For the estimated 1.6 million Americans diagnosed with cancer each year, making it to the holidays can feel like a personal triumph and a huge blessing. However, for many cancer patients the big family dinners and holiday parties that are part of the festive season can come with an element of dread. Nearly everyone who has gone through treatment for a life-threatening illness will tell you that when surrounded by friends and family -- both distant and close relatives -- there's likely to be at least one guest with "foot-in-mouth disease."
Dana Manciagli, a stage 4 breast cancer survivor, recalled how she threw a holiday party in 2002 to celebrate coming through the end of her treatment that year.
"A woman walked up to me and said, 'How can you be so happy? You have cancer,'" Manciagli told CBS News. "I was surprised she didn't wear black to the party."
Manciagli recently lost her identical twin sister to breast cancer, and over the years the two kept a running list of things you should never say to a cancer patient, sort of like the Letterman Top 10, she said.
As the women alternately battled the disease together they learned ways to cope with the off-color, insensitive -- and downright strange -- comments they encountered at public gatherings. "I know everyone's touched by [cancer] but I don't want to hear about anyone. They'd literally talk about their dogs that had cancer," she said. "If you're feeling awkward, probably something will come out awkward."
Dr. Joe Taravella, a psychologist at NYU Langone's Rusk Rehabilitation, said it's natural to feel uneasy in the presence of someone you know is very sick, especially at a festive social gathering. "I think basically what happens is people don't know what to say in difficult situations, or sad situations, or when they hear not-so-great news," Taravella told CBS News. "People just don't know what to do with it. Instead of actively listening, they want to give advice and make someone feel better."
But Tarvella said these social encounters are not the time to offer medical advice, even though it might feel weird not to address the "pink elephant in the room."
"People often are going to be insensitive, whether it's intentional or not," he said.
He said if you're interacting at a social event with someone you know is seriously ill, it's best to let that person take the lead and determine what they'd like to talk about, whether it's the weather or work or their cancer treatment.
Tarvella added that the holidays are also a time to reconnect with people, which is especially important in the case of someone who is ill. "Follow through on making future plans and ultimately be yourself," he said. "If you're funny be funny, and if the person wants to express some sadness listen and don't try to take it away from them."
For those dealing with serious illness, social encounters can be nerve-wracking. But some have found a little humor can go a long way.
Saranne Rothberg, a stage 4 breast cancer survivor, said she learned a valuable lesson while in treatment that continues to serve her well: Don't take people too seriously and encourage them to do the same.
"I personally think that humor is a great diffuser in social situations, and that if you can basically have a few lines that are your deflectors, that in a polite way deflects the conversation into another area or diffuses the tension in the situation, it's a great strategy," she told CBS News. "For example, if somebody is fumbling around the whole hair topic you could say something like 'I'm just having a no hair day today.'"
Rothberg, who is the founder of the Comedy Cures Foundation, a nonprofit that uses therapeutic humor to help raise awareness about cancer, said many people wrongly assume that even in (joyous) social situations, a person with cancer wants or needs to discuss their prognosis and treatment. Rothberg said it's acceptable to respond by simply saying you'd like to keep that information to yourself. Or, she suggests, "Say something like, 'I'll give you an update on my cancer if you tell me a joke.'"
Still unclear about what NOT to say to someone with cancer at a holiday gathering (or any time of the year, really)? Here's a quick primer:
"You're going to be fine."
"Everything will be fine."
"I know how you feel."
"How serious is it?"
"God doesn't give you more than you can handle."
"I have a [friend, cousin, grandmother, relative, dog, fish] who survived cancer."
"My [friend, cousin, grandmother, relative, dog, fish] just died of cancer."
"Why aren't you trying this treatment I read about on the Internet [or heard about from a friend of a friend]?"
"Is there anything you need?"
"Is there anything I can do?"
"Would you like to talk about it?"
"Happy Thanksgiving! [Merry Christmas, Happy New Year, etc.] It's so nice to see you!"