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The diagnosis of cancer can be overwhelming, not only for you,
but also for your friends and relatives. People often don't know what
to say. They may feel sad and uncomfortable and may be afraid of
upsetting you. They might be frightened about the possibility of losing
you. Sometimes it is easier for people to say nothing because they are
afraid of saying the wrong thing. Some people find it easy to talk
while others may become overly careful or too cheerful.
Sometimes just being with a person can be more meaningful than
anything that might be said. In this document, we offer some
suggestions to help you, your friends, and family feel more at ease
when facing this new situation together and how you might talk to each
other about it.
How are you feeling?
It's completely normal to wonder, "Why me?" or to feel sad,
angry, or afraid. You will most likely have many different emotions as
you learn more about your diagnosis and begin to think about treatment
decisions. Physical changes related to treatment or to the illness
itself can also have an emotional effect. The first step is to admit to
yourself how you feel. It is okay to allow yourself to feel the way you
do.
Only you can decide when to talk to your friends and family
about having cancer. Most people need and want to talk to someone.
Sometimes, telling those close to you helps you to begin to take in the
reality of your situation. Some people find that by talking, they begin
to solve problems and think about other issues to explore as their
family and friends ask questions. As you talk with them, you may want
to write down questions that come up that you want answers to.
You may find it helpful to start by making a list of people
that you want to tell about your cancer in person. Then you can make
another list of less close friends that another friend or family member
may contact with the news.
Also give some thought to how much you want to share about
your diagnosis. You may want to explain what kind of cancer you have,
which treatments you might need,and what your outlook (or prognosis)
is. People are very sobered by the news that someone has a cancer
diagnosis. You may want to reassure them that you will do what is
necessary to fight the cancer and would like to have their support and
encouragement.
Think about your "trigger points" or topics that are too
sensitive for you to talk about yet. Do you become angry when people
question your choice of treatments? Maybe this is a topic you will have
to avoid altogether. Does it annoy you when people bring their religion
into the situation, saying, for example, "God never gives you more than
you can handle"? Think about the things that people have said or could
say that bother you. Then, plan a response that is comfortable for you
and effectively cuts off the conversation. And once you've shared what
you wish to share, be prepared to change the conversation to another
topic.
What can family and friends do to help?
One of the first things a friend or family member will often
say is "What can I do to help?" You may be tempted to say, "Oh, nothing
right now. We're just fine," because you want your privacy and feel you
have all you can handle without having people around you. Remember that
people really do want to help, and it is likely that you will need some
extra help during your cancer treatment. Your friends and family need
to do things for you and support you. It helps them feel they are a
part of your life. Allow friends and family to help you. Be as specific
as possible about the kind of help you need. For example, tell them
when you need a ride to the doctor, or find out if they might be able
to help with housecleaning, yard work, or child care. There will
probably be times when you won't know what you need, but even just
saying that will be helpful.
Encourage loved ones to talk to you about how they are feeling
so you can work through questions together. You can say, "How are you doing? Can you
believe this?" This gives your friend or family member permission to
talk with you about their feelings. If you are not prepared to hear
about their fears and worries, don't ask questions like this. But if
you want to foster an atmosphere of openness, this is one way to do
that.
Sometimes you may not
want to talk about how you feel or about how others feel. You can
gently tell others this just by saying something like, "You know,
usually I am OK to talk about things like this, but today I just can't
handle it. I'm sure you understand." In saying this, you set your own
boundaries about when and under what circumstances you are able to
discuss your illness.
Who should I talk to?
In general, tell the people close to you how you feel.
Although it is sometimes hard to do, it is healthy to express emotions.
If you do not feel comfortable doing this, you may want to find a
support group or a mental health counselor to help you. Your support
group or counselor will be there for you at a regular time set aside
for you to focus on and talk about your concerns and issues. Others
prefer workshops, peer groups, or religious support. Try different
things until you feel you have found what works for you. When you keep
other people involved and informed about your illness, it helps ease
your burden. Friends and family can share their strength and concern
with you and with each other, which can be helpful for everyone
involved.
If you or your family usually do not like to talk about
certain personal issues, remember that it's okay not to open up
completely to everyone. Some people are very selective about who they
talk with and what they talk about. This might be a good time, though,
to start to work slowly on becoming more expressive with those close to
you.
What do I do when they say these things?
You may have friends or family members who tell you to "cheer
up" when you tell them about your sadness or fears. It is okay to ask
them gently if they would be willing just to listen, without judgment
or advice (unless you request it). It is important for your mental
health to find someone you can talk to. Don't allow yourself to be
discouraged by people who are uncomfortable with your feelings. Some
people are unable to listen, not because of you, but because of their
own experiences or their own sadness. That has nothing to do with you.
You may just have to realize that this person may not be the best
sounding board for you. Others may handle it better.
When you feel that you are pressured when you don't feel like
it, you might ask a family member or friend to be your spokesperson. It
can be emotionally exhausting to repeat the details of your illness to
everyone who is concerned about you. Sometimes, your cancer illness can
be "big news" in your community. Often, people are concerned but really
don't know you very well. There are Web sites or "blogs" designed for
cancer patients and families where they can update medical information
daily without having to talk on the phone for hours about what is going
on. This can be especially helpful for patients going through longer
illnesses , such as a bone marrow transplant or treatment for leukemia
or Hodgkin disease. You will need a computer-savvy friend or family
member who can take on the task of signing up family and friends and
then regularly updating the news. Other people send out group emails
every few days to update their concerned friends whenever something
changes. This can save many phone calls and yet keep the information
coming for the caring or the just curious. The important thing is to
find something that works for you.
