Talking about metastatic breast cancer can be very challenging, even with those closest to you. Loved ones have their own feelings about what's happening, and they may sometimes find it hard to communicate in a way that feels supportive. It's important to know that they may have very raw emotions, and it may take some time to adjust to your diagnosis.
The first step is to know how to spot a loved one struggling with the news, then to use helpful ways to encourage an honest conversation with them.
What Are Signs That Loved Ones Are Struggling With Your Diagnosis?
When it seems someone is having a hard time dealing with your diagnosis and the changes that are coming, keep in mind that they may be simply trying to understand, think of ways to help, or avoid saying the wrong thing.
So if you notice any of these signs, give your loved ones some time. Professionals say it can take anywhere from 6 weeks to 6 months to adjust to a major life change.
Avoidance and denial. Some people may generally withdraw from you, which can mean avoiding your phone calls or failing to follow through on offers of support. When they do see you, they might avoid talking to you about your cancer or cut you off when you try to bring it up. You might notice that they also seem to ignore the diagnosis and act as though everything is normal.
"Denial is a way we protect ourselves from really painful emotions, and some of that is OK," says Gregory Garber, a licensed clinical social worker and administrative director in the Division of Supportive Oncology at Jefferson Health. He says denial lets us boil down and absorb tough information, and that could take time.
Abnormal behavior. If you notice that a loved one isn't acting like themselves – having unusual anger or a lot of frustration – this could be a sign that they're struggling with your situation. They may also have a different heaviness about them, or they may stop doing things they enjoy.
For children, this could look similar. They may do things they've outgrown, like bedwetting or not sleeping. If they begin to behave differently than normal at school or at home – such as acting out or suddenly struggling in class – that may be a sign your child is having a hard time dealing with the news.
Overly positive attitude. If you find that those closest to you insist that "You're going to be fine" or "You're going to beat this," they may be in denial.
"While those are things that people think are encouraging to say, sometimes they can be difficult for someone living with a metastatic diagnosis to hear," says Amy Colver, a licensed clinical social worker and senior specialist in health information and publications at Susan G. Komen. "Sometimes it feels like they're minimizing the seriousness of the diagnosis."
Tips for Having Honest Conversations With Loved Ones
It can take some time to figure out how to talk with family and friends about your diagnosis. What you say may be different from group to group, and there's no perfect way to handle these sensitive conversations. Still, there are some general tips about how to guide conversations with people closest to you.
Before conversations
Consider potential questions. Use what you know about your loved ones to predict their reactions to tough conversations. Ask your doctor for a written summary of your last appointment to help answer people's questions. Jot down the date of your next appointment so you can share next steps.
Prepare them for news. Try to speak to loved ones sooner rather than later. When you schedule a time to talk, tell them that you want to talk about something serious so they aren't blindsided by the weight of the conversation.
Plan to handle off-limits topics. Create boundaries for questions you may not be ready or willing to answer yet. Pinpoint things people have said or could say that bother you. Prepare a response you can use to change the topic if any of those things come up.
Consider more than one-on-one. You may want to ask others to join the conversation with a specific loved one if you think it'd help, whether it's a mutual friend or additional family members.
"When you bring more people in who are close and who are supportive, it dilutes the emotional intensity of it a little bit," Garber says. "That can sometimes make a conversation that felt impossible a little more possible."
During conversations
Set expectations. Communicate what you hope to get out of the conversation. Do you want to talk about what you're feeling, or do you plan to ask for specific support?
Start with facts. Share what you know about your current situation, leaning on your doctor's summary if you need to. Outline what still needs to be known and what comes next.
Be honest and open. Don’t feel like you need to pretend to be OK and cheerful to protect your loved ones. It's better for you and them if you share your true feelings. Encourage them to share how they’re feeling, too, so you can work through any questions together. Try to listen with patience and without judgment.
Know when to wrap up. If you notice people are overwhelmed, offer to come back to it later. Assure them that everything doesn't need to be resolved in one conversation.
