Friends fill different parts of your heart. You have Christmas card friends -- the ones you touch base with once a year. Then there are the cheerleaders who’ll drop everything and throw you a personal pep rally. And all the mom friends, work pals, and friends of friends in between.

You’re on the same page with them in so many ways. But when you have advanced breast cancer, there are big parts of your life they may not understand if they haven’t been there themselves.

It helps to know what your friends may be thinking so you can put their mind at ease.

How Did This Happen?

Pam Kohl knows this disease inside and out. Seven years after a breast cancer diagnosis, lumpectomy, and radiation, a routine mammogram showed a suspicious area in the same breast. After a mastectomy and PET scan, Kohl’s doctors discovered the cancer had spread to a lymph node near her lung.

“One of the most important things my friends want to know is why and how did this happen,” says Kohl, who’s now the executive director of Susan G. Komen, North Carolina Triangle to the Coast. “I had such a great prognosis 7 years ago. After the recurrence and mastectomy, they assumed everything would be OK again. It’s not a linear process, unfortunately, and it’s definitely not black and white.”

You Don’t Seem to Be Yourself

You’re still you. But on top of the cancer and the emotions you may be feeling, some of the medicines that you take may have side effects. 

“They can make you feel crazy, moody, and not yourself,” says Dana Dinerman, a San Diego mother and founder of Hulabelle breast reconstruction and mastectomy swimwear. “It’s good to tell people, ‘I’m on these new drugs and I don’t know how they’re going to make me feel. Have some patience with me as I figure this out.’ ” 

Why Did You Cancel Our Plans?

You felt fine a few days ago, when you agreed to dinner. But when the time came, you were too exhausted, so you backed out.

“Friends don’t understand that you’re living moment to moment,” Dinerman says. “They’ll say, ‘Gosh, you look really good,’ then get confused when I cancel a party invite because I’m hurting from chemo,” she says. “They think I’m doing OK, but they don’t see the whole process.”

Do You Want to Talk About It?

The truth is, not always. You’re a lot more than your breast cancer. Sometimes you need a break from the topic.

When Kohl wants to talk about her cancer, she tells her friend she wants to schedule a “schmooze, when we need go a little deeper,” she says.

“If I run into them at lunch, I’m not necessarily going to want to go there,” Kohl says. “I just may want to talk about my kids or the last movie I saw. And how I definitely don’t need any more casseroles.”

What Can I Do?

Your friends want to help but don’t know what you need. They may make a general offer, like Let me know if you need anything. This is an open door. If you need something, go ahead and get specific.

“I have treatment on Thursday, and by Saturday I’m so tired I can’t cook. Can you bring me dinner on Saturday night?” says Susan Brown, a registered nurse and senior director of health education for Susan G. Komen. She finds online calendar tools to be a great way to manage that. Or you can say something like, “My child has baseball practice on Thursdays and it’s tough for me to make it. Can you take him?” she says.

How Can I Talk About My Problems When You’re Dealing With Cancer?

Just after Dinerman’s cancer came back for a second time, a close friend confided about marriage problems. It was a dark time for both women, but for Dinerman, being able to focus on her friend instead of the cancer was a gift.

“I always try to let people know I want to hear their problems. It helps me get my mind off [mine],” she says. “Women in general have to survive so many things. They’ve got more in them than they know.”

What’s the Prognosis? Are You Scared?

It’s probably the No. 1 question on your friends’ minds.

“No one is promised tomorrow,” Dinerman says. “I tell them yes, I’m scared. And sometimes I’ll cry.”

Her decision: Keep going no matter what.

“I’ll ask my husband, ‘Am I crazy for moving forward every day?’ But mostly it feels good to help my friends understand that none of us know what the future holds. And we should just enjoy the day.”

Did I Say Something Wrong?

There’s a lot of talk among people with cancer about words like fighting, battles, and survivors. Some people like this language. But a lot of people don’t.  And your friends might not realize that.

“I don’t want to hear what a fierce fighter I am or that I’m going to beat this thing,” Kohl says. “Everybody who has cancer is a fierce fighter.” 

You can let your friends know that you appreciate their encouragement and support, and let them know how you’d like to talk about it. If they haven’t had cancer themselves, they may need you to help them know what words or phrases you like and which ones to avoid.

Remember, your friends want to be there for you in big and small ways, just like with everything else you’ve been through together. And you’ll all feel better for it.

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