by Carolyn Thomas ❤️ Heart Sisters (on Blue Sky)
“If you have to get cancer, yours is a good kind to get!” That’s what someone recently said out loud to me. It’s the kind of thing you might say out loud if you were truly trying to cheer me up but weren’t quite sure what on earth to say to a heart patient with a newly diagnosed malignant breast tumor the size of a small grapefruit. Yale University professor of psychology Dr. Laurie Santos calls this cheerfully minimizing response to a cancer patient as “the kind that decides ‘bad’ negative emotions could be fixed if only we had a more ‘look on the bright side!’ attitude.”
Nobody wants to say the wrong thing to any newly-diagnosed patient, but that perky “good kind of cancer” comment landed with a hollow thud. It’s also an example of something that only a patient might say one day – when this is behind her.
First, nobody “has to get” cancer. Second, there is no “good kind of cancer’ to get. That’s like saying: “If you have to get hit by a bus, this is a good bus to run you over!”
Mental health researchers call minimizing responses like this “toxic positivity” or “unrelenting optimism.”
It’s good to be positive. It’s good to be optimistic. But each can sometimes paint negative emotions (fear, anger, sadness, distress) as somehow a failure or weakness on the patient’s part. I’m learning this important lesson firsthand, day by day – and I’ve only been diagnosed since April 1st. Tomorrow morning is my first chemotherapy appointment, but already I’m feeling completely overwhelmed and exhausted by what lies ahead: 11 months of chemo, and then surgery. And from what I’ve been learning about cancer, that’s a completely predictable and “normal” way to respond, especially in the early days.
I’m not strong. I’m not brave. I’m just showing up for tests, scans, procedures and doctor appointments at the Cancer Agency – appointments that I sincerely wish I didn’t need to attend.
And another thing: there’s a pervasive tendency out there to start comparing medical outcomes. This reminds me of what I call the Hierarchy of Heart Disease (which I think I invented, but could also be just a global phenomenon). I discovered this tendency on my first day at cardiac rehabilitation in May of 2008. I was the only woman there, and the youngest by at least two decades. That first morning, a cheerful elderly man approached me on my treadmill and asked “What are you in for?” I told him that I’d had a heart attack and now had a stent implanted. He interrupted me on the spot to announce enthusiastically:
“I have THREE stents!!!”
Three stents?!
Suddenly my misdiagnosed “widow-maker” heart attack was barely worth mentioning anymore. His enthusiastic declaration was immediately followed by fully reciting his entire medical history, every exquisite detail – as I wrote in: “One-upmanship: you think YOU have pain?“
One-upmanship compels us to do or say something in order to prove that our stories are better/more interesting/more dramatic than yours. But worse than that is one-DOWNmanship – as the iconically hilarious Monty Python skit called Four Yorkshiremen demonstrates (in which the lads sit around and argue about which one of them had endured the worst poverty in childhood: “A house? You were lucky to live in a house! We lived in one room, all 26 of us!”)
A woman who had also been diagnosed with breast cancer years ago recently asked me the name of my specific kind of breast cancer. “Invasive ductal carcinoma”, I replied.
“That was my diagnosis, too”, she said dismissively. “But I had the BAD kind. . . “
I was so gobsmacked by her statement that I was briefly tempted to sarcastically respond with some wisecrack about feeling so very very lucky to have the FUN kind of cancer – but instead, I bit my tongue.
I’m new to these cancer conversations, but I seem to be biting my tongue a lot more these days.
So here are seven tips based on patient suggestions from the Canadian Cancer Society (shared by experienced cancer patients) on what to say or not say to freshly diagnosed cancer patients:
1. No two cancer journeys are the same. That’s why sharing your own personal cancer stories with a newly diagnosed cancer patient is typically NOT as helpful as you may hope your stories will be. Replace with something like “I’m here to support you.”
2. Avoid saying: ‘Relax!’ Replace with: ‘Waiting is the worst’. And waiting IS the worst (for endless appointments, tests, pathology reports, treatments and calls to be returned).
3. Avoid saying: ‘Let me know if I can help!’ Replace with: “I’m bringing you some (meals, muffins, magazines, groceries” (whatever you know this person enjoys). As one patient recalled: “All the best memories of those early days when day-to-day tasks felt overwhelming were things that people did, rather than said.” (My favourite kind of offer to help was: “I’m at the grocery store – what can I pick up for you while I’m here?”)
4. Avoid saying: “It’ll be okay!” Replace with ‘I’m with you every step of the way’. Try not to trivialize their experience by telling them that everything will work out. You don’t know that. Validate their feelings, and offer heartfelt sympathy for what they’re going through. And reminding them how much you care about them can really help.
5. Avoid saying: ‘Stay positive’. There’s so much pressure on patients to stay positive – but this isn’t always possible or even realistic during treatments, side effects and new challenges. Help them find things that can improve their quality of life – but sometimes, they just need to “wallow with gusto” – and that’s okay. And even if I do spend an entire day crying on and off (as I did last week), it’s not failure or weakness. It’s just me trying to make sense of something that makes no sense.
6. Avoid saying: ‘You can fight this battle!’ Replace with: “I hope you’re back doing the things you love soon.” Combat language like ‘fight, battle or warrior’ may seem encouraging, but actually are rarely helpful to a patient who now feels responsible for LOSING this cancer battle if they don’t try hard enough.
7. Avoid over-sharing about your own life. Replace with listening. Just listen. Hearing about complaints or seemingly minor difficulties from visitors can trigger confusing emotions for patients struggling with a serious diagnosis. As one cancer patient said: “It’s awful when people call up to see how I’m doing, but then spend half an hour telling me about all their little aches and pains.” Sometimes, just sitting in silence and being present can be a compassionate way to show you understand what they’re going through. As one cancer patient reminded us: “I’m a writer who happens to have cancer, not a cancer patient who happens to write…”
Finally, BBC reporter Allie Volpe wrote about a more realistic framing that’s called ‘Tragic Optimism’:
“This perspective suggests that hope and meaning can be found in life while also acknowledging the existence of loss, pain and suffering. First defined by Austrian psychologist and Holocaust survivor Dr. Viktor Frankl in his 1959 book about his years as a prisoner in Nazi concentration camps during World War II, he explains that in tragic optimism, there is space to experience both the good and the bad, and that we can grow from each. . .”
Q: Are you a tragic optimist?
NOTE from CAROLYN: My blog-turned-book, A Woman’s Guide to Living with Heart Diseaseis based on many of my 900+ blog posts about women’s unique experiences when we become patients. You can ask for it at your local library or neighbourhood bookshop (please support your favourite independent bookseller) or order it online (paperback, hardcover or e-book) at Amazon – or order it directly from my publisher, Johns Hopkins University Press (use their code HTWN to save 30% off the list price).
Heart Sisters 
Hi Carolyn, the words of encouragement I received from a healthcare provider along the lines of what you share here were actually very good. I had the same diagnosis you did and rather than tell me it was somehow better than some other diagnosis or whatever, they said that if I had to have cancer, there has never been a better time to have it, because they know so much more about it now than even just a few years ago. The medical technology and training have never been more advanced and outcomes are a lot better for patients now than in the past. I hope that really does give you some encouragement.
And your experience with the mix-up in your first appointment time made me think of my first oncologist appointment, which was truly comical. I was given the diagnosis of breast cancer by a person in radiology following my biopsy who then scheduled me to see the oncologist. When my husband and I arrived on Friday morning for the appointment, my name was not on the schedule. The receptionist poked at her computer for a moment while I told her about the phone call from radiology and suddenly looked up at me with fire in her eyes and snaps, “Was that Angie?!” I shrugged my shoulders (even though I think it was) — obviously an ongoing problem and I wasn’t about to get involved!
She then hurried off and talked to the oncologist, who then agreed to see me during her lunch hour. I offered to just reschedule but she said, “No, no, we treat our patients right here. It’s no trouble and she doesn’t mind.” Well, okay then!
Meanwhile, I had a sheaf of paperwork to fill out that would surely take me until noon. There was a little cafe right across the hall so we went over and bought breakfast and I began to wade through the forms. Suddenly the receptionist bursts through the door and says, “You didn’t pay for that, did you?!” Well, uh, yes, of course we did? “No no no! Our patients don’t have to pay here, we will give you a gift card. We treat our patients right…”
Honestly, I was shocked by all this but I felt like I’d found the Cadillac of healthcare. I’m still laughing over it.
Will keep you in my prayers, Carolyn. I hope you are blessed with a great healthcare team and that somewhere in the midst of all this you will find moments of hilarity to laugh at too.
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Hi Meghan – That does sound comical (minus the “fire in her eyes” look and of course the snapping at you!)
