How do I tell People I Have Cancer?

Or maybe your question is…do I tell people I have cancer? Both are fair questions, and when newly diagnosed or facing a recurrence, people certainly ask themselves both of these questions. This is a highly personal decision, and if you asked 10 different people facing a cancer diagnosis, you would most likely get 10 variations on the answer. My intent is not to tell you what to do, but rather to help you think through your own choices so you can make an intentional decision instead of simply reacting in the moment.

First – define your relationships. This might sound somewhat callous, but in this situation it can be helpful to think through (and in a sense rank) your loved ones, family and friends in terms of how close you are to them. One strategy that can be helpful is to think of the people in your life in terms of concentric circles – like a bullseye. The inner circle of friends and family are those people closest to you – your significant other, best friends and closest family. The next circle out might be your wider friend circle, colleagues at work or fellow students at school that you consider friends, extended family, and so forth. Perhaps the next circle would be for casual friends, acquaintances, coworkers, etc. You can create as many circles as you want and think of them however you want, the key is to have an idea of who means the most to you, and therefore will get the most information from you directly.

1. Your inner circle:  These are people you will most likely want to tell first and personally, and keep updated regularly. They will likely be heavily impacted by this news, as people are often grief-stricken to find out a loved one has been diagnosed with cancer. They will support you, but you may also find yourself supporting them along the way. They will likely be the ones you turn to most for support, both practical and emotional. Be prepared, though – you may need to guide them in how to best support you. Some people do this naturally very well, but to be honest the vast majority of us really don’t. Even though it will require some up front work on your part, I truly encourage you to think about what type of help you need and who will be best prepared to help you in each specific way. My hunch is that you’ll learn quickly who is good at providing emotional support, who can be counted on for practical help, and who to go for when you need your spirits lifted. You also may learn who not to go to at all (even if they are in your inner circle) because their “help” tends to be less than helpful.
2. Circle two:  Extended family, your wider friend circle. Opinion varies greatly once you step out of your inner circle – you will undoubtedly hear lots of opinions from others on this matter, but ultimately it is of course up to you to determine how much energy you want to put into telling people about your diagnosis, and whether you want to be the one to spread the news or whether you’d like to enlist the help of another person or a media platform. Some people still want to personally share information with these extended circles of friends and families, but others will feel comfortable having a loved one help them with this. Many people create closed groups on Facebook, but there are also great resources for creating new websites that are open only to the people you specifically invite for the purpose of providing medical updates (such as CaringBridge). These types of sites are great not only for relaying information and updates to others, but also for coordinating assistance from people in your friend group, keeping a “diary” of your own experience, and sending mass responses to friends and families instead of responding individually to each and every person. By the way, these types of sites are also invaluable to primary caregivers, who often take on a great deal of communication during treatment and recovery periods. If you are going to enlist the helps of a loved one to update others on how you are doing, make sure you have clear communication about what type of information you want shared, and with whom you want them to share. Never assume that your loved one will know what you want shared or what you want kept private – just tell them directly. Think also about what your message is (which may change over time). Do you want people to only hear that you are optimistic and doing well? Or do you want them to know that you are struggling and need support? Do you want to share details of your medical care? Or only “treatment is moving forward and my medical team is pleased.” If you don’t feel certain, find someone you trust and talk it through with them. Mental health professionals – therapists, counselors or social workers – are also great resources for conversations and decisions like these.
3. Everyone else:  Your outer circles ~ casual acquaintances, neighbors and so forth.  You really have no obligation to provide any information to people who fall into these external circles. If it helps you to share with others and process what you’re going through, then by all means share. Just remember that it’s a gamble whether you will get a helpful response. I would recommend that if you decide to share information with people in the casual circles, you are also prepared with an exit strategy from the conversation in case it takes a quick turn towards their Great Aunt Mildred who has a suspicious lump that they “keep telling her she needs to get checked out!”

Once you decide who you’re going to tell and how much information you feel comfortable sharing, the next step is to be ready to tell them what you want them to say back to you and do for you. As in, what type of help would you actually find helpful. People, as a very broad, sweeping generalization, are not all that great about responding to this type of news or knowing what to say or do. They get scared themselves, fall back on cheerleading, platitudes, or their own fear or grief. I can empathize ~ I’ve worked in this field for almost a decade and I still find myself saying things that come from my own fears or need to “fix” whatever is wrong, and are clearly the wrong things to say. So if you know what you want and need from others, just let them know!

1. “Right now I just need people to offer me encouragement.”
2. “Today I don’t really want to talk much about cancer, but would love some company.”
3. “Honestly I’m feeling really angry about all this and just want people to agree with me about how unfair this is!”
4. “What I don’t need are stories about miracle cures. What I do need are recommendations for good books or blogs or other things that might make me laugh and keep my spirits up.”

Remember that not everyone will respond exactly the way you want or need them to, and remember that usually that has more to do with the other person than with you. This is challenging, because in my experience people are not always certain ahead of time who is going to handle this news well, and who won’t. You may be pleasantly surprised by how some people show up in your life with love and support at this time, but you may also be deeply hurt when people you thought you could count on suddenly disappear. I don’t know of any way to make those disappearances easier, except to adamantly reassure you that when people panic and desert you while you are going through hell, it has absolutely nothing to do with you.

While I’m certainly going to need to repost this in a blog for caregivers, I will share it with you readers as well. I am a huge fan of Emily McDowell and her amazing empathy cards. They are the perfect antidote to every time someone tells you “everything happens for a reason.” Even if you don’t need to buy them (or maybe you do…for yourself!), read them on her website and know you are not alone in this mess, and that someone out there just might get you. She also co-authored a book that you could anonymously send to friends and family if they are falling short in how they respond to you…I’m willing to bet it helps!