When cancer strikes - how to be a friend

"Cancer wasn't the most painful thing to happen to me, it was the fact that my friends moved away, unsure of themselves."

Listening to a 40-year-old man successfully treated for cancer gave me pause for thought.

I wondered for a moment whether this was because men maintained fewer close friendships or were typically thought to need less help coping with serious matters.

My patient, who I'll call Ted (not his real name), was a well-liked local entrepreneur who, though a bachelor, had no lack of friends. Ted talked about them fondly, so it was sad to hear him mention their absence well after his ordeal with chemotherapy had ended.

"I am sorry to hear this", I replied.

"It made me rethink a lot of things I have taken for granted," Ted said. "Now that they see me well, those friends are slowly trying to re-enter my life. But I don't feel like engaging with them. I know that cancer scares other people but I still feel let down."

Then Ted asked me a searching question. "Does this happen to your female patients too?"

On this, I could emphatically reply yes. Cancer affected the relationships of both men and women, I told him. The challenge of coping with an illness, the side effects of treatment and maintaining friendships and relationships through this time was difficult for everyone.

Ted nodded, seemingly consoled. "At least this has taught me how to be a better friend when someone else gets cancer," he remarked.

I asked Ted if he would mind sharing his experience with me.

1. Be there

"When I discovered my cancer diagnosis, my mind was in a total spin. I texted three or four of my friends madly and the word spread within hours.

"I was at the hospital all day and my phone was overwhelmed by messages of support but when I got home, I was all alone. Not one person thought to come by.

"And while I certainly didn't want a crowd there, I'd have given anything to have a close friend's shoulder to cry on. The silence was haunting and it tempted me to think of the most awful outcomes, something I didn't need right then."

One of the most important things you can do for a cancer patient is simply to be there, physically, emotionally, and with your entire self. Nothing you say on Facebook is more powerful than your physical presence. The consolation of a hundred concerned text messages pales into insignificance in front of a friend who shows up to say: "I am sorry at your news. I am here."

People commonly worry about imposing on a cancer patient. They feel that if they have offered help it is up to the patient to seek it, but the truth is the patient is occupied and upset and already feels they are inconveniencing people, so it's unlikely they will demand your attention.

Supporting a friend through the initial discovery of cancer is not always about providing support but showing visible sympathy and human communion. Many patients tell me that they wish their friends wouldn't think too hard about being physically present and would just try it.

2. Listen

"Put the word out there doc," Ted smiles.

"Tell people to just shut up and listen. Don't tell me about the neighbour who got cancer, or the neighbour's dog who survived cancer. Don't tell me about the miracle treatment in the newspaper, don't tell me about how hard it must be, don't tell me it's going to be fine.

"In fact, sometimes, don't talk. Sit with me, bring a book, and quietly tell me that you are there to listen when I am ready. And if I don't talk for the whole hour, you will still feel comfortable returning. If this sounds demanding, know that I have lost control quickly in many aspects of my life and this is one where you can give me control back."

Ted is right.

3. I can help

"Throughout my illness, I resolved that the worst question to ask a cancer patient repeatedly is 'How can I help?'"

Cancer means being bombarded by questions by doctors, nurses, paramedics and all manner of healthcare professionals. A good friend should try to avoid entering this category of supporters and instinctively know how to be helpful. My patients sigh that it's becoming increasingly common for people to email or text to ask how they can be of help, but it is very difficult for a patient to constantly ask favours such as mowing the lawn or folding the laundry.

"I kept thinking it had to be something big and impressive that should result in my asking for help, but every day I secretly hoped someone would empty my dishwasher, pay my bills on the computer and water my dying flowers. These tasks sounded menial, but they were absolutely the things that would have helped."

Don't wait to be asked to help. Instead, cheerfully offer to take on jobs. Don't ask "How can I help?" Say, "I can help." Make a mental list of all the things that you might do to keep your household running during a serious illness, chances are others share many of the same priorities. Pick a few that you can help with. If you like cooking, help by preparing meals for the patient. If you are better at cleaning, offer to mop the floor, take out the garbage and fold away clothes.

You could help with the children's homework or just provide company at mealtimes when the patient hates being alone. Don't let the fear of a long-term commitment to these chores stop you from helping now.

Everyone, especially the cancer patient, understands that people have other commitments in their lives and can't guarantee their availability, but most gratefully accept the help that comes their way. The point is that the only thing stopping you from helping a friend is your imagination.

4. Build a team

Being a friend or a supporter of a cancer patient is not a one-person task, no matter how much goodwill and capability you possess. So gradually build a core of people who can offer support. This does not diminish you, rather it sends a signal that you care.

Chances are you have more time to read about the available resources, make phone calls and research your friend's options. With your friend's permission, try to link them into appropriate resources. But remember that your useful ideas may not necessarily be shared by your friend. That's okay. Bide your time and know that you have done it in their best interest.

5. It's not always going to be easy

Supporting a friend through cancer is hard work.

The ideal friend is available, supportive and non-judgemental. He or she knows when to respect silence and when to speak up and advocate for you.

The patient may suffer crises of confidence. You may witness moods that swing from the heights of optimism to the depths of despair. Bad news may provoke intense upset one day and anger or denial the next. Other people's anxiety and despondency can be infectious too. And try as you might, you can't get inside the head of the cancer patient. That's okay. It is okay to not always understand exactly what's going on in someone's life, but retain the capacity to empathise and be of practical use to them.

Many people who have been diagnosed with cancer confess that they felt more concerned for their friend or carer than themselves, because while there is widespread support for the patient, friends aren't supposed to be 'needy'. But it's perfectly okay to be driven mad by the changing needs of a patient.

Pace yourself. Just like you are someone's support person, find someone removed from the cancer to talk to and vent your feelings. Acknowledge your frustrations or fears.

Perhaps in time you and the patient may be able to share your feelings, but in the meantime, in trying to shield the patient, don't compromise your own health. No one expects you to be perfect.

Patients are grateful that someone cares to join them in their journey, however imperfectly.

I never fail to be surprised by the number of patients who comment on the loneliness of being a cancer patient, despite being surrounded by scores of people who mean to help. It leads me to conclude that the best way of helping someone as a friend is by being there and setting yourself apart from others in the way you listen to and engage with the patient. The patient is the focus, everything else comes second.

Aristotle appreciated this when he said:

"My best friend is the man who in wishing me well wishes it for my sake."