(Editor's note: As the holidays — and the stress they often bring with them — grow near, we're republishing this piece from December 2014.)
Surviving the holidays takes on a whole new meaning when you’ve been diagnosed with cancer. Sure, you’re happy to be alive, but how are you supposed to bake cookies when you can’t stand the sight of food? Attend the annual holiday party when you’re wrung out from radiation? Go shopping or wrap presents when your hands and feet don’t work because of chemo-induced nerve damage?
“I feel pressure from others and from myself to make Christmas the best for my kids,” said Brandie Langer, a 35-year-old breast cancer survivor and mother of three who went through mastectomy, chemo, radiation and reconstruction three years ago. “People ask me to do things or help out and I love helping, but there’s only so much energy to go around.”
Dr. Karen Syrjala, co-director of the Fred Hutchinson Cancer Research Center Survivorship Program, said one of the biggest challenges for cancer patients and survivors is to think in terms of how the holidays are now as opposed to how they used to be or “should be” in our minds.
“It’s easy to get caught up in that ‘I’ve always done these things’ mindset,” she said. “But survivorship can be an opportunity to rethink your priorities and go forward rather than carrying around the baggage of expectation. It’s a chance to focus on the meaning of the holiday rather than the mass consumption.”
Whether you’re still reeling from a recent diagnosis, currently going through treatment or still trying to adapt to your “new normal,” here are some tips to help you navigate the holidays post-cancer.
Limit your list. In years past, you’ve chopped down your own tree, held a dazzling holiday fête and baked enough cookies to give Mrs. Fields a run for her money. But that was before diagnosis and treatment. Now, you may not even have the energy to put on an ugly Christmas sweater much less shop, wrap, decorate, bake, clean and send out hundreds of handwritten cards. While it’s frustrating not being able to do everything you did before, try not to beat yourself up about it: your body, your brain and your budget have been through the mill. Instead, be gentle with your post-cancer self. If you want to buy gifts, shop online instead of braving the crowds and all their cold and flu germs (especially if you’re immunocompromised) and definitely take advantage of gift-wrap services. Use email or social media to send out holiday greetings. Ask a neighbor or friend to string your holiday lights. Prioritize one or two things that are especially meaningful to you — trimming the tree? making cookies with the grandkids? — and simply jettison the rest. “My best advice is to cut your holiday list in half,” said Jody Schoger*, a breast cancer patient and advocate. “Then cut it in half again. Staying within your limits is one of the best gifts you can give your family.”
Pull the cancer card. The holidays can be overwhelming for most people, but they can be especially tough for cancer patients, survivors and/or caregivers who may also be juggling treatment, medical appointments, side effects, and the psychological and emotional toll of a diagnosis. “Allow yourself to do less, to delegate and to let people know you may not be up for certain activities,” Syrjala said. “It’s okay to pull the cancer card although you don’t even have to say the word ‘cancer.’ Just say, ‘It’s been quite a year and I won’t be able to do things the same way this holiday.’ People will get it.” Instead of making the holiday dinner, ask someone else to host, opt for potluck or go out to a restaurant. Limit your time with high-maintenance friends or relatives or, better yet, simply skip seeing them. Extend the holiday into January so you can enjoy the company of loved ones at a much less frantic pace. Too tired or overwhelmed to even think about gifts or shopping? Then don’t. People will understand.
Be prepared for crazy cancer comments. Patients and survivors hear stupid cancer comments all year ‘round. Why should the holidays be any different? “The first step is to know they’re coming,” said Syrjala. “Expect the boneheaded questions and the stupid wrong advice and have your response ready. Then it’s easier to almost ignore it.” If a friend or family member gives you a basketful of “cancer-curing” shark cartilage or some other questionable cancer-related gift, simply thank them for thinking of you and move on, said Syrjala. Ditto for the people who pass judgment on your treatment. “If someone says, ‘I’m so sorry you’re doing chemotherapy. If you’d just take these supplements, they’d cure you,’ tell them, ‘I’m so glad you care.’ Don’t feel you need to explain or educate. In a holiday setting, you don’t have to go there.”
Make space for yourself and keep moving. Physical activity is the best way to benefit your health during the holidays or any time of year, Syrjala said. It makes your body and your brain function better and it can even reduce your cancer risk. Unfortunately, the holiday machine can often sideline even the best-laid plans. Don’t let it. If you normally walk a mile a day or more, depending on your fatigue/fitness level, lock those times into your schedule now. “If you have a regular exercise plan, make sure that it’s a priority you keep,” she said. “Write it down on your calendar so that other things don’t get scheduled during that time.” Other ideas: if you have the energy, sprinkle 10-minute mini-walks twice in your day; do a community fun run/walk with your family or other survivors; play Just Dance or a Wii game with the kids instead of watching TV. or go-ice skating with a few friends.