After conversations
You might want to think about using a free service, such as CaringBridge, to share updates. You can also use it to remind people of certain details you’re not willing to discuss about your condition. To have more direct discussions, you can also ask your care team to bring specific loved ones to either sit in on the actual appointment or to have a formal family meeting.
Though it can take time to recharge after honest conversations, try not to ignore friends or family members who may need to open up and talk with you more. But if you find that certain loved ones are struggling to hear you, consider taking a step back.
"How essential is that person, and is that something [you] want to spend [your] energy on?" says Celeste Vaughan-Briggs, an oncology social worker and program manager of the Breast and Cervical Cancer Screening Program at Jefferson Health. "It's OK to let those relationships rest for a while."
Vaughan-Briggs suggests asking another person in your support circle to speak to those who are having a hard time with the news to give you some space. These conversations take a lot of energy, so it's OK to focus on people who are already prepared to support you.
Your partner
Your partner or spouse may have a few main concerns about the changes in your lives after hearing about your diagnosis. But there are ways to talk with your partner about metastatic breast cancer that can help you work through them together.
Household responsibilities. Let your partner know what you need, and be as specific as possible. Do you need help cooking or doing laundry? Tell them. Also ask them what they need. It may be helpful to ask friends and family to help with certain tasks or errands so the pressure isn't just on the two of you.
Intimacy. Be open with your partner about how treatment affects your sex drive and your sex experience. You can also discuss new ways to connect physically and emotionally, whether that's holding hands, going out to dinner, or going on a walk together.
Open communication. Normal check-ins can help bring you closer. Set aside time to be together and to talk about what’s happening. Be honest about how you’re feeling emotionally and physically, and ask your partner how they're feeling, too.
You might also consider inviting them to your appointments if you haven't already. This kind of involvement can make you feel more connected while helping your partner understand your diagnosis, treatments, and potential side effects.
Your children
You may be tempted to hide parts of your diagnosis from your children, but they usually sense when something is going on. It's very hard to explain that the condition isn't curable, but it's important to be as honest as possible. And though there is no wrong or right way to tell children about metastatic breast cancer, here are a few tips to guide the conversation for kids of all ages.
Be detailed. Use specific words that are age- and developmentally appropriate based on what you know will work well for your child. Be clear, but emphasize that your doctors have medicines that they hope will help you. Explain that you'll also let them know about any changes in your health situation.
Talk about how it affects them. Share any changes your treatment may have on their day-to-day lives or schedules, and ask them if they have any questions for you. Try to have normal follow-up conversations with them, and let them know about other trusted adults they can also talk to.
Tips for talking to younger children
With kids under 10 years old, it's best to keep things simple.
Explain the basics. Tell them there is cancer in your body – and where – and that doctors are treating it. To give younger children a visual, you can point parts of your body, use a doll, or show pictures. Let them know that the cancer is not contagious, so they can't get it from you.
Reassure them. Children ages 3 to 6 may think the cancer is their fault or that your treatment is punishment for something they did. Assure them that your condition has nothing to do with anything they did or thought, and let them know that you love them.
Prepare them for changes. Tell them about the side effects you may have, such as hair loss or fatigue, ahead of time to help lower any fear or anxiety they may have. Explain how their daily routines may change, too.
Tips for talking to older children
If you're preparing to have a conversation with older children or teenagers, you can share more details of your condition.
Explore and explain facts. If your child is old enough to use the internet, suggest that you look at trusted websites together if they want to learn more about your diagnosis. Let them know about the side effects you might have, such as hair loss, nausea, or fatigue.
Address questions. Encourage your child to ask questions, and offer them detailed answers. Be prepared for questions about death. You could let them know that metastatic breast cancer is serious, but your doctors have treatments to help you live as long as possible.
Go over support choices. Let them know that if they need to vent their feelings outside of the family, there are trusted adults – like a family friend or counselor – they can go to. Tell them exactly who those people are.
