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A cancer diagnosis comes as a shock.Here are some suggestions on how to share your message

Miguel Angel Partido Garcia/Getty Images

A woman with cancer wearing a pink scarf and her hands in her pockets. Talking to children about cancer can be difficult.

Miguel Angel Partido Garcia/Getty Images

When my wife was diagnosed with breast cancer, she told…well, not everyone, but pretty close.

Martha told me that after a routine mammogram, the radiologist called from the car and said (rather callously), “It does look like cancer to me.” (I said flatly, “Uh, That doesn’t sound good, and it makes Martha even more frustrated”)

She told her mother (her father was dead) and her two sisters…and the family grapevine did the rest.

The news that the Princess of Wales has cancer reminds me of the busy first days after the diagnosis.

Buckingham Palace kept this information secret for…how many weeks? How many months? Kate then revealed the news in a public appearance. A heartbreaking video.

Apparently, the royal family has its own set of concerns about going public with a cancer diagnosis. But the instinct to keep secrets is understandable. In our culture, no one likes to share bad news. People don’t always know how to react and conversations can become uncomfortable.

You don’t want to be called a “cancer patient.”

Maybe that’s why some people are reluctant to reveal it, saying Monique James, Ph.D.“They think this medical diagnosis is now going to be the only thing people see,” said one depressed patient who counsels patients at Memorial Sloan Kettering Cancer Center.

Therefore, anyone who has been told they have cancer must make difficult decisions when sharing this news. Would you tell the children at home? An older relative? Colleagues at work? All your friends and neighbors?

Finally, many people did decide to speak out. Martha’s approach was typical, James said. “I find that most people share with someone close very early on, maybe within the first week or two.”

That’s because cancer “can be a very lonely disease,” she points out. Having at least a few close friends can ease the loneliness.

Still, while some may find sharing cathartic, it can also be exhausting and feel like adding extra stress on top of an already confusing time.

Here are the pros, cons, and best ways to share a cancer diagnosis, as I learned from my wife’s experience and from interviewing dozens of cancer patients for the two books I later wrote: breast cancer husband and working with my oldest daughter, My parents had cancer and it was really bad.

Decide how much you want to say – and to whom

Take a moment to think about how much you want to tell someone. Maybe you’ll come up with a 2-minute script for casual acquaintances and a 20-minute script for close friends, James said.

But keep in mind that if you decide to keep messages from certain people in your circle but not others, or if you have different versions of what was said, you may end up adding to the problem as you try to remember who knew what your own stress levels,” says Hester Hill Schnipper, an oncology social worker in private practice and author of this blog Have breast cancer.

For a cancer patient who is reluctant to discuss issues with many people, designing a close family member to serve as an informant can be a boon, she said..

It may also be helpful to develop a strategy for responding to unhelpful remarks. Like a relative told my wife she got breast cancer from using deodorant. Or someone, upon learning of a diagnosis, says, “I knew someone who got cancer and died.”

Schniper suggests responding: “Why did you say that?” Such comments, she said, “shift the responsibility away from you and onto someone else.”

You can refuse to answer probing or unhelpful questions at any time. Try saying, “I just need a break,” Schniper suggests.

Honesty is often the best policy for your children and other families

Martha decided to withhold the diagnosis from our children, who were 12 and 15 at the time, for a few days. Her fateful mammogram came on the Friday before Labor Day. School starts next Tuesday and she and I both think it won’t be good. On top of the nerves of a new school year, they’re also dealing with the stress of their mom’s cancer.

When the kids were typically obnoxious teenagers, Martha would cryptically say, “You don’t know how I feel.”

Of course they didn’t. This made the next few days strange.

She told them when we picked them up from school on their first day. This turned out to be a good strategy. Therapists say the car is a good place to tell your child. No eye contact is required, which can be intimidating. Of course, kids can’t quit the conversation and run to their rooms.

Some parents want to keep their young children away from the news, which is possible if cancer treatment doesn’t cause noticeable changes (such as hair loss, fatigue, or prolonged hospitalization).

But when cancer appears in the family, keeping it a secret even from young children can backfire. Maybe they overhear a relative or neighbor saying the word “cancer.”

Even young children are “keen observers,” James said. “They may not know what’s going on, but they can see things. Involving them in what’s going on in the family unit is the best thing to do.”

“People want to protect their loved ones by not sharing important information,” said Leonard Ehrentak“In general, it’s best to be honest even with children, otherwise they will feel cheated,” says a social worker at Medstar Georgetown University Lombardi Comprehensive Cancer Center.

The same is true for older children. I’ve interviewed people who decided not to tell their adult children who were in college or living elsewhere in the country.

Therapists urge you to consider the consequences: Have you set a pattern so that your adult children don’t feel they need to share their life crises with you? When they finally find out, they may feel betrayed—because secrets are very difficult to keep.

As for older and frail family members, they may have experienced many life crises. However, if a frail parent or other relative lives far away from you in old age, they may face death. Schnieper understands that cancer patients may decide it’s best to protect them.

If talking about cancer is taboo in your culture, family disclosure can be complicated. This may mean that a parent or sibling may not be willing to listen. The solution, James said, is to find other avenues — perhaps a support group.

Chat with colleagues and professional contacts

If you have a job, you may worry about the stigma associated with sharing your diagnosis with coworkers. People may indeed think, Oh, you can’t do the job you’re supposed to do, Ellen Tucker said.

However, sharing with a supervisor may be necessary because you may need to miss a few days of consultation, perhaps for surgery or other treatment.

Schnieper added: “I would recommend talking to the person in charge to find out what the rules are regarding benefits. Do you have an option for short-term disability? Can I use it intermittently or can I use it as a one-time benefit?”

“But you don’t have to go into detail with everyone,” James points out. If a colleague — or anyone — presses for details, you can always say, “I’m not willing to go into detail.”

My wife teaches high school and she decided to tell her students. She wanted them to know that cancer happens, that people get over it, that she would miss days of school for chemotherapy, but that she would continue to teach even though she had decided not to mention the cancer in her…breasts since they were teenagers.

Privacy is, of course, a choice – but sometimes you become public in ways that surprise even you

The therapists I interviewed all recommended “telling the truth,” but they also recognized that it depends on the patient.

James said she worked with a psychologist who often said “the cancer patient is in the driver’s seat” while other family members are in the passenger seat.

So, yes, some cancer patients choose to remain relatively silent. But Kate’s saga shows that once the news is shared, there is a huge outpouring of support.

This is how Martha (and I) feel. We are swamped in a huge wave of love for every unfortunate remark. I still remember how our neighbor brought the most incredible tuna noodle casserole for dinner one night.

Although cancer is not a funny thing, sometimes you can speak openly with a sense of humor.

One woman told me that while she was wearing a wig during chemotherapy, she was out to dinner with friends and a diner at the next table complained loudly, “My hair is bad today!” The cancer patient wearing the wig caught her wig, pull it off your head and declare, “You think you had a bad hair day today…”

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