Snapping at patients (and dealing with the ‘Angies’ of the world about “ongoing staff problems” right in front of a patient seems odd during such vulnerable and stressful times for many patients. By the way, I agree with everything your healthcare professional told you about current treatments vs. the “old days” (which were pretty grim, when hospitals and researchers did not yet know about the high risks of radiation-induced or chemo-induced cardiomyopathy and heart failure that oncologists were simply unaware of back then.
When my oncologist makes those same reassuring or informational statements to me, he’s not minimizing my diagnosis or trying to somehow cheer me up like the person who offers: “You have the ‘good kind’ of cancer!” comments – not at all. I also agree with your thoughts on laughing – surprisingly common in the waiting rooms filled with patients chatting and laughing that I’ve experienced already.
It IS encouragement and education when coming from a physician or cancer nurse. What I was writing here about, though, were the people in our lives (the average non-doctors!) when they’re not quite sure what to say, so their default response is the “look at the bright side!” platitude.
Thanks for keeping me in your prayers, Meghan… ❤️
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Recently, I’ve seen a lot of stuff in the media with titles like “How to Speak to Someone who is Dealing with an Illness”.
As a result, I have been looking on the bright side (see what I did there?) and had started to believe that most people are getting the message: STOP false positivity, one-upmanship, trivializing, and that horrible “fight talk”. Guess I’m wrong and have now learned a lesson about being a Pollyanna.
I’m so sorry you’ve had to experience these interactions. My first thought was – that sounds like my family! Parents/ grandparents were all falsely positive and trivializers. It wasn’t “polite” to wallow. So I adopted all that nonsense from childhood and am only now learning to keep my mouth shut unless I have something truly considerate to say. There must be about a bejillion of us out there. Stop biting your tongue. Go ahead and tell us how unhelpful we’re being. And wallow. Keeping my fingers crossed for you, Wonderful Person.
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Hello Deborah – I don’t think I’ll be telling people how unhelpful their comments are (although on second thought, I did do exactly that last week 😦 … to my lovely sister!
Both of us are new to this cancer stuff: me as the patient, her as my Support Person. It boiled down to us both holding unrealistic EXPECTATIONS: she expected me to be the “old” me whose brain could function (even despite clear evidence it wasn’t – missing appointments, forgetting what she’d just told me just seconds afterwards, unable to comprehend calendars or drug schedules, scary stuff.
Meanwhile I expected her to understand ALL of the mental/emotional realities of a cancer diagnosis as if she were a professional. We sorted it all out, crying, hugging, talking it out. While I was writing this post, I read that “nobody wants to say the wrong thing” during these interactions. I think I’ll embroider that on a pillow…
PS Did we grow up in the same family?!?!? 😉
Take care. . . ❤️
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This is such an important conversation, Carolyn.
You perfectly unpack how those well-intentioned platitudes like “look on the bright side” can actually be incredibly isolating and unhelpful when someone is truly struggling.
Your points about the power of simply listening and allowing space for real sadness resonate deeply with me…
Marie Ennis-O’Connor
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Hello Marie – it’s all in the listening, isn’t it? It’s so hard for other people to watch us being upset or scared or sick. We want and NEED them to be better, to be their usual predictable self. I do understand that want and need, and I know that the “bright side” advice almost always comes from a place of caring (and wanting to “cheer us up” in some way). But sitting quietly and just listening – wow, what a gift that can be.
Take care. . . ❤️
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Hi Carolyn,
All I can say is, you’ll likely be biting your tongue quite a bit in the future. Or don’t.
You needn’t keep quiet when someone says something inappropriate. It depends on who’s saying it, of course. And sometimes, it’s not worth spending energy on ridiculousness.
The “good cancer” is one of the worst. Ugh…
Good luck as you start chemotherapy tomorrow. I’ll be thinking about you, my friend.
As for being a tragic optimist – maybe.
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Hello Nancy – such a smart idea: “it’s not worth spending energy on ridiculousness (is that a word?! 🙂
I feel like i have precious few moments of energy these days, so let’s spend those trying to feel better – not worse.
And speaking of “worse” – my first Chemo Day was actually on Friday morning. I got a last minute phone call at lunchtime on the day before (Thursday) to show up for my first chemo on the next morning (despite their standard instructions: “You will be given a date for your chemotherapy appointment 3-4 business days prior to your appointment.” (This gives patients a few days to book a blood test at the lab, organize a chemo bag, get their pre-chemo meds sorted out, and speak to their oncologist). But instead I just got a rushed phonecall at lunchtime on Thursday for a 9 a.m. chemo appointment the next morning (Friday!)
