community, because you deserve to feel better than OK – you deserve to thrive.

But it’s important to know that there will be times when you don’t feel better than OK. And this is OK too. In fact, if you understand why it is important to acknowledge that there will be times when you feel less than OK then these moments will pass more quickly and you will be better able to deal with them. So in the bigger picture, embracing your bad days is all part of the process of being better than OK.

Living with a brain tumour during a global pandemic

During this COVID-19 pandemic, we all have more than enough reasons to not feel OK. And this is on top of the fact that our worlds have already collapsed at some point with hearing the words ‘You have a brain tumour.’ Not being OK is a space we’re used to living in. Sometimes it feels better to have this acknowledged, rather than hearing what people think we want to hear – so the pep talks, the affirmations, the ‘sending sunshine your way’, the ‘everything will be alright’. Maybe, just this once, it won’t be OK.

We need to hear too that it is OK not to be OK. Acknowledging this gives us space to breathe, and allows us to feel our emotions, instead of suggesting we bury them, where they can fester and undermine us.

Toxic positivity

There is a phrase for these ‘positive vibes only’ – it’s called toxic positivity.  It has been described as:

‘The assumption, either by one’s self or others, that despite a person’s emotional pain or difficult situation, they should only have a positive mindset.’[1]  Dr Jaime Zuckerman, clinical psychologist and cognitive behaviour therapist.

Whilst there’s nothing inherently wrong with positivity (it can be a force for good that helps motivate you) it can also become harmful when it’s insincere, forced, or devalues real feelings of anxiety, fear, sadness, or hardship. It invalidates our genuine feelings and encourages avoidance, which can do more harm. It suggests that we are somehow wrong to be feeling the way we do and that we should move on. This in turn can make is feel guilty, ashamed or embarrassed that we shared how we felt.

So not only it is OK to not be OK – we need to acknowledge this. In fact – it is essential. We can’t just choose only the emotions we want to have – that would deny what it means to be human. It simply doesn’t work that way. Feeling all of our feelings, painful or not, keeps up grounded in the present moment. It is a normal human emotion to be anxious during a pandemic and/or a serious illness. ‘Anxiety is a very normal response to a very abnormal situation. We are currently experiencing a shared trauma. No one is alone in this,’ Zuckerman says[2]. So, she adds, “It is important to remove the expectation and goal of feeling positive.” Instead, accept whatever genuine feelings come up, sit with them, and then let them pass on their own. Acknowledge how you feel, and feel all your emotions, good or bad. Avoiding how you feel will only prolong the discomfort and can cause physical distress such as rapid heartbeat, poor sleep, depression. You might want to read more about acceptance commitment theory here.

How we talk to others

Think too about how you respond to others in distress. How often have we told someone “you’ll get through this, it will be OK, it could be worse, you don’t want to think like that”.  This suggests that the person is incapable of handling their emotions. Instead use phrases that acknowledge what the person is feeling, phrases that show you are listening:

  • It’s OK to not feel OK– these feelings are valid.
  • You wouldn’t be human if you didn’t feel this way.
  • Take your time. I am with you.

You don’t need to be part of toxic positivity either as a giver or a receiver. Feel your emotions, sit with them. It’s OK to be not OK.



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The Brain Tumour Data Dashboard lets you explore up -to-date, population level data about the brain tumours diagnosed in England between 2013 and 2015. Using the drop down menus on the left you can select different groups of patients to view in the charts below. In these charts the number of patients for every 100 diagnoses is displayed as images of people. Patients have been grouped by date of diagnosis, type of tumour, age, gender, and region in England.

For each group of patients you can explore the different routes to diagnosis, the proportion of those who received chemotherapy or radiotherapy, as well as the survival of the patients within each group. For more information about what these metrics mean please see the glossary.

How to use

  1. Select the year of diagnosis using the drop down menu.
  2. Select your patient group of interest from the four drop down menus in the following order:
    1. Tumour group
    2. Age at diagnosis
    3. Region of England
    4. Gender of patient
  3. To view a second chart to compare different groups of patients, click the ‘compare’ button.The second chart will appear below the first chart.

*Note that the tool is best used on a laptop or tablet rather than a mobile phone*

Unavailable data

Some of the data in these charts is not available.There are two main reasons for this:

  1. How the data has been grouped

If you cannot select a patient group from the drop down menus, the data is unavailable because of how the data has been organised.

