Coping With Cancer During the Holidays

Coping With Cancer During the Holidays Live Chat with Diane Blum, MSW, and Deane L. Wolcott, MD
Tuesday, December 3, 2002, 4:00 - 5:00 PM EST

About Diane Blum, MSW

Ms. Blum is the Executive Director of Cancer Care, Inc., Editor-in-Chief of Cancer.Net. Ms. Blum has written and lectured extensively about the psychosocial needs of cancer patients and their families.

About Dean L. Wolcott, MD

Dr. Wolcott is the President of the American Psychosocial Oncology Society and the Vice President, Clinical Systems and Knowledge Management at Salick Health Care. Dr. Wolcott has spent the past 12 years developing psychosocial service programs for cancer centers.

Moderator: On behalf of the American Society of Clinical Oncology (ASCO), welcome to the Cancer.Net chat on coping with cancer during the holidays. This is a live question-and-answer session co-hosted by Diane Blum, MSW, and Deane L. Wolcott, MD. During this hour, our hosts will answer as many questions as time permits. Some questions may be adapted so the answers can help as many people as possible.

You may begin sending questions at 3:45 PM ET. The chat will begin at 4:00 PM ET and end at 5:00 PM ET. As you phrase your questions, please keep in mind that our hosts are unable to give individual medical advice in this setting.

This chat is governed by all terms and conditions of the Cancer.Net website.

Good afternoon everyone, and welcome. Thanks for logging on. Our hosts are now taking questions.

Dr. Wolcott and Ms. Blum, let's start by having you each talk for a minute, since you both have considerable experience working with people with cancer. Dr. Wolcott is the President of the American Psychosocial Oncology Society and Vice President, Clinical Systems and Knowledge Management at Salick Health Care in Los Angeles. Dr. Wolcott has spent the past 12 years developing psychosocial service programs for cancer centers.

Before the chat, Dr. Wolcott and Ms. Blum told us about some of the most common stresses people experience around the holidays. The holidays hold special personal and family significance for many of us:

Giving gifts
Participation in family, social, community, and religious or spiritual events
Reflection on cycles of time and life: endings and beginnings
Reflection on spiritual and/or religious significance: deeper life meaning; gifts of life itself; faiths or beliefs; review of one's own life goals, accomplishments, and priorities

While this is a very special time, the added responsibility can also bring more stress:

High levels of physical effort: shopping, preparing for family events, traveling, etc
Bad memories of previous holiday seasons
Family relationship stresses are often intensified by time together
Concerns about the future

What problems might these stresses cause for people with cancer during the winter holidays? Dr. Wolcott?

Dr. Wolcott: Individuals might experience anxiety, depressive feelings, sadness, worry, trouble sleeping, fatigue, etc.

Moderator: Thank you. Diane Blum, MSW, is the Executive Director of Cancer Care, Inc., and Editor-in-Chief of Cancer.Net. Ms. Blum has written and lectured extensively about the psychosocial needs of people with cancer and their families. Ms. Blum, what else would you like to add?

Diane Blum: When someone in the family has cancer feelings are often intensified. At holiday time, the stresses of the holiday combined with the stress of dealing with cancer can create tension and anxiety within a family.

Moderator: Thanks. Here is the first question from our participants:

Suzy: What is the difference between real depression and the normal sadness that comes with the stress of cancer?

Dr. Wolcott: Real (serious) depression is characterized by sustained, severe depressed mood, anxiety, trouble sleeping, decreased appetite, and decreased pleasure/enjoyment.

Normal sadness is usually not as severe, is related to a specific loss, and usually is not associated with severe physical symptoms such as trouble sleeping.

Suzy: Do all cancer patients experience depression?

Dr. Wolcott: No! The frequency and severity of depression is related to many aspects of the cancer and its treatment and stage. Probably 20% to 40% of cancer patients experience fairly significant depression at some time during their illness.

John: I was thinking of doing a video diary for my kids (just in case). Would that be of benefit for them?

Diane Blum: It would definitely be a benefit since many people get great pleasure from recording family occasions. We would recommend that you talk to your family about doing this, and make sure that everyone who will be in it is enthusiastic about it.

Dr. Wolcott: I believe that many children would benefit from a video diary about their parents, even if the children are adults and the parents die at a very advanced age (as mine did).

Suzy: My mother is reluctant to see a therapist to help cope with her diagnosis. She is very involved with the church, is clergy a good source for support?

Diane Blum: The clergy is a good source of support. What is most important is that people are talking to someone with whom they are comfortable. If the church is important to your mother, it is appropriate that she seeks support from her clergy person.

Dr. Wolcott: Clergy are often major helpful sources of support. However, many therapists are also understanding of and supportive of individuals' religious/spiritual beliefs. For more severe problems, I would consider seeing a therapist.

Michelle: Should we include our in-home nurse in holiday plans?

