On supporting a friend with cancer

After my own experiences of cancer diagnosis, treatment and remission, I more or less regularly receive requests from people whose friend, family member or colleague has just been diagnosed asking for advice on how they might best care for them. I thought I would post one of my answers (with permission) in case it is of some benefit to others.

Hi friend,

Good to hear from you, though sorry to hear about this news.

I guess the first thing I'd say, which may actually not sound very helpful at all, is that cancers are very different and the experiences of cancer patients even more diverse, so I would be quite hesitant to extrapolate too much from my own story.

Having said that, it is still possible to say a little more. Grief and suffering come in many forms (even in the same person) and bring with them various needs and opportunities. At times, silence is the best support; at others, the chance to talk to a sympathetic ear; at others, a word of comfort; at others, an act of silent service. In general, I guess I'd suggest that responsiveness is therefore key, being willing to play whatever role will be a blessing to those in need. While at times grief needs space, I suspect it rarely needs absence, so as a start, simply indicating your willingness to be there for them and to grieve with them is probably the best bet. If they have practical needs, then offers of help from trusted friends may well be appreciated (babysitting while parents go to some of the endless appointments these things seem to involve? Doing some housework? Frozen meals? The latter can probably be safely brought without being asked, as long as you stick to any known dietary requirements). Some people may find themselves with little energy for daily tasks like these. Others might throw themselves into them as a distraction and comfort.

Depending how wide and deep the pre-existing support networks of this family are, it may be that they are initially swamped with offers of help and sympathy. If you think this might be the case, you (or someone else) could perform the service of coordinating the practical support (putting together rosters for babysitting or frozen meals, etc.).

Don't neglect the partner of the patient, whose grief is double: grief for their partner's sake and for their own (potential) loss. And depending how old the kids are, they may need extra support from trusted family friends.

Again, depending how well you know them, then make your level and form of contact fit the relationship. If you are not close friends, then make contact through forms that can be ignored or noted and replied to later (email, letter, card, SMS). Only call if you know them well, because they might receiving a string of calls and probably don't want to be having the same conversation with dozens of people.

If my experience is anything to go by, they are likely to find themselves the target of more unsolicited advice than at any time outside of pregnancy. Although I know everyone meant well, I'd suggest keeping any crank miracle cures you've heard of or stories of amazing recoveries to yourself. It is actually not very encouraging to be told about someone's aunt who was cured simply by prayer and faith or someone's grandfather who drank only goji berry juice and lived to 100. Such stories are (a) irresponsible (I'm not a big fan of alternative medicine, nor of purely faith-based healing, for both scientific and theological reasons) and (b) sometimes contain an element of accusation in them ("if only you had enough faith, you too would be healed like my cousin").

Many cancer treatments become complex, and there is often a high volume of information to share with those concerned. One suggestion that a friend made to me (more unsolicited advice from a guy I didn't know well at the time, but of all that I received, almost the only piece of pure gold I got) was that it might be a good idea to set up a blog where interested family and friends can self-medicate on as much or as little information as they wish. This means that rather than having the same conversation fifty times after each appointment, I could simply write out a summary once and post it on the blog, then direct people to the blog. Mine is here (only updated very infrequently now).

I would also suggest keeping your theological comments minimal unless they raise it. I was probably unusual in that I'd just written my 4th year paper on suffering and the problem of evil just weeks before being diagnosed and so was (usually) quite happy to discuss theology with anyone who wanted. But not everyone is in that place, and for many, just retreating into survival mode is all they can handle for a while (once treatment started, my willingness to talk dropped rapidly as I just had little energy for anything).

I could write reams about my experiences of treatment, but here, the specifics of the cancer become most stark and what I say may bear little or no relevance to their situation.

They may or may not find it helpful to meet with other cancer patients, though I suspect that such groups will be available through the hospital, so you probably don't need to worry about that.

Finally, I'd suggest taking this tragedy as an opportunity to reflect upon your own mortality. Our society has hidden death and dying as far from view as possible and here is one place that the gospel truly does have good news (though not always easy news). Of all that I read, wrote and heard during the intense few months after diagnosis, the best was undoubtedly this talk by Stanley Hauerwas. It may or may not be appropriate to share with your friends (that is for you to judge), but it is almost certainly worth an hour of your time (if you can get past his braying cackle and Texan twang).

It hardly needs saying, but when words and wisdom falter, groans are also part of a faithful response to serious illness.

Grace & peace,
Byron

PS If you don't mind, I might post my reply (omitting your name and any other identifying details) on my blog since I have been asked this question quite a number of times (not that I mind being asked!) and putting it there will mean I can refer to it in future. Let me know if you'd rather I didn't.

