Breast Cancer, COVID, and the Holiday Season: Advice for Safely Connecting With Loved Ones

It appears that the COVID-19 pandemic will remain a concern through and beyond this holiday season.

Many of us have been disconnected from family and friends for these past months, and have been hopeful that we’d somehow be able to gather for the fall and winter holidays. But even if you wear a mask, large indoor family gatherings, shared meals, and travel are still not safe.

With cold weather on the way, it may be tempting to throw caution to the wind and have traditional indoor holiday celebrations with people outside of your immediate household. But it’s especially important to prioritize your safety if you have certain medical conditions, such as breast cancer. A current cancer diagnosis is one of the medical conditions the Centers for Disease Control and Prevention (CDC) says can put you at risk for serious illness from COVID-19.

“As much as I would like to celebrate Thanksgiving with my children and grandchildren, it probably will not happen this year,” said Community member Betrayal. “I am at higher risk due to age and [medications] which lower my immunity. My grandchildren are in the age groups where they are considered to be possible asymptomatic carriers. So I see them from a distance but miss their hugs and kisses tremendously.”

If you’re being treated for breast cancer and struggling with how to handle the holidays this year, you’re not alone. We spoke with several experts who offered advice on how to safely connect with your loved ones this holiday season.

Know your risk

As you’re thinking through what holiday events may be safe or unsafe for you, it’s important to understand your level of risk based on your age, health, and medical conditions.

According to the CDC, your risk of severe illness if you get COVID-19 increases with age. The CDC also says that certain medical conditions, including a current cancer diagnosis, can increase your risk of serious illness from COVID-19. And certain breast cancer treatments, such as chemotherapy, can weaken your immune system and increase your risk of infection. It is not known whether a history of cancer increases your risk.

To get a full picture, it’s smart to talk with your doctor about how your age, medical conditions, medications, and treatments all affect your level of COVID-19 risk.

“As we approach this holiday season, we will have endured 8 to 9 months of living in a worldwide pandemic, and patients may feel like letting down their guard, throwing caution to the wind and planning celebrations with all the folks they have missed so much this year,” said Julie L. Salinger, LICSW, MSW of the Dana Farber Cancer Institute in Boston, Mass. “But if the safety recommendations remain in place, it is important to ask your medical team about any additional risk factors you may have over the average person, both for your sake and for your family.”

Where you are in your breast cancer treatment journey and the types of treatment you’re receiving are especially important when it comes to your COVID-19 risk, said Megan Kruse, M.D., breast medical oncologist at the Cleveland Clinic in Cleveland, Ohio.

“People on chemo with suppressed immune systems should be the most cautious about limiting the number of people they interact with,” she said. “Many patients who are survivors may no longer be on treatments that put them at higher risk. Those people can really do what the average person can do in terms of managing their risk.”

For patients living with metastatic breast cancer, “the discussion can be a lot harder,” Kruse said. “Day to day, they may not have to adjust their activities, but with the winter virus season, potential family gatherings may have to change.”

Accept that being physically apart is safer

Since the beginning of the pandemic, wearing masks, frequent handwashing, and sanitizing surfaces have been recommended for helping to prevent COVID-19 from spreading. But physical distancing (avoiding crowds and staying at least 6 feet away from people outside of your household) has been the most important and most effective of these safety recommendations. This hasn’t changed, so as difficult as it may be to accept, staying apart during the holiday season is the best way to avoid getting sick or spreading the virus to others.

People are “craving that opportunity to get together in person,” said Elizabeth Robilotti, M.D., MPH, assistant attending physician and associate medical epidemiologist at the Memorial Sloan Kettering Cancer Center, on an episode of the podcast. But “celebrating virtually is the lowest risk way to enjoy the holidays with friends and family.”

Since physical distancing has been recommended for months, many people have already had some practice at holding virtual events, and you can find many ideas on the internet. Some tips for a successful virtual holiday celebration include:

·         Setting a time that works for everyone, despite time zone differences

·         Virtually sharing a meal

·         Structuring the event around a game or activity, like holiday Bingo or opening gifts

·         Watching a holiday movie together through group streaming services such as Netflix Teleparty

If you choose to celebrate in person, stay as safe as possible

Again, celebrating apart and avoiding indoor family gatherings with people outside of your immediate household is the best way to reduce the spread of COVID-19 this holiday season. But if you end up in a risky situation despite these recommendations, do your best to minimize that risk.

Robilotti shared these strategies for reducing your risk of getting sick if you decide to celebrate with others in person:

·         Meet outside as much as you can.

·         Have a small number of attendees at your gathering.

·         Maintain social distance of at least 6 feet apart.

·         Have participants wear masks.

·         Consider bringing your own food and utensils to minimize the number of people touching different things.

·         Monitor local COVID and flu rates; look for this data either from local news reports or from your local Department of Health. Consider cancelling plans if those rates are rapidly increasing.

·         Keep meetups short.

The CDC also says that good ventilation is an important way to make indoor settings safer. So if you end up celebrating indoors, it’s smart to avoid enclosed spaces and consider opening windows to increase fresh air flow.

Communicate with your loved ones

Regardless of personal levels of risk, it’s important for loved ones to respect what each individual is comfortable with this year, said Dr. Robilotti.

“One of the most important messages about celebrating the holidays safely and happily is being respectful of everybody's boundaries, and not wanting to put anyone in a position where they feel they have to be in the room if they're not ready to do so,” she said.

But everyone’s relatives don’t think alike. It can be difficult to discuss why your level of risk or tolerance may differ. But it’s important to have these conversations, especially to make sure your loved ones know that they should stay home if they are feeling sick, or if they have or may have come in contact with someone who is sick.

“If you decide you are going to see family members, plan ahead by asking them to quarantine, get tested before visiting, and check to see if they are otherwise healthy,” Dr. Kruse said.

Knowing what is best for you is crucial when having what can be tough conversations.

“Acceptance is key in all this,” said Community member Simsarama22, in a discussion about different family members who don’t share her opinions about how to stay safe during the pandemic. “I’ve learned to accept them all for who they are, love them anyway, but prioritize myself and my children no matter what. While I feel bad my children can’t have the holiday celebrations full of tons of family that I had, I can’t take that kind of risk so as long as there’s no vaccine, so we will be staying away from them.”

This unprecedented 2020 holiday season may indeed be challenging, especially after months of being apart. But it can help to know that we’re all going through this together.

“Remember that the holidays come around yearly, and if we must live through a season unlike any before or after, we will survive,” Salinger said. “Communities all over the world will be doing the same thing.”

Written by: Cheryl Alkon, contributing writer

This content was developed with contributions from the following experts:

Megan Kruse, M.D., breast medical oncologist at the Cleveland Clinic in Cleveland, Ohio

Elizabeth Robilotti, M.D., MPH, assistant attending physician and associate medical epidemiologist at the Memorial Sloan Kettering Cancer Center

Julie L. Salinger, LICSW, MSW of the Dana Farber Cancer Institute in Boston, Mass.

This article is part of Circle of Care: Finding Support with Metastatic Breast Cancer, presented by:


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