6 Things Not to Say to Someone With Cancer

talking_about_cancer

Quick summary

Experts caution that when caring for someone with cancer, there are six things friends or family often say -- in an attempt to be sympathetic, supportive, or encouraging -- that can have just the opposite consequence: shutting down communication and making the person with cancer feel worse.

Psychiatrist Jeffrey Knajdl, director of psycho-oncology services at Creighton University in Omaha, Nebraska, points to these six common sayings to avoid, along with suggestions for what to say instead:

1. "Everything is going to be all right."

You have no way of knowing if it will be or not, says Knajdl, and such a statement ends up sounding like an empty platitude -- plus you establish a sense of mistrust. "It doesn't make the person feel better," says Knajdl, "because he knows it's not true and it just makes him feel dismissed and not heard."

What to say instead: What the person really wants to hear is that you're going to be there for him through the good times and the bad, and that he's not going to go through cancer treatment alone. There will be days when it does feel like everything's going to be all right, and you'll be there to celebrate that with him, but there will be days when discouraging test results come in or he's in pain -- and you'll be there for that, too. "When you talk to patients, their two big fears are that they won't make it through treatment, and that they'll be alone and in pain," says Knajdl. "Just keep telling the person that you'll be there with him and you'll make it through this together."

2. "I know how you feel."

This is almost an automatic response for many of us when someone is sad or upset. We say it out of the best of intentions, to demonstrate our compassion, our sympathy, our sense of having been there. The problem is, it has the unintended effect of shutting the other person down, says Knajdl. "When you say, 'I know how you feel,' the unspoken second part of the thought is, 'and therefore you don't have to go into any detail about it,'" Knajdl says. "It increases the patient's sense of isolation, because it's like telling him you don't want him to talk about it."

Unless you've been treated for the same type of cancer and have undergone exactly the same treatment, you really don't know how the person feels. "We have no idea what it's like, and it's upsetting to the patient when we act like we do," says Knajdl.

What to say instead: A better approach, according to Knajdl, is to ask something like, "How are your mood and spirits holding up through this?" If the person you're concerned about is anxious or sad, this gives him a chance to tell you how he feels, which can be a big relief to someone who's trying to pretend he's doing just fine. And even if he answers that he's holding up pretty well, he'll still feel better that you asked.

3. "Try to keep a positive attitude, relax, and avoid stress. It can help you heal."

Cancer patients hear endless variations on this "mind over body" theme. There are going to be days when a patient doesn't feel positive at all, and you certainly don't want him worrying that he's sabotaging his own chances of recovery. And what if he has a stressful job, or is a type A personality who reacts easily to stress -- do you want him feeling guilty or worrying that his high-strung personality or tendency toward anxiety either "caused" or will worsen his cancer?

Unfortunately, an awful lot of the literature conveys, in one way or another, the underlying message to cancer patients that they may have "caused" cancer through stress, worry, or a negative attitude, and that they could heal the cancer if they'd only develop a mellow outlook or sunny disposition. All that really happens is that they feel even more anxious about trying not to be anxious, or they feel guilty for not feeling happy. Even some visualization techniques can make cancer patients feel a sense of defeat, Knajdl says, if the focus is on healing but healing doesn't seem to be happening.

What to say instead: Suggest specific solutions. When your loved one is tense or anxious, ask him to identify what's stressing him out and how you can help him put the worries to rest. In other words, instead of saying "relax," help him relax by eradicating the stress trigger. For example, try refocusing any visualization he's doing toward a concrete and reasonably accessible goal, such as comfort or sleep. Instead of trying to visualize eradicating a tumor, suggest that he visualize falling into a deep sleep in a quiet, safe, pleasant place. Sometimes you can help eradicate stress with a concrete act of assistance. Knajdl remembers one patient who was very anxious in the hospital because he felt he hadn't put his financial house in order. His son brought all the documents to the hospital, and they took care of them one by one.

4. "We can beat this."

In our rush to be supportive, it's all too easy to fall back on such encouraging and inspirational messages. But they can give cancer patients a deep-seated feeling of failure. "I call this the Lance Armstrong syndrome, this idea that if you have the right fighting spirit you can overcome disease," says Knajdl. "I admire Armstrong and he's done great things to publicize cancer, but this idea that people can triumph over cancer with will power and an upbeat attitude is just crazy. There are all sorts of factors that contribute to why some people recover and some don't. The truth is, some people just get lucky."

This problem tends to come up with cancer survivors in particular, who may believe very deeply that their attitude, philosophy, spiritual focus, or belief in healing helped them survive. And sometimes hearing such stories can make other patients feel hopeful and optimistic. But if things aren't going well -- if a scary test result has just come in, if chemo's side effects are almost unbearable, if your loved one is facing the fact that his cancer may not be curable -- then hearing others' tales of triumph may not be helpful.

