What to Say or Not

According to the National Cancer Institute, about 40% of men and women in the U.S. will be diagnosed with cancer during their lifetimes. Nearly everyone will eventually have a close connection to someone who has cancer and/or become a person with cancer.

Now that I have some experience on both sides of being a person with cancer and having friends with cancer, I’m sharing a few suggestions hoping to help you deepen your connection with your friend or friends with cancer.

Examples below all start with a comment to avoid, then explain the problem, then suggest another approach.

“Cancer is so frightening, but I know what you are going through, and I’m here for you.” — You can’t know what your friend is going through, physically and emotionally, because every type of cancer has different signs, symptoms, treatments, prognoses, and outcomes. Each individual is different and two people with a similar diagnosis will have different experiences. Try saying, “I would like to know what you are experiencing, what are you going through now?”

“I had extremely painful side effects during chemotherapy, I hope you don’t have to go through that.” — If you are a person who also has cancer, speaking to your friend with cancer, then it’s OK to briefly share from your experience.  Try not to compare your experience, nor create expectations for treatments, side effects, or outcomes that your friend may not share. Preferably say, “I have the same form of cancer that you have and I took 6 months of chemotherapy. What has been your experience of your treatment so far?”

“I’m sure you will be OK, because my friend Matthew had the same thing and he has been fine for the last 10 years.” — Regardless of your good intentions, don’t tell anecdotes that compare your friend with others, with the same form of cancer or some other form of cancer. Put more effort into listening than speaking. Ask open-ended questions: “How are you feeling today?” or “What are you looking forward to in the coming week?” or “What do you know about your cancer?”

“Have you written your bucket list of experiences to accomplish in life? I’ve heard that’s a great thing to have a better chance of staying well.” — The future is uncertain, especially with a threatening disease like cancer. Some people will want to continue their basic weekly routine. Others may want to take dream vacations or visits to old friends and extended family. Wait for your friend to bring up their dreams for the future, rather than suggesting they should be checking off their bucket list. You can reduce your friend’s stress by focusing on past and the present. You might say, “Remember the time we went on that road trip to Alaska?” or “Look at those clouds today, so splendid and tall. What do they remind you of?”

“What is your medical team telling you about your treatment plan?”  — Don’t assume that your friend is willing to share details about their experience and what they know about their cancer. Better to ask “Do you mind me asking questions about your treatment?” or “I would like to know more about what you are going through, please stop me if you prefer not to talk about it.”

“I’ve read that despite the billions of dollars spent on cancer, many forms of cancer are still incurable. What treatment are you being given?” — Criticizing Medical Science or Medical Health Care in our country is tedious in this context. Instead, show respect the considerable advances that Medical Science has developed for treating cancer. Keep in mind that more people with cancer are living longer than ever before. You might say, “I have heard that more people are living with cancer now than ever, how do you feel about your situation?”

“My friend Sally had lung cancer. She refused chemotherapy and opted for Richard Simpson Hemp Oil, which put her into remission.” — Don’t assume that it is appropriate for you to recommend a magic treatment for your friend’s cancer.  Many of us have read or heard anecdotes about alternative treatments that worked for somebody. You are not an oncologist, so keep such stories to yourself. Instead you might ask, “What treatment has been recommended for your cancer?”

“It’s amazing how people try unproven supplements and dietary treatments for cancer. The Internet is full of cancer scams.” — Do respect your friend’s right to explore alternate treatments, preferably to supplement their medical treatment. Humans have remarkable immune systems that sometimes defeat cancer with a little help. A variety of supplements have been found to have anti-cancer properties and various activities are known to help the body heal from injury and disease. You might say, “Interesting that you are working with a Naturopath on dietary changes. Tell me more about what you are learning.”

“I heard you are being treated by the medical team at Kaiser and I know the chief neurosurgeon there. I would be happy to arrange for him to see you.”  — Respect the specialized expertise of oncologists. Different forms of cancer are legitimate specialties, with their own body of knowledge, treatments, and side effects. If your friend appears to be following an doctor or oncologist who is a generalist or practicing a specialty different from their form of cancer, you might say: “I notice that your oncologist specializes in cancer that is different from yours. I believe it’s best to follow an oncologist who specializes in your form of cancer. Would you be open to asking for a referral to a specialist in your form of cancer?”

“It is so important to find the best medical facility available in order to gain access to the very latest treatments and trials. Our town is too small to attract the best doctors. You should make an appointment at the Mayo Clinic.” — Don’t make it your mission to motivate your friend to become a patient at the best medical center in the country. We can’t all be patients at M.D. Anderson or the Mayo Clinic. But, if your friend expresses qualms about treatment advice from a questionable oncologist or medical center, it’s reasonable to support your friend in getting a second opinion. It may be possible to get that opinion from a specialist at a medical center with a national reputation, although it may involve additional cost. You could say, “You seem uncertain about whether to undertake the treatment being recommended by your oncologist. I have heard that it’s possible to get a second opinion from specialists at the Mayo Clinic in Rochester. May I help you find out how to arrange that?”

“I am praying for your healing every day.” — If you are a Christian, Jew or Muslim, you probably imagine that it’s supportive to tell your friend that you pray for them. That is probably OK when you know that your friend believes in prayer. If you don’t know, avoid problems by saying, “I think of you often and hold you in my heart.”

“You have to keep fighting this disease. Don’t give up on yourself!” — Respect your friend’s decision to decline treatment. Fighting cancer is not an appropriate metaphor for everyone. Moreover, there may come a time when your friend’s disease has overwhelmed her defenses and all reasonable treatments have been unsuccessful. If she wants to decline further treatment, recognize her right to make this choice. You might say, “It seems you are choosing to make the best of your life, rather than suffering with treatment that you believe will not be helpful. Is that the way you see yourself?”

Others with cancer have written about what they have appreciated in interaction with friends. Following are a few of my favorites: