How to Help Your Friend with Cancer

    How to Help Your Friend with Cancer

    by Colleen Fullbright

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    Colleen Fullbright is a writer who was diagnosed with and treated for breast cancer in late 2000. She lives in Fort Collins, Colorado.

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    How to Help Your Friend with Cancer

    By Colleen Dolan Fullbright

    American Cancer Society

    Copyright © 2015 American Cancer Society
    All rights reserved.
    ISBN: 978-1-60443-239-8



    Fall, 2000: When I received the call from the hospital radiologist telling me that a biopsy had revealed a malignancy in my breast — something about "ductal carcinoma" — it was late on a Friday afternoon and I was home alone. I remember asking the voice on the other end of the line, "Does that mean I have cancer?"

    "Yes, I'm afraid so."

    "What do I do now?" I asked.

    "Well, you'll need to find a surgeon ..."

    I will never forget that brief conversation. I felt just as I had when a police officer came to the door in 1974 and told me my father was dead. I couldn't take in the words. I didn't know what to do. I hadn't expected that the abnormality on my mammogram would be anything more than a cyst. Like most of us who have gone through cancer, I couldn't have been less prepared for the news. I remember driving frantically over to my mother's house and blurting out to her, "I have cancer!"

    * * *

    In the beginning, when the diagnosis is announced, there is no rational thinking, no plan — just shock. In an instant, the person is thrust into an unfamiliar and frightening world.

    From the time that she learns she has cancer until the day she begins treatment, your friend will be faced with major decisions. She may feel rushed to make choices and yet have trouble processing information or recognizing that she has options. She will wonder why this is happening to her. She will wonder whether she is going to die.

    At this point, she will need time to absorb what is happening. She will need high-quality, up-to-date information so that she can begin to sort out her options and determine where to go from here. And more than anything, she will need support from friends and loved ones and assurance that they will be there for her throughout her experience.

    There are three basic types of support: emotional, instrumental, and informational (Helgeson & Cohen, 1996). Emotional support is the verbal and nonverbal communication of caring and concern — being there, listening, empathizing, comforting. Instrumental support includes furnishing material goods or providing a service, such as transportation or housecleaning help — the practical, concrete sort of support. And informational support is the provision of information to guide or advise. Some sorts of support are more helpful at different stages than others. In general, though, emotional support is always helpful. Survey after survey bears this out.

    It can be difficult just to be with someone without trying to fix things. But sometimes just being there is precisely what is needed. As you think about how best to be there for your friend, remember these words from Henri J. M. Nouwen (1974): "We feel quite uncomfortable with an invitation to enter into someone's pain before doing something about it. Still, when we honestly ask ourselves which persons in our lives mean the most to us, we often find that it is those who, instead of giving much advice, solutions, or cures, have chosen rather to share our pain and touch our wounds with a gentle and tender hand" (p. 38).

    Most of the following suggestions will be helpful not only in the period just after diagnosis, but also during your friend's treatment and beyond. In general, try to remember that whatever would be helpful to a healthy person is likely to be beneficial to someone with cancer, unless it also creates additional work or pressure. And remember, little things do count. The right touch, a knowing glance, or a kind smile can do wonders.

    DO ...

    GET IN TOUCH WITH HER, and keep in touch. This may seem basic. But when I sat in on a support group for those with cancer — many whose journeys had been long ones, and their cancers advanced — I learned just how common it is for friends of people with cancer to disappear. For these group members, the memory of having been avoided or abandoned — perhaps years earlier — was still fresh and still stung.

    Stephanie Madsen (2014), a motivational speaker and three-time cancer survivor, describes cancer as the adult version of cooties. "Getting it is not cool, and will send some around you scurrying away in search of a large tree to hide behind," she writes. And as hard as it is to understand why friends flee — it's not as though the person with cancer doesn't notice — it's a reality that some friendships do not survive the challenge.

    You may be uneasy contacting her the first time after the diagnosis. This is normal. If words escape you, you might tell her that you're not quite sure what to say, but you will be with her throughout her illness. If you can't visit or live far away, send cards and notes. Actual physical cards sent through the mail are especially nice, as your friend can display them or keep them close by and look at them over and over again. You might even include a photo that she'll like. Continue to send cards and notes throughout her treatment. Many people tend to send a card only at the beginning of the illness. Don't worry if your message stays the same; a simple "I'm thinking of you" is fine. Leave a supportive voicemail message when you know she will be gone to treatment: extend your good wishes and tell her she doesn't need to call you back.

    LET HER TALK. And talk, and talk, if necessary. One of my newly diagnosed friends found that talking about issues with her friends over and over again while they listened was the only way for her to clarify her thoughts. Remember: you are not there to provide medical advice or theological answers. Simply listen. In Kitchen Table Wisdom: Stories That Heal, Dr. Rachel Naomi Remen (1997) writes of the power of listening:

    When we interrupt what someone is saying to let them know that we understand, we move the focus of attention to ourselves. When we listen, they know we care. Many people with cancer talk about the relief of having someone just listen.

