Emotional Support

When you find out someone you know has cancer, you won’t always know exactly what to say or do to make their experience easier. The guidelines below serve as a starting point to having a conversation with someone who has cancer.

Cancer is infuriating and heartbreaking and unfair. Learning that a loved one has cancer can come as a shock and it's important to take time to manage your own emotions before talking to your loved one with cancer. Spending too much time expressing the difficult emotions you're feeling may overwhelm and upset the person with cancer. While it’s appropriate to authentically communicate your feelings about their diagnosis, it’s important to remember that you’re sharing their moment. If your emotions are being expressed with greater intensity than theirs, it becomes your moment and the focus is shifted away from the person with cancer. As bad as you feel, your loved one feels worse and you don't want to put them in the position of having to comfort you.

People with cancer are often asked many questions by their friends and family members and it can be physically and emotionally draining to repeat the same information multiple times. If possible, see if a family member or mutual friend can give you the basics. Do a little research online at credible websites to learn more about the specific treatment, side effects, and recovery to have a better idea of what your friend will be going through.

Changes to their appearance can make people with cancer feel self-conscious or lonely because they feel different from other people—even if the changes don’t seem obvious. Fatigue, weight loss, and hair loss are common side effects of cancer and its treatments. It's best to refrain from commenting on changes in their appearance. 

Every person with cancer has a different experience and they react to a cancer diagnosis in their own way. Learning some of the more common emotional effects of cancer can help you better understand what your loved one may be experiencing.

Sadness

Most people with cancer feel sad. They feel a sense of loss of their health and disruption of their role in life that gives them meaning and satisfaction. 

Fear

A cancer diagnosis is scary. It's common to worry about the treatment, the possibility of debilitating side effects, the prognosis, as well as the overall impact on quality of life.

Anger

It's natural to ask, “Why me?” They may feel anger toward the cancer itself, healthcare professionals, themselves, God or the universe, and people who don't have cancer.

Loneliness

Cancer can be lonely. Even when they're with people, many patients feel alone in their pain and fear, and feel that other people don't understand what they’re going through.

Self-Blame

Some people believe their cancer diagnosis is because of something they did or did not do, and they wonder if they could have done something to prevent it.

Guilt

People with cancer often say their main concern is for the people they love. They feel guilty about how their illness will impact the lives of their loved ones. 

Loss of Control

Many people feel helpless or powerless which is especially difficult for those who are used to being independent or being the one who takes care of everyone else.

Pressure

They can feel like they have to be strong and protect their friends and families. There is often pressure to be positive, to be a good patient, and to handle the illness well.

Hope

Once the diagnosis has been accepted and treatment has begun, they often begin to feel a sense of hope. There is good reason for hope as the chances of living a full and active life with cancer—and living beyond it—are better now than ever before. 

Cancer can be an isolating experience, but just by showing up and listening, you can help them feel less alone. The most important thing is not what you say, it's that you're present and available. There are no perfect words and it’s always better to admit not knowing what to say than to avoid calling or visiting out of fear. Everyone, no matter how strong they appear, benefits from the support of a friend. Showing up, being consistent, and following through with offers of help, all serve to communicate how much you care.

People with cancer need to talk about what is happening and to express their honest feelings about what they're going through. Listen actively by giving them your full attention and try to hear and understand how your friend feels. Listen without always feeling that you have to respond. Sometimes a compassionate and caring listener is what the person needs most. And if they don’t feel like talking, it’s okay to just sit with them quietly. There is a lot of power in simply being present.

It's important for the person with cancer to set the tone of the conversation. Listening carefully to what they have to say will help you know how to best support them. Have they mentioned feeling overwhelmed by visitors or phone calls? Or have they said they’re feeling lonely and restless? Do they want to talk about their cancer treatment? Or do they want to talk about everyday matters as a reminder of the life they have beyond cancer? Keeping the person's personality, likes and dislikes, and comfort level in mind helps you respond appropriately. If you have trouble reading the situation, there's nothing wrong with simply asking. 

Before visiting, contact them first and be sure they’re up for a visit. This is true whether you’re visiting someone at home or in the hospital. Give your friend permission to say no to a visit and be flexible and understanding if they cancel at the last minute. Days can seem very long for people who are hospitalized or convalescing at home and a visit from a friend or family member can really lift their spirits.