Talking to grandchildren
Your approach to this conversation depends on your family dynamic and your relationship with your grandkids. Start by talking to their parents about the best way to talk about your diagnosis.
Regardless of whether you meet directly with your grandchild or with their parents, too, it's important that you lead the conversations or at least be there for them. That way, your grandchildren can see you and share any thoughts or questions they may have.
Your parents
Telling your parents about your metastatic breast cancer can be uniquely hard and emotional.
Prepare ahead of time. Set aside uninterrupted time to talk with them, and rehearse what you’re going to say. If it’s comfortable, try role-playing with a sibling or your partner.
Be open. When you talk, let your parents know your honest feelings and explain what you need. Stop, listen, and watch their body language every once in a while to see whether they’re absorbing what you’re saying. Then, encourage them to ask you questions.
Your friends
The first thing you'll want to do is consider how much you want to share with friends vs. family. Make a list of close friends you want to talk to in person. Then make another list of friends you're less close with and consider having another friend or family member share news with them.
For those you're speaking directly with, first explain what kind of cancer you have, which treatments you might need, and your outlook. Then, you can use many of the general conversation tips to navigate the conversation. Friends often ask how they can help, so you may want to prepare a list of ways they can support you.
How Can You Ask Loved Ones For Support?
Often, your loved ones may already be ready and willing to help out – they just need the opportunity. Here are a few ways to ask them to help out:
Start with home life. Begin with your spouse or partner. Explain your needs and limitations and ask them where they need support, too. Together, discuss changes you need to make at home. If it’s too much for the two of you, consider asking family and friends to help out.
Delegate what matters. Depending on your support network, you'll first want to figure out the things you need the most help with. Then, pick a group of people you know are able to help so you're not relying too much on one person. Assign certain tasks to specific people based on what they can best handle. Maybe you delegate meals to a friend who loves to cook, or have a friend who works from home pick your child up from school.
Identify specific tasks. This comes in handy when someone asks you how they can help. Accept the offer and have specific suggestions prepared, such as help with child care, errands, or meals. The more direct you are with your requests, the better.
"I would also encourage people, too, if they're comfortable, to let the other person know why this type of support would help them," Colver says. "I think it makes it more meaningful that way."
Let them take the lead. Delegation means you'll need to give up some control. Accept that your friends and family will handle tasks differently than you – and that's OK. Remind yourself that things are getting done, which is most important.
When Should You Try Group Counseling?
If you find that you need help discussing the different ways you and those closest to you handle your condition, or if you are having issues talking openly about the changes in your life with each other, a counselor can help guide some of those conversations. Here's when to consider this path forward:
Ongoing strain. If, after a while, you sense that your loved one is struggling and it's creating tension between you day-to-day, consider professional help.
Conflict. You may also want to try group counseling if someone very important to you refuses to come to appointments and is questioning your care choices. They may insist that you try other treatments or a different doctor.
Serious diagnosis. If your metastatic breast cancer is very serious and there's more urgency for honest conversations, it may be time to work with a counselor.
Start by asking your health care team for help. Your doctor or nurse can refer you to a professional who helps families talk about cancer.
Show Sources
(Photo Credit: iStock/Getty Images)
SOURCES:
American Cancer Society: "Telling Others About Your Cancer."
Amy Colver, licensed clinical social worker; senior specialist in health information and publications, Susan G. Komen.
Breast Cancer Now: "Telling family and friends about your breast cancer."
Breastcancer.org: "Talking to Your Family and Friends About Breast Cancer," "How to Accept and Ask for Help When Living With Metastatic Breast Cancer."
Celeste Vaughan-Briggs, licensed clinical social worker; oncology social worker; program manager, Breast and Cervical Cancer Screening Program, Jefferson Health.
Gregory Garber, licensed clinical social worker; administrative director, Division of Supportive Oncology, Jefferson Health.
Living Beyond Breast Cancer: "Talking with family."
National Cancer Institute: "Coping with Cancer."
