• What not to say to your friend with cancer

    You know what they say about good intentions, right?

    I think it’s fair to say that people generally have very good intentions when they make encouraging (or what they think to be encouraging) statements to friends, family and acquaintances who are dealing with cancer. Unfortunately, even the best of intentions can end up sounding disingenuous, empty, disconnected, and ultimately discouraging. If you’ve said any of the things below to someone, don’t feel bad! I’ve been working in a cancer setting for nearly a decade and still find myself occasionally saying things that I know are unhelpful, and kicking myself later. It’s almost a knee-jerk reaction sometimes. Hopefully, though, knowing what not to say** and why not to say it will help you say unhelpful things less often and be genuinely supportive more often.

    This is by no means an exhaustive list, but I’ll start with some of the most common “encouraging statements” I’ve heard patients express frustration with over the years.

    1. You look great! I’m starting with this one because it seems so incredibly innocent, and is probably one of the most common. Here’s the deal with the “you look great” statements:  Cancer is weird. Sometimes during treatment and/or recovery you look “sick” (no hair, pale, bruised) but feel pretty ok. Other times you look totally normal and maybe even better than you used to (having lost weight because you have no sense of taste and are nauseated all the time), but feel lousy. The outside of a person simply does not always reflect the inside.
      • If you’re feeling pretty good but not looking your very best and find people treating you differently because they think you are “sick,” it can be discouraging, even de-motivating. You can end up doing less, trying less, accomplishing less partially because of the way others might be treating (codding) you.
      • On the other hand If people tell you you’re looking great when you feel like crap…well…what do you say to that? “Thanks but actually I feel completely awful.” “Yup, cancer – most effective diet plan ever!” Somehow the assumption is that if you look good, you feel good, and then everything can be normal and no one has to worry about you, support you, help you. You should be behaving perfectly normally.
    2. You’re a fighter/survivor/so healthy/so strong, you’re going to beat this! Are you a doctor? Specializing in cancer? Do you own a crystal ball? Are you a fortune teller? If not, then PLEASE don’t say this. Actually, even if any of the above statements are true, still DON’T SAY THIS. Why? Because…
      • It can often trigger a “what if I don’t?” reaction in whoever you’re talking to, but doesn’t actually give them an opening to talk with you about that “what if?” feeling. The socially appropriate response to this statement is something similarly positive…no matter what the person is feeling inside. People end up feeling stuck pretending they are nothing but optimistic instead of being honest about how hard and scary this process can be. It is, by the way, entirely possible to be positive, optimistic and hopeful…and still have times that you can’t help but wonder “what if?” Those feelings and behaviors are not mutually exclusive.
      • The “you’re a fighter/survivor” statement also assumes that there are survivors in the world, and there are non-survivors. It assumes that there is something intrinsic to the person you’re saying this to that makes them a survivor who is going to beat this, but maybe not the person in the chemo chair next to them. There are 2 problems with this – If you are a “survivor” and don’t beat cancer, did you fail? Is it your fault? Did you give up? Not try hard enough? Second, if there really are survivors and non-survivors…well what if the person making the statement is wrong and you are actually not in the survivor group? What if their crystal ball is wrong and the person in the other chair is the survivor? Then are you doomed? Is it fate? You can see how this can be problematic, right?
    3. Congratulations! You’re better now, right? This one usually comes in response to people completing a round of treatment, getting an all-clear from the doctor, or reaching some other milestone. To be sure, there are times that people experience cancer as being behind them when treatment is over, but for many people cancer (and the fear of recurrence) is something they continue to live with. It is very normal to continue to worry about cancer 1 year, 3 years, 5 years, even 10 years after completing treatment. The expectation that you’re “all better” can be confusing and feel shaming – “Everyone else seems to be relieved, why aren’t I?”

    I could go on and on, but I’ll stop there for now.

    The good news is that even if you have screwed up and said the wrong thing, it is fairly easy to repair this mistake. Just acknowledge it, apologize and try again. Ask how you can be a good friend, and what you could say instead next time.  And remember that none of us get it right all the time!

    **My disclaimer is that there are always some people who find some of these statements and sentiments to be helpful either all of the time or some of the time. No judgement toward them! Knowing what’s helpful to you personally (if you’re the one dealing with cancer) or to the person you are supporting who is going through cancer is what is most important. This blog, more than anything, is meant to start the conversation and provide some insight into why certain things that seem helpful and innocent might not actually feel that way to the person they’re meant to encourage.

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