(This is an Excerpt from Coping with the Emotional Impact of Cancer by Dr. Neil Fiore)

In groups I’ve led for cancer patients and their families, the issue that surfaces as the most pressing—after the shock of the diagnosis and the stress of coping with cancer therapy—is how to communicate with doctors and family. Whenever I ask group members about problems with their interpersonal communications, approximately 75 percent initially say, "There’s no problem." But on reflection, the patient, a relative, or both, will acknowledge that often it’s not so easy to talk about what’s really on their minds.

The relatives of the patient often feel that the patient considers certain topics taboo. Patients, on the other hand, often feel that if they allow themselves to get upset, everyone else will become hysterical. The patients then feel they have to suppress their own feelings in order to take care of the rest of the family. Soon it becomes obvious that everyone has become overly cautious about bringing up certain topics.

What gradually emerged from these groups was a series of statements that are particularly effective in initiating discussions of uncomfortable thoughts or feelings. While many of these statements might be helpful to either the patient or the family, the first two are primarily from the patient’s perspective and the rest are from the point of view of the family.

• I'm afraid that my cancer has made us strangers. I’m feeling increasingly isolated and alienated from you, as if we’re going through our own private hells separately. Is there anything that I can do to help you through this time? We’ve become so tentative with each other, lately. Can’t we find a way to really talk?

• I'm finding it very difficult to tell you of my feelings about this illness, this cancer. And I’m afraid that if I bring it up you’ll get upset.

• You know, some things are really hard to think about, much less talk about. And I just want you to know that if you ever want to talk to me about them, I’m more than willing to listen.

• I feel bad about avoiding talking to you about all the troubles you’ve been going through. I’m afraid that if we start talking I’d break down and cry, and you wouldn’t like that.

• You seem really calm about all this, so I’ve tried not to get you upset with my feelings. But I’m really scared about losing you.

• Please don’t tell me not to worry. I am worried, and with good reason. This is serious! And I get very upset when you make jokes about it, and tell me there’s nothing to worry about. I don’t want to lose you.

• Let’s figure out what we’re going to do if the test comes back positive. I’m hoping for the best, but I’d feel a lot better if I knew what you were thinking and what we’ll do if it turns out to be bad news.

What the Family Can Say

In spite of all the good intentions and efforts on the part of the family, at times the patient seems to be resisting all efforts to talk seriously about the illness. Under such circumstances there’s not much to do but to trust the patient’s way of coping and to let him or her know that when it’s time to talk, you’ll be there. This kind of support can be vital to a patient who’s waiting for a sign that somebody cares. You might say it like this:

I want to talk to you, but I get the feeling that there are some things you’d rather not talk about now. I want you to know that when you’re ready to talk, I’m ready to listen. I won’t turn away if you cry, and I hope you won’t mind if I cry. I want you to have someone to share your thoughts and feelings with, if you want to. If I were in your place, the worst thing would be feeling isolated from my friends. I don’t want you to feel that way. We’ve shared some good times; we can share this too.

If you can’t imagine yourself actually saying these things out loud, you may want to write down your thoughts in a note. Writing down difficult feelings enables you to complete your message without the fear of interruption. It also allows you to make as many changes as you need in order to accurately express how you feel.