The Rise of Ringing the Bell for the End of Cancer Treatment

Siobhan Harris


October 02, 2018

It's not unusual to hear the sound of a bell ringing in radiotherapy or chemotherapy departments in hospitals across the UK these days.

Bell-ringing ceremonies to signal the end of cancer treatment are a practice that originated in the US more than 20 years ago. They're widespread in the US now and getting more popular in Britain.

Often families, health staff, and other patients gather to celebrate this milestone with the bell ringer.

Bringing the Idea to the UK

The idea was brought over from the US by a Manchester family whose daughter was receiving cancer treatment there in 2013.

Emma Payton was 8 when she was diagnosed with rhabdomyosarcoma, a soft tissue sarcoma. She had an operation to remove the tumour and a chemotherapy course before Emma and her family went to Oklahoma for proton beam therapy, courtesy of the NHS.

When they were there the family saw lots of patients ringing a bell after finishing their treatment. Finally, after her last dose of proton beam therapy, it was Emma's turn to ring the end of treatment bell. She couldn't wait to do it. 

Back in Britain, Emma's family looked forward to the day when she would finish chemotherapy. They showed the bell to the nurses who agreed it was a fantastic idea. A bell was made in time for Emma's last chemotherapy treatment and she was the first to ring it at Royal Manchester Children's Hospital.

187 Bells and Counting

Emma is now nearly 5 years out of treatment and doing well. Her mum Tracey in the meantime has been raising money to provide End of Treatment Bells for hospitals throughout Britain and beyond. She does this through the Maria Watts Birmingham Foundation.

"To date we have sent out 187 bells in total, 176 of those to hospitals in the UK," says Payton.

"To us the bell was our end goal. It meant this part of Emma's treatment path was over and it meant we were going home. We loved seeing others celebrate and we couldn't wait for it to be our turn."

Since that time thousands of children have rung the bell. They often recite a simple wall-mounted poem too, which says: "Ring this bell three times well, its toll to clearly say, my treatment is done, this course is run and I am on my way!"

Hannah Chambers is spokesperson for the charity Children with Cancer UK. She says: "For a child with cancer, ringing the bell is a huge milestone as they have finished their treatment, many of whom will have been treated for a number of years. It's a moment for the whole family to celebrate, an opportunity to reflect on both the emotional and physical journey, and to think about the future. It also inspires children with cancer to persevere and it provides hope for the future."

All Ages Ring the Bell

Originally the bells were provided to children's cancer wards but the symbolic benefit for people of all ages has been recognised. 
In May 2018 a bell was donated to the Queen's Centre and Castle Hill Hospital, which is part of Hull and East Yorkshire Hospitals NHS Trust.

72-year-old Stephen Buckley rang it in June after treatment for prostate cancer.

"I was told I'd need a course of 20 radiotherapy sessions which I began after Christmas, so I've been travelling daily from Bridlington for treatment, that's 1200 miles in total! Ringing the end of treatment bell is something I've been looking forward to since day one. Every day I walked past it, I thought 'I shall be ringing that bell off the wall soon'," he said.

The installation of the end of treatment bell was the idea of radiographer Lydia Dearing. She says: "We've had a lot of interest in the bell, a lot of people have asked if they can ring it, and we often see our radiographers come to support the patients they have treated when it's time for them to ring the bell."

It's Not for Everyone

Most people's reaction to the practice is overwhelmingly positive, but it's not for everyone.

Reactions on some cancer forums and blogs suggest some patients feel superstitious about ringing the bell and that they are in some way tempting fate. 

Patients with metastatic cancer or terminal cancer may experience feelings of jealousy, anger, or depression, when they hear the bell being rung. It brings home the fact that they'll never experience ringing the bell as they'll never be rid of their cancer.
Some feel it's inappropriate to celebrate the end of their treatment when other people, who may be nearby in the hospital, are going to die from cancer.

Even though it can be a celebratory moment Chambers says: "We also have to acknowledge that not everyone gets to ring the end of treatment bell." 

There's no pressure to ring it but it can be a simple, symbolic act for many. If you don't want to ring it you don't have to.

"Everyone crowded in the lobby to cheer on the latest patient and it did feel really special," says Payton. “We've had lots of messages of support from people saying it gave them hope and something to aim for."

Each bell costs £145 and End of Treatment Bells is run entirely on fundraising and donations. Every penny received is spent on bells. 


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