Information Session: Coping with Cancer at the Holidays

Corporate Speakers:

• William Breitbart; Memorial Sloan Kettering; Department of Psychiatry and Behavioral Sciences Chair
• Diane Reidy; Memorial Sloan Kettering; Associate Deputy Physician in Chief and a Medical Oncologist
• Chris Nelson; Memorial Sloan Kettering; Psychiatry Service Chief
• Allison Applebaum; Memorial Sloan Kettering; Psychologist, Caregivers Program
• Jill Bowden; Memorial Sloan Kettering; Director of Chaplaincy Services
• Monique James; Memorial Sloan Kettering; Psychiatrist

PRESENTATION

Operator:  Good afternoon, and welcome to the Memorial Sloan Kettering Information Session:  Coping with Cancer at the Holidays.  Our host and moderator for today’s call is Dr. William Breitbart, Chair of the Department of Psychiatry and Behavioral Sciences at MSK.  I will now turn the call over to Dr. Breitbart.  Please go ahead.

William Breitbart:  Thank you.  Welcome, everyone, to this MSK Information Session:  Coping with Cancer at the Holidays.  I am William Breitbart, and I’m the Chair of the Department of Psychiatry and Behavioral Sciences at Memorial Sloan Kettering.  I’m also a psychiatrist who focuses on such problems as anxiety, depression, pain, fatigue, symptom control, as well as existential issues such as preserving meaning and hope living with cancer.

Thank you for joining our call today.  I want you all to know that MSK is working hard to keep you and your loved ones safe when you come for an appointment or treatment at any of our locations.  We know that the holidays can often be a difficult time for our patients and their loved ones and that this year may be especially challenging because of the COVID pandemic.

Today with our panel of experts we’ll answer some others questions you shared with us in advance of this call.  We will try to get to as many of these questions that you sent in as possible during our time together.  I do want to remind you that your MSK doctors and care teams are ready and willing to talk to you directly about your concerns.  I encourage you to reach out to them to ask them any questions that you do not get answered here today. 

So before we get to some of the questions about this holiday season, I’d like to ask Dr. Diane Reidy, who’s they Associate Deputy Physician in Chief and a Medical Oncologist at Memorial Sloan Kettering, to talk a bit about why it’s so important to contain with cancer treatment and cancer screening especially during this COVID period time.  So many of you wrote in to ask about that.  Diane, do you have some comments about that?

Diane Reidy:  I do, Bill.  And first I do want to thank you so much for inviting me to be here today with all of you and want to start by wishing everybody on the call a very happy and safe holiday season.  It’s always with a heavy heart around the holidays and when I think of my patients that we’ve all lost to some of these terrible disease and their loved ones, and I think this year the suffering has been so great and there is so much uncertainty with COVID. 

But I think the first question that you pose is really an important one because there is certainty for sure around safety at MSK.  And it’s just so critically important that our patients continue with the screening as well as with the live-saving cancer treatments that they desperately need.  We have spent the last year since the COVID pandemic started really focusing on these sounds protocols that are now in place to keep our hospital and our clinic safe.

And so, thankfully we have really good date to show that those protocols are successful, so I would encourage all of our patients to really think about if they haven’t gotten that mammogram screening to really make those important – those appointments because we don’t want, God forbid, something to happen that we should have done a treatment or we should have done a screening test that we didn’t do because of anxiety because the protocols are sound.

William Breitbart:  Thanks, Diane.  And a related question a lot of our listeners also asked if it was safe to gather with family and friends over the holiday because of concerns about COVID.  I know this is going to be tough for many people the idea of getting together over the holidays or not getting together over the holidays because of the COVID pandemic.  Can you share why it’s important for our patients to be extra cautious this year?

Diane Reidy:  Yes, [so as I said], I mean, the safety protocols here in our clinics and hospitals are very sound, but it’s just not the same as sitting around a dinner table or celebrating with our family and friends.  And though I wish more than anything in the world that we could say you could do so, we know our patients are just so vulnerable.  And so, we totally appreciate how miserable of a year it’s been and how we all want to celebrate the holidays.  Doing that alone can be very hard, but we know.  We have over 300,000 deaths in our country and 3,000 patients a day that are passing, so it’s just not worth it. 

