After the shock of receiving a cancer diagnosis, you will likely feel scared, anxious and overwhelmed. There will be a hundred questions whirling around inside your head, from your prognosis to treatment options. But one of the first big questions that comes up for many people is: how on earth do I tell my friends and family?
Talking about your cancer diagnosis might be the last thing you feel like doing, but being open about it can bring many benefits. The sense of a shared burden can take the weight off of you to an extent, and you might be surprised at how many offers of practical support you receive.
Having said that, it’s worth thinking about how much you want to share, and with how many people. This is deeply personal. Some prefer to keep their diagnosis private, with friends and colleagues learning about it on a need-to-know basis, whereas others don’t like the feeling of harbouring a secret and prefer that everyone knows.
When I received my breast cancer diagnosis in 2021, I was in the second camp. I didn’t want friends and extended family to hear about it third-hand and then not be sure if they should text me since I hadn’t been the one to tell them. I wanted everyone around me to feel comfortable mentioning it. Also, I welcomed advice. So I did an information blitz, calling my closest friends and family right away, texting others that evening and doing an Instagram post about it. This might sound like a horrendous overshare to some, but the advice and support I received was incredible.
Whether you are totally open about your diagnosis, completely private or somewhere in between, there is no right or wrong. Decide what works for you. Then you can think about how you’re going to tell people.
Preparing to tell people about your diagnosis
Before you dive in, think about what kind of thing the person you’re telling might ask.
“It can help to think about what you will say in advance,” says Dame Laura Lee, chief executive of Maggie’s, a cancer care charity. “Telling them about your type of cancer, and the treatment plan, is a good place to start as it gives you something practical to focus on. You may find it’s easier to plan the conversation first with a healthcare professional. You could talk to your specialist nurse or come into a Maggie’s centre and talk to one of our professional team.”
There are 26 Maggie’s centres around the UK, all on hospital grounds, and the staff will be happy to chat through anything at all – there is no such thing as a silly question.
How to tell family and friends
Chris Bolton is a service knowledge specialist at Macmillan Cancer Support, and he says that callers to their support line are often more concerned about their friends or family’s feelings and emotions than their own.
“It’s one of the things that makes talking about your cancer diagnosis an incredibly daunting prospect,” he explains. “We often hear that people don’t want to upset their loved ones or become a burden. It can be useful to try and write down these thoughts, to help understand how you are feeling and what sort of support you might need along the way.”
How to tell colleagues
The ways in which cancer impacts your work will depend on many things, including the nature of your job and the type of treatment you’ll have. I was self-employed, which is a double-edged sword. On one hand, I was my own boss so didn’t feel the pressure of having to log in to a Zoom meeting from the chemo ward (as I once saw someone else do). On the other, I wasn’t entitled to any sick pay, so I had to keep working.
If you’re on a payroll, you have rights. “Letting your employers know about your diagnosis means they can be more flexible with working hours and time off for appointments and rest,” says Lee, adding that – again – preparation is key.
“Before you speak to your employer, work out what you want to do and what might be possible,” she says. “Do you want to keep working? Are there adjustments that you and your employer could make so that your work becomes easier? Is there support on offer at your work for people with cancer?”
It’s important to know your rights, so you might want to have a chat with one of the Maggie’s benefits advisers first. The Macmillan website also provides practical support about work and finances, including welfare rights and a benefits calculator.
Remember that cancer counts as a disability in employment law, so not only is it unlawful to discriminate against you in terms of redundancy, promotion and career development, but you also have a right to ask for reasonable adjustments to your role.
Once you’ve had the conversation with your employer, you can think about how to tell your colleagues. “Lots of people find that their employers and colleagues end up as an extension of their support network, and telling them can remove a layer of stress from your diagnosis,” says Lee.
How to deal with people’s reactions
“Cancer is one of the hardest things a person can experience, and we know how important it can be to have the support of family and friends,” says Lee. “However, you may end up having to deal with their emotions as well as your own.”
Most people who have been through a cancer diagnosis will know the feeling of telling a friend or family member the news, only to find yourself comforting them, when it really ought to be the other way around.
There are two other types of well-meaning but not very helpful responses from those closest to you. First of all, the unsolicited advice. It comes from a place of love, but no one needs to hear that their cancer “is all down to stress” or “can be healed with vitamin C”.
Then there’s the response of trying to shut down the conversation as soon as possible, or changing the subject. “This can happen because they don’t know what to say or feel so they won’t be able to manage their emotions,” says Lee. “They may feel they shouldn’t ask questions or discuss the cancer for fear of upsetting you or saying the wrong thing.”
