In 2001 Marsha Silver was buttoning up her blouse after a repeat mammogram when the radiologist walked in and announced, "Sure looks like breast cancer to me." Stunned, Marsha (who was 53 at the time) left the office and immediately called her husband Marc at work. After asking a few questions, he said, "Okay, honey. See you tonight," and hung up the phone. Marsha later told him she thought she'd called the wrong husband.
"She thought I wasn't going to be any help and that I would not be able to be there the way she needed me," says Marc, remembering his early missteps as a caregiver. "That first weekend, I didn't know what to do because she looked so stunned and sad. I had no frame of reference for how to be a caregiver and support someone with a cancer diagnosis. I thought I should cheer her up, so I took her to a big festival. She walked around like a zombie. She looked so bereft and lost. Whatever I was doing was not the right thing."
The Tuesday after receiving that shocking news, Marc and Marsha met with a surgeon to discuss her options. During that appointment, Marc realized he couldn't run away from the situation. He had to face it head on.
"Realizing that it's very important to be there for a family member or friend facing any medical crisis helped me adjust my behavior," says Marc. "I still didn't know what to do. It was very confusing and overwhelming, but I began to understand what my role was," says Marc, a journalist who went on to author Breast Cancer Husband: How To Help Your Wife (And Yourself) Through Diagnosis, Treatment, and Beyond in 2004.
Marc is one of countless people in this country supporting a friend or family member with breast cancer. According to the American Cancer Society, it's estimated that 1 in 8 women in the United States will develop breast cancer in her lifetime, and it is the second leading cause of cancer death in women. (Though extremely rare, breast cancer occurs in men as well. The ACS estimates that 2,470 men will be diagnosed with breast cancer, and 460 men will die from breast cancer in 2017.)
The good news is that breast cancer mortality rates in women have dropped to 2.7 percent – that's a decrease of 39 percent, from 33.2 annual deaths per 100,000 women in 1989 to 20.3 annual deaths per 100,000 women in 2015. There are currently more than 1.3 million breast cancer survivors. If someone you love is one of them, here are ten ways you can support her.
Ask what is most helpful
"It's impossible to know what a survivor needs without actually asking," says Allison J. Applebaum, a clinical psychologist who specializes in helping cancer patients and their caregivers at Memorial Sloan Kettering Cancer Center in New York. "Maybe they want to be accompanied to treatment appointments, but perhaps they don't."
When Amy Schreibman Walter, 41, was diagnosed in July of 2017, she didn't know what she might need, so she didn't ask for anything. "But one of my best friends basically cornered me and said, 'Look, people want to help you! Let them help. If you don't tell us what will help you, we'll have to guess.' So together we came up with the idea for supermarket vouchers, which I used to buy healthy, prepared food. It was such a pleasure to come home after radiotherapy appointments each evening and have fresh, healthy food waiting for me."
Face fear (yours and theirs)
"Breast cancer survivors tend to have high levels of depression and anxiety," says Rachel Cannady, strategic director of cancer caregiver support at the American Cancer Society. "Even after treatment has ended, anxiety turns into fear of recurrence, and we've found that it's higher than with other types of cancer."
So when it comes to offering support to those with breast cancer, Cannady's first piece of advice is to find ways to broach the subject of fear and be open to hearing the patient's concerns. Don't be afraid to talk about the cancer. Let them know you are a safe person for them to discuss their fears and concerns.
"Make them aware that it's ok to be scared and that you are there to help support them," says Cannady. At the same time, she says not to share stories of other peoples' bad experiences with cancer.
Looking back on the weekend his wife got her diagnosis, Marc Silver says he learned you can't talk someone out of their feelings. "If someone is really feeling scared or upset, you don't say, 'Let's go see a funny movie' because that may not be what they need. That first weekend, I could have said, 'What will help you get though this? Do you want to stay home or go out? What do you want?' That's [sometimes] hard for people to do because everyone thinks they know best," says Marc.
Applebaum says it's important to acknowledge out loud that even after treatment has ended, the fears have not gone away – for the survivor or the caregiver.
Serve the survivor
"You have to face the fact that you can't fix it, but that doesn't mean you are useless," says Marc. "The person with breast cancer is in charge, and she has to pick the doctors and treatments that are right for her. I jokingly say that the breast cancer husband's motto is 'shut up and listen.' But you really do have to listen and find out what the patient needs from you. That's the critical role that any caregiver can play."
Be good company
Jackie Froeber, 35, was diagnosed with stage III breast cancer in May 2016, and she recommends asking your loved one if she would like you to accompany her to doctor's appointments and treatments. "It's scary," she says, "For some women, a friend offering to go and take down notes so the patient can just sit there and listen would be an amazing thing."
"It's really nice to have someone volunteer to go with you and play Uno or bring a tablet and watch a movie. Maybe you want to do chemo on your own, but it's nice when someone makes a plan," says Froeber.
Walter initially wanted to go alone to radiology appointments, but sitting there in the waiting room every day for three weeks began to feel monotonous. When she mentioned this to her friends, they started coming along with her, which made the appointments more bearable. "I wasn't alone for my radiotherapy appointments after that. I didn't [realize] how nice the support would be," says Walter.
Be a designated driver
Froeber preferred going to appointments on her own, but there were some things she couldn't do by herself, such as drive home from the hospital after surgery. "Somebody has to take care of you, and it can be a very stressful time," says Froeber. "To have somebody in your life that can take the day off from work and make sure you have a safe ride home is amazing," says Froeber, who had a double mastectomy in January.
Think before you speak
Even people who mean well can say insensitive or inappropriate things. "You don't want the person going through cancer to be focusing their energy on how you feel," says Froeber. "If you are starting a sentence with, 'I know I should have…' then reconsider what you're about to say. People that didn't reach out, and then come back with an apology put the onus on the survivor to forgive the other person. If you didn't know how you felt about it that's ok, so maybe just take yourself out of it and think about the survivor," Froeber says.
Prepare for a caregiving marathon, not a sprint
"Something that helped both of us was breaking down this marathon into smaller obstacles," says Tom Korzon, Froeber's longtime boyfriend. "Looking at the entire process from start to finish was extremely daunting and overwhelming. However, by mapping out each obstacle (surgery, chemo, radiation, etc.) it became a much more achievable, goal-oriented way of looking at things."
Bring joy and laughter
Although it's important to provide a safe place to discuss fears, Cannady says that cancer shouldn't dominate every conversation. "Don't neglect the things that make the survivor happy. If gardening brings her pleasure, but she doesn't feel good enough, do everything [you can] to support that behavior," Cannady says. "If she loves going to the movies or symphony but can't sit that long, bring pillows so she can enjoy it a little bit longer."
"As a caregiver, make sure you help the survivor accomplish things they really desire," Cannady says.
Silver credits laughter with helping him and his wife get through her treatment. "When friends asked what they could send us, I would tell them to send us anything that's funny," he says.
Keep up the support after treatment
"Just because a patient is in survivorship mode, doesn't mean they no longer have anxiety or can go back to the world before," Applebaum says. "Sometimes it's a more difficult period because it presents its own unique challenges. There are many emotions that don't get expressed during active treatment that come out during survivorship. Ask questions like, 'How are you doing? What do you need right now? Should I be doing what I did before, or do you need something different? How can I best support you right now?'"
Remember that small gestures are important too
"I reassured Jackie that I was there for her every step of the way," says Korzon. "Just little gestures like leaving her notes or making sure she had flowers after every surgery or [treatment] milestone let her know that I was always thinking about her."
"If someone takes time out of their day to choose a card and mail it to me, it never gets old," Froeber says. "You know someone is thinking of you."