    I have even learned to respond to someone crying by just listening. In the old days I used to reach for the tissues, until I realized that passing a person a tissue may be just another way to shut them down, to take them out of their experience of sadness and grief. Now I just listen. When they have cried all they need to cry, they find me there with them.

    This simple thing has not been that easy to learn. It certainly went against everything I had been taught since I was very young. I thought people listened only because they were too timid to speak or did not know the answer. A loving silence often has far more power to heal and to connect than the most well-intentioned words (p. 144).

    LET YOUR FRIEND DECIDE what to talk about and with whom. Many well-intentioned friends will attempt to draw their friend out, to encourage her to disclose her deepest thoughts and fears. It is best not to force these types of conversations. Also, do not feel slighted if you offer help and she chooses to draw on others. There are plenty of tasks to go around. We all need to be needed, but let her decide how and with whom to share her concerns.

    SIMPLE, HEARTFELT EXPRESSIONS are comforting. Your words needn't be profound. People sometimes feel that if they don't have anything insightful to say, if they can't find the "right" thing to say, they shouldn't say anything at all. Your friend doesn't need profound words; she needs the comfort and presence of someone who cares. And don't be anxious if there are quiet periods when you're together: better silence than hollow words. In fact, silence can be restorative.

    BE GENUINE. "Cancer is a disease, not a demand to reinvent a relationship" (p. 176), wrote Dr. Roger Granet (2001) in Surviving Cancer Emotionally. Your friend needs the security of knowing you will be the same person with her you have always been. In one survey, a majority of people with cancer felt their family and friends exhibited optimism that felt inauthentic (Peters-Golden, 1982). You can be optimistic, of course, but don't overdo it. Acknowledge her fears, doubts, and concerns; don't downplay them. People with cancer need all types of support from family and friends, not just a cheering section.

    BE CALM. Your composure can serve as a source of stability during a time of high anxiety. Try not to become excessively emotional. You can certainly mourn with your friend and express your sorrow, but you want to console her, not the other way around. However, it is important to find someone you can go to for comfort who can be there for you. Perhaps it's your spouse or partner, another friend, or a clergy member. Even a pet can be a source of comfort and calm. The important thing is that you find an outlet for your own feelings.

    TRY TO GIVE balanced support. Everyone has times when she needs more space than others, times when a person wants to talk and times when she wants quiet. Try to express your concern for your friend without being intrusive. Give her space without letting her feel deserted. If you're not sure you're striking the right balance, ask her directly how you can best support her. Don't make assumptions. Balance is essential, too, in allowing your friend to feel capable. She's still a competent person; she's just been thrust into an unfamiliar world. Let her do for herself in whatever ways she feels comfortable. Her levels of self-reliance will probably fluctuate during the course of her illness.

    BE SENSITIVE to her particular coping style. There are a number of ways that people cope when faced with cancer. Some rely on their faith; others turn to humor. Some people need to vent to friends and family to come to terms with what's happening in their lives. Some people use "problem-focused coping" — they might employ a long-range plan, for example — while others have a more "emotion-focused coping" style — like the use of humor (Gilbar & Ben-Zur, 2002). Usually people draw on a combination of strategies. Counselors emphasize that there is no one "right" way to cope. Accept your friend's coping mechanisms. Be supportive of her own style of expressing her fears, pain, and anger. Don't put your expectations or desires on her. Your job is to be there, listen, and help, not direct or make her feel as if she has to act a certain way.

    If she is an extrovert, she will most likely acquire her sense of well-being and resilience from others, according to Jana Bolduan Lomax (personal communication, March 13, 2014), a clinical health psychologist who works in cancer support services. She will likely be more open to frequent visitors than someone who is introverted. Lomax says introverts tend to look within themselves for their strength and rejuvenation, and they will need more privacy and solitude in their cancer journey than extroverts.

    Keep in mind you may need to expand your comfort zone just a bit if you are unaccustomed to a particular coping mechanism. Your friend may be angry, for example, and need to vent her anger and frustration as a way to cope. During trying times, keep in mind that your friend has selected you as someone around whom she can safely be herself. Let her.

    RESIST THE URGE to change the subject whenever something uncomfortable comes up. In one study, researchers from Virginia Commonwealth University examined supportive and unsupportive behaviors experienced by people with cancer (Grange, Matsuyama, Ingram, Lyckholm, & Smith, 2008). Among other findings, they found that it was important for those with cancer to have people in their social networks who were available and willing to listen to their cancer-related concerns, needs, or stories. When this type of support was absent, there was a strong sense of how valuable it would have been to have people listen to them. People need to feel heard, even if the subject is uncomfortable.