As much as possible, treat the person the same way you did before their cancer diagnosis—ask their advice, solicit their expertise, and talk about the things they’ve always enjoyed. You loved one has a lot to offer—they don’t want to live and breathe cancer 24/7, and it’s important to remember the person they really are. 

Include the person in usual social events, plans, and work projects. Don’t assume they don’t want to be included in activities because of their cancer. The person may feel too tired or ill, or they may not feel comfortable with the physical manifestations of cancer, but one way to show your support is to keep inviting them to participate. They need to feel like the valuable contributing member of the community that they are. Let them decide for themselves what they can and cannot do.

Your friend can be feeling any one of a wide range of emotions. Those feelings and outlooks can change daily or even hourly. They will be dealing with a lot of stress and may also be on medication and other interventions that affect their mood or hormones. It’s normal for a person with cancer to be quieter than usual, to need time alone, and to be angry at times. If you reach out but your friend doesn’t return your phone call or email, don’t take it personally. Extend them grace within the context of what they’re going through and be flexible when making plans.

Cancer can be a long journey with many bad days and difficult moments. It’s important to let your friend talk about feeling sad or fearful. This is a normal response to what is happening to them. While it can be tempting to try to cheer them up, it also stops them from talking about what they’re really feeling. They should be able to express feelings like fear and uncertainty, as difficult as it may be to hear. Support your friend’s feelings. Let them be negative, withdrawn, or silent. Resist the urge to change the subject.

Recognize that your friend with cancer may make decisions about their treatment or lifestyle differently than what you might do. It's important to support their choices, even if you don't agree with them. Don’t offer medical advice or your opinions on things like diet, vitamins, and herbal therapies. Before making suggestions or launching into research you’ve done, ask permission first and be prepared to stop if you’re not encouraged to continue. As well-intentioned as you are, unsolicited advice can cause unnecessary stress to the person with cancer. 

Knowing that many people are sending positive thoughts or praying for their wellbeing can provide the person with cancer with a deep sense of comfort and support. A cancer diagnosis can cause people to face their own mortality, leading them to contemplate the subject of faith. Even those who’ve not historically been religious can be triggered by existential concerns about the meaning and purpose of life. Whether you send prayers or healing thoughts or positive energy from the universe on behalf of your loved one, they’ll be comforted by the collective power of hope for their wellbeing.

People are often offered a lot of support in the beginning, but offers of support tend to diminish over time. Be the friend who stays in touch consistently from initial diagnosis to the end of treatment and beyond. Ways to stay in touch include:

Cards and Notes

In an age of mostly digital communication, there is something special about receiving a handwritten note. Taking a few minutes to write encouraging words by hand is a great way to show your support. Your note will come as a pleasant surprise to your loved one and it will give them a physical memento to look back on when their day needs brightening.

Phone or Video Chat

Constant visitors can be overwhelming, but a phone call can offer the healing power of social support without the stress of having company. Phone calls or video chats can also be a great way for you to connect if you live too far to regularly visit in person. Hearing the voices of people they care about can be an incredible source of comfort.

Regular Visits

Going through cancer treatment can feel isolating and having the support of regular visitors is one of the best way to combat that feeling. Coordinate with your loved one to find the days that work for both of you for a regular visit or activity. Simply showing up consistently makes a world of difference to someone going through cancer treatment.

Unlike any other illness, the language of cancer is infused with wartime rhetoric such as battle, fight, and warrior. Cancer battles are said to be bravely fought, won, or lost. Such language implies that if a patient fights hard enough or long enough, they’ll be able to “win the war,” and if they don’t fight hard enough, they’ll have, “lost the battle.” It can reduce patients to a game of winners and losers against the unfair opponent of cancer. At the same time, to be called a warrior can make a person feel strong and invincible, giving them the momentum to continue through a potentially long battle. For others, telling them they’re brave or strong puts pressure on them to feel or act differently and it holds them to a standard they don’t aspire to when they’re simply trying to survive. There is no right or wrong when it comes to using wartime language, there’s only what feels right for your loved one. 

Some of the most questionable words and phrases are spoken by caring people who mean well but don’t fully appreciate how their words may be heard by a person with cancer. In general, you want to tread carefully when using language that imposes meaning on another person’s experience. There is a critical difference between people finding their own meaning in their cancer experience and other people prescribing for them what meanings they should derive. Potentially problematic language includes:

Telling them how to feel such as, "You're brave," or "You're strong," when the person may be exhausted by treatments and is justified in feeling weak or dispirited.