Have a food/alcohol strategy. The holidays can be a lot like that old board game, Candy Land. Every time you make a move, you run into a Molasses Swamp, Peanut Brittle House or Gingerbread Plum Tree. Syrjala said survivors may want to come up with game plan to help them navigate the relentless gauntlet of holiday goodies. “Give yourself a strategy so you don’t find yourself facing a tray of cookies when you’re hungry,” she said. “For some people, starting in on the snacks and the sugar is the road to ruin. But you can also just postpone having that cookie. Human nature rebels a lot more against ‘no’ than it does against ‘later’ or ‘a little bit is OK.’” Looking for other tips? Record your meals in a food journal or food-tracking app. Eat a small meal before heading off to food-focused holiday parties. Fill up your plate with fruits and veggies first when you hit the buffet. Alternate between alcoholic and non-alcoholic drinks at parties and drink lots of water (hydration lessens fatigue!). And balance calorie-rich snacks with exercise. “We all indulge on treats during the holidays so just up the ante with your exercise,” said Jo Taylor, metastatic breast cancer patient and founder of the UK-based website, After Breast Cancer Diagnosis. Experiencing nausea, mouth sores or taste changes due to chemo? Eat whatever you can (mashed potatoes? sweet potatoes? pumpkin pie?) and put your focus on the other things that hold meaning for you like music, laughter, family, fellowship and yes, even football.
Get your sleep. Lack of sleep can make you cranky, clumsy and far more likely to catch a cold or the flu, but it can also have serious health ramifications. People who don’t get enough sleep are more susceptible to stroke, heart disease, diabetes and obesity. And there’s even a sleep/cancer connection. Fred Hutch public health researcher Dr. Amanda Phipps, who investigates sleep’s impact on cancer survivorship, said it’s crucial not to discount the power of sleep. “Around the holidays, there are lots of distractions and sleep is one of the first things to be compromised,” she said. “But you cannot underestimate the importance of good quality sleep. Make sure it’s a priority.” Having trouble getting your ZZZs? Cut back on caffeine and limit booze before bedtime. Exercise regularly but not right before you hit the hay. Try yoga. Keep a worry journal. Keep “screens” (TV, smartphones, tablets) out of the bedroom. And call your doctor if you need additional help.
Beware of bugs. ‘Tis the season for colds and flu, so make sure and wash your hands a lot, especially if you’re playing with those sweet little germ factories, otherwise known as your kids, grandkids, nephews and nieces. Also remember that food poisoning is far more common during the holidays; it can be especially hard on people with an immune system that’s already weakened by cancer treatment. Need a primer on best potluck practices? Check out these great food safety guidelines from Seattle Cancer Care Alliance.
Don’t be blue about feeling blue. Maybe you’re bald and recovering from surgery. Or you’re years out of treatment and still dealing with fatigue. Whatever the case, you’ve got as much holiday spirit as a cup of congealed cocoa. Don’t fret, said Syrjala. Instead, take time to consider the difficulties you’ve faced over the year(s). “Validate your own experience and remember that you’ve been through a tremendous amount,” she said. “It’s okay if you don’t feel in the mood or if your holiday is more low-key.” Connections and exercise are the best way to beat the blues, said Syrjala, who encourages those touched by cancer to still get out and experience the things that usually bring them joy. “Go for a walk and see the Christmas lights or anything else that might give you a sense of cheer and feel familiar,” she said. “Even if it’s not 100 percent the same feeling, give yourself the chance to have that enjoyment.” The most important thing? Not withdrawing in front of the TV, no matter how tempting. Instead, have coffee with a cancer buddy, go on a holiday hike with Team Survivor Northwest or schedule a soothing massage. Feel like you’ve got more than the holiday blues? The mental health counselors at Seattle Cancer Care Alliance may be able to help.
*Editor's note: Jody Schoger died of metastatic breast cancer in May 2016.
Diane Mapes is a staff writer at Fred Hutchinson Cancer Center. She has written extensively about health issues for NBC News, TODAY, CNN, MSN, Seattle Magazine and other publications. A breast cancer survivor, she blogs at doublewhammied.com and tweets @double_whammied. Email her at email@example.com. Just diagnosed and need information and resources? Visit our Patient Care page.