When someone you love has cancer, what do you say?

Chances are you know someone with cancer. According to the National Cancer Institute, there are now nearly 14 million people in the United States with a history of cancer. What’s more, approximately one in two men and one in three women will develop cancer over the course of their lifetime. The good news is that advances in prevention, early detection and treatment are leading to less cancer overall, better treatment success rates, and longer lives after a diagnosis. Nevertheless, when someone you love is given a cancer diagnosis, it hits home quickly.

You may find yourself wondering, “What do I say?” It’s not unusual to find yourself at a loss for words as you struggle to be helpful, but fear you might say the wrong thing. Fortunately there is much we can do to comfort and support our loved ones. The research on this is very clear: Social support can make a tremendous difference for those with cancer. I recommend taking the following steps: Follow your heart, follow their lead, and follow through.

Step 1: Follow your heart

Oftentimes when we find ourselves talking to someone with cancer, we feel we must say something quickly. We may wonder if we’re supposed to offer encouragement, express sympathy, change the topic or offer to make a casserole. The truth is there is no one “right thing” to say. Instead of trying to determine what you should say, look inward first. Shift from thinking about what you should do and instead get in touch with your desire to be helpful. (I’m going to assume you are reading this article because you want to be helpful.) People with cancer tell me all that time that what they appreciate most from their loved ones is genuine support; the specific words or deeds matter less than the intent behind the gesture.

Getting in touch with our desire to be helpful can be made more difficult by our own emotions. Some of us have been hit hard by cancer, through losing a loved one or some other difficult personal experience. We may flash back to feelings of grief, anger, loss or agitation. Hearing about someone having cancer may remind us that we, too, may develop cancer. We may find ourselves suddenly feeling anxious, looking for a fast exit from the conversation. If you notice your mind racing, try to slow down and take a breath. This is probably a sign that at some point it would be a good idea to talk about these feelings with someone you trust. But for the moment, try to put these feelings aside and focus on the person you are talking with.

Step 2: Follow their lead

We all have different personalities, different likes and dislikes, and different ways of doing things. Nothing about a cancer diagnosis changes this fact. For this reason, there is no one right way to be helpful or one right thing to say. Once you are connected with your own desire to be helpful, try to focus on what your loved one tells you; let your loved one set the agenda.

I usually find it is sufficient to simply ask, “How are you doing?” When we resist the temptation to say the “right thing,” we do our loved ones the favor of deciding what to talk about — or whether to talk at all. Some people are just looking for a hug. Others want a shoulder to cry on. Still others need help with rides to appointments, managing personal responsibilities and other practical matters. There are also people who want someone to have fun with: Just because you have cancer does not mean you always want to talk about it. But you can’t possibly know how best to be helpful unless you follow their lead.

As you follow your heart and listen to what your loved one is looking for, think about how you can be uniquely supportive. Are you really good at listening? Great, offer to be there to talk if that is something your loved one is looking for. On occasion, take the initiative by making a call or reaching out in some other way. Do you have some free time? Offer rides to appointments if transportation is an issue — many times medications, fatigue and other medical issues get in the way of driving. Do you like doing yard work? Maybe you could help to take care of your loved one’s yard or do the shoveling. And so on.

While there is no one right thing to say, there are a few things you may wish to avoid saying. To start, don’t ask “How are you doing?” if you don’t have the time to listen.

“You just have to stay positive” is one of the most frequently offered bits of advice to those with cancer, and perhaps one of the most unhelpful. If your loved one has expressed the desire for encouragement, then by all means offer it. But if a loved one is turning to you with anxiety, doubt, sorrow or some other difficult emotion, try to keep in mind that cancer is always serious — and these are normal, completely understandable emotions. The best we can do in these situations is to offer our understanding. And with our understanding and support, often our loved ones will work through their difficult emotions.

For those who have lung cancer, try to avoid asking “Do you smoke?” This question, perhaps more than any other, causes a lot of heartache.

Step 3: Follow through

Cancer is a chronic illness, with an emphasis on chronic. The treatments alone can last for weeks, months or even years. And this does not include the time it takes to recover physically and emotionally. Many people who have a history of cancer tell me that there was an outpouring of support early on, soon after they told others of their diagnosis, but that over time the support faded away. This is understandable: we all have our own responsibilities, concerns, stressors. It can be difficult to keep up with another’s ongoing concerns when we have our own list of concerns. But we do not need to confuse staying involved with being overextended. A phone call, an e-mail or an offer to help with something specific can all go a long way, especially when made on a regular basis. If your intent is to be helpful, think about offering help over time.