The diagnosis of cancer can be overwhelming, not only for you, but also for your friends and relatives. People often don't know what to say. They may feel sad and uncomfortable and may be afraid of upsetting you. They might be frightened about the possibility of losing you. Sometimes it is easier for people to say nothing because they are afraid of saying the wrong thing. Some people find it easy to talk while others may become overly careful or act too cheerful.

Sometimes just being with a person can be more meaningful than anything that might be said. Here, we offer some suggestions to help you, your friends, and family talk to each other about cancer, so that you can feel more at ease when facing it together.

How are you feeling?

It's normal to wonder, "Why me?" or to feel sad, angry, or afraid. You will most likely have many different emotions as you learn more about your diagnosis and begin to learn about treatment options. Physical changes related to treatment or to the illness itself can also have an emotional effect. The first step is to admit to yourself how you feel. It is OK to allow yourself to feel the way you do.

Only you can decide when to talk to your friends and family about having cancer. Most people need and want to talk to someone when they find themselves in this kind of situation. Sometimes, telling those close to you helps you begin to take in the reality of what's happening to you. Some people find that by talking, they begin to solve problems and think about other issues as their family and friends ask questions. As you talk with them, you may want to write down the questions that come up so that you can discuss them with your cancer care team.

You may find it helpful to start by making a list of people that you want to tell about your cancer in person. Then you can make another list of less close friends that another friend or family member may contact with the news.

Also give some thought to how much you want to share about your diagnosis. You may want to explain what kind of cancer you have, which treatments you might need, and what your outlook (or prognosis) is. People are very sobered by the news that someone has a cancer diagnosis. You may want to reassure them that you will do whatever it takes to fight the cancer and would like their support and encouragement.

It is common for people to have many questions about your cancer and how it's treated. It can be OK to explain all this to 1 or 2 close friends, but it may get tiring to tell a lot of people this much detail. You can always suggest that they call or visit us to learn more for themselves, or to find out how they can best offer help. (See the "Additional resources" section.)

Think about your ''trigger points" or topics that are too sensitive for you to talk about yet. Do you become angry when people question your choice of treatments? Maybe this is a topic you will have to avoid. Does it annoy you when people bring their religion into it, saying, for example, "God never gives you more than you can handle"? Think about the things that people have said or could say that bother you. Then, plan a response that is comfortable for you and cuts off the conversation. And once you've shared what you wish to share, be prepared to change to another topic.

What can family and friends do to help?

One of the first things a friend or family member will often say is "What can I do to help?" You may be tempted to say, "Oh, nothing right now. We're just fine." Maybe you want your privacy, or feel you have all you can handle without having more people around you. Remember that people really do want to help, and it is likely that you will need some extra help during your cancer treatment. Your friends and family need to do things for you and want to support you. It helps them feel they are a part of your life. Allow friends and family to help you. Be as specific as possible about the kind of help you need. For example, tell them when you need a ride to the doctor, or find out if they might be able to help with housecleaning, yard work, or child care. There may be times when you don't know what you need, but even just saying that will be helpful.

Encourage loved ones to talk to you about how they are feeling so you can work through questions together. You can say, "How are you doing? Can you believe this?" This gives your friend or family member permission to talk with you about their feelings. If you are not prepared to hear about their fears and worries, don't ask questions like this. It can be tough enough to manage your treatment and figure out how you feel, without worrying about others. It takes effort and emotional work that you may not have the energy for. But if you want to foster openness, this is one way to do so.

Sometimes you may not want to talk about how you feel or about how others feel. You can gently tell others this just by saying something like, "You know, usually I am OK to talk about things like this, but today I just can't handle it. I'm sure you understand." In saying this, you set your own boundaries about when and under what circumstances you are able to discuss your illness.

Who should I talk to?

In general, tell the people close to you how you feel. This is sometimes hard to do, but it is healthy to share with others what you are feeling. If you do not feel comfortable doing this, you may want to find a support group or a mental health counselor to help you. Your support group or counselor will be there for you at a regular time set aside for you to focus on and talk about your concerns and issues. Others prefer workshops, peer groups, or religious support. Try different things until you find what works for you. When you keep other people involved and informed about your illness, it helps ease your burden. Friends and family can share their strength and concern with you and with each other, which can be helpful for everyone involved.

