Cancer treatment can make any holiday more complicated, but Thanksgiving is especially difficult. Thanksgiving is like the ultimate dinner party, with high expectations of the festivities and feasting, and cancer is like an unwelcome, uninvited guest that shows up and threatens to disrupt, or even ruin, the experience. Because cancer treatment almost always causes appetite and taste changes, it can be hard to enjoy, or even partake in, the Thanksgiving feast. Understandably, this can lead to a lot of difficult emotions and can make it difficult to feel “thankful” as you are “supposed” do to on this holiday. Don and Jessie are both dealing with cancer treatment during Thanksgiving; their challenges are typical of what many people experience as they go into Thanksgiving while in the midst of chemotherapy, radiation therapy, and surgery to deal with cancer.
Don is a 50 year old man with a mouth cancer who has just finished radiation after surgery on his throat. He has only been able to take sips of water and nutrition shakes since surgery, but has held on to high expectations the he will recover his swallowing in time for Thanksgiving. To Don, Thanksgiving is a time of feasting – mashed potatoes and stuffing are his favorite, and when he thinks of them his mouth waters with anticipation. Over the last 2 months, he has made some progress in swallowing, but big bites of mashed potatoes and stuffing are unlikely to go down smoothly (he may choke) by Thanksgiving. Not only is his swallowing is so out of shape that he will not be able to eat a full meal at Thanksgiving, but his taste buds have changed too, and many foods taste like cardboard. Don struggled with how to think about Thanksgiving in a positive light without the feast that he always enjoyed so much in years past. “How am I supposed to feel thankful when I can’t hardly eat?” kept circling in his mind.
For Don and many other cancer patients, there is going to be disappointment that cancer treatment interrupts the feasting on Thanksgiving. Being sad, or even a bit irritable, is normal. The way to manage the disappointment is a three-step process:
1. Give yourself credit. This means recognizing that cancer treatment is hard, and it is normal to have an emotional reaction when your body is going through such a difficult time. Finding energy to participate in the holiday festivities even a little bit is a major accomplishment.
2. Check what works. Shift your focus from what you can’t do to what you can – in the context of Thanksgiving, this means looking for ways to participate in festivities beyond eating. Can you use your hands to chop, stir or combine ingredients in the kitchen? Can you listen to the conversation or holiday music? Can you watch the ball game or kids playing in the yard? Your swallowing may not work well now, but what parts of your body are working? Training your brain to focus on what does work will help you move away from the disappointing emotions like sadness and irritability.
3. Plan-ahead. For Don, this meant deciding ahead of time what he could have on his plate and in his cup during the Thanksgiving meal so not to keep worrying about all the choices. He picked foods that he had practiced eating (soup worked best), ones he knew favoring to counter the cardboard taste (his daughter’s corn dish), and a glass he had been using for water that was “shaped just right” so he would not get too big a gulp. Part of the plan was also to leave the table with the kids after one plate of food and go outside with them so that he was not tempted to eat too much. Watching them play ball in the fallen leaf piles was more fun than trying to swallow seconds on turkey. A helpful phrase Don started practicing before Thanksgiving to use when his disappointment came up was “this Thanksgiving I’m all about kids and time outside” versus stuffing and potatoes as in years past.
Jessie is a 60-year-old who finished breast cancer treatment in October and is recovering slowly from the effects of chemotherapy as the Thanksgiving holiday approaches. Her challenge is different than Don’s in that she gained 25 pounds during chemotherapy – steroids had increased her appetite, and the treatment had been so energy-depleting that she couldn’t exercise. “I don’t even feel like myself with this extra weight. Losing my hair is not nearly as bad as being this fat! Losing weight feels impossible, especially with all this food around for Thanksgiving!” In the past, Jessie had always enjoyed baking for her family at Thanksgiving, especially pecan and sweet potato pies, but now she was so disappointed and distressed about her weight that she could not generate any enthusiasm for baking.
Rather than caving in to store bought pies or boxed cookies, Jessie decided to use the same three step process that Don used to manage her disappointment. When she took the time to think about her experience during chemotherapy, she was able to give herself credit for getting through 6 infusions that came with hair loss, nausea and fatigue, as well as continuing to read stories to her son at night, walk the dog daily, and manage the household laundry. She also credited herself with having lost weight in the past so she recognized she could do it again. Breast cancer treatment had been a setback, but she could tell herself, “I have done it before, I can lose weight again.” When she checked what was still working, she realized she did have an interest in cooking again, could tolerate grocery shopping better now than during chemo, and her concentration and focus were actually improving each day. Planning ahead for Jessie meant getting back on track with her food log, portion control and focus on water not soda in order to tackle the weight gain. With renewed self-confidence, Jessie made a plan for Thanksgiving that included a one plate of food rule per meal (no seconds), permission for one small slice of pie for dessert (she does make awesome pies), and a commitment to one long deep breath between every bite so to slow down her eating and thus feel full sooner. After giving self-credit, checking what worked, and making a plan, Jessie took on baking the pecan and sweet potato pies, much to her family’s delight. “Doing things like baking for other people actually makes me feel better, and my pies are so much tastier than the boxed cookies!” Jessie was able to move away from distress about her weight to feeling thankful that she had a skill like baking that could make other people happy.
Food has been part of celebrations all through history, and this is especially true for Thanksgiving. If your holiday experience is going to be impacted by cancer treatment, you may feel disappointment, but there are ways to manage it. Paying attention to your strengths, recognizing that there are still some ways you can participate, and then creating a plan for managing the day of Thanksgiving (especially the meal) will help to keep the distress in check. After all, the goal of being in treatment for cancer is to continue to live your life fully, as much as possible, even if an unwelcome and uninvited cancer guest shows up for the holiday.