We can taste that vaccine.  It’s here.  And so, we just are really pleading with our patients and their family members to take these next couple of months to just stay safe so that the rest of 2021 and beyond we can all live safely again, but I would – I would say that we know that there are very, very serious risks in getting together around the holidays with our family and friends and doing the things that we would normally do.

So we don’t want people to be alone.  We want Zooms and we want other ways to gather and sort of unique and creative ways, but to get together and to travel and it’s just – it’s an unsafe moment in our history that we’re all living, so I would encourage folks to not do that.

William Breitbart:  Thanks so much, Diane.  Appreciate that advice.  The holidays could be a difficult time under any circumstances, but especially this year partly because of COVID.  Chris Nelson is the Chief of our Psychiatry Service.  Chris, I was wondering, several listeners wrote in asking about how to balance all the anxieties that they may be feeling, [with] both cancer and COVID.  Can you – can you talk a little bit about that?

Chris Nelson:  Yes.  Yes, thanks, Bill.  Yes, and thanks for having me apart of this panel, and I want to thank our callers for, I guess, calling in a listening, and hopefully kind of what we can say is helpful and beneficial to you, but we all know cancer is anxiety-provoking in and of itself.  The diagnosis, deciding about treatment, the side effects, the scans, and then as you place COVID on top of that, it just makes it even more difficult.

And so, I know for the patients that I’ve been working with it’s just been a – it’s just been a very difficult time since the start of the year, dealing with both cancer and COVID.  And so, I just – first I want to say if you're feeling stressed or overwhelmed by this, MSK has resources to help.  And so, we have psychiatrists and psychologists who are here and available to see you and work with you on these issues. 

We have wonderful social workers here who are also available to work with you individually and run groups.  We have amazing chaplaincy services that can help in terms of faith in helping your cope with integrative medicine services here, who offer yoga, meditation, acupuncture, exercise classes.  And so, in terms of resources we certainly have some resources to help here at Sloan Kettering if you're feeling overwhelmed. 

Saying that, some things that you can also do on your own is really to think about the cancer experience, and oftentimes the cancer experience takes us out of our normal life.  We think about the diagnosis.  We concentrate on the treatment and what’s happening.  And then you combine that with COVID, which also has taken us out of our normal life, and then sometimes you just sit back and say, wait a minute, I’m not doing the things that I’ve done in the past that I enjoy doing, that I think are important, that I think have some value to me, that help me de-stress.

And so, I encourage everyone to think about kind of those type of activities and try to reintegrate those things that you usually do that you enjoy, that are interesting, that you think are important because oftentimes cancer and COVID can take us out of those, and clearly in the time of COVID we need to be creative about how you do that and think about how you do that, but there are ways to continue and reengage in your life.  And so, those type of activities can certainly be helpful. 

And then on a real concrete, practical suggestion is that kind of as cancer and COVID takes us out of our normal life, the first things we usually drop or stop doing are those things that help us de-stress or reduce our anxiety.  And so, I’d really encourage everyone to think about those activities that are de-stress activities for you, and they're different for everyone, but some people like to read and that helps them reduce their stress.  Some people like to exercise.  And so, think about reincorporating those things into your life as much as you can. 

And some other suggestions or examples are things like deep breathing relaxation and meditation, and certainly that’s been helpful for a lot of my patients.  And so, on Sloan Kettering’s website, if you just go on the Sloan Kettering website and actually put in “meditations,” our integrative medicine service had meditations online that are deep breathing relaxation meditation activities, which can be very helpful. 

And I usually encourage my patients to do something like that 5 to 10 minutes twice a day, once generally in the morning, once in the afternoon, and to try that for a good two weeks and see if that helps reduce your anxiety some.  But ultimately know that there’s help here at MSK.  Think about reengaging in those activities that you think are enjoyable and trying to make sure you integrate those activities that are stress reducing for you.

William Breitbart:  Thanks, Chris.  That was really helpful.  For many people the holidays are going to look very different this year.  We’ve heard from many of you who are listening about that, including one listener who asked how can you help a loved one with cancer that you can’t see at the holidays because of COVID restrictions?  Allison Applebaum is a psychologist who heads our caregivers program, and Allison, I was wondering if you might answer that question.  Give some – what would your best advice be here?

