It’s hard to know what to say when your friend or relative tells you they have cancer. In that painful moment our tact, good sense, knowledge and insight is put to the test – and so easily fails us. 

As Joanna Moorhead of the Daily Mail recently wrote, the most inappropriate comments and messages have, at least, provided some laugh-out-loud moments after she was diagnosed with breast cancer. But with just a little effort, we really can do better. Here’s a guide to What Not To Say, and a few suggestions of better options.

1. Nothing at all. Not saying anything is fine if you have another way to be there for someone who’s hurting. Eye contact, a compassionate smile, a (welcome) gentle hug or hand squeeze, a small act of courtesy or kindness – all so important, and so much better than a verbal blatt. Actions really do speak louder (and often better) than words.

Yet even the blattiest, dumbest remark (“My friend died of breast cancer”, “Not another one with cancer, it’s too much”, “Oh no, I can’t lose you”, “What bad luck!”) may be better than silent avoidance, which leaves the person feeling isolated and rejected.  People with cancer know it’s difficult for others -they’ve been through those emotions of shock too – but your absence is noted, and it hurts. It comes across as not caring, even though the truth is that you fear saying the wrong thing.

Rather, go for simple sincerity: “I don’t know what to say, that’s terrible news” is absolutely fine. You don’t need sophistication: “That sucks, I’m so sorry” is also quite OK. After that, let your friend or family member’s response guide what happens next. You are part of her life for a reason, so just being yourself is all that’s needed.

2. Meaningless platitudes. If you woke up with stomach flu and spent a couple of days feeling utterly washed out and miserable, would you appreciate a walking, breathing Hallmark card suggesting that you count your blessings and be strong for your family? No, you would not. So why would dealing with a longer term but equally unpleasant illness be different?

The fact that someone has cancer (or any other chronic illness) does not mean that he or she is unaware of the many wonderful blessings in life. Quite the reverse, in fact. Yet an ‘attitude of gratitude’ does not do away with pain and suffering, and “being strong” does not require an elaborate pretence that this doesn’t hurt. So dig deep and find a way to be there, alongside the suffering – be one of those blessings instead of talking about them.

3. False optimism. It’s good to get feedback from others that we are amazing, strong, capable and lovable people. But this is cancer, not a prospective job interview.  Comments such as “You’ll be just fine” or “You’re such a positive person” – even if it’s true – are best avoided. It’s bad enough being diagnosed or treated for cancer, without also feeling that people will be disappointed if you’re not a noble example to everyone else.

On the subject of platitudes, how about ditching some tired metaphors such as “doing battle”?  Cancer is not like Joan of Arc leading her troops into glorious battle – it’s more like riding the Tour de France on a broken bike with a heavy backpack. And it’s OK to be scared, or angry, or broken hearted, so show your loved one that you understand and accept this.

A good alternative might be: “I hope things get better/go well for you today/this week”. Hope needs to be reasonable if it is to be truly empowering, so keep it focused in the here-and-now.

4. Preaching and pontificating. A word to the wise: Cancer and other dread diseases have no “silver lining”. People can and do create beauty out of the worst of situations, because beauty dwells within us. Yet cancer is not a gift, and attempts to make positive sense of it are invariably unhelpful at best and deeply hurtful at worst. That which doesn’t kill you, makes you….nearly killed. ‘

Cancer is not a punishment, either. The person with cancer did nothing to deserve it and cancer is not God’s lesson plan specially for you. You can do all the unhealthy things and never have cancer, you can be an organically fed fitness fanatic and still get it anyway. Did that person do something wrong in a previous life?  You may consider this query to be over the edge of insanity let alone insensitivity, but it’s actually been said!!

Again, rather keep it simple: Bodies are not perfect, many things go wrong with them, and cancer is one of those many possible things. Our efforts to understand and prevent it are, so far, very imperfect; and until we can do better cancer is just one of those things that happen to people.

Unlike bodies, “Words once spoken, never die”. You can’t unsay it. Rather, before gifting the other person with homespun philosophy, ask yourself: “Who benefits here?” The honest answer may be, “this is not about what you need, it’s about me and what I need”. If someone has cancer, try to hold this thought in mind: it’s about her, and her alone. This is a great time to show respect for the other person’s beliefs and choices, including preferences for medical treatment, quite regardless of how they compare with your own.

5. Being pushy and intrusive.  On hearing the news of a cancer diagnosis, some people seem almost to pounce, as though drawn to be part of the drama. Such “new best friends” should be kept FAR away from anyone who is in cancer treatment, though over-intrusion can be a way to manage understandable anxiety over someone you love and fear to lose. But remember the mantra: it’s not about you, it’s about them.  There is a time to arrive, and a time not to arrive….Unless invited, don’t say “I’ll come and visit you in hospital“. Most people who’ve recently had cancer surgery don’t want visitors other than their spouse.

People who are seriously ill experience constant intrusion into their personal space and a loss of control which doesn’t get easier as time goes on. So being extra-respectful of that space is a really good idea. Your loved one probably doesn’t look like she has cancer and certainly doesn’t need anyone to point that out.

As a person with cancer, you do not need someone to talk to you as if you were three years old and a bit dim or deaf, to ask intrusive questions (unless they are a medical professional and sometimes not even then), or to touch you when it’s not warranted or welcome. If in doubt, ask: Are you OK to talk about this now? Is it OK if I give you a hug? Can I give you a hand with that? 

It is also not great to ask: “What are your chances?” Even doctors seldom give more than a general estimate based on experience and research. Cancer specialists will gladly say that patients have on occasion proved medical science wrong when it comes to life expectancy. And whilst most people prefer to stay optimistic, and to focus on stories of people who have come through cancer and are living rich lives, they are more likely to value prognosis-talk if they’re able to share what they’ve been told by doctors (or found out for themselves) without anyone judging it. Critics and cheerleaders are not needed – only kind and attentive listeners.

People who are ill will tell you that the most welcome visitors are those who are able to relieve the burden of thinking and talking about the illness all the time. Treat your friend or family member normally, talk about ordinary things, and if they do want to talk about cancer, listen more than you speak – really listen, not in order to reply, but in order to understand what they are going through.

It is good to be specific in your offers of help. A vague and general “Call me if you need anything” is nice to hear but not nearly so useful as “Let me…” followed by a specific offer of help based on your knowledge of that person’s life and commitments. Offers of help that are likely to be gratefully received include:  help with workload, with transport, providing moral support at difficult appointments, finding information that is needed, and last but not least – financial help for important, morale boosting benefits that may not be available from medical aids, such as a wig or a really nice scarf.

It goes without saying that if you make any offer of help, you keep your promise without fail and show up. Including the person in your routine can be very useful – let them know if you’re on your way to the shops, will be in a position to pick up children, or whatever. And add a “no need to respond” to any and all communications. Since it’s not about you, there is no reason to take offence if your message isn’t answered or your call returned!

Cancer survivor and psychiatrist Elana Miller says that for friends and family, being in relationship with someone who has cancer is “an opportunity to show up and be the best kind of person who exists on this planet”. By words and actions, we can say “I love you” and “you matter to me” and “I am here for you”.

When days are dark and nights are darker, that can be literally life-saving because it stands as a constant reminder of a life worth fighting for, a destination worth reaching no matter what it may take.