What to say (and what not to say) to a friend who is going through cancer

Receiving a cancer diagnosis is an incredibly frightening and isolating experience that can last long beyond that first hospital appointment. Friends of course want to say and do the right things to support those in the situation, but sometimes it can be very hard to know what exactly the right thing to say is, what the wrong thing to say is, and how you can really offer meaningful support. Natasha Whelehan offers her insights.

When I first thought about writing a post on what to say to your friend who has cancer, I initially envisaged a quick list of Do’s and Don’ts. But then I started to really think about it. I recalled my own cancer experience. I remembered what brought me comfort, and what upset me. I thought about the stages of treatment and how different phases required different support.

In reality there are a number of very different and distinct phases to a cancer journey, and there may be different things you can do at each phase of treatment. Cancer treatment can last many months and include surgery, chemotherapy, radiotherapy, oral chemotherapy, hormone therapy or a combination of the above depending on what type of cancer you are dealing with.

So with this in mind, I’ve tried to break things down a bit and offer some ideas on how you can offer support at the different phases of treatment. I’ve written the following based on my own experience (breast cancer) and the fact that I was quite open about my diagnosis. I’m very mindful of the fact that support can take many forms depending on the individual and how much they wish to share. But I hope there is something in here that may prove helpful for anyone who has a friend going through treatment.

The Diagnosis Phase

In the early days after diagnosis, everything seems like a whirlwind. Often it’s difficult to know what to say or do. In many cases the early days are a time of scans, biopsies and enormous uncertainty while the doctors work to get a clear picture and formulate a plan.

How can you support your friend during this often extremely uncertain period?

Do:

• Tell them if you don’t know what to say, but let them know you care, you are sorry this has happened and they are facing this and that you are there for them.

• If they wish to talk about their diagnosis, listen, ask questions if they are comfortable answering them, pay attention and try to remember what they have told you. If they don’t wish to talk in detail respect this and don’t probe.

• Everyone reacts differently to a cancer diagnosis some people will cry, some will crack jokes and use black humour. Your friend may not be reacting the way you imagine you would react. Remember that this is about them, so take your cues from them.

• Ask them when they have appointments or scans planned. Take note of the dates. Perhaps let them know your thinking of them and don’t expect a reply but wanted them to know they are in your thoughts. A simple text can mean so much.

• Consider having one designated person who will let other people know the results of tests, scans etc if/when your friend is ready to share. Lots of messages ‘checking in’ might be overwhelming, as can be repeating the same information over and over, especially if the results are not what your friend was hoping to hear. Perhaps set up a WhatsApp group or group email.

• There can be a lot of appointments during this period, a lot of hospital visits. Logistical help might be really appreciated but not everyone feels comfortable asking. Don’t make vague offers of ‘let me know if you need a lift’. Be specific, tell them exactly when you are free and that you are happy to drive them, attend, wait with them if they wish, etc.

• If your friend has young children, offer to do the school run, or take them to the park, local soft play centre etc. Something to distract them if needed as often there can be a lot of visitors to the home, a lot of worried looks and people asking how things are during this early phase of the ‘marathon’. Children are perceptive and your friend is likely to be concerned about the impact of their diagnosis on them. Knowing they are happily playing at the park can be a huge weight of their shoulders.

A few things NOT to do:

• Don’t tell your friend that you ‘just know they will be fine’. The reality is you don’t know that.

Conversely, if your friend says that they believe they will be fine then support them wholeheartedly.

• Please don’t tell your friend to ‘just be positive’ if they say they are scared, or worried. They may want to talk about their fears. Listen to them, accept that they might be frightened. If you don’t know what to say, tell them that. Their fears are real, and it might be hard for you to listen to them, but imagine how hard it is for your friend to be FEELING them. If ever there was a time to put yourself in the other person’s shoes, this is it.

• Don’t tell your friend about your great aunt, neighbour, the man down the road who had ‘what you have’ and died! This is not encouraging. And believe it or not, it happens! True story, someone told me about a lady who ‘beat’ her breast cancer but then it came back 5 years later and ‘went through her in a few weeks’. I hadn’t even started chemo. It was not inspiring!

Active Treatment

Treatment can involve a number of different stages depending on the individual’s treatment plan. For me it was surgery, chemo and radiotherapy. Active treatment lasted 8 months. For others it is less, for some even more.

