Talking to Your Loved One About Cancer

December 23, 2022

When a family member, friend or loved one says, "I have cancer," it’s hard to know what to say. You may feel emotional – of course you are shocked and sad. But so is your loved one. Oncology-certified social worker Eileen Matteo, LISW-S, OSW-C, describes the things you can do and say (and not say) to be supportive in this very difficult and emotionally charged situation.

“Probably the most important thing is to meet the person where they are in the moment,” says Matteo. “Every cancer journey is different – some people will go through treatment and thrive, others may not. Don’t try to look ahead or predict the outcome. Instead, take a day-to-day approach. Ask them ‘How do you feel today, right now?’ Always try to bring the conversation back to the present – what can be done today to make their journey more manageable.”

“Take cues from your loved one and let them direct the conversation,” she adds. “Sometimes, it is okay not to say anything – to just be there to listen and hold their hand if that’s comfortable and appropriate for you both. If the person is up to talking, never challenge or argue with what they are saying or feeling.”

Sometimes What You Don’t Say Is More Important

Many people react to news of a loved one’s cancer diagnosis by trying to minimize or even deny the reality of the situation. They might say things like:

But you don’t look sick.
Don’t worry - everything will be okay.
I’m sure you’ll be fine.
I don’t believe it - maybe the doctor is wrong.

“All of the above statements encourage denial and are not helpful,” says Matteo. “Also, never suggest that you know how they feel. Even if you have had cancer, your feelings and your journey are unique to you – your loved one’s feelings may be very different and will likely change from day to day and week to week. The most helpful approach is to listen, acknowledge and validate whatever they are feeling in the moment.”

“Another well-meaning but unhelpful comment is, ‘God doesn’t give us more than we can handle.’ This actually puts a burden on the person – suggesting that they should be stronger, more resilient at a time when they may feel hopeless and frightened. If they are spiritual, and the relationship supports it, it’s okay to offer to pray with them. If they are angry, let them be angry – don’t judge.”

Offer Specific Ways You Can Help

Instead of asking open-ended questions like “How can I help?” or “What can I do?” be proactive and specific – your loved one may be reluctant to ask for help or may be too anxious to think clearly. Some suggested ways to offer help include:

I made a pot of soup today – I’m bringing some over for you.
I’ll pick up your kids from school today.
I’m going to the grocery store today. If you make a list of what you need, I’ll shop for you too.
We’ll be over to mow your lawn this weekend.

In addition, every conversation doesn’t need to be about cancer. It’s okay to inject a little humor now and then. “For example, I often ask patients to make a David Letterman style list of the top 10 worst things well-meaning people have said to them. This can lighten the mood for a few minutes and allow them to laugh a little. It’s absolutely okay to talk about positive things in your life and in theirs – ask about their non-cancer-related news and fill them in on what’s going on in your life. Talk about Aunt Betty’s latest antics or what so-and-so at work did or watch a funny TV show together. I firmly believe that laughter really is the best medicine,” says Matteo.

Be Honest, Gentle and Direct

People with cancer will often ask some hard-hitting questions of their friends and family. And, even though it can be difficult, it’s important to respond sensitively, but honestly. For example, if they ask about their appearance, answer gently but truthfully. Acknowledge any changes but then quickly redirect to how they feel in the moment. For example, you might say, “You do look a little thinner but not much more than last time. But how do you feel today?”

In situations where the person has been told there are no more treatment options, they may ask you, “Am I dying?” The best response to this is, “I don’t know. What did the doctor say?” Never say things like “don’t talk like that” or “don’t be silly” – that only dismisses their feelings and may shut the conversation down.

“Instead, if they are open to discussing it, try focus on what can be done vs. what can’t be done. Ask them about the plan going forward – emphasize that having a plan can help them feel more in control. Talk about next steps. Talk about what they want to do with their remaining time. Introduce the option of palliative care if pain is an issue for them. And, if the relationship warrants it, ask what the doctor has told them to expect in the coming weeks or months,” says Matteo.

“The most important thing is to let your loved one know they are not alone and that they will have your support throughout their journey, regardless of the prognosis. Acknowledge their feelings and fears as well as your own – we’re all only human and it’s natural to be sad when someone we love is sick and hurting.”