The Beam: Tips for dealing with holiday stress; learn about patient navigators; meet Dr. Sara Hardy

Tips for dealing with stress during the holidays

The holidays are a time of year when some people experience heightened emotions — from joy and excitement to anxiety and grief, which can be compounded by the stress of a cancer diagnosis or cancer treatment.

“Most people have memories, traditions and expectations around the holidays which get turned on their head when they receive a cancer diagnosis,” said Elizabeth Darlington, MSW, LICSW, a proton therapy social worker at Fred Hutch Cancer Center. 

For some people, maintaining holiday traditions is extremely important. For others, the traditions become less important or even burdensome, but they might feel pressure from family or friends to do things the way they’ve always been done year after year.  For many people, the holidays can also be a time of deep loneliness.

No matter what a person’s feelings are towards the holidays, having cancer will likely change the way a holiday is experienced. Their physical, emotional, mental, spiritual, financial and social situation might be different than it was in the past. Side effects from treatment, like fatigue and nausea, can make an all-day food occasion impossible to enjoy.

Darlington along with Medina Abdi, MSW, LICSW, another Fred Hutch social worker, offered these suggestions for dealing with holiday stress:

Acknowledge that things are different

“I think most people can benefit from acknowledging their energy levels or emotions have changed and should plan for some traditions to be different, too,” she said. “If you’ve traditionally hosted a big meal for your family, maybe you can become the family DJ, or write down your recipes and teach them to others.”  

Name the things you are thankful for

“It sounds cheesy but going around and naming what you’re thankful for and hearing what other people are grateful for can be heartwarming. Do take time to honor how you feel, cry and grieve changes” she said. “Afterwards, gratitude can help recenter and focus you on what you do have.” 

Remember that you don’t have to always be pleasant

“As a cancer patient, you are going through a lot. Even though many people think you need to be pleasant during the holidays, never underestimate the release and freedom you can experience from authentically expressing your feelings,” Abdi said. “Some people try to put on a brave face and I just want to remind them that it’s OK to experience the full range of emotions.” 

Be mindful

“Finding balance is perhaps key to navigating the holidays,” Darlington said. “As with everything in life, nothing is all good or all bad. Breathe, slow down, have patience with yourself and others and let the season wash over you. Slowing down in this way is a key element of mindfulness. Experiencing and being aware of our five senses — smell, touch, taste, vision and hearing, and paying special attention to these, is a wonderful way that we can stay present in the moment.”

Need some help and don’t know where to start? Check out Cancer Lifeline’s local support groups to join during the holiday season. 

An in-depth look at the Proton patient navigator/concierge team

Patient navigators/concierge are the first line of support when patients come to the proton therapy facility at Fred Hutch. They are the go-to resource for any questions patients and caregivers have. Patient navigators/concierge perform many duties, including administrative tasks such as registration, checking in patients and staffing the front desk and phones for any questions. They also assist patients with logistics such as helping patients coordinate lodging, transportation, social services and community services. 

“Our role is to get to know patients and be a trusted source of care,” said Ian Rice, patient navigator lead. “We meet with each new patient to provide an orientation to the facility, introduce them to protons and continue to have supportive conversations with patients throughout the course of treatment. We also serve as a liaison between the clinical teams and patients, as well as with patient access, scheduling and more.”

The patient navigators/concierge played an integral role in implementing the new NASA program, Mission: All Systems Go!, which provides an engaging and uplifting experience for — and aims to alleviate anxiety in — pediatric patients by comparing their health care experience to that of NASA astronauts. The program includes a video narrated by astronaut Kjell Lindgren, who is also a medical doctor.

Not only were members of the patient navigation team closely engaged in creating it, they also start new patients in the program, help them track their progress on a countdown magnet board, and celebrate with them at the end.

By collaborating closely with a wide range of teams, including child life specialists, social workers and medical staff, the patient navigator/concierge role is uniquely positioned to identify patient needs and challenges, allowing them to implement creative, effective solutions.

“Through our internal surveys, we actively gather feedback to ensure continuous improvement, always brainstorming new ways to elevate the experience for both patients and their caregivers,” said Patient Services Manager April Clements, who leads the patient navigator/concierge team.

Patient navigators know how to problem solve when challenges arise.  For patients traveling for proton therapy, there can be complex logistical issues, especially when it comes to finding lodging in the summer months, which is the height of tourist season in Seattle. The team has secured special rates at a variety of housing options for proton therapy patients and their families. Machine downtime can also create delays in appointment times, and the team does their best to mitigate these situations by providing snacks, activities, service recovery vouchers and most of all, timing updates and reassurance to patients so they can make a plan for their day.

“Sometimes it can be challenging to serve as the glue between patients, schedulers, clinicians, transportation and insurances, but that’s an integral part of our work and essential to patient care,” Rice said.

Rice said one of the things patient navigators love about working at the proton therapy facility is the entire care team’s dedication and commitment to treating patients in the best and kindest way possible, remembering patient’s names, recalling conversations and needs and celebrating with them when they “graduate.”

“They provide extremely valuable guidance/counseling and support. Vital to the program. Turned out to be one of the most important parts of the team!” said one patient survey comment.

“They made you feel welcome every time you walked in the door. Answered any questions you had about upcoming appointments or anything else. If they we unable to answer, they found you the answer,” said another.

“Patient feedback is the primary source of motivation for our team,” said Clements. “And the opportunity to make a meaningful difference in our patients' lives.”

Meet Dr. Sara Hardy, central nervous system cancer specialist

Sara Hardy, MD, joined the Fred Hutch proton therapy physicians as the newest member of the central nervous system (CNS) tumor team in September. Hardy holds dual board certifications in neurology and radiation oncology. 

Hardy’s mother, father and multiple uncles work in psychiatry, predisposing her to an interest in the brain. After her father was diagnosed with Parkinson’s disease, she considered a career in brain medicine.

“I like understanding how the brain functions and helping people deal with neurologic symptoms like changes in memory that can really impact quality of life after treatment,” Hardy said. “Proton radiation treatment can help reduce radiation dose to healthy brain tissue and may help us reduce these side effects. Access to protons for CNS cancers is incredibly important. It’s one of the reasons I wanted to work here.”

The palliative and procedural aspects of radiation oncology are especially appealing to Hardy. Even short courses of radiation can be effective in managing patient symptoms and can be curative as well. Hardy is engaged in a number of studies that look at how best to help patients dealing with cognitive effects from cancer and cancer treatment.

She currently has a grant from the American Cancer Society for research examining how patient frailty affects cognitive side effects. 

“Frailty is a measure of how well patients can bounce back after stressors such as a cancer diagnosis or cancer treatment,” Hardy said. “I hope we can find ways to integrate frailty data at the time of diagnosis to help us decide on the best treatment course, ways to minimize side effects and how to maximize our impacts on controlling tumors and survival.” 

She has also been working with patients with advanced glioma to talk about their goals and values ahead of treatment so that if they lose their capacity to make decisions during treatment, the care team and family can make sure to adhere to their wishes. Part of that is making sure they have an advanced directive in place.

When not working, Hardy loves to spend time with her two little boys; she also loves to draw, paint and read. She is in multiple book clubs and even had a book-themed wedding where her bridesmaids’ bouquets were made of their favorite books and each table was named after a novel. She especially enjoys her Jane Austen book club, launched eight years ago, which focuses on the classics.

Say “hi” to Hardy when you see her at the proton therapy facility and share your views on one of her favorite books: “The Book of Questions” by Pablo Neruda. She’d love to hear them. 

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