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If someone you know has cancer, knowing what and what not to say can be emotional and difficult.

As a psychiatrist at Memorial Sloan Kettering Cancer Center, Monique James, MD, has particular expertise in helping people cope with the challenges presented by chronic illnesses. She shares some of what she’s learned about having helpful, honest conversations with people who have cancer.

Whatever type or stage of cancer is involved and whatever relationship you share with the person who has cancer, a good place to begin is with watching and listening.

“Whether it’s a loved one or your local barista, it’s important not to make assumptions about what people might need,” James suggests.

“Take your cues from the person with cancer. Observe verbal and nonverbal cues about whether someone does or does not have energy that day, wants to talk or feels more silent, is looking for silver linings and feeling optimistic or is feeling scared.”

If you want to support someone with cancer, an important skill to develop is the ability to hear and support a wide range of feelings — even ones you don’t expect.

“People with cancer are going through the full gamut of emotion,” James says. “And it can be hard not to be allowed to have all the feelings. What people often appreciate is someone who is comfortable sitting with emotion.”

It isn’t uncommon for people with cancer to experience anger, anxiety, depression, guilt, and loneliness, but it’s also perfectly normal to feel gratitude, hope, and happiness. In fact, it’s possible to cycle through these emotions in the course of a single day and experience both contrasting emotions at the same time.

Depending on the nature of your relationship, the time, and the place, it may be appropriate to simply say what you notice. You might say, “I see that you’re scared,” making space for someone to safely share anxiety or vulnerability.

And you can also make space for lighter emotions — times when someone says, “I just want to watch a movie tonight.”

It’s natural to want to share a story or a resource you think might help someone feel better. Before you do, take a moment to find out whether the time is right.

“The words, ‘Is it OK if we talk about…’ go a long way,” James notes. “It’s important to find out if someone is in the mood or open to that conversation. That’s true when talking about your experiences, too. You can say, ‘Can I share with you what I experienced when I went through the same kind of cancer?’”

Asking permission is especially important if you want to offer something that could be considered advice. James suggests saying something like, “I read a wonderful article the other day. Is it OK if I share it with you?”

People with a cancer diagnosis are often inundated with well-meaning suggestions, information, and anecdotes, so it’s important to ask before you add anything more — especially if you’re communicating via social media.

One recent study involving 30 women with breast cancer and more than 21,000 Facebook posts found that most posts were emotionally supportive. But social media can also be used to pass on advice that’s unwelcome, unreliable, or unhelpful.

If you do share advice, make sure it’s from a reputable source, such as the American Cancer Society.

“People with cancer often tell me they are overwhelmed by the support and overwhelmed by the need to respond to people who offer support,” James says. “If you’ve been told it’s A-OK to call, text, or email someone, expect not to get a response in the normal timeframe.”

In fact, it might be kind to let the person know it’s OK not to send a reply at all. You could say something like, “There’s no need to respond. Just sending you love.”

A note to caregivers: Taking care of yourself matters.

If you’re close to someone with advanced cancer and you’re providing daily care, it’s important to maintain your own well-being.

Studies show that when caregivers have a good quality of life, it can keep the person with cancer from feeling like a burden. And that, in turn, can lessen their feelings of anxiety or depression.

The Dana Farber Institute offers a caregivers’ reading list that you may find helpful.

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If you want to do something practical or send a gift, be as specific as you can with your offer. James points out that the general, “Let me know if there’s something I can do” can create a “tough situation” for the person with cancer — because it places the onus on them to reach out to you for help.

“If you’re not sure about what to do or give, go with your talent. If you knit, cook, make great playlists — go with what you do well,” James says.

Another option? If you know something about this person, choose a gift or offer to do something you know they would appreciate. Ask yourself, “What does she love?”

The American Cancer Society suggests that taking over regular errands or tasks may be one practical way to help — mowing the grass or shuttling kids to and from practice, for example. Of course, it’s important to discuss these tasks beforehand so that you can be sure you’re offering the help that’s most wanted.

Be aware of cultural differences

Research shows that people with different cultural backgrounds may respond differently to unsolicited offers of support.

In some communities, people may feel loved and valued when others step in unasked to cook meals or run errands in a time of need.

But that isn’t always the case. If you’re not close friends, you may want to talk to someone nearer to the person with cancer to find out how best to help.

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If you have a long-standing, close relationship with someone who has cancer, it’s only natural that the diagnosis and treatment will affect you, too. You may feel worried, guilty, sad, or angry yourself. You may have lots of important questions to ask. It will be important for you to find ongoing support.

When considering how much of your own fear or feelings to share with someone who has cancer, James suggests following the ring theory first described by psychologist Susan Silk and mediator Barry Goldman.

“Imagine a series of concentric circles extending outward. At the center of the circle is the person with cancer,” James explains.

“In the next larger circle, the significant other or perhaps the parent of the person with cancer. In the next circle, family members. In the next, close friends.” The larger the circle, the more emotional distance exists between the person with cancer and the person in the outer circles.

“The general idea is that you want to comfort inward and dump outward,” James notes. Whichever circle you’re in, offer comfort to people who are closer to the center.

If you need to express your own feelings, Silk and Goldman recommend that you vent to people in your same circle or in a circle farther from the person with cancer.

This concept is sometimes explained using a flashlight. “Imagine that the person with cancer is holding a flashlight and pointing it outward. Ideally, people should only express their feelings to someone less brightly lit than they are,” James says.

5 Ideas to Keep in Mind

  1. It’s OK to say, “I don’t know what to say.”
  2. If you do say something about how you’re feeling, keep it brief. You can say, “I feel scared” or “I feel sad.”
  3. Say how you’d like to give support. For example, you might say, “I can sit by you today.”
  4. Stay connected. Keep the person with cancer on the group chat or text list.
  5. Only promise what you can deliver. It’s important to follow through on anything you offer to do.
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When you know someone who has cancer, whether they’ve just been diagnosed, they’re in treatment, or they’re on the road to remission, it can be hard to know what to say. Start by listening, both to their words and to the many unspoken clues about what they need in the moment.

You can create a safe space for talking about whatever feelings and issues they’re experiencing day to day, and you can discuss specific and practical ways to help. If you want to share stories or offer advice, be sure to ask permission first, because unsolicited advice may not be helpful.

If you find yourself grappling with your own tumultuous emotions, look for a safe place to process how your friend’s cancer diagnosis is impacting you — just know that the person who has cancer probably isn’t in a position to help you with those feelings right now.

And if you do say something you later wish you hadn’t said — as everyone does from time to time — it’s OK to apologize and begin again. If cancer makes anything crystal clear, it’s that we’re all human.