At a Loss for Words

Last fall, four years after my sister had a malignant lump removed from her breast, she learned her cancer had spread to the bone. Fortunately, the metastasis was limited and treatable. Still, we were both scared, and as the bad news sank in, I often found myself struggling to find the right words to express my concern. Finally I decided to share my confusion with her, which led to a wonderful conversation about the ways I could be appropriate and helpful.

It occurred to me that if I had trouble knowing how to talk to someone with cancer, I probably wasn't alone, so I asked some cancer survivors what kinds of comments felt good, and what rankled them. “I find that people ask a lot of questions because they feel a need to fill space,” my sister told me. “I don't like to be asked for medical information — what's your prognosis, what's your treatment — and I don't like my emotional life probed. Heavy sympathy, like 'Oh my God, that's awful,' feels like pity. It's meant to be kind, but it isn't. I just want people to act normally. Say something like, 'It sounds like you're going through a hard time. If you need anything, I'm here for you, and move on.”

I learned from Suzanne Miller, director of behavioral medicine at Fox Chase Cancer Center, that my sister falls into a category of patient she calls blunters: “They don't want to dwell on their illness, and would rather be distracted and let life go on.” The other type of patient is one Miller labels monitors, information hounds who will surf the Web and read everything they can get their hands on. They're happy to discuss details of their illness, and take in all the comfort and reassurance offered. “You have to respect the patient's style and let that be your guide,” Miller explains. “With monitors, you turn the volume up, and with blunters, you turn it down. Follow their lead.” That advice was echoed by Lynn Marks, a breast cancer survivor who is board chair of Living Beyond Breast Cancer: “Take your cues from the patient. Cancer patients are hypersensitive, so the best thing is to listen more and talk less.”

Marks had a litany of remarks that cancer patients loathe. At the top came comments grouped under, “My aunt Millie/second cousin Barbara/friend Sue had the same diagnosis, and this is what happened to her.” Every situation is different. Margaret Lazar, director of patient and family services at Penn's Abramson Cancer Center, cautions, “Don't give advice unless it's requested.”

Another resented question is, “How are you really feeling (or coping)?,” accompanied by an oh-you-poor-thing facial expression. Then there are comments about appearance: “You look sooo good” — when the patient knows she looks terrible — and, conversely, “You're awfully pale; you ought to use a little more blush.” Other things to avoid: “Oh my God, how could this happen to you? You're in such good shape.” Nobody creates cancer. “Gosh, it seems like everybody has breast cancer these days.” Duh! “Don't worry, you'll be fine.” Dismissive! “Gee, this reminds me to schedule a mammogram.” Selfish! “My sister had chemo, and it was just awful.” Thanks a lot!

You can't go wrong if you keep it simple, caring and neutral: “I'm so glad to see you. I don't have any words of wisdom, but I'm rooting for you and I'm here to do anything I can for you or your family.” Finally, consider letting your fingers do the talking. Penn's Lazar says what's rarely offensive and often forgotten is the comforting power of touch. She says, “Just quietly holding someone's hand, giving them a warm hug or patting their back, can be worth a million words.”

Speaking of Cancer

» In the case of cancer patients, actions truly speak louder than words. Leave a nice message on an answering machine. Drop off a meal, a video, or a book on tape. Deliver a hug through the mail with a card or note. Make a donation to a cancer organization.

» Tell the patient about Annabella's Lingerie and Breast Care Boutique (26 Chestnut Road, Paoli; 610-296-4610), where a wonderful breast cancer survivor has created a professional center specializing in post-surgical products.