Sharing Your Cancer Diagnosis: Now or Later?

I am a believer in the truth. It has always seemed inarguably important to share information about cancer with one's family, close friends, and employer. Sometimes there are others in the closest circle who seemingly should be included in the early news. However, over the years of my clinical practice, I have learned that there are exceptions.

Most often, these exceptions have been related to very elderly or infirm parents. Occasionally, they have applied to other distant family members. Of course, family members and close friends who are nearby and sharing the experience must know the real story. But what about a 98-year-old frail parent who lives a thousand miles away? What about an 80-year-old parent with dementia who lives in a nursing home? What about a 90-year-old parent who daily lives with intense anxiety and needs a great deal of care and attention? My patients have wrestled with difficult decisions like these and taught me that there are sometimes shades of gray or lies of omission that are loving and responsible.

There are other people from whom it may be wise to withhold the cancer news at least for a while. It you have children who are about to celebrate a life milestone like a graduation or a wedding or if your kids are about to take important exams, such as SATs or MCATs, it may be smart to stay silent for a few weeks. If your business is about to be sold or you have a brand-new boss or a promotion decision is pending, you might choose to wait a bit.

Remember, delaying the news for a few weeks is not the same as never sharing it. Your children, no matter their age, deserve to know what is happening. So do your close family members and friends, and it is important to be honest at work. Once you have talked about your diagnosis, you can't take back the words, so it is always smart to pause and think a little about the other side of the conversation.

If you have been diagnosed with cancer and are worrying about this, there are some guidelines that may help you make the best decision.

• First, do no harm. Of course, sharing bad news is inevitably painful for people who love you, but, most of the time, they can cope and support you. If learning of your cancer is likely to seriously damage them or their life arrangements, think carefully about whether and when and what to say.
• Often it is impossible to keep this secret. If you regularly see an elderly parent, s/he will notice if your visits become much less frequent and you are ill. If your treatment will cause hair loss or other obvious physical changes, it is even harder to be silent. If, on the other hand, you see them only a few times a year, you may be able to keep your counsel.
• If your child is away at camp and won't be seeing the daily business and distress at home, you probably can wait until camp is done. If, however, s/he is away for a semester or a longer period of time, it probably is not fair to keep the information away from her/him for so long.
• If your parent or other relative or close friend lives far away and is frail, consider a trip to visit before starting treatment. When you are there, you can make a decision about whether to speak of your diagnosis. Remember that the place of cancer in our world has changed. Older people recall when the c word was whispered and meant sure death.
• Sometimes it works best to make a visit after surgery or other treatment has been completed. You can then honestly emphasize the good news of recovery, and your parent will be reassured by seeing you.
• Visit or no visit, it is often helpful to save the information until you can also share a plan. You will feel better when a plan is in place, and so will someone who loves you.
• Consider carefully the odds of your news staying secret. Are there other people who may let the word slip? It would be worse for anyone who loves you to hear of your cancer from someone else.
• If you must share the news by phone, consider arranging for someone to be with them during that call. If that is not possible, don't conclude the phone call without a plan for their next few moments or hours.
• Always be reassuring. If you have been given especially dire prognostic news, it is not necessary to tell your very elderly or ill parent this detail. Share anything hopeful your doctor has told you and remind your parent that you are receiving excellent care. If there is more bad news in the future, you can share it bit by bit when the time comes.
• There is nothing harder for a parent of any age than to have a child with a serious or life-threatening illness. They will be devastated and will need the support of people nearby. You cannot be responsible for this and need to enlist the help of other family members or close friends.
• Your adult children who live far away may also be devastated and frightened. If possible, plan a visit home in the near future. During these COVID-19 times, this is even harder, but you can at least promise to stay in frequent contact by Zoom.
• If you are worried about telling your boss and colleagues, consider first speaking to someone in HR to fully understand your options. Part of the conversation with your manager should include your thoughts about much you will be able to work and whether you will need to take time away from the office.
• Your primary responsibility is to yourself and your immediate family. Focus there.