Allison Applebaum:  Sure.  Thank you so much for having me here, Bill, and I’m grateful that caregivers have joined in the conversation today, and I think that this panel is actually a great example of the rich and supportive community that we have here at MSK, both for our patients and for their loved ones.

This is an important question.  I know it’s something that we’ve all been grappling with this year.  The first thing I would suggest is to directly share with your loved one that the reason that you're not there in person is explicitly to protect them from additional illness and to remind them that while this distancing is really difficult emotionally it’s so important from a physical health perspective.

I’d also encourage this listener and others to ask their loved one specifically what can I do to help you?  Are there additional things I can do to provide you with support?  And I encourage you to be as specific as possible.  So for example, if your loved one says – [asks] to check in on them, you might want to ask how frequently they’d like to be checked in on.  For example, every day, every few days, once a week. 

I think the key here is to be really clear and open with your communication, and of course I think it’s helpful to think about what hasn’t changed like the ability just to connect with one another, to laugh, to connect in the ways that Dr. Nelson just mentioned.  One example, some of – one of the caregivers I’m working with, she and her loved one are now meditating together [just] from afar. 

And so, obviously this is an activity that is stress reducing both for patients and caregivers, and it’s an opportunity for the two of them to connect, to spend time together, but to do it safely from afar.  So I encourage you all to think about how you can continue to engage in self care and care for one another in the context of these restrictions.

William Breitbart:  Thank you, Allison.  A related question, I’m wondering about, very often I hear from some of my cancer patients that when they ask things of their loved ones, people who are their caregivers, they are very concerned about being a burden to them.  Does that come up at all in your conversation with some of the patients that you see?

Allison Applebaum:  Being a burden is one of the key topics in the Caregivers Clinic for sure, and I think that I always encourage everyone with whom I’m working to think about some of the benefits that we can derive from taking care of one another and actually thinking about how the relationship is an opportunity to connect on a deeper level.  Certainly there are great challenges right now, greater now than ever before, but I certainly encourage reflecting on what are some of the potential growth opportunities in providing care and loving one another in that way.

William Breitbart:  Loving one another has some benefits, huh?

Allison Applebaum:  Yes, definitely.

William Breitbart:  Definitely.  Thanks, Allison.  We’ve heard from many of our listeners about the sense of isolation that they're feeling at this time of year when they can’t be with their loved ones.  I’d liked to ask Reverend Jill Bowden, who’s the Director of MSK’s Chaplaincy Services, to talk a bit about some of the ways in which we can combat the is sense of isolation.  Jill, do you have a thought on that?

Jill Bowden:  Thanks.  Sure.  Thank you, Bill, and thanks for inviting me to be part of this call today.  Everyone has such valid points, and I’d like to add to Diane’s mention of family gatherings and Chris mentioning the services that are available here at MSK and Allison’s very pertinent words about distancing, but one of the things that we’re missing most is our ability to attend religious services. 

It’s so meaningful to many of us at this time of year and to be apart from that – from that candlelight service that may be so meaningful or to be with family and friends, lighting the Hanukkah candles.  It’s just a yearly thing that we look forward to, and it makes an open place inside us. 

And I’d like to remind everybody, especially in this COVID time, that Zoom is your friend.  We don’t need to be in isolation when we can have Zoom because we can be present and we can choose how much to be present, which is really important.  There are times that people feel fatigued or they feel like, oh, I just can’t do one more thing, but you don’t have to commute, and that’s a good thing.  And you can be present for the amount of time that you have the energy and the desire to be present for with others that you care about and who care for you.

So use that – use that ally to speak for you, to say when you can be present and for how long.  And keep in touch.  Reach out for those religious services and those family gatherings for as much as you feel like being present.

William Breitbart:  Jill, the last several comments by yourself and Allison make me think a lot about the idea of connection…

Jill Bowden:  Yes.

William Breitbart:  … but also connection to something greater than ourselves.  Very often, holidays represent a number of things.  They represent things like family.  They might represent religious ritual.  And so, there are things that are greater than ourselves like our own individuals selves, like our family and all the people who we grew up with sharing these holidays with may or may not be with us, et cetera.  Could you talk a little bit about that notion of connecting to something greater than yourself, love that Allison was talking about, the benefits of that?