The best way to cope with this is to tell them exactly what you need. If you need them to listen without offering advice, tell them. If you need a shoulder to cry on, tell them. If you don’t want to talk about cancer today, tell them. And if you’re feeling like you really need a positive mindset to power you through treatment, let them know that sad noises and sympathetic head tilts are not what you need.
How to talk to children about cancer
If you have kids, telling them about your diagnosis is probably the most difficult conversation you’ll have. If you’re stressing over the “perfect” way to tell them, be reassured by clinical psychologist Dr Becky Kennedy, author of Good Inside: A Guide to Becoming the Parent You Want to Be. “There is never a right way to explain something that feels so unexpected and hard,” she says. But there are a couple of things she recommends:
Firstly, use real words. If primary-school-age kids are able to understand what’s happening, it avoids unnecessary confusion and anxiety. Use the word “cancer” as opposed to “illness” or “sick”. This helps to separate cancer from something like a cold that your child has and will experience.
Remember that your child is also wondering about their own safety, especially if they are young. You may want to say that there is nothing anyone did to cause this, and no one is going to “catch” it.
At the time of my breast cancer diagnosis, my own kids were six and three, and I was aware that they knew my aunt had died of ovarian cancer the year before. I wanted to be very clear that my diagnosis was different, and I wasn’t going to die. Of course, I was lucky to be able to tell my kids that my stage 3, grade 3, triple negative breast cancer had been caught in time for treatment to be curative. But what if your diagnosis does not have such a positive prognosis?
“My advice always comes back to the same guidelines: tell the truth,” says Dr Kennedy. “When the truth is especially hard, the conversation is especially hard. But it isn’t information that scares kids so much as being alone in the absence of information. So when the truth is uncertain, we have to help our kids sit with uncertainty, which means we have to acknowledge it as well.”
She recommends the following line when explaining really bad news: “I will always answer your questions honestly, even when things feel uncomfortable, because I know we can get through hard things together.”
Who to talk to
The psychological stress and emotional trauma of cancer treatment means that it’s necessary to talk about it, but there is value in seeking support from outside your closest relationships. If you’re scared about what the future may hold, you might find that you don’t want to share such fears with those close to you.
“It can help to talk to someone who isn’t directly affected and can offer support and advice,” agrees Lee. “This might be via a support group, either locally or online, or cancer forums. You could drop into your local Maggie’s centre and join a group, talk with one of our cancer support specialists, or speak to others who are going through a similar experience.”
If fear and anxiety are becoming all-consuming, you might need professional support. “Macmillan’s free and confidential support line has specialised teams who can help,” says Chris Bolton. “We can also make referrals to partner organisations should additional support be required.”
The benefits of talking through your diagnosis
Whether you talk to friends, family, a support group or a therapist, do make sure that you talk to someone. “Opening up and having someone listen to you without judgement may reassure you that what you are feeling is normal,” says Bolton. “It can also offer solutions to things you may not have thought about on your own. Talking may also strengthen the bond you have with loved ones, making them feel valued and able to support you better.”
This is an important point because, as much as none of us ever wants to be an inconvenience, this is a time when people really do want to help. So let them. I certainly appreciated the friends who looked after our kids so my husband could drive me to chemo, or left meals on our doorstep, and we became closer as a result.
“Telling people about your diagnosis means that your family and friends will feel more included,” says Lee. “Knowing when treatment is happening can mean they might be able to come with you, or help look after your children, or simply bring you shopping when everything feels too much.”
What to do if you don’t want to talk
Despite all the benefits of being open with others, there will absolutely be times when you don’t want to talk about it at all.
“Some people do not want to talk about their thoughts or feelings, or about the cancer and their treatment,” says Bolton. “But not talking about it at all can cause problems after a while – it may become hard to make decisions about treatment or work. This can delay your treatment or cause problems with your finances and relationships.”
Macmillan has a lot of resources to support you, including information and community blogs online, and its support line, which is free to call between 8am-8pm, seven days a week, on 0808 808 0000. If you prefer to talk to someone face to face, many hospitals have Macmillan centres on site. If there’s a Maggie’s centre near you, make sure you’re using it.
“However, there may be days when you find that you want to talk about normal things and your family and friends may not always realise this,” says Lee. “Let them know that you’re still you, and explain that you’ll talk about your cancer when you’re ready.”
For more information, Rosamund Dean’s latest book, Reconstruction: How To Rebuild Your Body, Mind and Life After a Breast Cancer Diagnosis, is out now.
Six breakthroughs pushing us closer to a cure for cancer