How to talk about a cancer diagnosis: Shots

Miguel Angel Partido Garcia/Getty Images

Miguel Angel Partido Garcia/Getty Images

When my wife was diagnosed with breast cancer, she said…well, not all of them, but pretty close.

Marcia said she called from her car after a routine mammogram and the radiologist told her (rather insensitively), “It sure looks like cancer.'' (I casually said, “Well, I don't think that's a good idea,'' making Marcia even more disappointed.)

She told her mother (her father had passed away) and her two younger sisters…and the family vine did the rest.

The news that the Princess of Wales has cancer brought back memories of those hectic first days after her diagnosis.

The palace kept the information secret for…weeks? How many months?Kate then revealed it in an article Inspiring video.

Apparently, the royal family has their own concerns about making the cancer diagnosis public. But I can understand the instinct to keep it close to the vest. In our culture, no one likes to share bad news. People don't always know how to react and conversations can become uncomfortable.

And you probably don't want to be known as a “cancer patient.”

Perhaps that's why some people are reluctant to say it, he says. Dr. Monique James“They think this medical diagnosis is going to be the only thing people will ever see,” said a psychiatrist who counsels patients at Memorial Sloan Kettering Cancer Center.

Therefore, anyone who is told they have cancer faces a difficult decision about whether to share the news. Are you telling the little ones in your family? An older relative? Colleagues at work? All your friends and neighbors?

Eventually, many decide to speak out. James says what Marcia did was very typical. “We find that most people start sharing with those close to them very early on, probably within their first week or two.”

That's because cancer “can be a very lonely disease,” she points out. Having at least a few close friends makes you feel less isolated.

Still, while sharing may be cathartic for some, it can also feel like it adds more pressure to an already exhausting and confusing time.

My wife's experience, and the interviews I've conducted with dozens of people who have battled cancer for the two books I've written, have led me to understand the pros, cons, and best ways to communicate a cancer diagnosis. is as follows: husband with breast cancer And in cooperation with my eldest daughter, My parents have cancer and it's really hard.

Decide how much you want to say and to whom you want to say it

Take a moment and think about how much you want to convey to others. Maybe for casual acquaintances he'll come up with a two-minute script, and for close friends he'll create a 20-minute script, James says.

However, if you decide to tell some people in your circle the news and not others, or if there are different versions of what you're telling them, remember who knows what. Remember that you may be increasing your own stress levels even more as you try to do so. says Hester Hill Schnipper, practicing oncology social worker and blog author. Living with breast cancer.

Cancer patients who don't want to discuss everything with too many people may benefit from naming a close relative as an informant, she says..

It may also be helpful to develop a strategy for responding to unhelpful remarks. Like the relative who told his wife that he got breast cancer from using deodorant. Others respond to the news of a diagnosis by saying, “I know someone who died from that cancer.''

Schnipper suggests answering, “Why did you say that?” Her comment “takes away her own feelings and imposes them on other people,” she says.

You can always refuse to answer questions that are intrusive or unhelpful. “I need a break,” Schnipper suggests.

When it comes to children and other family members, honesty is usually the best policy

Marcia decided to keep the diagnosis secret from her children, who were 12 and 15 years old at the time, for several days. It was the Friday before Labor Day when she had her fateful mammogram. School starts next Tuesday, and both she and I thought it would be a bad idea to stress out about her mother's cancer on top of her back-to-school stress.

It was almost impossible to get coverage on the news. When the children were mostly annoying teenagers, Marcia said in a rather enigmatic tone:

And of course they didn't. It's been a strange few days.

That first day, when I picked her up from school, she said, It turned out to be a good strategy. Therapist says the car is a great place to tell your kids something. There's no need to make eye contact, which can be daunting. And, of course, children cannot stop the conversation and run to their rooms.

Some parents may want to shield their really young children from the news, which may be possible if cancer treatment does not cause noticeable changes such as hair loss, fatigue, or prolonged hospital stays.

But if there's cancer in the house, keeping it a secret, even from young children, can backfire. Maybe you hear a relative or neighbor say the word “cancer.”

Even young children “have keen powers of observation,” James says. “They may not know exactly what's going on, but they understand things. It's best to include them in what's going on in the family unit.”

“People want to protect their loved ones by not sharing important information,” he says. Leonard Ellentuck, a social worker at MedStar Georgetown University Lombardi Comprehensive Cancer Center. “Generally speaking, it's better to be honest with your kids, too, or they'll feel cheated.”

The same goes for older children. I've interviewed people who have decided not to send their grown children to college or live in another part of the country.

Therapists encourage us to think about the implications. Are you setting up a pattern where your grown children feel like they don't need to share the crises in their lives with you? And it's so hard to keep a secret that they may eventually find out. You may feel betrayed when

If you have an elderly and frail family member, you have likely experienced many life crises. But if a frail elderly parent or relative is at the end of their life, lives far from where you live, and may be facing their own death, cancer patients may Schnipper understands that may decide it's best to protect them.

Family disclosure is complicated if talking about cancer is taboo in your culture. It may mean that parents or siblings may not be comfortable listening. The solution, James says, is to look for other avenues, perhaps a support group.

talk to colleagues and experts

People at work may worry that sharing the news of their diagnosis with co-workers will be stigmatized. In fact, Ellentuck says, people may think, “Oh, you can't do the job that's expected of you.”

However, you may need to take a few days off for a doctor's appointment, perhaps for surgery or other treatment, so sharing with your boss may be essential.

“We encourage you to speak to your representative to find out what the benefits provisions are,” Schnipper added. “Are there short-term failure options? Can it be used intermittently or all at once?”

“But you don't have to explain the details to everyone,” James says. And if a colleague at work, or indeed anyone, asks for more details, you can always say, “I don't feel comfortable saying more.”

My wife, who teaches at a high school, decided to tell her students that. She wanted people to know that cancer happens, that people get through it, and that even though she will miss a few days due to chemotherapy, she plans to continue teaching. It was. But since they were teenagers, she decided not to tell him that her cancer was in her breast.

Privacy is of course optional, but sometimes we become public in ways that even surprise us.

All the therapists I've interviewed advise “telling the truth,” but they also recognize that it's up to the patient.

James said she works with a psychologist who often says, “The cancer patient is in the driver's seat, and the rest of the family is in the passenger seat.”

Indeed, some cancer patients choose relative silence. But the development of Princess Kate's story shows that people can offer great support if this news is shared.

That's how Marcia (and I) felt. With each unfortunate remark, we felt an immense wave of love. I still remember one night for dinner, her neighbor brought over the most amazing tuna noodle casserole.

And while cancer is no laughing matter, it can sometimes be brought out in public with a sense of humor.

One woman said she went out to dinner with a friend while wearing a wig during chemotherapy. A customer at the next table was complaining loudly, “Her hair is in bad shape!'' A gray-haired cancer patient grabbed her wig and pulled it off her head, declaring, “I think I'm having a bad hair day…”