Minimizing their diagnosis as in, "You have the good kind of cancer," or "I'm sure you'll be fine," when in reality all cancer is scary and the outcome is never certain.

Denying their cancer by saying, “You don’t look like you have cancer," or "But you're so young," when in fact they have a serious illness and are deserving of empathy and concern.

Suggesting they be grateful for cancer when the person has gained a new outlook on life and cancer is credited as the spiritual enlightenment program they needed.

Offering metaphysical justifications such as "It must be God's plan," or "You're never given more than you can handle," which can indicate they needed to learn a lesson while you as a person without cancer did not need the same lesson. 

Blaming them for the cancer including suggesting their lifestyle habits or stress are the cause of cancer, when the truth is that the cause of most types of cancer is elusive. 

Comparing them to others by recounting the heroic recoveries of other people with cancer that are not the norm which they may find demoralizing rather than inspiring. 

Offering unsolicited advice on treatment options or lifestyle choices when the person is already overwhelmed with information.

While many of these words and phrases are well-intentioned, consider what you know about your loved one and their stage of treatment before including these topics in conversation. The last thing you want to do is inadvertently cause more harm than good.

Here are some things you can say to start a conversation and show how much you care:

• “This is hard. I don’t know what to say.”
• “I'm sorry you're going through this.”
• “Whenever you feel like talking, I'm here to listen.”
• “I care about you.”
• “I'm thinking about you.”
• “I’m always here if you need a shoulder to cry on.”

Avoid using the following language as it can be harmful to a person with cancer: 

• "I know how you feel."
• "I'm sure you'll be fine."
• "Everything happens for a reason."
• "I know what you should do."
• "You have the good kind of cancer."
• "Everything will be okay."
• "It's part of God's plan."
• "All you need to do is think positively."
• "What kind of cancer do you have? Oh, my neighbor died of that."
• "You're only given what you can handle."
• "It could be worse. At least it's not ___."
• “My cousin cured his stage IV cancer. You can too."
• "How long do you have?
• "At least you've lost weight."
• "Don't worry about that scar. It's not like you're a model."
• "You're strong. You'll beat this. Attitude is everything."
• "You don't look sick."
• "You've had a good life until now."
• "Wow. I'm going to miss you."

As the caretaker of someone with terminal cancer, I know how difficult it can be to accept reality, even when reality is staring you in the face. Steve's cancer began as a sarcoma in his leg, then moved to his spine, and later wrapped itself around his aorta and metastasized to his brain. After three years of fighting cancer, including multiple rounds of chemotherapy and radiation, participation in two clinical trials, undergoing surgery to have steel rods inserted into his spine, and eventually becoming paralyzed from the chest down, Steve was out of options. At 43 years old, he was going to die. The idea was so outrageous that it was difficult to accept. In the face of such overwhelming evidence, reality was not outright denied; instead the denial manifested itself in our continuing to extend his life, “a couple more months,” until time suddenly and abruptly ran out. If you have a loved one whose treatment is not going well and you’re having a hard time accepting the inevitable, I've been there and I understand.

Our job is to gather our strength, move past our discomfort, and help our loved one transition from this world to the next. One way to do this is to put our focus on them and to think about how they must be feeling. As a society, we tend to be uncomfortable with talk of death, but avoiding the subject can leave the person feeling lonely and frightened as they struggle to cope on their own. We can still hope for a miracle while at the same time helping our loved one prepare to leave this world. The person who is dying very likely knows the reality, and to be surrounded by people who are denying reality in hopes of a miracle burdens them at a time when they most need our support. Be the person who has the courage to broach this subject. Paying close attention to their cues and letting them set the tone will help ensure the discussion is welcomed and not forced upon. They deserve to have us put their needs first. This is the time for strength—we can fall apart when it's over. Knowing that you had the privilege of helping your loved one transition to the next world, that you did your best for them, is something you can take comfort in for years to come. 