If you or your family do not normally like to talk about certain personal issues, remember that it's OK not to open up to everyone. Some people are very careful about who they talk with and what they talk about. This might be a good time, though, for you to start to work on becoming more expressive with trusted loved ones.

What do I do when people do unhelpful things?

Telling you to cheer up

You may have friends or family members who tell you to "cheer up" when you tell them about your sadness or fears. It is OK to ask them gently if they would be willing just to listen, without judgment or advice (unless you ask for it). It is important for your mental health that you find someone you can talk to. Don't allow yourself to be discouraged by people who are uncomfortable with your feelings. Some people are unable to listen, not because of you, but because of their own experiences or their own sadness. That has nothing to do with you. You may just have to realize that this person may not be the best one for you to talk to. Others may handle it better.

Many people asking about your cancer

You may find that sometimes you are pressured to answer questions about your cancer when you don't feel like it. To avoid this, you might want to ask a family member or friend to be your spokesperson. It can be emotionally exhausting to repeat the details of your illness to everyone who is concerned about you. Having a spokesperson keeps you from having to do this, but keeps loved ones "in the loop" without wearing you out.

In some cases, your cancer illness may be "big news" in your community. Often, people are truly concerned but really don't know you very well. Of course, there are also people who are just curious. Cancer is very personal and you need to be comfortable with how much you share with people who just want to know what's happening. You may have to think about ways to tell people you don't want to talk about your personal business. In many cases, "Thank you for asking, but I'd rather not talk about it right now" is enough to make people understand, but sometimes you may have to be more direct. "I'd prefer not to go into details" or "I don't want to get into my private health issues" may be needed. Think about how you want to handle questions from curious people you don't know. Try to prepare a response that works for you.

There are also Web sites or "blogs" designed for cancer patients and families where they can update medical information without having to talk on the phone for hours about what is going on. This can be especially helpful for patients going through longer illnesses, such as a bone marrow transplant or treatment for leukemia or Hodgkin disease. You will need a computer-savvy friend or family member who can take on the task of signing up family and friends and then regularly updating the news. As another option, some people send out group emails every few days to update their concerned friends whenever something changes. This can save many phone calls and yet keep the information coming for the caring or even the just curious.

Friends, loved ones, and even complete strangers will ask you about your cancer. Think about how you want to deal with these questions. The important thing is to find a way that works for you.

Bringing up cancer when you're doing something else or just not in the mood

Sometimes people will try to comfort you on a day when you are feeling especially angry. Or a person may come up to you and begin talking about your cancer when you are trying to focus on your child's play at school. Maybe someone you barely recognize stops you in the grocery store with the sad story of her father's cancer. You really don't want to hear their story, but you know they are just trying to be nice or relate to you. How can you stop them politely? Sometimes you just have to take a couple of deep breaths and say calmly, "Thank you so much for your concern, but I need to focus on something else today." Remember, this is your illness and it is your decision about whether or not you choose to discuss it.

When others become impatient or angry with you

Sometimes those close to you may become angry too. Just as you are going through many different emotions, those around you may be going through the same kinds of feelings. Most people will feel angry at some point, but try to keep in mind that family and friends are angry with the situation -- not with you. You are probably going through exactly the same thing at times.

You may hear, "You aren't doing the things you used to do." Children, and even some adults, can be extremely self-centered. Your social, family, and work roles will change as you begin to focus on treatment and healing. You may not be able to do all that you had been doing. You will adjust more easily if you explain this to those around you and share your reactions to the different changes taking place in your life. Talk to your family about how tasks can still be done even though you will not be able to do all of them yourself.

Keep life as normal as possible

As much as you can, allow yourself and your family members to keep life as normal as possible while you are having treatment. Encourage your family to keep doing the things they always did (enjoying hobbies, playing sports, exercising, spending time with friends, and so on) without feeling guilty. Children, especially, benefit from the routine, but adults also find that it offers them an anchor for day to day life.

What about singles?

The same ideas apply to people who are not part of a couple. But you may feel unsure how and when to talk about having cancer if you are single, especially if you are just starting to date someone. Trust yourself to be the judge of the best time to share this part of your life with them. You may want to talk about it very early in a relationship or you might want to wait until you feel a closer bond with the person. This decision is yours to make. Whatever reaction the person has, you are not at fault for sharing the news at a bad time. You may find it helps to practice what you will say with a friend before sharing with your new partner.