Diane Blum: If the person in your family requires nursing care, an in-home nurse could help to make the holidays more comfortable for everyone. A nurse would help to take on some of the tasks and allow other family members to participate in holiday activities. We would recommend that before you hire an in-home nurse you talk with the person in your family who is ill and tell that person why an in-home nurse would be helpful.

John: I am not afraid of dying, but my kids (ages 8 and 6) are scared for me. What can I do to help them understand the process?

Dr. Wolcott: They are quite young, and intellectually are limited now in their ability to understand the permanence of death. The keys for them are more emotional than intellectual.

They need to know you love them deeply, that your illness is not their fault, and that there are other adults who deeply care for them. You need to answer their questions candidly, but supportively.

Diane Blum: It is often helpful to seek professional help from someone who is skilled and knowledgeable in working with children. Children ages 8 and 6 need information and help that is specific to their age and understanding. A professional can help you know what is right to help them.

Jtlysiak: How does one go about dealing with the fear of recurrence?

Dr. Wolcott: You need to understand your own typical responses to potentially fearful situations and what works for you. While cancer can recur, it is very important that you find ways of living your life to the fullest now, and hope for the best while at some levels preparing for the worst.

Diane Blum: Most people with cancer have a fear of recurrence. It helps to deal with it by discussing your fears with your physician and make sure that you are getting the best possible follow-up in your medical care. It is also helpful to talk with other people in a similar situation in a setting such as a support group since people have useful ways of coping with these fears and sharing them can be very supportive.

momida3: At social gatherings I constantly hear "you look great" when I know I don't. I have started avoiding these gatherings. What can I say to the family?

Dr. Wolcott: Obviously people are trying to be supportive and encouraging. Sometimes you can accept their statements as a simple social conversation. Sometimes it is okay to let them know you feel less well, so hopefully you can communicate with that person more honestly and openly.

Diane Blum: It is helpful to talk to your family members before you see them in a family gathering and bring them up to date on your medical status. In the conversation, you might mention that you feel that you are not looking well, but are coping well and appreciate their support and interest. It is important to keep going to these family gatherings and get the support of your family and friends.

Cliff: Because a lot of family will be in town, my wife thinks this is a good time to celebrate lots of events? birthdays, graduations, upcoming wedding, etc. I think this is morbid. What should I do?

Dr. Wolcott: You and she can celebrate key events or collapse the celebrations into a single celebration. It is not wise to exhaust yourselves with celebrations!

Diane Blum: Your wife probably thinks that these kinds of events would be enjoyable for you. Since you don't think so, it makes sense to tell her that you don't want to participate in all of these events, and perhaps just choose a couple of things you can do together with your family.

Michelle: My Mom has stage IV breast cancer. Everyone in the family is making an effort to travel to see her for the holidays. What tips can I pass onto them about ways to keep spirits lifted during this difficult time?

Diane Blum: I would talk to your family members ahead of time and give them an update about your mom's medical situation. I would encourage them to tell her about what is going on in their lives, and make her feel an important part of the family. You don't want to isolate her at this point or make her feel as if everyone is treating her differently because of her breast cancer.

Dr. Wolcott: It is important to express love and caring. Often people with advanced cancer need to be able to openly express their fears/concerns/sadness about the possibility this might be their last holiday season. Do not seek to totally avoid open discussion of these "negative" emotions.

Michelle: As a follow-up, my Mom (who has breast cancer) has lost a lot of weight and much of her hair. Many of the grandchildren that will see her over the next month have been told that Nana is sick, but seeing her may alarm them. How can we prepare them?

Diane Blum: You can prepare them by telling them that she looks different than they last saw her but that she is still their grandmother and cares about them. It might be helpful to send the grandchildren a picture of their grandmother before they come to visit.

Dr. Wolcott: I would tell them that she is sick and that her physical appearance changes are due to her illness and treatment. I would let them know that if they are frightened when they see her they can talk to a parent. You can observe them for signs of distress.

Guest44: Dr. Wolcott, earlier you indicated that 20% to 40% of cancer patients develop some form of depression. Would you recommend that all cancer patients be screened for depression or anxiety by their oncologist?

Dr. Wolcott: I do believe that regular screening for anxiety, depression, pain, and fatigue are all good ideas. However, the most important thing is for the patient and the physician to be openly communicating about these common problems cancer patients experience, and deciding together what help would be needed.

Don: My wife is taking care of her mother who has cancer, and I am worried for my wife's health because she is always focused on others and doesn't sleep or eat well. How can I help her?

Dr. Wolcott: Your wife may feel that she must be the only, and continuously available caretaker. She can express fully her love and commitment to her mother without being there all the time. Perhaps she can talk with other family members, or even participate in a caregiver's support group.

