How to Talk to Someone With Cancer

When I got the news in my oncologist’s office that I had stage IV cancer, he uttered the words…something to the effect of “we knew your numbers were high; it’s not good news.” They didn’t send us home with a pamphlet on how to manage life with cancer, how to talk to your (adult age) kids, family, or friends. We left with nothing but the salt of our tears still in our cheeks.

The absolute toughest conversations were that day. My favorite (West Coast) Aunt was in town for Thanksgiving. We summoned her from my sister’s house. My daughter was out-of-state, my other two boys were working. Eventually we had a quorum in the family room in front of the unlit fireplace. I couldn’t make eye contact and used similar words; “it’s not good news” eventually making eye contact with Aunt Marge who had lost two partners to cancer.

Since then, I’ve grown to accept my situation (most days,) and try and live by the mantra of the podcast (The Butterfly Pavilion Podcast) that I started with my daughter to talk about life stories and living with cancer—”finding light in darkness.” It may sound cliche, and I can’t always live by those words in practice. Today, I sang in the shower, I threw seeds along the back fence hoping they’d grow. That was me finding light in darkness. 

Reactions and coping mechanisms for family and friends have varied from slightly putting feelings in a box on the shelf to ignore, to showing empathy (but not quite knowing what to say or do,) and in the case of my wife and daughter; exemplary balance of love, support, and quite often knowing what to say. Those aren’t the only two; I’ve had steaks sent from a cousin, all sorts of gifts and food from another, cards, and low level activity crafts. All meant to show that I’m loved and being thought of. It’s appreciated.

As I often share with those closest to me, I don’t want sympathy, but with those close to me it would be nice to have empathy. As the days and weeks go by, as the cancer is treated, as it simmers as a volcano, or percolating again, people quite often don’t know what to say. We’ve talked about it ad nauseum on the podcast in a number of episodes.

Perhaps the above is important for one to understand the feelings we might be going through as context for conversations you may have with me or someone that’s seriously ill. The most often used phrase is, “well, you look good.” While having a conversation is appreciated and the phrase is well-intentioned, it doesn’t always “land well.” It may not reflect the pain, emotions or fatigue that are smoldering in that volcano.

Early on, I would send either emails or texts to the family and close friends as the news and appointments are exhausting and as I learned with long Covid, even talking at length can wear me out, and multiplying that by x is not possible. 

With that, I’ve compiled a list of perhaps what to say, or what not to say; especially if I’ve taken the time to share a cancer update.

With that, I’ve compiled a list of perhaps what to say, or what not to say; especially if I’ve taken the time to share a cancer update.

When someone is suffering or shares a health update; it’s okay to say;

How are you holding up? 

How are you doing? 

Are you okay? 

I don’t know what to say, but I’m thinking of you.

Is there anything I can do? (most often, no, but the offer is nice.)

I'm sorry, how are you? 

Are you in any pain, are you exhausted? (most often yes, and yes.)

I don't understand, what does that mean? 

What's next? 

If I’ve taken the time to update, don’t simply reply with an emoji. 

Sorry, but a heart emoji used for a cute puppy video shouldn’t be the same tool used for “I’ve stopped responding to treatment, or my numbers are growing.” Not replying at all, or ignoring it altogether deserves an angry or thumbs down emoji back to you. This isn’t meant as a “calling out” measure, but an attempt to help us both.

Ignoring can be painful especially if it’s someone close to you. I had a close family member that didn’t say a thing for over two years. That’s weird. Having said that, my wife helps keep me centered and we both subscribe to the theory of expecting a specific reaction from someone that doesn’t happen is setting one’s self up for disappointment.

While the above is used in the event of an update; it can be used over time in conversations or simply reaching out. I had a good friend from High School say in conversation, “I don’t really know what to say” was met by my response of, “you just did”—meaning, I could tell that he cared and I was in his thoughts. Use your own words, but the above could help if you’re struggling to find the words. 

I met with another friend of over 30 years who I used to work with over dinner with a small group of friends from the same group. As we were saying our goodbyes, the laughter turned to tears welling up in his eyes, and I hugged him without crying myself. I told him I was okay; or at least that night at that dinner I was. He told me I was brave. I could tell that he genuinely cared. Thanks Ken. I appreciated that.

Well done.