What to say instead: The best way to help your loved one feel positive and hopeful is to just keep reassuring him that you're in this together, and that you'll keep caring for him and supporting him and making him as comfortable as possible during his treatment.

5. "Now, now, don't get yourself all worked up."

Your loved one is scared, angry, or in tears, and you want him to feel better. But unfortunately, a statement like this makes it sound as if you want him to put his feelings, which are natural and unavoidable, under wraps. "In this situation, it's okay to get worked up, and it's okay to vent," says Knajdl. "We have this fear of feelings getting out of control. But sometimes a patient needs opportunities to cry or get angry or get upset, and if you can help him express these feelings and get them out, in the end he'll feel better."

What to say instead: If you don't know what to say, it's okay not to say anything at all, Knajdl says. Just offer the comfort of your presence, a hug, or an arm around the shoulders. Allowing some silence without rushing to fill it gives the person a chance to say what's on his mind in his own time. Perhaps he's afraid of pain, afraid of letting you down, or frustrated by feeling incapacitated by his illness. "One patient surprised his son by saying, 'I feel frustrated lying here in the hospital because I feel like I'm wasting my time,'" Knajdl says. "It turned out he was actually upset that he didn't have his legal affairs in order. The son responded by saying, 'Would you like me to get a lawyer to come in so we can take care of that?' That made his father feel much better."

6. "Congratulations, you're done with chemo [or radiation]."

As a friend or family member, you'll feel thrilled when treatment is finished, but the patient's feelings are likely to be much more mixed. During treatment, he's taking action. That can be empowering because the focus is on a solution, either a cure or progress in pushing back the cancer. When treatment is finished, it can feel like there's nothing more for him to do but wait, and naturally he may feel anxious and uncertain. "Often, people don't feel like celebrating. Instead they think, 'Now what do I do? Just wait for the cancer to come back?'" says Knajdl.

No matter how relieved you are, try to keep it to yourself. "It's really common to say something like, 'Boy, am I glad that's over,' but that implies two things: that the treatment has been a burden on you, and that you want your loved one to be happy about it when maybe he's not feeling happy," Knajdl says.

What to say instead: Give the person a chance to express how he's feeling. Try asking an open-ended question, such as, "How are you feeling now that we're finishing up the chemo?" This way, you allow him to control the response. He might say, "I know we were talking about throwing a party when I finished chemo, but I really don't feel like it." The bottom line is, whatever he's feeling is okay, and your job is to make it clear you're ready to listen.

Resources

Websites

The American Cancer Society Cancer Survivors Network has lots of resources about how to talk to someone with cancer.

People Living With Cancer (www.cancer.net) has a helpful section on talking about cancer.

Books

Cancer Etiquette: What to Say, What to Do When Someone You Know or Love Has Cancer, by Rosanne Kalick, (Lion Books, 2005)

Help Me Live: 20 Things People with Cancer Want You to Know, by Lori Hope (Celestial Arts, 2005)

Other resources

Guided visualization tapes are available from the Healing Mind (http://www.thehealingmind.org), created by Martin Rossman, MD, one of the pioneers of this mind-body technique.


4 months ago, said...

There are other things one should never say to a person who has just told them she has been diagnosed with breast cancer. The first words out of my older sister's mouth were "don't give me too many details. Just tell me what I absolutely have to know and nothing more because I just can't let this make me crazy." My younger sister's first words were, "This has hit me hard, real hard, so I will let you know when I can handle more news from you. Now, that makes them sound cruel but they, especially the younger one, are not cruel people and I thought we were close to one another. That being said and not knowing what I am allowed to say to them, I just don't say anything which has left me alone in the world while on this bitter journey. When cancer news upsets you, please, please try to show some level of support to the one with cancer.


11 months ago, said...

My parents and brother live far from me. Whenever I have surgery to a treatment for my stage 4 kidney cancer they thank my husband profusely for "taking care of her". I hate this. It makes me feel 1) that I'm a terrible burden to be passed around and 2) that they think he might consider leaving me over this! I know there are bad spouses out there but mine isn't one of them. They are probably also trying to express gratefulness to him for doing what maybe they wish they could if they lived closer. I think what would sound a lot better is, "We are so glad you are in Elena's corner. You have a wonderful relationship and are lucky to have found each other".


over 1 year ago, said...

Here's something NOT to say to a person with a life-threatening illness: "And...??? What's that to ME?" Yes, she actually said that to me. She's not a friend anymore. And I'm all better, by the way.


almost 2 years ago, said...

