Things Not to Say to Someone With Lung Cancer

And what to say instead

young girl covering her mouth as if she's said something she shouldn't have
What should you NOT say to someone with lung cancer?. istockphoto.com

There are some things you ideally shouldn't say to someone with lung cancer, as well as things that are better to say instead. Far too many people with lung cancer have shared their hurt over comments made by friends and loved ones. Sometimes the remarks are insensitive, but often times they seem very innocent, especially to someone who hasn't lived with lung cancer. These comments are usually made with good intentions; people aren't trying to be hurtful and cause pain. On the contrary, many of these comments are attempts to connect and share an understanding. Too often, these comments have not only been hurtful, but they've felt devastating when they come at a time when people need as much love and support as possible.

Many people living with cancer have shared that it's not the actual words spoken which hurt so much, but rather what they read into the words. For example, if a loved one's cancer is in remission or NED (no evidence of disease), out of kindness and concern you may say, "How do you really know your cancer is gone?" Rather than feeling the love and concern that is intended, however, a comment like this can create anxiety about progression or recurrence and even a instill a sense of loneliness as they realize that they are alone with their own body in their journey with cancer.

What seems hurtful to someone with cancer might not immediately make sense to you.

As you read through this list, don’t chastise yourself if you’ve inadvertently made some of these comments to friends with cancer. We’ve all stuck our feet in our mouths at times, and your friend with cancer most likely made (and still makes) comments that can be hurtful to others coping with different struggles. People with cancer are forgiving, but being mindful of the words we use may help someone with cancer feel perhaps a tad less alone in their journey.

Since it's frustrating to hear about "the wrong things to say" without also having a solution, we will suggest some alternative things you might say in these situations. That said, keep in mind that often it’s not just our words alone that people "hear," but our body language; body language being thought to account for 50 percent to 70 percent of communication. If you want to send a clear message to your friend that you’ll be there and want to help, make sure your body (and actions) convey those words as well.

1. Don’t Say: "How Long Did You Smoke?"

It seems almost universal that for those living with lung cancer, one of the first comments a person makes upon hearing of their diagnosis is "How long did you smoke." For some people with lung cancer, these words aren't particularly painful, or they mask their hurt with a comment such as one lung cancer survivor made: "Thank you for telling me that I deserve to have lung cancer." But for many people, these questions are terribly hurtful as they feel they are being blamed for causing their disease. In addition to hurting emotionally, the stigma of lung cancer has actually led some people who have lung cancer to receive inadequate care (with poorer outcomes), as they feel unworthy of proper treatment.

People often ask about smoking or length of smoking because it means their own chances of developing lung cancer (if they didn't smoke or smoked less) are lower.

People don’t usually ask about smoking to be hurtful. Instead, it's often a way of reassuring themselves that they're "safe."

But anyone who has lungs can get lung cancer.

There are many lifestyle choices we make that can raise our risk of developing cancer, but for some reason lung cancer is often singled out. When we hear that a friend has breast cancer, we don't immediately ask "How long did you breastfeed each of your children?" We don’t ask people with colon cancer how long they’ve been sedentary. Out of all of the comments listed in this article, if there is one to avoid, avoid asking about smoking. Keep in mind that 20 percent of women who develop lung cancer have never touched a cigarette, and the incidence of lung cancer in young, never smokers is increasing. But even if someone has chain-smoked her entire life, she still deserves our love and care, our support, and the best medical care possible.

As a last note, we've heard people argue that this question is important; that asking people with lung cancer about their smoking helps to educate others about the dangers of smoking. We will reply here that there are many resources for learning about the dangers of smoking, without doing so at the expense of hurting your friend.

Instead say: "I’m so sorry you have to face this disease."​

2. Don’t Say: "Call Me if You Need Anything"

This might look like a typing error. After all, why wouldn’t you ask your friend with cancer to call if she needs something? The reason this isn't an error is that most of the time that call just won’t happen. When we ask someone to call, we put the burden of calling on that person. And living with cancer is enough of a burden. In addition, since offers of "call me if you need anything" are so common and often spoken lightly, your friend might question the sincerity of your offer. If you do offer help with "anything," make sure you wouldn't be put out if he calls you to clean out his gutters in a rainstorm.

In writing this, we aren't saying that you shouldn't offer help. Please do! But when you can, ask what you can do in a specific fashion, one that relieves your friend of the burden of needing to think. When people are going through cancer treatment, it can be very difficult to think about what types of help they need. Even decisions such as an answer to the question "would you like me to bring lasagna or pizza" are sometimes difficult, as people can be overwhelmed by all of the decisions they must make concerning treatment. What often helps the most is specific offers of help. For example, you might ask if you can come over on a Saturday and plant flowers for your friend. (A question like this requires only a yes or no answer.) Then, if the answer is yes, simply show up yourself or with friends and a trunk load of flowers to fill your friend's flower beds.