Jill Bowden:  Oh, yes.  Yes.  Exactly.  That connection, that sense of what gives our lives meaning and purpose is really what the holidays is all about.  We can be in our homes and have a sugar cookie, but it means something totally different when we are laughing with others and sharing that. 

We can think about lighting a candle, but when that candle has a special meaning and purpose it takes us out of who we are in this moment and gives us a larger sense of life and community that does keep us with all those we love. 

William Breitbart:  Sure.

Jill Bowden:  And also of our meaning and purpose for our whole lives. 

William Breitbart:  Yes.  Thank you Jill, that – thank you very much.  I want to bring Dr. Monique James who is a psychiatrist in the Department of Psychiatry and Behavioral Sciences here at Sloan Kettering.  Monique, one question that we got that I think lots of people can relate was around setting boundaries at the holidays. 

People may not be feeling well enough to do certain things and they might feel pressure, et cetera.  How can – how do you think patients can navigate letting family and friends know that they can't necessarily do everything that they typically do during the holidays?  This was a question that was submitted. 

Monique James:  Right.  So, thanks again, Bill, and to MSK to have – to have this kind of session for our patients and their loved ones and for caregivers.  I do want to echo everyone's sentiment so far, that this is such an important topic to be discussing right now as the holidays are upon us and really in a year that is quite, quite unprecedented.  I know we say that a lot, but it's just so true.

So, the first think about setting boundaries and having some limits during the holidays is that you can do this and still be loving, compassionate, be kind, still connect to others and still enjoy the holidays.  So this is – this is a really important point.  Setting boundaries and limits is there to help preserve and protect these connections that we have. 

The first is that often tell my patients is that we all have limited energy and that is true whether you're going through cancer treatment or not, however of course, going through cancer treatment and recovery, our energies are even more limited.  So, it is going to be important to prioritize them. 

So, the first thing about setting boundaries is really being honest with ourselves to know our own limits, right.  Now, I often encourage [in] prioritizing your energies, right, to take stock of the things during the holidays that you really enjoy.  So, what is it that you want to place your energies in, because you first have to have this kind of – kind of internal dialogue, right, before you give them to your loved ones.  So, be honest with yourself, listen to your body. 

Oftentimes when people are going through treatments there'll actually be some pattern, so for example chemotherapy is – often have a pattern.  Chemo day and night might actually be very tiring, the next day you might have a little bit of energy, the next three days you might crash and then you might come up again.  So, plan activities as much as you can, whether it's the Zoom calls or other things around these times, right. 

For other people it might be the time of day, so if you know that the mornings are typically better, less nausea in the mornings, then do things in the morning right.  So, also set yourself up to try to have the best kind of experience that you can with others.  And it's okay to acknowledge that we have these limitations, it's okay to acknowledge that we have these breaks, right. 

Jill said that one of the pros about Zoom is that we really can limit this and that is so, so true.  I think the other thing, right, is it's okay to coach our loved ones in how to care for us, right.  So, when we send these boundaries with our families in sense we can say I have limited energies, I really want to preserve them for the family Zoom call at XYZ time and so for right now I'm going to rest.  So, you kind of reassure your loved ones that you will participate and connect, but in order to do that you do have to take some rest and you do have to kind of take care of yourself and preserve yourself and your energies in that kind of way.

And the last thing I just want to say is that it's natural to be kind of fearful about what others may say that thinking that they might get angry or [upset] if we try to put in some of these limits and these boundaries.  I think the first thing is to say that's also a natural reaction by our loved ones and far and away most often this is because they do want to spend time with you.  So, some of this, they just need to have some time to adjust, right.  Some of this is that they need to have expectations.  So, it is good to give them their reassurance that I can do this even though this might be too hard, right.

And then on some level we also have to remember that we can't often manage other people's reactions.  What we can do is set our boundaries, set our limits and then be there, be there to connect, be there to say what you appreciate about them, but also be there to take of yourself, right, because we need to take care of ourselves during the holiday season as much as our loved ones. 

William Breitbart:  Wow, it's very interesting, Monique.  It's almost like you're suggesting that it – that setting boundaries is not so much about saying no, it's about the things that you say yes to, right?

