Here’s What Not to Say to Someone With Cancer

By
Photo: jsmith/Getty Images

One Thanksgiving a few years ago, as the festivities were winding down, I rolled off the couch to hug my cousin good-bye. She embraced me and then whispered in my ear, “Stay strong.”

At the time, I was 25 and just one week into chemotherapy for a rare liver cancer. My hair hadn’t even fallen out yet, and yet it seemed I had still surprised everyone by showing up for dinner and remembering how to use a fork.

It was far from the last time I’d hear those two words, which never failed to drive me out of my mind. What does “stay strong” even mean? Is it showing up for treatment on time? Or is it not crying whenever a nurse jabs me with an IV? What if I’m too busy being eaten alive from the inside out to stay strong?

The only thing you can count on with cancer is that people will bombard you with clichés. “Stay strong” was a fan favorite. So were “You’re my hero,” and “You’re so inspiring,” even though I’m the sort of person who doesn’t hold elevator doors for people. And then there was the requisite battle terminology: “You just have to fight this,” or “You’re going to win this thing.” (Just look at Senator John McCain, whose brain cancer diagnosis last month spurred a wave of politicians to describe him as a “fighter” and a “warrior” who would “give [cancer] hell.”)

But I didn’t fight. I didn’t do anything besides take a cab to Memorial Sloan-Kettering every week, where I would lie under a warm blanket for hours while I was infused with a chemo cocktail. If anything, my team of doctors and the chemo drugs did all the heavy lifting. Even now, in remission two years later, I do not refer to myself as a cancer survivor. I prefer “former cancer landlord.” After all, I only hosted the cancer before modern medicine evicted it. That’s my gripe with words like strong and brave and the accompanying battle metaphors: Cancer doesn’t care how tough you are. If it kills you — as cancer is wont to do — it’s not because of some lack of grit or determination.

The whole “fighter” thing is also just unrealistic, assuming a positive outcome by default when a positive outcome is far from guaranteed. (No one says, “Wow, this new diagnosis really sounds like your Waterloo.”) Research backs me up on this: “These metaphors can be particularly detrimental when the person is not getting better, because the idea of losing a battle can suggest individual responsibility, and hence, failure,” explains Elena Semino, a linguistics professor at Lancaster University in the U.K.

That’s not to say I don’t get why people feel compelled to use them. Cancer is a disease that’s difficult for doctors to figure out, let alone patients and the people dealing with them, and war terminology gives them something to grab on to. “We tend to think metaphorically about concepts that we cannot directly experience,” says David J. Hauser, a social psychologist and postdoctoral research associate at USC’s Dornsife Mind and Society Center. “For example, time is abstract, so we think of it as if it were money. It can be wasted, spent, and exchanged. The same holds for cancer. We don’t truly understand it, so we relate it to simpler things, like an enemy.”

This type of thinking can also help people feel like they’re being motivational at a time when motivation is hard to come by. “People often want to sound optimistic and encouraging in the face of someone else’s hardship, and these metaphors can express that,” Semino says.

And to be fair, fighting metaphors are better than nothing. Cancer can be so incomprehensible that people don’t talk about it, which in practice can mean they just don’t talk to you at all. Sharing my diagnosis was like a real-life version of purging my Facebook friends list. As for my friends who didn’t disappear into the night, I found that I appreciated it most when they avoided the topic of my cancer entirely. One night sticks out: I was out to dinner with two close friends, and one talked endlessly about her Bumble dates. It was so good. For once, no one was asking me how I was feeling or telling me how I’m an inspiration. Just tell me about how one guy cooked you dinner but you like the other more. That’s it.

It also helped when people were super-specific. “Let me know if you need anything” was useless, because I couldn’t even figure it out for myself. (Perhaps a new body?) Instead, one friend asked me what my favorite dinner was — Swedish meatballs, for the record — which she made from scratch and dropped off at my office.

Or, in certain contexts, being super-vague worked, too. “How are you feeling?” made me feel like they were asking about (and only interested in) how my cancer and I were doing, and the answer was always the same: Bad. I liked “What’s up?” which allowed me to avoid the topic entirely if I didn’t feeling like talking about it.

All this comes with a caveat, though: That’s what worked for me. But there’s really no one correct thing to say to someone who’s sick. “We shouldn’t use a general language for everybody in public health discourse,” says Carla Remondini, an oncology nurse who’s analyzed the impact of language in cancer treatment. “It discourages individual expression from people dealing with cancer.” In fact, she’s found that certain patients can actually find the fight terminology empowering, while others prefer metaphors like “journey.” (And some, like me, will burst into flames if you call cancer a “journey.” Where? To hell?)

In other words, the right thing to say is  far from universal. But there’s one common theme Remondini has noticed. “I hear my patients talking about [cancer] being a challenge and always needing hope,” she says. “They need some sort of middle ground where they can find peace with themselves and their cancer.”

This makes sense to me. Sure, there’s not much to hope for when your cancer’s returned for a third round. But it offers more wiggle room than the alternatives of “You’re a hero” and “You’re going to beat this.” You hope the cancer doesn’t kill you. You hope the cancer doesn’t come back. You hope that a year from now, you’ll be posted up on a beach while drinking a Mai Tai the size of your face. It might not happen, and that’s the point: Hope implies that your situation is out of your control, that there’s potential for multiple outcomes both good and bad. Not knowing is what makes it realistic. And with cancer, for which nothing is guaranteed, it’s a worthy match.

Here’s What Not to Say to Someone With Cancer