Diane Blum: You can help her by asking her how you can help her. If she says she doesn't need any help, you can tell her that you are concerned about her and offer to take over specific tasks like food shopping, running errands, cleaning and child care. Many people feel guilty asking for help and can get help most effectively when specific jobs are done by someone else. You can also let her know that there are other people who can help care for her mother.

Fiona: This is a comment, not so much a question. We have two people struggling in my family with cancer. We have found the holidays wonderful times to focus on what is important. Instead of gifts, we donate to local cancer organizations. We spend time as a family doing meaningful activities like making cookies, singing and reading.

Guest37: My youngest daughter was diagnosed with leukemia a year ago. Since the diagnosis, a lot of attention has been given to her. I have two other children and I don't want them to feel left out over the holiday. What are some things I can do to make sure they won't be left out?

Diane Blum: It is very difficult to feel that you are paying sufficient attention to your other children. We would recommend that you plan some activities specifically for the other two children.

Dr. Wolcott: Be sure you schedule personal time with each of them to do things they each specifically enjoy. Depending on their age you might want to discuss openly your concern they are being ignored.

guest10: Is anyone doing research in anxiety and depression for people with cancer?

Dr. Wolcott: Yes. There is quite a bit of research. Many cancer treatments can directly cause anxiety and depression. Medications, good news, communication with family and friends all help. Support groups also help.

Toby: What is research saying now about the benefits of having a positive attitude? Can patients really live longer by being positive?

Dr. Wolcott: There is some scientific evidence that a positive attitude and certain educational/support group interventions may help extend life. However, this is not an established scientific fact. A positive attitude may result in following treatment better, which may extend life.

Diane Blum: A positive attitude can help people feel better but we do not have any evidence that a positive attitude can make you live longer. We also get concerned when people feel guilty because they do not have a positive attitude. Everyone at some time particularly when dealing with cancer, can find it hard to maintain a positive attitude.

Guest436: I have been diagnosed with cancer four times and have won the fight. Now I am battling it again, and sometimes it gets very hard. Has anyone out there ever fought so hard and won?

Diane Blum: Support from family and friends and professionals can help.

Dr. Wolcott: You clearly have been through an extended series of battles. This life experience is quite rare. Only your doctor can discuss with you your prognosis, but you clearly have a strong spirit and body, which are major assets as you fight cancer again. I wish you great success in this battle!

momida3: What can I do when I have an anxiety attack? The other night I was doing Christmas cards and thought this could be the last year, I nearly was physically ill.

Dr. Wolcott: In general a single episode of an anxiety attack, while very distressing, does not indicate the need for specific treatment. Often breathing more slowly and deeply helps. Learning relaxation techniques can help. Sometimes anti-anxiety medicines are needed for brief periods of time.

Diane Blum: The anxiety you describe is common when people start to think about the future. It's helpful to talk about these feelings with someone close to you or a professional. For the anxiety attack, there are specific ways to deal with that like relaxation techniques and some medicines.

Madeline: I am an oncology nurse. Many of my patients have problems with fatigue, and are having trouble meeting the demands of regular life, much less shopping, cooking, and the financial burdens of the holidays. What can I tell them?

Diane Blum: You can encourage them to set clear priorities and to feel comfortable doing less. You can help them by explaining that many of your patients feel this way and also by discussing with them how they will tell their family that they want to do less and that they can benefit from help with tasks like shopping.

Dr. Wolcott: Fatigue is one of the most common, severe, and often neglected symptoms. There are many causes? anemia, chemotherapy, radiation therapy, and depression. They should have access, through their doctor, to an appropriate medical evaluation. Many patients with even mild levels of anemia have lessened fatigue when treated.

Guest28: Please tell me about anxiety and the caregiver. It is terrible. A living nightmare. What studies are there to show that caregivers get ill and burnout?

Dr. Wolcott: There are some studies about caregiver stress and distress, a very common problem. I recommend you talk with family members, the doctor, enter a caregiver support group, or find some additional help so you can have a brief "holiday."

Diane Blum: Being a caregiver for a long period of time can be very stressful. There is research that shows that caregivers can be overwhelmed by their burdens. It can help to seek professional help in dealing with the responsibilities as well as asking other family members or friends to participate in the care.

Sue: I have head and neck cancer and cannot swallow right from the radiation. Advice for Christmas dinner? Can I drink alcohol?

Dr. Wolcott: I recommend you talk with an oncology dietitian about your diet. Any specific recommendations about alcohol need to come from the dietitian or your doctor. Hopefully you can find an approach that allows you to fully enjoy the dinner!

Kathy: I am told I only have a few years to live at best. That was two years ago and I am in chemotherapy and feel great. I have been completely honest about my health with family and friends. I find all that know this are in denial of it which really irritates me. Do you hear of this very often?

Diane Blum: It is hard for your family to be as honest and direct as you are. This is not uncommon. Have you talked to them about the fact that they do not seem to be as realistic as you are. It might be helpful to do this at least with one member of your family.