Monique James:  Yes.  Yes, yes.  I love putting that spin onto it, Bill, that is exactly right.  And when you have something to say yes to that's not only setting yourself up for the expectation, but also the people around you that you will be there, that you value the connection.  But, it just might look differently. 

William Breitbart:  Yes, thanks so much, Monique.  Chris, one listener asked, how do I put my cancer journey aside in my head to focus on the holiday season?  A lot of our listeners asked similar questions and I think it's an important one to address.  Can you start us off, Chris, and then I'd ask anyone else who wants to, to please jump in with more thoughts. 

Chris Nelson:  Yes, for sure.  And it's – yes, it's a question that's commonly asked.  And often time I talk to my patients about this notion of it's probably hard to completely your cancer journey or forget about your cancer journey totally.  And that instead of trying to forget about it, maybe the concept of just trying to move it in the back of your mind a little bit and allow some other things to go in the front of your mind, again, the things that are important to you, you want to focus on and you want to concentrate on. 

And so, in the holiday season instead of focusing on how do I get rid of these thoughts about my cancer or how do I not think about my cancer, instead focus on those things in the holiday seasons which are really important to you, that – the rituals, the things that you really enjoy about the holiday season, whether that's – whether that's writing out holiday cards, whether that's decorating for the holidays, the music for the holidays and focus on those type of things with the acknowledgment that the cancer experience will still be there.

But hopefully if you focus on those things that are enjoyable during the holidays you can move that a little bit back in your mind, maybe not think about it as much, and maybe not be worried about it as much and then hopefully enjoy the holiday season more.  So, I'd love to hear some other thoughts on this too, to hear other [perspectives].

William Breitbart:  Yes.

Jill Bowden:  I'd like to chime in, if I may.  This is Jill.

William Breitbart:  Please.  Go ahead, Jill.

Jill Bowden:  One of our patients said recently that what she needed to remember to do was to live every moment that she's alive.  To be present in each moment and know that that's going to be different from moment to moment.  She might – she said, she might need to give herself a timeout from time to time, but really that what helped her through was remembering to live every moment that she's alive. 

William Breitbart:  Yes, I have a very similar thought to you, Jill.  This is Bill Breitbart.  Yes, I think the challenge for all of us, especially when you're struggling with cancer, is how to – how to live.  How to live with cancer, that's the – that's the challenge and life for all of us is about choices.  And we are constantly making choices. 

And so, it's not – it doesn't take a great deal of effort to focus on the things about cancer that are worrisome or obsessing or upsetting, but it does take some effort to focus on sources of joy and awe, so that you can feel alive and the holidays can be full of those kinds of opportunities. 

And so, I think it's a matter of taking the attitude, choosing the attitude that this holiday I'm going to try to experience a sense of awe and joy and love so that I can fully – be fully – [while] fully alive.  (Inaudible)?

Jill Bowden:  I love those words.  They're so relevant; joy and awe.  Yes, thank you. 

William Breitbart:  Awe.  How do you understand awe, Jill?

Jill Bowden:  Well, you mentioned an existential sense of meaning and purpose before and knowing that there is something that is a mystery to all of us that we just don't understand and being in the presence of that I think is the holiday experience.  And that generates that feeling inside of me maybe because I am waiting for it and that expectation generates that sense of, oh, wow, that is awe to me. 

William Breitbart:  All right, any other comments? 

William Breitbart: Okay, Allison, for – from the caregiver's perspective, one listener asked, how can we enjoy a celebration despite a family member’s underlying health concerns?  Can – you think you might make any comments?

Allison Applebaum:  Yes.  Sure.  So, I'm actually thinking about the conversation that you and Jill Bowden just had a few minutes ago actually made me thing of a metaphor that I use in therapy with many of the caregivers that I'm working with, and that is of the crème brûlée, so the crème brûlée happens to my favorite desert and for those of you on this call who are not crème brûlée aficionados, when it's done right and it's rarely done right, but when it's done right, it's crispy on the outside, it's creamy on the inside, it's hot and it's cold all at once. 

And so, when you take that first bite there is a lot going on.  And this is really how I think about the experience emotionally of caregivers and all – and patients with cancer and all of us as humans, this idea that the fear and anxiety and sadness can co-exist with joy and strength and love and many other wonderful things. 

