What do you say to a person who has cancer?

Well-meaning but clueless person: “Let me know if you need anything.”
Snarky me: “Really?  Thanks!  Empty your purse and let’s see what you have in there. Wait, is that purse Prada? I need that, I have medical bills to pay and want to look good paying them. Oh, that’s a pretty wedding ring, lots of diamonds, can I have that too?”

What you should say is absolutely nothing. This is a time to do, not talk. Pick up the phone and order a day  of housecleaning service. Send over a fruit basket. Knock on the door and drop off a casserole.  Come over and scrub the tub.  Pick up the kids from school during chemo week.   Bring a DVD of a funny movie and some chocolate.  Stay with her in the hospital so she will get good nursing care.  Do something, don’t just talk about it.  And, when you stop by to help, don’t be shocked if the house is a mess.  No judging –  the person has cancer and maybe can’t move her arms, and housecleaning is far from important.  Just  help, and don’t ask permission first.

You don’t really think we are going to pick up the phone and ask you for help – do you? Would you? If you don’t want to do anything (and there is nothing wrong with that)  than here is the right thing to say:  “I’m sorry you have cancer.”  No meaningless additions needed.

CP:  “You are so brave”
SM: “Wow, how did you know about the child I rescued from the burning building last night? It wasn’t even in the papers!  Oh, are you referring to the time I went to war and fought for my country and got in the firefight and dragged my injured friend to safety? Or, do you mean the time I single-handedly stopped a bank robber from shooting that elderly lady?

No? You are referring to me showing up on time for doctor’s appointments?”

It’s nice to be called brave, but we cancer patients all know we aren’t. Brave is a word best reserved for people who deliberately put themselves in harm’s way.  Trust me, if I could get out of this, I would.  I’d run so fast I’d leave old people and children behind.  And puppies. All the puppies.  The truth is, I have no choice but to put one foot in front of the other and do what my doctors say.

What you should say:  “I’m sorry you have cancer.”  If you must add another phrase, you can say, “You are handling this difficulty with grace.”

Then order housekeeping service, because I am guessing what is going on in that bathroom isn’t that graceful.

CP:  “I know exactly how you feel.”
SM:  “Oh fantastic, let’s talk about the best way to relieve chemo-induced constipation without bringing on diarrhea! What’s your tip?”

Here’s the right thing to say:  “Tell me how you feel?”  And, then listen.  I’ll probably say I’m fine.  Because, I am.  But, someday I might not be.  And, if I want to tell you that my butt is plugged like a 2 year old tube of super glue, than try to listen without telling me about the time you had the same experience.

CP:  “Oh, my Aunt Sally died of that.”
SM:  “Oh cool, was it a long, painful death?  Tell me all about it!”

What you should say:  “I’m sorry you have cancer.”    If you think I’m going to relate to you because you had relative who died of my disease, you are thinking incorrectly.  I’m well-aware this disease is fatal but maybe I’m in a good mood – don’t bring me down.

CP:  “You never know, you could get hit by a bus.”
SM:  “Our school has cancelled busing, thanks to budget cuts, so the very real risk of a bus crashing through the front window into my office has been eliminated.  Whew.

Here is a fact:  40,000 women a year die of metastatic breast cancer.  I’m not quite up on how many people die by getting hit by a bus each year, but I’m guessing it’s more  in the 40 range.  (You might have to include trains in that too).  Which do you think is more likely for me?

What should you say? “I’m sorry you have cancer.”

CB:  “At least you get perky new boobs.”
SM:  “Honey, you have clearly never seen reconstructed breasts.  Trust me, nobody is giving me any beads during Mardi Gras.”

Try, “I’m so sorry you are going through this.”

CB:  “You can beat this!  There are great treatments now.”
SM:  “Which one do you think will keep me in remission longer?  Navelbine and Herceptin?  Should I switch to Xyloda and Tykerb?   Should I ask for stereotactic body radiation or radiofrequency ablation?  What do you think about portal vein embolization?”

There are great treatments now. Some which keep cancers at bay for years.  None of which – to date – cures a woman with metastatic breast cancer. And, I’m guessing you have no clue what is out there for metastatic breast cancer patients. How about saying, “I hope you find a treatment that is easy, and I’m sorry you have to go through this.”

CB  “Just keep a positive attitude”
SM: “Don’t worry, I’m so busy concentrating on controlling the rivers of diarrhea without needing a diaper, my blood levels being so low I can get infected if my dog sneezes, and vacuuming up the peeling skin on my hands and feet that I’m too busy to think negatively.”

It’s awful to tell somebody to think positively.  Do you think all those cancer patients who are now dead thought negatively?  It’s not a good thing to put the burden of our disease on us.

CP:  “Don’t worry, everything will be okay.”
SM:  “Oh, great! Did you read that in the tea leaves?  Was it in my horoscope?  Do you have a crystal ball?  Can I see?”