    RECOGNIZE HOW DIFFICULT IT MAY BE for your friend to ask for and accept help. It is easier for most of us to give than receive. Leslie Wolowitz, a Chicago-based clinical psychologist, has noted that we grow up learning to be "anti-dependent" (Sherman, 2014). The habit of "doing it ourselves" can be hard to let go. Self-reliance and independence are among the toughest things to give up, and, for many of us, needing help can give rise to a scary feeling of vulnerability. You might acknowledge this possibility and tell your friend that she would be giving you a gift in allowing you to help. Express to her that while you cannot make her well, you want — and need — to support her.

    OFFER TO HELP, and don't stop with the initial offer. At the outset, she may believe that she can handle everything by herself. As treatment progresses, however, she will realize that she has some limitations. As time passes, she may be more likely to accept assistance. Ask about her needs throughout her illness, even if she says all is well.

    When you make offers, propose ideas that fit your time and abilities. Don't offer to drive if traffic makes you crazy or offer to cook if you always burn the oatmeal. Jeanice Hansen (personal communication, March 13, 2014), an oncology social worker at Saint Joseph Hospital Comprehensive Cancer Center in Denver, Colorado, suggests that you say to your friend, "This is what I'm good at and what I like to do." For example, "I really love to garden. Can I help do the planting? Can I come and pull weeds?" Or, "I can offer my husband. He can come and mow your lawn every Saturday." In this way, you're matching your abilities and your strengths with your friend's needs. When her cancer is first diagnosed, she may not have a good idea of what her schedule will be like. But even at this early stage, you may be able to commit to a regular task. Caring for her pet, for example, taking out the garbage on trash days, or picking up her child from school — these could all be valuable ways to help out. Knowing that she can count on consistent help can lessen her worries a bit and help her and her family make plans. Keep in mind that you will need to follow through with whatever you put forward.

    BE SPECIFIC in your offers. Say, "I would like to do/tell/find ____." A vague "let me know if you need any help," while well intentioned, is not helpful. Chances are high that she won't let you know, or she won't have the time or energy to identify her needs and call you to ask for help. Try to be specific and concrete. Some further examples of ways to help follow, and many more can be found in the next section, "During Treatment."

    FIND RELIABLE INFORMATION, if she asks for it. The need for trustworthy information is one of the top concerns of new patients and their caregivers (Matthews, Baker, & Spillers, 2004). Doctors sometimes do not fulfill this need adequately because they underestimate their patients' capabilities to understand the complexities of treatment options (Keitel & Kopala, 2000). At diagnosis, your friend will likely feel as though she is in a whirlwind and can't quite get her bearings. This might especially be true in finding information. Ask her what types of information she needs. Would she like to know more about her specific type of cancer? Information about doctors or specific treatments?

    There are some caveats to consider. There are many websites where you can find all types of information on cancer, treatment options, clinical trials, and complementary and alternative treatments. But because anyone can post information online, it's important to evaluate all sources carefully. For example, what type of organization is publishing the information? In the United States, the most reputable sources tend to be government agencies, hospitals, universities, and major public health organizations. These types of entities will publish information that has been reviewed by experts and will update that information often. In general, beware of sites that promise scientific breakthroughs, miracle cures, or that a product can cure a wide range of illnesses (American Cancer Society, 2014). The American Cancer Society offers more information on its website about sorting through cancer information on the Internet.

    OFFER TO FIND OTHER CANCER SURVIVORS with the same diagnosis, if she is open to the idea. Psychooncologists have found that people who have been through cancer — "veteran patients" — are better equipped to understand the patient's concerns, especially in areas that might be hard to talk about with family members (Mastrovito, Moynihan, & Parsonnet, 1989). For example, someone facing a loss of bowel function or a change in sexual capabilities may depend desperately upon other people who have been through similar experiences for reassurance. It might be easier for a person with cancer to trust a veteran patient to hear her honest thoughts, feelings, and concerns without judgment or disappointment. Talk with someone at a hospital, clinic, or local agency about finding a veteran patient to support your friend. A support group also might be helpful for her (see the next point).


    Excerpted from How to Help Your Friend with Cancer by Colleen Dolan Fullbright. Copyright © 2015 American Cancer Society. Excerpted by permission of American Cancer Society.
    All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
    Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

    Table of Contents


    CHAPTER 1 Diagnosis,
    CHAPTER 2 During Treatment,
    CHAPTER 3 Supporting the Family and Caregiver,
    CHAPTER 4 After Treatment Ends,
    CHAPTER 5 If a Cure Is No Longer Possible,
    "Cancer Is So Limited",
    Resource Guide,
    Reference List,
    About the Author,

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    Many studies affirm that friends can make a profound difference in the well-being of a person with cancer, but friends often find themselves riddled with questions: I want to help, but what do I say? How best can I help my friend with practical matters? What about spiritual support? Many are hesitant to take any action; they need ideas that are helpful in a variety of situations and quickly accessed. How to Help Your Friend with Cancer provides insight into a friend’s cancer experience in each part of the journey, answering questions such as What do caregivers cite as their number one need? and What does a cancer patient fear most when active treatment is over? It contains suggestions for expressing concern and helping in practical ways throughout a friend’s cancer experience, from diagnosis, through treatment, and after active treatment.

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