Just as Dr. James mentioned, being able to enjoy the holidays can co-exist with challenge and difficult thoughts about cancer and caregiving.  So, for [this callers] an any other struggling with this, I might encourage them to think about whether the physical and emotional challenges and the positive experiences can co-occur.

And I think actually taking time to purposely reflect on accomplishments and gratitude and love for one another, it’s a really powerful way to honor the holidays without ignoring the challenges that we’re all facing.

I also think it’s really important to think about what traditions can be maintained and I’ll – and certainly in a different way and this has, of course, been touched upon a handful of times so far in this call.  I’m thinking about a patient I saw last week and he’s separated from his brother, who he’s taking care of, and he shared with me that he felt really disconnected because they used to always cook together.

And we were talking about how meaningful it might be if when he was cooking the latkes in his kitchen for Hanukkah, if he might FaceTime with his brother because it wasn’t actually the actual act of cooking the latkes but it was the connecting through that tradition that was honoring their parents and grandparents [and linage] that was so meaningful.

And so, while of course it’s not the same as doing it in person, nothing is, doing that allowed them to connect and certainly to carry on an important tradition and to share their love for one another.  So I think sometimes it’s really hard to think that we can continue to connect to the good parts of that crème brûlée but I think that making an effort to try to carry on traditions, albeit perhaps differently this year, is perhaps more meaningful than ever.

William Breitbart:  Thanks, Allison.  And I don’t think anyone could’ve answered that question and mention both crème brûlée and potato pancakes or latkes in the same answer.  And they are both crispy on the outside and…

Allison Applebaum:  Yes.

William Breitbart:  …(inaudible) on the inside if they’re made well.

Allison Applebaum:  Exactly.  I should…

William Breitbart:  If they’re made well.

Allison Applebaum:  If they’re made well…

William Breitbart:  Yes.

Allison Applebaum:  …which mine weren’t the other night.

William Breitbart:  They were not, huh?

Allison Applebaum:  They were not.  They were all crispy.

William Breitbart:  No, I think – I know Jill mentioned lighting candles but – for Hanukkah but the candles they may not be quite as important as the latkes but…

Allison Applebaum:  Totally.

William Breitbart:  …I think some people might disagree with me out there listening.  Chris, one listener asks, how do I balance being sad and missing my dad with the joy of the holiday season?  Obviously someone whose dad isn’t at the – an empty chair at the table for the holiday season [this year].

Chris Nelson:  Yes.  And I think whether that’s an empty chair because your father passed away this past year or it’s an empty chair because your father and the rest of the family can’t be around because of COVID, it’s clearly a difficult and can be a distressing situation.

And I – really I don’t know if I could answer this better than Allison just did with really kind of her answer to the last question.  But thinking about kind of – and Allison – there are a few things I actually wrote down that Allison had said in addition to the crème brûlée.  But even like she – she said a lot going on and feelings can co-exist.

And so, clearly when you’re going through some grief again whether it’s related to a loved one passing away or whether it’s just related to loved ones that you’re not able to see this holiday season there is grief there and ultimately, right, there can be a lot going on with that grief.  And I think knowing that that grief is natural and part of the process and as you try to enjoy the holiday season knowing that grief can co-exist with the joy of the holiday season.

And thinking about your loved one and having a time to think about them and potentially being sad and grieving them but also potentially thinking about past holidays that you spent with them and the joys that you had with them during the holiday – during those holidays.  And what are those things that you remember that make you smile about your loved one.

And as you go through the holiday season with your friends or family or kind of as you’re experiencing it, know that grief comes up and it kind of can creep up on you and you can experience it.  And then a few minutes later go back to potentially enjoying the holidays.  And so, it’s really I think the balance between the two and this notion of co-existing that’s important.

William Breitbart:  [Does anyone else] have any thoughts on this one?  I was speaking about how important remembering is.  When you remember someone you reconnect with them in very profound ways.  And we human beings seem to drive an awful lot of a sense of meaning and an experience of feeling fully alive and fully ourselves part of history when we are connecting the past and the present and the future.  And so, remembering is sometimes sad but it’s often very joyful as well in terms of the sense of feeling reconnected.