What you should say is … say it with me … “I’m sorry you got cancer.”  Don’t deny our reality.  It’s very likely that – for those of us with metastatic disease – everything will not be okay.  We hope it will.  We want it to be and we are going to do everything in our power to live as long as we can.  But you have no idea what will happen.

CP: “Hey, look what happened with Lance Armstrong.”
SM:  “I know, I only wish I’d gotten cancer of the balls!”

The truth is, while not taking away from Lance’s story, his type of cancer has a high cure rate even at a later stage.  At the last stage of testicular cancer, Stage III,  there is a 50% to 80% five year survival rate.  At Stage IV breast cancer, there is a 16% to 20% five year survival rate.  So, yeah, look at Lance.  So what?

CP:  “So, how ARE you?” (Grave voice, sad face)
SM: “”Fine thanks, and you?””

I’m still the same person, please talk about me behind my back like you are supposed to. When in front of me, put on your unconcerned face.

CP:  “Everything is going to be fine.”
SM:  Why yes, everything will be fine. After I die, the world will still turn on its axis, people will get born, people will grow old. Flowers will bloom, rainbows will sparkle. I won’t be there to see any of it, but sure, it’ll be fine.

At least, until a moon-sized asteroid crashes into the earth and kills you all.”

Here’s the truth.  You can say any of those things to me, and I won’t mind.  You know why?  I lived 50 years without having cancer, and I probably said them all to somebody who did have cancer at some point too.  Nobody really knows what to do or say, and that’s part of being human.

The thing is, We With Cancer are just the same as we always were.  We aren’t braver; we are just sick.  We have the same hopes and dreams.  So, just treat us normally, as you would want to be treated.  Please, ask how we are doing and then take your cue from our response.

The one thing you should never do is put the onus of our illness back on us.  We didn’t cause it by negative thinking, by eating a hotdog when we were 12, by sitting in the sun, or by not exercising.  It just happens.  I am positive in spirit but that won’t cure my cancer. Neither will being negative kill me.  It’s not my fault. Never deny our reality, whether you agree with it or not.

When all else fails, what do you say to a person who has cancer?

“I’m sorry.”

Ann Silberman is a breast cancer patient who blogs at But Doctor… I Hate Pink.

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  • Tracy Krulik

    Gonna be honest. At first I thought the responses were a bit maybe too snarky, but then I read, “Oh cool, was it a long, painful death?” and I cracked up. You’re absolutely right. People are so clueless about what to do and say when they find out I have cancer. I will always have cancer, because mine is one of those really slow growing incurable kinds which is more like a chronic disease than crazy scary CANCER, and they still turn white and back away from me. Thanks for a good laugh.

    • http://twitter.com/JRGunnCLNC Julie R. Gunn

      Many years ago as a 17 year old nurses aide, a physician walked into my patient’s room while I was making his bed.  The patient was sitting in a chair and I started to leave the room to facilitate physician/patient privacy.  The physician advised I could remain and continue my duties while he talked with his patient. Within a few seconds I wished I had left the room.  The physician sat down beside the patient and stated “Well Joe you’ve got cancer.  There really isn’t much we can do other than a few treatments that might prolong your life a little, but you’re gonna die”.  The physician then turned and walked out of the room leaving both the patient and me completely startled and at a loss for words.  I have never forgotten the curt and uncaring bedside manner of that physician who basically “announced” the patient’s impending demise and then abruptly leaving the patient.  As a registered nurse for 37 years, I have (thankfully) never witnessed such actions repeated by any other physician.

  • Anonymous

    If only I had a dollar for every time a clearly well-intentioned friend, family or stranger told me to “think positive” when I was going thru my breast cancer battle – - and for every time someone who loved me assured me that I was “going to be ok”. Inside I was screaming “POSITIVE THINKING?!?!? REALLY?”  and “I’LL BE OK? HOW DO YOU KNOW? YOU SAID THAT WHEN I HAD THE BIOPSY?!!?. This article will be incredibly helpful to well meaning folks who really only want to say something to make you feel better AND of course to those on the receiving end. Thank you for sharing!

  • Anonymous

    Ann, thank you for giving SM a voice: your honesty and candor teaches/guides/reminds the rest of us how to be better friends, supporters, and caregivers.  May the blessings you bring to others through your writing be yours in return as you take this journey; I’m so sorry you are going through this, please know that through the power of the Internet many are thinking of you.
    Regards,
    Tina Tockarshewsky
    The Neuropathy Association

  • Anonymous

    Just perfect, Ann, thanks so much!