Sometimes just doing something without asking can be the greatest gift. Depending on your friends personality and your relationship, sometimes simply doing rather than asking can be a tremendous gift. One woman with cancer had friends show up with trays of frozen meals and supply from the grocery store (the friends also took them straight to the fridge and freezer and unloaded them) without asking.

A final quick note on this topic is to provide your friend an "out" if needed. When asking a yes or no question, let her know you won't be offended if she says no. Likewise, when bringing gifts, let her know that you don't expect a thank you (amidst the craziness of her treatment) or even that she uses the gift. For example, if you bring her a pile of your favorite books, you might make sure you tell her not to feel obligated to read any of them. That way she knows to appreciate the gesture alone.

Instead, say: "Can I come over next Wednesday and wash windows?"

There are hundreds variations of this such as "Can I drive you to your next treatment," that will depend on your loved one's needs, but the point is to offer tangible help in a way that makes it clear you are available. Even making decisions about these types of questions can be challenging with cancer. Depending on your relationship, you may just want to show up to drop off a meal (and not stay unless it's clear your friend doesn't feel obligated to entertain you since you showed up).

3. Don’t Say: "My Neighbor’s Second Cousin’s Ex-Husband Had Lung Cancer and He _______ "

It happens all the time. Upon hearing of a friend’s diagnosis, we offer stories about others we’ve known with a similar condition. But instead of these comments doing what they are intended to do—create a connection—they often do just the opposite; leave our friend feeling even more alone.

Sharing stories about people who died or horror stories about treatment are the last things someone living with lung cancer needs to hear. But any comparisons can miss their mark and end up being hurtful. For example, a person might comment that her daughter had "the same thing" and never missed a day of work. The intent in this comment may be to lessen the fears about treatment for your loved one with cancer. Instead, it might leave that loved one feeling judge if she needed to take time off —like somehow she "failed." Conversely, a person might point out how wonderful it was that her sister was not only able to quit her job after she was diagnosed, but that her husband began doing all of the cooking and laundry as well. Not helpful if your friend with cancer needs to work to keep her health insurance.

On rare occasions, sharing a story may be helpful. An example would be if your friend was just diagnosed with stage IV lung cancer. Telling her about, and better yet introducing her to someone who was diagnosed with the same thing 15 years ago (and is still thriving) may be a blessing. But think carefully before sharing any stories, especially if you don't have a deep understanding of her disease. (There are many different types of lung cancer. Talking to someone just diagnosed with extended stage small cell lung cancer about a 15 year survivor of non-small cell lung adenocarcinoma with an EGFR mutation wouldn't be wise and could increase her pain.) Even if you understand your friend's disease, the focus of your conversation should be on your friend, not on other people in your life who have faced cancer.

Instead say: "How are you holding up?" And listen.

4. Don’t Say: "I Know How You Feel"

If you make this comment, what will your friend think? "Really? You know what it’s like to have my body, with my particular type of cancer, with my specific symptoms, living with my children, in my home, with my financial concerns?" We realize that most people who say "I know how you feel" are trying hard to be supportive and make their friend feel less alone, but in reality, this can leave your friend feeling even more lonely and isolated.

Unless you are living with lung cancer—and even if you are—you can’t understand what it’s like to be your friend. Everybody’s journey is different. It can be very tempting to say something like this if you’ve had cancer yourself. In some ways, having cancer gains you admission to a secret society of survivors, but comparisons among cancer survivors can be even more painful. For example, someone living with stage 4 lung cancer doesn’t want to hear someone with a stage 2 breast cancer say "I understand how you feel." Because they can’t.

Instead, say: "How are you feeling?" And be prepared to listen.

5. Don’t Say: "You Need To Have a Positive Attitude"

Keeping a positive attitude with cancer isn’t a bad thing; studies even suggest that having a positive attitude may help the immune system and reduce stress hormones in our bodies. But just as there is a time to be positive, there are times when you need to have a good cry. 

Telling people who are coping with cancer that they need to stay positive invalidates their feelings. This, in turn, can cause them to shut down and hold their feelings inside.

Just as it's normal to experience negative emotions at times without cancer, negative feelings such as anger, resentment, and fear are common among cancer survivors. And just like people who don't have cancer, negative emotions that go unexpressed with cancer can affect people physically (think fight or flight reaction) and come out in other ways. It's important for people with cancer to express anger and other negative emotions.

Telling someone with cancer that they are "so strong" can have the same effect. If you want to support your friend with cancer, let him be in a place where he can be weak and express his fears.

Instead say: "I’m sure you feel down at times. If you need a shoulder to cry on, I’ll be here for you."

