When cancer affects friendships

Cancer always impacts many relationships. The changes to our friendships are usually unexpected. When I meet with someone who has been just diagnosed, I suggest they make a list of people whom they can depend on and those whom they suspect will not be helpful. The directions then include putting the list aside for a year. When it comes out again, there will be surprises in both directions. There will also be new names, people who have been part of the cancer experience and who may have become trusted confidantes. We often feel that our cancer buddies, our companions in the waiting rooms or support groups, understand us better right now than others can.

Both the old, dependable friends (remember the old Girl Scout song: Make new friends, but keep the old. Some are silver, and the others gold.) and the new ones are our biggest treasures. It is the other group, those people who have hurt us or abandoned us, who bring us pain. It is especially difficult when the absent person is someone who has been a longtime close friend or even a relative. I have heard many stories of a sibling who made one phone call and then was silent for months or a dear childhood friend who never communicated after hearing of our diagnosis. We understand that this bad behavior is due to their issues, but that does not make the hurt easier. Most of us have cried over a lost friendship.

I wish that I had suggestions or strategies about how to prevent these losses or identify the likely culprits. I don't. We may think that a friend whose sister died of lung cancer last year will be too hurt to be close to us, but may find that she is constant just because she understands and appreciates our needs and feelings. Someone else may have no known cancer triggers, but vanishes nonetheless.

I do have some thoughts about how to think about these relationships after cancer and make thoughtful decisions about what, if anything, to do. During cancer treatment, no one has time or energy to devote to this problem, but you can count on it still being there later. The first and most difficult question is whether the friendship is still worth saving or whether you are too hurt or angry to want to reconnect. If the answer is yes, it probably will fall to you to pick up the phone or send a note. I would suggest a real written-on-paper note instead of an email. Especially in our era of little mail, a handwritten note has significance.

We all know that friendships change and come and go through life. We may have close friends at work or in the neighborhood we gradually lose when our lives change. Other young parents from the playground or soccer team may have less in common with us 10 years later. We usually aren't hurt by these changed friendships, but they probably weakened gradually and not in the midst of a personal crisis. This is different.

If you do decide to take the risk of further hurt or rejection and reach out, keep it simple. The note can begin: I have missed you. Your friend knows all too well that she disappeared at a very vulnerable and difficult moment, and there is no need to assign blame or criticism. If you want to continue the relationship, you will need to understand what happened and have a chance to honestly talk. It won’t be easy, and there may be more pain and tears, but it may be worth it. You will probably hear an awkward explanation of I didn’t know what to say or So much time passed that I was embarrassed to call you. Hopefully, you can get past these superficial comments and share the feelings. Your friend needs a chance to apologize, and you need a chance to forgive.

Whatever your decisions and whatever the outcomes, cancer teaches us what is most important in life. The answer, of course, is the people whom we love. Hold tightly to them.