What we do with what we know: a story

A few years ago, I was diagnosed with cancer. It was not an easy cancer to explain to people, because, basically, the doctors hadn’t seen any cases quite like it before and could not identify precisely where it had started or what caused it. Since it was such a rare growth, they could also not give me a meaningful prognosis. The scans indicated that it was of a significant size, in a critical location and there was good reason to think it was probably growing quite rapidly. Their recommendations were that surgery would be almost impossible (one of them told me, “I’m not into killing my patients”), but that chemotherapy and/or radiotherapy might have some effect (one oncologist spoke of “curative doses” and another simply of reducing its size).

Now at this point, I had a variety of possible responses open to me. I could go and get further oncological opinions (I had already gone to three different hospitals and had multiple scans and a variety of tests).

I could have weighed up the probable side effects of treatment (quite a long list!) and decided that it was not worth it and tried to make the most of my remaining time, however long or short that turned out to be.

I could have heeded the many voices telling me that traditional medicine doesn’t know how to deal with cancer and that I needed various alternative treatments: homeopathy, acupuncture, meditation, herbal remedies, hypnosis, miracle diets and many more that were urged upon me by well-meaning contacts, often with powerful testimonials.

I could have listened to the Christian sisters and brothers who told me that I would be healed if I had faith, that God loves miracles and would preserve my life without treatment, that they had seen or been given amazing recoveries after prayer.

I could have embraced the cynical critiques of the medical system by noting that it is in doctors’ interests to keep me thinking that I am sick, that I need them, that I need their expensive and complicated treatments.

I could have gone onto Google and attempted my own re-diagnosis on the basis of extensive reading of the most popular sites, or by consulting the most helpful discussion boards.

Each of these options were being put forward by people who apparently desired good for me. Yet deciding to go ahead with the recommended treatment was a relatively easy conclusion for me. Despite its costs, I do not at all regret the decision and suspect there is a very good chance I would not be here today without the excellent treatment I received at the Royal Prince Alfred Hospital. Indeed, it has been three years today since I had my last radiotherapy dose, a few more days since my final round of chemo.

I’m sharing this story not for the sympathy vote, nor to celebrate an anniversary, and nor yet to ridicule the faith or intentions of those who urged me to avoid treatment. I share this story to raise the issue of the relation of knowledge to ethics. How does our knowledge of the world affect our obligations and opportunities to pursue good?

Many factors contributed to my decision to accept treatment, but significant amongst them was the considered advice of recognised experts in the field based on years of empirical research. I was not morally bound to follow this advice. The research has not been exhaustive. Not all the experts I saw recommended exactly the same treatment. My case involved some degree of novelty. Not all cancer treatment is as effective as mine has been so far. But I do believe I would have been both foolish and seriously at fault if I had simply ignored their advice, or acted as though the diagnosis must be wrong because I’ve heard of some misdiagnoses in the past, or if I had presumed that I would be alright because some tumours undergo spontaneous remission.

It would be no good to say that since the scriptures don’t tell me whether or not to trust doctors, then I have no reason to trust them. It would equally be no good to say that since the scriptures don’t tell me to have cancer treatment, then I was under no moral obligation to take the advice of the oncologists seriously.

Of course, receiving treatment in order to try to stay alive was neither my only nor my highest moral obligation. There are worse things than death. There are ways of staying alive that diminish the point of being alive. But all things considered, I believe there was a compelling moral case for me to accept the recommended treatment. I believe that not only was it possible to pursue this treatment without being distracted from more important things (like loving those around me and praising the wonders of the one who gives all life), but that the treatment was in fact a means to that end, keeping me alive for more service and song, and opening many opportunities to love and praise that I might otherwise not have had.

It may be obvious where I am going with this, but in case it is not let me spell it out. There is a large and diverse body of scientific experts with years in the field who point to widespread and growing empirical evidence of a critical diagnosis, which we cannot in good conscience ignore. They may offer a variety of different (even sometimes conflicting) advice on specific treatment, but it would be irresponsible to dismiss their warnings or to treat the situation as though it were nothing but a distraction from what is truly important.

Our knowledge of the world, though fallible and incomplete, is nonetheless sufficient to contribute to the moral deliberation of Christians. The evidence for alarming anthropogenic climate change is strong enough such that wilfully ignoring or burying the issue at this stage has become irresponsible. This is not a denial of sola scriptura nor to fall into legalism. Nor is it to say that climate change is the only or primary moral challenge of our day, or that all Christians ought to become climate change activists. And neither yet do I claim that Christians owe their allegiance to any particular mitigation strategy. But as one significant pastoral and social issue amongst others, and one linked to fears and guilt, to anger and confusion, to questions of greed and of faith, hope and love, addressing climate change Christianly is neither a luxury nor a distraction from the gospel.