Chris Nelson:  Yes.  And then I think – and I think that’s right, Bill, and I think it’s the balance of knowing that potentially both of those are possible.

William Breitbart:  Yes.  Monique, one additional one is how do I deal with post-traumatic feelings of the anniversary of my diagnosis just before Christmas last year?

Monique James:  Thanks, Bill, for this other question.  I think the first thing about this is that this is also normal.  It’s normal, it’s typical, it is common, it is understandable, whatever word we want to use here.  But the body and the mind are fascinating, fascinating things and sometimes the body remembers even before the mind does.

So sometimes people often tell me that I had this time of the year and I had difficulty sleeping and I was a little irritable and I was a bit fearful for no reason and then they realize that it was actually an anniversary of this sort.  Some kind of anniversary whether it was of a diagnosis, of a treatment beginning or an end, even something like the last question about someone perhaps passing away.

And so the body remembers, right?  The body remembers when we do go through these kinds of stressful situations and reactions.  For everyone it’s a little bit different but you can get physical symptoms.  So that might be sleep disturbance, that might be irritability, that might actually be something that feels more like anxiety so things like in your stomach or even pain.  It could come in the forms of mental symptoms.

So, different kinds of thoughts, different kinds of flashbacks, you might be re-experiencing things.  Sometimes people can tell me the exact day, time, temperature of their diagnosis, what they were wearing, the smells that they have, so a lot of these – kind of our senses are involved as well.

And of course you can have emotional symptoms.  Now these actually run the gamut and sometimes people can be really surprised because they might expect the – maybe the sadness or maybe the fear.  But they might not expect the anger or they might have relief, they might have comfort.

They might have these kinds of things, a sense of reflection.  Even as though you were saying before, right, that a lot of what you do with your patients is how to preserve meaning and purpose and hope even with cancer.  And sometimes people tell me that around their anniversary they’re surprised at the meaning that they’ve been able to draw and the purpose that they have.

So, the emotions might be different but I think what’s common and what’s universal is usually that something of experience.  So, we often say to try to plan for it.  It’s hard to prepare.  Sometimes the – we try to prepare as much as we can and kind of life happens, right?  But as much as we can to kind of plan for this to give yourself space, give yourself room to have all of these reactions.

Now of course if these symptoms become very severe, we even say moderate to severe, reach out.  Reach out to your oncologist, reach out to all of the wealth of resources that MSK has that Chris mentioned.  Reach out to the mental health department to social work to chaplaincy to friends to loved ones, definitely reach out.

The other thing, just to give you one like kind of practical coping strategy, I often suggest for my patients to make a little toolkit that they can keep on themselves and use almost at anytime.

So if you love music, have a playlist ready, don’t go searching for the songs that you love.  If you love books, have passages that you love to read ready on your iPhone, your tablet, in your wallet.  If you have pictures of loved ones that you love, have an album on your phone ready for that, right?

So that when you have these kinds of symptoms that come up, you have a coping strategy that’s right at your fingertips, especially now in this pandemic [we’re in] where a lot of some of these external or other kinds of coping strategies might not be as accessible.  We do need to have some of these things kind of at our fingertips when we need them.

William Breitbart:  Thank you, Monique.  We are getting very close to the end of the podcast, so I do want to just turn quickly to a couple of general – more general questions that we received.  And Diane, this one’s for you.  One listener asks, how can you stay positive when dealing with treatment setbacks?  Diane, how do you talk to your patients about this?

Diane Reidy:  It’s such a great question …

William Breitbart:  And by the way, can you also – in your response can you just mention or talk a little bit about your podcast series …

Diane Reidy:  Of course.

William Breitbart:  …Cancer Straight Talk from MSK.

Diane Reidy:  Yes, I’d be happy to talk about that as well.  So, I mean, I think Monique said it so beautifully.  We have moments that it’s hard to, quote, “stay positive,” going to that playlist that you love or calling that friend who knows you and loves you no matter what can be very, very helpful.

And on my team and with many of our patients we have – our slogan is “onward and upward.”  And I think all of us on this journey of life have those – I think all of us are constantly feeling that onward and upward feeling of sometimes we get through it second by second, sometimes it’s minute by minute, sometimes it’s hour by hour.