How about "You don't look like a chemo patient" Huh? Sorry, I don't meet your expectations. Should I shave my head, will that make it more believable to you?


almost 2 years ago, said...

Heard it all. There not the one in pain.


over 2 years ago, said...

I forgot, mine is rated aggressive, rare, and incurable. Then these twits say they saw on the Internet or heard from a nurse this is a minor thing.


over 2 years ago, said...

I have face cancer, so it's literally in everybody's face. I hate to be told that I should have used sun block-I'm 71, and sun block didn't come out until the late 1980s-and it was rated about 5. I hate being told that I should have worn a hat. Some people call my site- Fisherman's cancer because it's caused by the reflection of UV rays by water. I was an avid fisherwoman and I surfed. Also the huge floppy cancer hats don't shade this area. I won't go to cancer meetings, as many of the other cancer patients dump on me, saying that they wish that they had a cancer that could have been removed. For over 25 years, each time I saw a doctor, they stared at it. I asked them about it. I sat naked at the university, while dermatology students examined me, and each time, I asked the teaching Board Certified dermatologist to please cut it out. Then I have my huge stupid cancer hat. on my lap, table, etc. and i have to hear these twits tell me to wear a hat. We're indoors, stupid twits. You'd think that the ACS counselors that run these dog and pony shows would somehow intervene. They don't. My opinion is don't donate to ACS-do you realize how many sites they have? They seem to be in competition to each other.


over 2 years ago, said...

#6 ..... "we"...? *really*? I didn't realize there was a mouse in my pocket when I underwent chemo!


over 2 years ago, said...

Any suggestions on how to approach the problems and feelings of caregivers? We are often hurting as badly as our loved ones and some comments made by others like "Keep your chin up", or "I'm sure you can handle it" or "Just let go and let God" drive me crazy. These statements seem to say "I don't really want to help or hear about your concerns, I just want to hear about the patient". It is very hurtful, esp. when it comes from a family member.


over 2 years ago, said...

Also, don't ask melanoma patients if they're going to tan again. Some of them have never tanned. Like my husband.


over 2 years ago, said...

My son died of brain cancer some years ago. This article was very helpful in retrospect, and fortunately we did many of the things outlined in the article well. The article is very good.


over 2 years ago, said...

The comment that always gets those of us with myelodysplastic syndrome is "But, you look so good." I now just come back with "I'll be the best looking body in the morgue.


over 2 years ago, said...

The one that I heard often when my 30 year old daughter was diagnosed with thyroid cancer was "Well at least she got the GOOD CANCER". Definitely not anything you say to a Mother or anyone who has any kind of cancer.


over 2 years ago, said...

An acquaintance has just been diagnosed with cancer, I'm not really close to her, but I want her to know that I want to be supportive to her. This article is helpful.


over 2 years ago, said...

I would add a few: You have such a lovely-shaped head (oh, so better that I bald than you?) I could never have done what you have done (yes, you could. I didn't choose it either. We do what we have to do). And many, many variations of "what did you do to get this? You touched on that in your article


over 2 years ago, said...

You hit the nail on the head when you said: don't say ' I know how you feel" unless you have been down that same road.


over 2 years ago, said...

The author forgot the classic and offensive "Everything happens for a reason" Really??


over 2 years ago, said...

Add this one: "You look so good!" Just because I look good doesn't mean I feel good. I have a lot of pain that doesn't show as we traditionally think people with cancer look. I haven't lost a ton of weight either but I still have days that are impossible to get out of bed.


over 2 years ago, said...

Bravo!! Thank you for that article. Your dead on with Peoples feelings, and show us how to express our Kindness, care, support, empathy, etc. If you don't mind, I would like to send this article to jw.org, they've had similar Articles, and I'm sure would love to see this one. Thank's so much, Joel


over 2 years ago, said...

Here's another thing to not say to a patient: "How are WE?" YOU are not the one with cancer. Let the patient be the patient. For some stupid reason medical personnel are notorious for using the royal "we".


over 2 years ago, said...

LOL - 1. Oh, that's the same cancer that Momma die from. 2. If things don't work out - can I have your Love Bug? 3. You're going to beat this thing , if it kills you. 4. I'll be here for you, er...I mean, well we were planning o moving to Alaska. 5. How are you feelin? 6. How much time do they say you've got?


over 2 years ago, said...

Your so strong! !! You'll beat this!! I AM TIRED IF HEARING THIS.. truth is I am tired..unbelivably tired. Not as strong as they think and with kids and a husband who would rather forget then deal. Just because your strong doesn't mean it will go away.