    I’ve been writing and speaking about this subject for almost a decade and am thrilled that you have put such a humorous and memorable spin on it!
    Lori Hope
    Author of Help Me Live (Revised): 20 things people with cancer want you to know

  • pippaken

    Wow, I hear you Ann. 
    For those who want to listen to a short interview with a physician who had just this experience after being diagnosed with Stage 3 breast cancer, and decided, once she was in remission, to do something useful for cancer patients AND the folks who are trying to support them, listen to my podcast interview with Dr Melanie Bone and learn more about her and her organizations here at http://www.entrepreneurialmd.libsyn.com/webpage/what-a-tough-life-experience-taught-one-entrepreneurial-physician

  • Anonymous

    I can so relate to this and could add a few paragraphs of my own. It seems most people lump all cancers into the same category and think that stage I prostate cancer is the same as stage IV lung cancer or stage III breast cancer and so on. Further they think just because their aunt or grandpa or neighbor “beat cancer” I must have the same chance of doing so. Most don’t understand or maybe don’t want to understand what “metastatic” means.

    One of my many frustrations is that when I share that I have metastatic lung cancer, people automatically assume that I must have brought it on myself by smoking. In fact I’ve never smoked. Many people with lung cancer have never smoked. But whether they did or didn’t, it is equally devastating to them. They need compassion, not judgment.  

  • Elle Gee

    Awesome! Thank you so much!!!! I hate pink, too. October used to be my favorite month – no more. And, I’m sorry you have cancer.

  • Karen Glowacki

    Cleverly written! What a brilliant and thoughtful piece. I was having a conversation about this very topic today. For people who don’t know what to say, it’s ok to say, “I don’t know what to say, but I’m sorry you have to go through this.” Just be thoughtful and considerate.

    And I am sorry you have to go through this. Thank you for sharing your words that will hopefully resonate with others.Thanks again,Karen GlowackiWhatNext.com

  • http://twitter.com/ddwebster Dana Webster

    I didn’t even get half through your post when I’d already posted the link to Facebook, Twitter, messaged all my cancer friends.

    This week, I had a CT scan and received the news that the autologous stem cell transplant I had for recurrent Hodgkins Lyphoma apparently worked.  The my body put my family and friends through the past few months is apparently now put in its place.  That’s what we thought the previous 2.5 years, too.

    The best thing someone could say to me was, “I’m sorry…..this sucks!”.  Because it does suck.  Being 36, having 2 very young children and cancer for the second time really sucks.  My odds were great the first time, apparently it wasn’t enough.  My odds this time are 50/50.  I don’t take remission for granted (never have).

    But, I don’t need you to tell me to be positive until you’ve been in my shoes and experienced the horrible things I have just so I can live another day.  Yes, I appreciate the prayers…..but I appreciate the person who said, “Sometimes prayers just aren’t enough”. 

    Thank you for your wit and humor.  I’m sorry cancer has affected all your lives because, “it sucks!”

  • http://twitter.com/DoctorPullen Edward Pullen

    All so try, and delightfully written.  As a spouse of a woman with advanced ovarian cancer we had a nice laugh reading your post.  Oh so true. Especially about the unintended placing of blame back on the patient with well intended comments about how to help with things like diet, yoga, herbs, supplements, etc. I’ve added But Doctor I Hate Pink to my RSS reader.  

  • http://profiles.google.com/leejcaroll Carol Levy

    I am a person with chronic intractable pain and an advocate for women in pain awareness (WIPA).  We have this discussion a lot.  “Why do people say these things to us?”  Your answers and questions work for us too (and I imagine you could put in any number of disease and disorder names in lieu of cancer.) (The only difference is that with chronic intractable people too many people do not understand/believe we are really in pain.
    (I am going to link this article to my WIPA group.)
    Carol Jay Levy, B.A., CH.t
    author A PAINED LIFE, a chronic pain journey  
    Women In Pain Awareness
    https://www.facebook.com/?ref=home#!/groups/111961795481256/
    http://apainedlife.blogspot.com/ ,

  • http://www.practitionersolutions.com Niamh van Meines

    Ann,

    I’m sorry you have cancer.

    I’d love to help, but I don’t even know you, I can’t cook very well & I don’t even clean my own house, so I’m useless to you. 

    You forgot the “God only gives us what we can deal with” spiel.

    I hope you will throw them all a bone at some point & decide that you still like them even though they are clueless.

  • Anonymous

    Since I have cancer, I cannot bear watching people try not to offend, so I make it easy for them…Let them know I am OK today, but regret the whole damn thing ! We usually can have a reasonable chat afterwards… Trying to coordinate people helping was a nightmare, so banned the whole lot.. Easier to ask and see if people can or cannot. If they are not available to help, let them off cheerfully ! I had a very public illness and have gone to ground, since I got better. Everyone does it their own way and people generally are kind and do not wish to say the wrong thing.

  • http://twitter.com/dgyeo Denys Yeo

    Those of us with cancer do live in a different world, one that cancer free people may never be able to really understand. But your blog reminds me that we do have a voice and we need to let others know how it is for us; this may help to break down the barrier between these two worlds.

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