But certainly the support of the medical team becomes very critical and I think we all also have to really focus on the moments of victory along the cancer journey, too, that where there’s a bad scan often what will come will be the next one will be a good one.

And that happens, and so you wake up the next day and you say, you know what, a patient of mine would say sometimes I wake up and it’s a bad day and I say, oh, that wasn’t a good one.  Some days I wake up and it’s a great day.  And cancer or non-cancer, I think many of us feel that way.

We did create this podcast in part because we want to have more conversations like we’re having today to really try to connect with our patients and their loved ones and caregivers to say we want to educate you on this whole cancer journey and what it means and to sort of, I should say, translate to English the scientific discoveries.

But then also kind of try our best to empower our patients to really make sure they live happier and healthier lives.  So when we talk about nutrition what that really means for the cancer patient, when we talk about our own goals of care and what does that really mean when you talk about your goals of care.

Some of us are going to have a bucket list and some of us don’t have the bucket list and that’s okay but I think what’s important is that as an oncologist, I owe it to my patients and their loved ones to at least have the conversations on what’s important to them so that those things get addressed, that you are all about quality, that I know about that.

And so, the podcasts are really episodes that are trying to focus on all these different aspects so that we’re taking care of the whole patient like you all do all the time but many of us in oncology we’re just – we’re so focused on getting that cancer controlled that we forget about all the other stuff which is equally, if not more important.  And so, that’s what we’re trying to convey on the podcast.

William Breitbart:  Appreciate that.  Thank you, Diane.

Diane Reidy:  Yes.

William Breitbart:  Jill, do you have any thoughts on that question for how to stay – how can you stay positive --

Jill Bowden:  Sure.  And I thank…

William Breitbart:  -- [in the face of] (inaudible).

Jill Bowden:  …Diane for the [breadth] of that answer.  I mean, [that’s] some wonderful thoughts there.  I’m going to, in the interest of time, just tell you briefly about a wonderful cancer patient.  And I’m not giving anything away because she wrote a book of pictures about her cancer journey.

Her name was [Rita Foley] and [Rita Foley] would answer this question by saying be with today’s me.  Know that you can be, as Diane said, up one day and down the next.  But be with today’s me and be totally present and live fully in each moment with today’s me, being realistic about today so that you really can be fully yourself in every moment.  Thanks for asking me to weigh in.

William Breitbart:  Thank you, Jill.  If other people have comments, I’d invite that, too, but I did have a thought about this one.  And I think that occasionally I’ve heard patients express this notion of the tyranny of positive thinking, the idea that they have to be positive all the time.

And I think that there is no rule that says you have to be positive.  I think the question really is how does one deal with uncertainty, an uncertain future and how does one maintain some sense of hope in the face of an uncertain future?

And I remind my patients that an uncertain future is the only kind of future in which you have the possibility of participating and creating that future.  And so, that’s what I think needs to be emphasized.  Not so much whether you’re positive or not.  It’s not – [don’t need to be] strictly positive but continue to participate and be engaged in creating this each day, as you point out.

So, that’s – those are my thoughts about that.  We’ve pretty much ran out of time, so let me just make a few closing remarks.  I’d like to thank everyone out there who submitted questions and thanks to all of you who made the time to join this call today.  We hope that you found it informative and helpful.

I want to thank our wonderful speakers today.  Thanks, everyone.  You were fantastic.  We plan to host more calls like this in the future and we look forward to speaking with you again.  A replay of this call will be available soon on our website, MSKCC.org.  We’re all dedicated to moving your cancer care forward.  I want to encourage you again to be in touch with your MSK doctors and care teams.

Make all your appointments and schedule any necessary screenings.  Don’t delay your care, even in this time of COVID.  I also want to encourage you to reach out to any of our mental health experts at any time.  We’re always here.  You can find us on the MSK website as well.  Please be safe, take care of yourselves and your loved ones.

Remember, wear a mask, socially distance, wash your hands, sanitize and hopefully with the beginning of vaccines and vaccinations starting today and yesterday, we’re at the beginning of the end of this pandemic.  And thank you very much, have a lovely holiday season and new year.  Thank you.

Operator:  This concludes today’s call.  Thank you for joining Memorial Sloan Kettering’s information session for patients and caregivers.  Have a good evening.