For single people without supportive family members nearby, it may be even more important to let close friends know what's happening with your cancer and its treatment. Think ahead to tell them what they can do when they ask how they can help -- people who live alone often have a few extra needs that those who live with others don't. You may not feel OK going home alone after chemotherapy, for instance. Or, you may need to have someone you can call if you start having trouble during the night. Some of your friends may feel comfortable with food shopping or other less involved tasks. Remember that your friends want to help you, and by telling them what you need you can help them feel good about doing that.

When to call the doctor

There are some signs that should tell you that you might need help from your cancer care team. Talk to you doctor, nurse, or social worker if you have any concerns that seem too big to manage on your own or if you:

• are feeling overwhelmed
• are feeling depressed, sad, hopeless, discouraged, or "empty" almost every day for most of the day
• have lost interest or pleasure in activities that you once enjoyed
• notice a change in your eating habits (eating too much or too little)
• have weight loss or gain
• have changes in your sleep patterns (are unable to sleep, wake up too early, or sleep too much)
• find that others notice that you are restless or "slowed down" almost every day
• have decreased energy or fatigue (severe tiredness) almost every day
• have feelings of guilt, worthlessness, and helplessness
• have trouble concentrating, remembering, or making decisions
• have thoughts of death (not just fear of dying) or suicide, or make attempts at suicide
• notice wide mood swings from depression to periods of agitation and high energy

Cancer treatment may cause some of these symptoms, and you may have other problems and side effects that will need attention as well. But if you have the first 2 symptoms on the list above, along with 3 or more of the other symptoms, you may also be depressed. If these symptoms last for 2 weeks or longer or are severe enough to interfere with your normal functions, you need to be seen by a mental health professional.

Ask your nurse, doctor, social worker, or minister for help or a referral, or contact your local office of the American Cancer Society or call us at 1-800-227-2345.

For more information about the physical symptoms and side effects of cancer treatment, and when you should get help with them, talk to your doctor or cancer nurse. It may help to see our information about the treatment for your type of cancer. Call us or visit us on the Web at www.cancer.org.

What not to do

• Don't ignore or neglect a friend or relative who may need to open up and talk with you.

• Don't ignore your own need to talk with someone.

• Don't set up a false front, or a "happy face," if you don't really feel that way. While you might tend to try and protect your loved ones by acting as cheerful as possible, it will help you and them more if you share your true feelings.

• Don't feel that there is a perfect way to talk or handle your interactions with others. You will find that there are times when you feel great about talking and sharing and other times when you feel that communication is not going well. Realize that you -- and others -- are doing the best you can most of the time. And that is good enough.

Additional resources

More information from your American Cancer Society

We have selected some related information that may also be helpful to you. These materials may be ordered from our toll-free number, 1-800-227-2345.

• Questions That People Ask about Cancer (also available in Spanish)

• After Diagnosis: A Guide for Patients and Families (also available in Spanish)

• A Message of Hope: Coping with Cancer in Everyday Life (also available in Spanish)

• Listen with Your Heart

• When Someone You Know Has Cancer

• When Someone You Work with Has Cancer

• Helping Children When a Family Member Has Cancer: Dealing With Diagnosis

The following books are available from the American Cancer Society. Call us at 1-800-227-2345 to ask about cost or to place your order.

• Cancer in the Family: Helping Children Cope with A Parent's Illness

• Couples Confronting Cancer

• What Helped Get Me Through: Cancer Survivors Share Wisdom and Hope

No matter who you are, we can help. Contact us anytime, day or night, for information and support. Call us at 1-800-227-2345 or visit www.cancer.org.

References

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Text Revision 2000. Washington, DC: American Psychiatric Association.

Eyre HJ, Lange DP, Morris LB. Informed Decisions: The Complete Book of Cancer Diagnosis, Treatment and Recovery, 2nd ed. Atlanta: American Cancer Society 2002.

Figueiredo MI, Fires E, Ingram KM. The role of disclosure patterns and unsupportive social interactions in the well-being of breast cancer patients. Psycho-Oncology, 2004;13:96-105,

Manne S, Glassman M. Perceived control, coping efficacy, and avoidance coping as mediators between spouses' unsupportive behaviors and cancer patients' psychological distress. Health Psychology, 2000;19:155-164.

Yoo GJ, Aviv C, Levine EG, Ewing C, Au A. Emotion work: disclosing cancer. Support Care Cancer. 2009 May 12.

Last Medical Review: 06/16/2009
Last Revised: 06/16/2009