Christmas is an emotionally loaded time of year for many people — even those without cancer, says Nancy Payeur, a team leader for patient and family counselling services at the BC Cancer Agency's Vancouver Island Centre in Victoria.
"For cancer patients, Christmas can be loaded because they're reminded of some of the things they can't do or won't be able to do," says Payeur, pointing to often-debilitating fatigue and other effects from treatment and the disease itself.
"And that might really highlight for them the losses, the changes, the difficulties they're going through and what cannot be this year."
Brittany Boniface and her fiance Steve Shaw, both 26, were looking forward to their first Christmas in a new home in Hamilton when he was diagnosed with aggressive testicular cancer and went through almost three months of chemotherapy that ended in early December last year.
"So we had all these plans, you know, to do the big Christmas tree and the house and the big Christmas party, but unfortunately he was too weak to be able to put up the lights outside or to help decorate the tree like we'd wanted to or do our home," Boniface says.
"It changed a lot of our plans. We couldn't visit with family as much as we'd like to because of the germs," she says, explaining that treatment had suppressed Shaw's immune system, leaving him vulnerable to potentially life-threatening infections.
Boniface took a leave from her job to care for her partner, including spending eight hours a day at the hospital with him while he received chemotherapy.
"It really took a toll on us emotionally and physically," she says, though their spirits were lifted by phone calls and online support from family and friends.
"But there still was that fear of the unknown ... just because he'd finished the treatment, it didn't mean that he was in the clear, it didn't mean that things were good. And we weren't going to find that out until after Christmas."
"So as much as we tried to be positive and really enjoy the Christmas spirit, it was really difficult some days because we just didn't know: Is it gone? Is it still inside of him? That was always on the top of our minds and it's really hard to push that away."
In the end, however, they decided to invite their families for Christmas, and the guests pitched in to prepare dinner.
"We did take a big risk in having people come over (but) we just wanted to be with family more than anything that day," Boniface recalls. "It was the most special Christmas that we've ever had and the most emotional Christmas that we've ever had."
Still, there's no doubt that contending with cancer while surrounded by the sights and sounds of the holiday, and with everyone else seemingly full of joy, can lead to feelings of isolation and depression.
Some people seek solace from support programs such as those provided by the Canadian Cancer Society, says Sara Schneiderman, a senior peer support specialist for the organization's Hamilton branch.
"I can't say that over the holiday period we have a definitive increase in calls, but it's the needs of the clients I find become more pressing and more poignant," says Schneiderman, whose program connects volunteer survivors with cancer patients and former caregivers with patients' loved ones.
With the holiday season evoking childhood memories of magical Christmases past and the connection to religious traditions, those facing cancer can feel lonely, scared and in need of comfort, she says.
"And of course most people are looking for hope. And so to be able to reach out and talk to somebody else who's been through an experience that's similar to theirs — and to hear that that person is post-treatment and is doing well — can be very encouraging, especially if they're feeling lonely and they don't have a very good support network."
Rose Lee has grappled with cancer twice during the holiday season: in 2005, she was treated for breast cancer; two years ago, she was diagnosed with ovarian cancer and completed chemotherapy just three days before Christmas.
In past years, she had cooked Christmas dinner for her family and bought all their gifts. But the incapacitating effects of cancer and her treatment made that impossible.
"I was having a challenging time, lots of pain," says Lee, 68, of Vancouver, where two of her three grown children and two grandchildren also live. "At first, I didn't want anyone to come over. I just wanted to be alone by myself. But then, later, I didn't want to be left alone. Everybody's having a good time and I'm all alone by myself? That's no good."
"They came to do some decorations in my house and they did all the cooking and set all the gifts under the Christmas tree. My appetite wasn't good, so I ate whatever I could and then I just sat down and relaxed."
It was, she says, the most thoughtful gift her family could have given her.
While it may sound corny, acknowledges Payeur of the BC Cancer Agency, "the best kind of gift is your time — you."
"Think about that young single parent (with cancer) who's facing Christmas and has limited energy and is not feeling so great. What does she need? Does she need you to take the kids out for an afternoon so she can do some things to get ready for Christmas? Does she need you to prepare some meals? Does she need you to come and clean her house?"
"People don't think about those pragmatic things. They say, 'Oh, isn't that awful. Gosh, I don't know what I can do to help.' Well sometimes it does require a little bit of reflection and thinking ... Some people have tons of support and people are lining up to help them, but that's not the case for everybody."
Schneiderman says often the most appreciated gifts for someone with cancer are those that take away the feeling of being a patient, that make them feel "like a person again."
"Because it's been all about appointments and treatment and recuperation and side-effects for how many months, and it can take a toll on somebody," she says. "And just to have a reprieve from that, to take time to be with their family and to focus on being a person again, I think is so important."
That could mean giving presents that speak to a person's interests, such as arts and crafts supplies; theatre tickets if they are well enough to attend; a spa treatment; or music, books or a journal for recording thoughts and emotions.
But time together, as Schneiderman knows from personal experience, is the most precious gift of all.
Her mother was diagnosed with oral cancer last year and had to endure many sessions of aggressive radiation and chemotherapy, but "somehow made it through."
"It was very poignant because last Christmas ... we were not sure that she would be with us. So last holiday season was very emotional for all of us because my mother was still here. And we were able to celebrate another Christmas with her."
"And this year is going to be our second Christmas with my mom," who went into remission in the spring, she says. "And we're just so thankful she's here with us again."
Boniface says her fiance also has been deemed cancer-free, though he still suffers lingering side-effects from treatment.
Then in October came another set-back for the young couple: they had just started planning their wedding when her mother was diagnosed with breast cancer for the second time.
"Just when we thought, 'OK, this is going to be a good year, this is going to be a good Christmas, bring it on,' then we get hit with my mom and it's just like, 'Oh, man, can we have a healthy Christmas, please?'"
Cancer has changed how Boniface views Christmas. No longer is the focus on what presents to give, but about sharing time with family and friends.
"Making memories. That's what's important and that's what's going to last," she stresses.
"I'd like people to remember that life goes by really quickly and tomorrow is a mystery — we don't know what it's going to bring. So really enjoy the holidays for what they are, not because of gifts, but more for the memories, cherishing the little moments with your family and friends because you're not sure what next Christmas is going to bring."
Canadian Cancer Society: www.cancer.ca