Dr. Wolcott: First, physicians are not prophets, and may underestimate one's life expectancy. Family members often use denial. I would recommend you reflect (you may have already) what about their denial bothers you. Perhaps you can find a way to be less bothered.

Cathy1: I am so sad and really anxious not only the holidays, but also what the next six months might hold. What can I do to get through this tough time?

Diane Blum: It can be helpful to get some support outside of your family by participating in a support group or seeing a counselor. In a support group you might learn ways that other people cope with sadness and anxiety that is very common not only during the holidays, but also when dealing with cancer.

Dr. Wolcott: I am sure you have reasons to be concerned about the next six months. However, to the extent possible it is best to truly celebrate your life and your family this holiday, and try to fully live each day without worrying unduly about the future.

Tony: My wife and I were planning to give my father yoga classes as a gift. Is that something a person with cancer would benefit from?

Diane Blum: Many people with cancer find yoga very beneficial. This could be a very good present for your father but you might want to check with him first as to whether he would participate.

Dr. Wolcott: In general, yes. Under certain physical circumstances it might not be ideal. I would discuss with his doctor. It may be a great gift? and clearly a loving one!

Petecope: Is there any research about imagery of healthy cells in your body fighting the cancer cells?

Dr. Wolcott: There is not much really scientific research on this topic. However, it may clearly give one a sense of greater control over one's future, it might help, and is not likely to hurt.

Guest359: My Mom had breast cancer several years ago. I am so afraid that I might have it, too. I am too scared to go to the doctor. I can't even tell my husband. This is the first time I have shared this with anyone.

Diane Blum: Many women whose mothers have breast cancer have the same fear as you do. Having a mother that has breast cancer does not mean that you are going to get it. However, it would be a good idea to talk to your doctor about these concerns and get his or her recommendations for what kind of screening you should have. You should know that the feelings are common and it might be helpful to talk with other women whose mothers have had breast cancer.

Dr. Wolcott: You need to understand that you might not be at significantly increased risk for breast cancer. Breast cancer, when caught early has an excellent long-term disease free survival rate. Participating in screening programs, such as having a mammogram, is one of the best things you can do for your own health. PLEASE TALK TO YOUR DOCTOR!

Brenda: My young daughter has leukemia and is very tired from her treatment. I am afraid she will over-extend herself, as she wants to participate in all the holiday events. What can I do?

Dr. Wolcott: Hopefully you can convince her to ration her participation in events. Depending on her age, you may have a lot or only a little control over what she actually does. Hopefully she will agree to participate in only the really important events.

Diane Blum: It is understandable that she would want to participate in all of the events. You can organize her time by spending shorter amounts of time at events or encouraging family and friends to come to see you.

Emma: I have not told many people I have cancer. What is the best way to tell them?

Diane Blum: You should start by telling someone who is close to you and who you are comfortable with. You will probably find that as you talk about your diagnosis you will become more comfortable and it will be easier for you emotionally.

Dr. Wolcott: It depends on how well you know them. You need to feel settled internally about your understanding of the cancer, your prognosis, the treatment plan. Tell them individually, give them limited overview information, and let them ask more questions if they want.

Danielle: During the holidays, there are objects and photographs surrounding me that stir up emotions and bring back memories of a loved one I lost. Do you think it is best to remove the objects and photographs or leave them as they are? Also, are there ways to reduce the emotional response to those objects and photographs?

Dr. Wolcott: Usually, I would recommend you not remove the objects. Over time, as grieving (a normal health process) proceeds, your memories will become less acutely painful.

Diane Blum: These kinds of objects cause many people emotional distress. You might try to remove some of them and see how you feel. However, it takes a long time to get over sad feelings and removing the objects might not remove the feelings.

Yogagirl: Is it inconsistent to have a positive attitude and a fighting spirit and at the same time believe that God's plan for me may not be physical healing?

Dr. Wolcott: No, it is not inconsistent. We commonly carry within ourselves feelings and beliefs that are not totally consistent. Fighting spirit and accepting outcomes beyond our control is often very healthy.

Diane Blum: Talk to a clergy person about these feelings. It is helpful to have a positive attitude and a fighting spirit.

Petecope: Are there phone one-to-one volunteers available when people need to talk about their cancers?

Diane Blum: Yes. There are many organizations that link people with others with cancers and with professionals. ASCO's website www.cancer.net can help you find these.

Moderator: The chat is now ending. We hope this discussion has been valuable, and we regret not being able to answer every question. On behalf of Cancer.Net, thank you, Dr. Wolcott and Ms. Blum, for contributing your time and expertise.

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SAVE THE DATE: Cancer.Net's next chat will be in February 2003; the topic will be cancer clinical trials. Check back on Cancer.Net for more information.

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