Sometimes people will try to comfort you on a day when you are
feeling especially angry. Or a person may come up to you and begin
talking about your cancer when you are trying to focus on your child's
play at school. Maybe someone you barely recognize stops you in the
grocery store with the sad story of her father's cancer. You really
don't want to hear their story, but you know they are just trying to be
nice or relate to you. How can you stop them politely? Sometimes you
just have to take a couple of deep breaths and say calmly, "Thank you
so much for your concern, but I need to focus on something else today."
Remember, this is your illness and it is your decision about whether or
not you choose to discuss it.
Sometimes those close to you may become angry too. Just as you
are going through many different emotions, those around you may be
going through the same kinds of feelings. Most people will feel angry
at some point, but try to keep in mind that family and friends are
angry with the situation and not with you. You are probably going
through exactly the same thing at times.
You may hear, "You aren't doing the things you used to do."
Children, and even some adults, can be extremely self-centered. Your
social, family, and work roles will change as you begin to focus on
treatment and healing. You may not be able to do all that you had been
doing. You will adjust more easily if you explain this fact to those
around you and share your reactions to the different changes taking
place in your life. Explain to your family how tasks will still be done
even though you will not be able to do all of them yourself.
As much as you can, allow yourself and your family members to
keep life as normal as possible while you are having treatment.
Encourage your family to keep doing the things they always did
(enjoying hobbies, playing sports, exercising, spending time with
friends, and so on) without feeling guilty.
What about singles?
The same ideas apply to people who are single. But you may
feel unsure how and when to talk about having cancer if you are single,
especially if you are just starting to date someone. Trust yourself to
be the judge of the best time to share this part of your life with
them. You may want to talk about it very early in a relationship or you
might wish to wait until you feel a closer bond with the person. This
decision is yours to make. Whatever reaction the person has, you are
not at fault for sharing the news at a bad time. You may find it helps
to practice what you will say with a friend before sharing with your
new partner.
For single people without supportive family members nearby, it
may be even more important to let close friends know what's happening
with your cancer and its treatment. Think ahead to tell them what they
can do when they ask how they can help--people who live alone may have
a few extra needs that those who live with others don't. You may not
feel okay going home alone after chemotherapy, for instance. Or, you
may need to have someone you can call if you start having trouble
during the night. Some of your friends may feel comfortable with food
shopping or other less involved tasks. Remember that your friends want
to help you, and by telling them what you need you can help them feel
good about doing that.
When to call the doctor
There are certain signs that you might need help from your
cancer care team. Talk to you doctor, nurse, or social worker if you
have any concerns that seem too "big" to manage on your own or if you:
- are feeling overwhelmed
- are feeling depressed, sad, hopeless, discouraged, or
"empty" almost every day for most of the day
- have lost interest or pleasure in activities that were once
enjoyable
- notice a change in your eating habits (eating too much or
too little), or have weight loss or gain
- have changes in your sleep patterns (are unable to sleep,
wake up too early, or sleep too much)
- find that others notice that you are restless or "slowed
down" almost every day
- have decreased energy or fatigue (severe tiredness) almost
every day
- have feelings of guilt, worthlessness, and helplessness
- have trouble concentrating, remembering, or making
decisions
- have thoughts of death (not just fear of dying) or suicide,
or make attempts at suicide
- notice wide mood swings from depression to periods of
agitation and high energy
Cancer treatment may cause some of these symptoms. But, if you
have the first 2 symptoms on the list above, along with 3 or more of
the other symptoms, you may also be depressed. If these symptoms last
for 2 weeks or longer or are severe enough to interfere with your
normal functions, an evaluation by a mental health professional is
needed.
Ask your nurse, doctor, social worker, or minister for help or
a referral, or contact your local office of the American Cancer Society
or call us at 1-(800)-ACS-2345.
What not to do
- Don't ignore or neglect a friend or relative who may need
to open up and talk with you.
- Don't ignore your own need to talk with someone.
- Don't set up a false front, or a "happy face," if you don't
really feel that way. While you might tend to try and protect your
loved ones by acting as cheerful as possible, it will help you and them
more if you share your true feelings.
- Don't feel that there is a perfect way to talk or handle
your interactions with others. You will find that there are times when
you feel great about talking and sharing and other times when you feel
that communication is not going well. Realize that you--and others--are
doing the best you can most of the time. And that is good enough.
Additional resources
More information from your American Cancer
Society
We have selected some related information that may also be
helpful to you. These materials may be ordered from our toll-free
number, 1-800-ACS-2345.
- After Diagnosis: A Guide for Patients and Families (also
available in Spanish)
The following books are available from the American Cancer Society.
Call us at 1-800-ACS-2345 to ask about cost or to place your order.
No matter who you are, we can help. Contact us anytime, day or
night, for information and support. Call us at 1-800-ACS-2345 or
visit www.cancer.org.
References
American Psychiatric Association. Diagnostic and Statistical
Manual of Mental Disorders, 4th ed. Text Revision 2000.
Washington, DC: American Psychiatric Association.
Eyre HJ, Lange DP, Morris LB. Informed Decisions: The
Complete Book of Cancer Diagnosis, Treatment and Recovery, 2nd ed.
Atlanta: American Cancer Society 2002.
Figueiredo MI, Fires E, Ingram KM. The role of disclosure
patterns and unsupportive social interactions in the well-being of
breast cancer patients. Psycho-Oncology,
2004;13:96-105,
Manne S, Glassman M. Perceived control, coping efficacy, and
avoidance coping as mediators between spouses' unsupportive behaviors
and cancer patients' psychological distress. Health Psychology,
2000;19:155-164.
Revised: 04/11/08
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