It is not our job to tell someone how to feel or how to conduct themselves in their last weeks or months of life. Too often someone takes it upon themself to a deliver a "reality check," to the person who is dying. They don't need a reality check. They're living with the reality of their situation every day. Delivering a cold, hard, reality check to someone who has already suffered and who's trying to manage the best they can, from a person whose life is not being cut short by cancer, is beyond presumptuous. This amounts to telling them they're dying wrong, and that you as a healthy person know better than they do. Even if we don't agree with their choices, the person is coping in their own way and it's not our place to tell them how to prioritize the remainder of their time left. Nor is it our place to force them to accept the reality of death, or instruct them on how to spend their money, or remind them of things they will never do again. The person is facing their own death—they get to do it as they see fit. This is assuming there is no more than light cognitive decline present for which gentle methods of persuasion may be in order.

Like many people, Steve had moments of both acceptance and denial and it was my job to support how he was feeling either way. There were people who wanted to deliver a reality check when he refused to enter hospice which he viewed as conceding defeat. Instead he entered a skilled nursing facility. And there were people who thought I was crazy when I hauled a small bookcase into his hospital room and filled it with the books he requested—they felt he needed reminding that he would never work again and therefore did not need the books. I disagreed on both counts and felt it was up to Steve to decide how he wanted to spend his last weeks of life and that he didn't need any brutal reminders. During moments of acceptance, I was tasked with buying wedding cards for his two young children, ages 7 and 9, to be given to them on their future wedding dates. Also during moments of acceptance, he researched options for liquidating his business assets and read books on how to prepare his children for the death of their father. 

The person who is dying is contemplating a number of worries, from the mundane to the more serious. One thing you can do for your loved one is to relieve them of one or more of their burdens. The more specific you are, the better. If you're not specific, the person can't picture it clearly in their mind which makes a sense of comfort elusive. Let them know that you're going to make their children's lunches every day through the end of middle school and that you'll include them in your carpool. Tell them you'll help their husband with holiday gift shopping, or that you'll take care of all yard maintenance for their wife. Let them know you've pooled resources and have started an education fund for their children. Take what you know of your loved one, consider their worries, and then let them know specifically what you're going to do. Even small things, such as providing hair ribbons for a little girl's first day of kindergarten, can bring a sense of relief and comfort.

My grandmother was five years old when her mother died and her mother's last words were to remind her husband to be sure to buy ribbons for my grandmother's hair for her first day of kindergarten. 

They Want to Know their Life Mattered

It's easy to feel insignificant in the world we live in, and when people are facing the end of life, they often worry about the significance of their own contribution. One thing you can do for your friend is be specific about the impact they've had on your life. This needn't be a tearful bedside conversation at the last hour. Rather, it can be brought up in everyday conversation. Let them know they were a lifeline to you when you went through that crisis. Remind them of the advice they gave you that really helped. Reminisce about the vacation you took together or the project you completed. These memories all serve to remind them how much they mattered and that they touched the lives of others. 

They Want to Know they will not be Forgotten

Rather than the generic, "we will always remember you," let them know how they'll be remembered. Maybe every time you hike that trail, or visit that town, or play that game, or see their photo on your wall, you'll remember them. If they're hoping to hold on in order to attend an event, let them know that they'll be there, either in body or in spirit, and if in spirit, tell them specifically how: Will you hold a place of honor for her at her granddaughter's wedding? Will you recount the fun stories about him on your annual fishing trip? Think about what will trigger memories of them, and then let them know specifically how they'll be remembered.

Where they're Going

The person who is dying has one foot in this world and one in the next. It's natural for them to wonder or worry about what is next. If you know their religious beliefs, this can be an easier conversation to start. If you're unsure about their beliefs, you can always ask. Talking about near death experiences can be helpful; there are many books on the subject, with most having common denominators that apply regardless of faith or location, and nearly all convey a hopeful and uplifting sentiment. Expressing the idea that we are all eternal beings having a human experience, or speculating about who might be waiting for them, or even devising an experiment to prove the notion of life after death, are ways to introduce the subject. The fact is that your loved one will be leaving this world for a place unknown and you can help ease their anxieties by your willingness to talk about it. 

The Process of Getting there

Finally, it's natural for a person to be concerned about what their final moments might be like. If they're receiving hospice care, they've likely received counsel and are aware of the process and available options to keep them comfortable. As with everything else, it's important to defer to your friend's wishes. For some people, knowledge is reassuring and they're comforted to know what to expect and what their options are. For others, knowledge of what is to come is too frightening and they don't want to receive further information. Respecting your friend's wishes and reminding them they're not alone will go a long way to supporting them in their last days of life. 

❤️ Stay Strong