6. Don’t Say: "You Need to ___ "

Take your choice of any of the options below or come up with your own:

Some suggestions people make can be good. Some are neutral, and some could even be dangerous. Too many people with cancer have had well-meaning friends advice them to skip conventional treatments such as surgery or chemotherapy and instead just drink carrot juice every two hours (or some variant of this). Certainly, if your loved one with cancer has read the 2018 study published in JAMA Oncology showing that people who choose complementary therapies to the exclusion of conventional therapies are twice as likely to die, he may not follow this "advice." But the bottom line is that giving advice is probably not how your friend with cancer needs you to support him.

If you're about to say something that begins with "you need to___," think again. Your friend has likely done a lot of research and probably already overwhelmed with the options available. Likewise, sharing "conspiracy theories," or making comments about chemotherapy being a ploy for doctors to make money at the expense of cancer patients, doesn't do much to support someone recently diagnosed with cancer.

(With treatment for lung cancer changing so rapidly, there may be a few exceptions. For example, if your friend has been diagnosed with lung adenocarcinoma and her oncologist has not recommended next generation sequencing (on either a tissue or liquid biopsy), it's best to speak up, educate her, and recommend a second opinion.)

Instead say: "It sounds like you’ve chosen a good medical team. If you need, I’ll be happy to help you research your options."

7. Don’t Say: "Everything is Going to Be Alright"

Really? How can you be so sure? Even if you are an oncologist who specializes in your friend's type of cancer, we know that everyone is different. Two people who have the same type and stage of a tumor may have cancers that differ significantly on a molecular level. In turn, they may respond very differently to treatments and have different outcomes. But even with reasonable evidence that your friend will be OK, this is still not a good thing to say.

Telling your friend that you're sure she'll be fine is likely not only untrue  but minimizes your friend's fears about treatment and the future.

Instead, say: "I’m going to be there for you." And be prepared to listen to her fears.

8. Don't Say: "God Can Use This"

It's best to also avoid the variation, "Everything happens for a reason." When people with cancer hear this comment, they may just as easily say, "Rightm but He could have used me just as well without cancer."

Biblically, there's nothing that tells us that God "gives" people cancer so that they can help others. Instead, most clergy believe that cancer happens because we live in a fallen world, but God promises to be there through the journey. It's true that the experience may help someone with cancer help others, and that God may indeed use the experience (that He didn't cause) in this way, but to declare this to your loved one with cancer isn't helpful. Instead of validating your friend's own need for support and love, this comment discredits his needs and focuses on those of another.

Remarking to someone that "if they have enough faith" God will cure them is equally hurtful. Many people know of someone who had a very strong faith and beliefs, yet succumbed to cancer anyway. Likewise, miracles sometimes happen to those who have no faith at all.

Instead, say: "May I pray for you?" if you are comfortable doing so. And if your friend says yes, make sure you do.

9. Don't Say "Don’t You Wish You Had Breast Cancer With All the Pink Stuff Instead of Lung Cancer?"

Yes, this is a true comment once spoken to someone with lung cancer. There is an imbalance in the amount of support (and funding) for lung cancer relative to breast cancer, but isn’t that obvious enough (and painful enough) without commenting about it?

Another "don’t say" comment was actually written by someone with breast cancer about lung cancer awareness: "Lung cancer survivors need to stand up and make a difference like breast cancer survivors did." Yes, breast cancer survivors have done a wonderful job of raising awareness. But to walk or run for lung cancer awareness you need to have lungs, and you need to live. The overall 5-year survival rate for breast cancer is around 90 percent. For lung cancer it's just a little over 18 percent.

Instead, say: "I’m ready and willing to join in to help the cause as a lung cancer advocate."

10. Don't Say: Nothing

Silence can be the hardest thing for someone with cancer.

One of the greatest fears of people with cancer is being alone—facing treatment alone, facing pain alone, dying alone, or facing survivorship alone.

It's important to realize that there are a number of things it's better not to say to someone with lung cancer, but when it comes down to it, it’s better to say something than to say nothing at all. People with cancer are usually forgiving of the occasional less-than-tactful remark. It is astronomically more painful to feel abandoned.

Instead, say: "I don’t know what to say."

Final Thoughts and General Tips

Since silence is perhaps the worst thing you can "say" to someone with lung cancer, we don’t want people leaving this article paranoid that they’ll accidentally say the wrong thing. People living with cancer understand that their friends can find it difficult to know what to say. Instead of memorizing specific comments not to say, a few generalities might help.

  • Talk less and listen more
  • Ask open-ended questions, and let your friend direct the conversatio.
  • Instead of feeling a need to fix things or do something, what your friend needs most is simply for you to be there.
  • Avoid giving advice
  • Avoid criticism
  • Avoid the extremes—both belittling and catastrophizing the gravity of cancer can be hurtful to someone with cancer.

And remember: bad things do happen to good people. But sometimes, those bad things are a bit more tolerable when you have friends who make the effort to avoid saying things that can be hurtful, and replace those comments with supportive words instead.

"Kind words, kind looks, kind acts and warm handshakes, these are means of grace when men in trouble are fighting their unseen battles." - John Hall

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