So no requisition for the required pre-chemo blood test (I found out on my own that the hospital lab opened at 7 a.m. so on the chemo day, I raced down to stand in the walk-in hospital line by 6:30 a.m. (luckily the lab had an online requisition in their system for me – NOT for a pre-chemo blood test but for an upcoming cardiology appointment – so they used that requisition form to complete the blood test – even though a pre-chemo blood test probably looks for different things than a blood test ordered by a cardiologist! Yoiks!
BUT WAIT THERE’S MORE! – because I hadn’t taken the dexamethasone on the morning before, the chemo nurse asked my oncologist while I was still there if we should go ahead with the chemo – but the oncologist told her that the side effects would be “much worse” if I had not taken that drug the morning before!
The morning before however, was when I did not know I’d be having chemo the next morning! So the nurse unhooked me from the IV and I was sent home, rescheduled to come back for chemo Monday. The chemo nurse was lovely and apologized profusely for this last-minute confusion. But honestly, it was not an experience that inspired confidence. 😦
Take care Nancy. . . ❤️
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Oh, my. Not an experience that inspired confidence indeed! How frustrating, not to mention your wasted time and energy. x
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I hear you!
Before we can reach the optimism in the midst of tragedy there is a process of grieving we must go through. We are losing a “self” that we knew well. And even if/when the cancer is cured or the heart attack is survived, we are a different “self” when we come out the other side.
The grieving process can’t be speeded up by others, it just needs to be allowed and supported.
Blessings on your journey!
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Hi Jill – so true. And not only are we losing that “self” we knew so well, but we’re facing a firehose-like torrent of new information, changing information, confusing information, medical jargon – all coming at us at once. Throw in a couple of inevitable hospital staff who really should not be dealing with vulnerable overwhelmed patients – and there’s your issue right there…
As I like to quote Bruce Springsteen: “Sooner or later you get used to anything…” I have 11 months of chemotherapy appointments to get through, month after month, before surgery so I’ll become very used to chemo at some point!
Take care, Jill… ❤️
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Suffering of any kind or level is distressing to me. Optimism is helpful but it is really important to be truthful and acknowledge pain, suffering, distress, uncertainty.
Perky, false promises are insulting, not helpful. When people engage in out-sicking, it seems like there isn’t concern for or desire to comfort the one who is ill but rather a competition and attempt to show how much better? worse? the speaker’s experience was.
If someone has had a similar experience, tips can be helpful (i.e., this helped me with pain). I think it is uncomfortable for many to truly acknowledge the pain, fear, suffering a person is experiencing and they resort to annoying platitudes or sharing horror stories about someone else. People sometimes lose sight of the fact that at least most intend to comfort their friend or family member. Tragic optimism is a useful term. Hopefulness is key. Optimism with no basis in truth is demoralizing and infuriating.
In situations like these it can be helpful for people to take a breath and before speaking, ask themselves if this is a helpful comment to the person.
People dealing with serious medical issues can be fragile.
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Hi Helen – your entire comment is like a master class in active listening! Beautifully put. And thanks for adding that part about helpful tips- “this helped me with pain” (as long as the tips don’t turn into “better/worse” comparison scenarios.
I have a friend who was diagnosed with breast cancer decades ago – I often ask about her own experiences when I’m looking for some perspective (“Did you go through ______ (fill in the blank!) too?” Every time we have that conversation, I’m stunned by how different breast cancer care is in 2025 compared to her own experiences. Sometimes her experience was far worse (as a new math teacher, for example she had no sick days or holiday time so would go right back to the classroom all through her chemo. I’m so overwhelmed these days I couldn’t even imagine that reality!
On the other hand, a home care nurse came come to her house regularly for her injections – while now, patients receive bags of pre-loaded syringes and are expected to inject ourselves every evening (unless we can recruit helpful angels for those injections (7 days in a row after each chemo day).
And YES – “Fragile” is a perfect description of how I feel. I used to be a competent adult, but that adult seems to have left the building.
Take care. . . ❤️
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YES YES!!!!
Whenever I come across this kind of ‘support’ I try to tell myself that people want to say something, but don’t know what to say… and they fear silence.
I hate the ‘fighting this illness’ analogy: ‘you can do this!’, like you said, if the treatments fail, the person didn’t try hard enough, didn’t fight?
Thank you for bringing up this important discussion.
May your road not be too bumpy.
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Hello Dima – I think I’m going to adopt your last sentence as my go-to wish for best treatment results: “MAY YOUR ROAD NOT BE TOO BUMPY!” Brilliant…
Take care. . .❤️
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