For anyone supporting someone going through treatment, I would say the Do’s and Don’ts above still apply, but would add a few more:

• When your friend is in hospital, offer to visit (if at all possible), check if there is anything in particular they need. If they are away from home, and were hospitalised unexpectedly they may be lonely, worried or upset and would love a distraction. Or they might not be feeling up to visitors, they might not even get a chance to reply. Either way they will appreciate that you cared and thought of them.

• Sometimes the ill person can find it hard to admit they are not well and need support. Just dropping them a text and saying you’ll drop up some soup or a casserole or run to the shop for them can make all the difference.

• Offer to drop off and pick up young kids from school. This can be an enormous help, especially if ‘mum’ is the patient and dad is still trying to work.

• Be specific in your offers. Tell them when your free and what you can do if they need it. E.g. “I’m around Tuesday and going to Tesco, I can take you or else give me a list”. Remember, they may not accept your first offer, or your second, but it matters that you are offering and can be a real boost emotionally, so don’t stop.

• During chemo it’s possible your friend will lose their hair. This will change their appearance. For some people hair loss is huge. Support them in the way they choose to tackle this stage of treatment. Please don’t say ‘It’s just hair’, it’s really not.

• Treatment can be lonely at times. Offer to call around if you can and watch a movie together. Take your friend out for coffee. Meet up with friends and just have a chat and a laugh.

• Tiredness can be a huge side effect of treatment. If you are visiting your friend and they look exhausted or are dozing off ask them are they ok for you to stay, or tell them to have 40 winks while you go clean their bathroom or run to the shops or something. It’s not personal, treatment is just exhausting.

• Remember that the drugs your friend is on can have many side effects. They can affect mood, sleep, appetite. If your friend is not ‘acting like herself’, don’t take it personally. The days immediately after chemo can be the hardest, take this into account when visiting.

• Talk to your friend about things happening in your own life as well. Sometimes it’s nice to just have a distraction and not always talk about cancer.

Don’ts:

• Don’t pretend it’s just not happening. When you see your friend, ask them how they are feeling. You will be able to tell if they wish to talk about their illness or not. Take your cues from them. Or even ask them if they want to talk about it if you can’t tell. But don’t just ignore it.

• Don’t take it personally if your friend isn’t free to meet up or take your visits or rarely replies to your texts. They appreciate that you care, appreciate that you are taking time to make contact and check in on them. Keep texting, keep offering to visit. It matters and it makes a difference. Sometimes as you go through treatment the number of voices cheering you on becomes fewer and fewer as people get caught up in their own busy lives. The people who kept on cheering will always hold a special place in my heart.

The New Normal

Active treatment is over. The last session of radio, the final chemo, surgery complete. Everyone cheers. ‘You did it’, people say. ‘Now you can get back to normal!’

What people often don’t realise is that The New Normal can be a scary place. A place where anxiety and fear of recurrence can be daily companions. This is often the time the reality of what you have faced can hit you full force. It can also be a time when you start your maintenance treatment. In my case for example I will be on hormone therapy for the next 10 years. This includes a daily pill (Tamoxifen), a monthly injection (Zoladex) and every 6 months an infusion of a drug called Zometa.

These are in themselves drugs that come with many side effects.

This is often a difficult phase. People want you to be ok, they want everything to go back to the way it was before you were diagnosed. You want this yourself. Often it is just not that simple.

Offering support in this phase can include:

• If your friend is expressing fears and concerns then listen, be there for them, don’t brush their concerns aside and tell them ‘sure your fine now’. It can take time to process what they have just been through. Please remember that PTSD is a very real and common occurrence for many people after treatment ends.

• Remember that cancer treatments can have lasting side effects. It could take your friend months to recover their energy levels. Be patient with them.

• Your friend has been through a life changing experience. Be patient. Be kind. If they have hospital visits, are starting new treatments, have a scan and disclose this to you then ask them how they are doing, check in with them, celebrate the clear scan, ask them how they are feeling after the new treatment. Bear in mind that for them the cancer journey continues after active treatment ends and your friend is still likely to need some support.

I hope this is of some help if you have a friend who has recently been diagnosed with cancer. Please let us (and others) know in the comments section any other hints and tips you would add for anyone supporting someone through cancer.