Public Health England has grouped the data like a branching tree. The bottom of the tree contains all the patients with brain tumours, and then each branch divides the data by a certain characteristics, like age, or location of tumour. But the data is divided in an order, starting with location of the tumour (endocrine or brain), then by age, region, and gender. Age is at the start because it makes a bigger difference to survival rates and treatment rates than gender or region. Sometimes, after the data has been split by type of tumour and age, there is not enough data to be split again. This is because to protect patient confidentiality groups cannot contain less than 100 patients. Because some groups cannot be split further, you cannot create ‘totals’ for everyone by region or gender. For example, you cannot see results for all ages by region, or all brain tumours by gender. If these totals were calculated and released, it might be possible to identify patients, which is why Public Health England cannot release this data.

  1. Statistical reasons and data availability

If you can select a patient group from the chart menus, but the chart does not display, the data is unavailable for one of several reasons:

  1. Data is not yet available for the selected year from Public Health England.
  2. Data is not available because the data quality is too poor to release this statistic.
  3. Data is not available as the statistic is not appropriate for this group.
  4. Data is not available because the standard error of the estimate was greater than 20% and so the estimate has been supressed.

Up to date brain tumour data

Brain tumour data may influence the decisions you make about your care. Data also helps you understand the bigger picture, or landscape, in which you find yourself.

Brain tumour data and statistics influence the focus, and work of organisations like brainstrust. The information helps us to understand the scale and impact of the problems we are setting out to solve.

This tool helps you understand the landscape in which you find yourself having been diagnosed with a brain tumour. This landscape can be particularly tricky to navigate as there are many different types of brain tumour, all of which have a different impact.

The information you see represents the most up-to-date, official, population level brain tumour data available for England. Over time we will be adding to the brain tumour data available and publishing reports, with recommendations, as a result of what we learn from this data.

The data behind this content has come from Public Health England’s National Cancer Registration and Analysis Service (NCRAS) and is a direct result of the ‘Get Data Out’ project.

This project provides anonymised population level brain tumour data for public use in the form of standard output tables, accessible here:


The number or rate (per head of population) of new cases of a disease diagnosed in a given population during a specified time period (usually a calendar year). The crude rate is the total number of cases divided by the mid-year population, usually expressed per 100,000 population.


Malignant tumours which grow by invasion into surrounding tissues and have the ability to metastasise to distant sites


The number or rate (per head of population) of deaths in a given population during a specified time period (usually a calendar year). The crude rate is the total number of deaths divided by the mid-year population, usually expressed per 100,000 population.


Not cancerousNon-malignant tumours may grow larger but do not spread to other parts of the body.


The length of time from the date of diagnosis for a disease, such as cancer, that patients diagnosed with the disease are still alive. In a clinical trial, measuring the survival is one way to see how well a new treatment works. Also called ‘overall survival’ or ‘OS’.

Routes to Diagnosis

Under the ‘Routes to Diagnosis’ tab in the Brain Tumour Data Dashboard, you can explore the ways patients have been diagnosed with brain tumours. There are many ways, or routes, for cancers to be diagnosed in the NHS. A ‘route to diagnosis’ is the series of events between a patient and the healthcare system that leads to a diagnosis of cancer. The routes include:

  1. Two Week Wait

Patients are urgently referred by their GP for suspected cancer via the Two Week Wait system and are seen by a specialist within 2 weeks where they are diagnosed.

  1. GP referral

Diagnosis via a GP referral includes routine and urgent referrals where the patient was not referred under the Two Week Wait system.

  1. Emergency Presentation

Cancers can be diagnosed via emergency situations such as via A&E, emergency GP referral, emergency transfer or emergency admission.

  1. Outpatient

Outpatient cancer diagnoses include diagnoses via an elective route which started with an outpatient appointment that is either a self-referral or consultant to consultant referral. (It does not include those under the Two Week Wait referral system).

  1. Inpatient elective

Diagnosis via an inpatient elective route is where diagnosis occurs after the patient has been admitted into secondary care from a waiting list, or where the admission is booked or planned.

  1. Death Certificate Only

Diagnoses made by Death Certificate Only are made where there is no more information about the cancer diagnosis other than the cancer related death notifications. The date of diagnosis is the same as that of the date of death.

  1. Unknown

For some patients with a cancer diagnosis, there is no relevant data available to understand the route to diagnosis.


More information

If any of the statistical terms in this section of the brainstrust website are hard to understand, we recommend looking them up here:

Cancer Research UK’s Cancer Statistics Explained

If you are looking for help understanding terms relating specifically to brain tumours, and treatment, then the brainstrust glossary is available here: