Cancer is not just a devastating personal diagnosis. It reaches beyond, into everyday relationships with complex social rules and even its own vocabulary. It’s a disease that has touched just about everyone in some shape or form and still, few people want to think about it, let alone talk about it.
There’s no “one size fits all” strategy that addresses when to tell someone that you have or had cancer, how to tell them, and who to tell. Best practices for disclosure in dating and intimate relationships, in the workplace, or even with friends can vary by cancer type, age, or context. But regardless of who you ask – psychologists, career experts, or patients themselves – one common thread exists: It’s personal.
Relationships, Timing, and Vulnerability
Discussing one’s cancer can be difficult, especially when it comes to relationships and dating. The American Cancer Society points to challenges like feeling unattractive because one’s appearance has changed, problems with sexual function (e.g., vaginal dryness, inability to sustain an erection, or fertility issues), fear of being naked in front of someone else, and questions around finding someone who has an interest in dating someone who has or has had cancer.
“When it comes to dating someone for the first time, the question of whether or not to discuss one’s cancer status depends on [if] you think that it’s a friendship that is going somewhere, a relationship that has potential for growth,” explains Anita Astley, a licensed marriage and family therapist.
Samantha Cummis, a 53 year-old breast cancer survivor with BRCA mutations, says she “typically would not tell somebody right away, unless it comes up, like people are talking about their family and [mention] ‘my sister had cancer,’ and then I wouldn’t hold back. Or if someone asks, “why don’t you have children,” I might bring it up then.” (As part of her treatment, Cummis had her ovaries removed.) Cummis believes that holding back for too long, especially if the relationship is going strong after the first few dates, might raise issues about trust.
But she also emphasizes that context is essential. A person with stage IV lung cancer who is a 10-year survivor might have a different take on dating than she as a 15-year survivor with scars that she says are sexual in nature.
“I have to tell someone I’m with before I take my shirt off,” she says.
Patty Moran, PhD, a clinical psychologist at the University of California-San Francisco’s Helen Diller Family Comprehensive Cancer Center, says “keeping it a secret is a real burden. If somebody is going to have a bad reaction or not going to be accepting or supportive, there comes a point where it’s better to know than not; you don’t want to move on with a relationship and then find out months and months down the road that somebody is going to have a bad reaction.”
Fortunately, research suggests that fears about how someone responds to the information do not always equate to reality. Findings from a study examining people’s interest in dating a cancer survivor show that single and divorced people are as likely to be interested in a date with a cancer survivor as someone without a cancer history, unless they are still in active treatment. In these cases, widowed people expressed little interest in dating a survivor, mostly because they had already experienced the loss of a loved one. This is where age comes into play.
“If you’re in your late 20s or 30s, you can go – you know, four or five dates,” she says. I think that when you are older, maybe on the first or second date; if that person is not going to be able to deal with it, then there’s no point in pursuing other dates with them,” says Astley.
Thirty-seven-year-old Steve Rubin’s experience is altogether different from Cummis. Diagnosed with a rare bone cancer (osteosarcoma) at age 30, Rubin says that it came at a time when his career was soaring and he was engaged to be married.
Despite a postponed wedding and several recurrences since, Rubin often counts his blessings.
“I got very lucky that my wife was just rock solid and fortunately we have had years and years to build a really solid foundation. But if you don’t have that solid foundation, then I think you do the best you can,” he says.
It’s important to avoid underestimating the magnitude of a cancer diagnosis. “It’s a huge thing; the person has to be on board for it. If they’re the type of person who’s meant to be with you, then that’s amazing,” says Rubin. “And if they’re not, then focus on your health first, on your personal development next, and put it into developing the type of life that somebody wants to join – not out of pity – but because you’ve focused on making yourself a good person.”
Having a game plan for how you might respond to a person’s reaction(s) can also be helpful.
“I’ve had to learn to leave space for people to process the weight of my story,” says Rubin, something that his wife has helped him with.
Navigating Work and Careers
Many of the considerations around dating also apply to the workplace.
Rebecca Nellis, executive director of the nonprofit Cancers and Careers, says that where and when you disclose is a choice. “It may change over time, in the evolution of how you see yourself, how your treatment is going, what you need, how your workplace is reacting to what you have or haven’t shared.” This is especially true for online spaces.
“The way that people disclose online has an impact on relationships and dating, as well as on the employment space,” Nellis emphasizes, noting that it’s important to consider whether you’d be comfortable with a current or future colleague knowing your story. “If it was on the front page of your favorite news site, would you be OK?”
Finally, to avoid any potential landmines:
- Be strategic. Locate any materials that might have been provided in the initial days of being hired, e.g., policies and procedures or employee handbooks. Discuss physical or mental limitations with your health care team and check out company policies for health leave and absences. It’s also important to check out the Americans with Disabilities Act, which provides a federal safety net for people with disabilities.
- Decide who you are going to tell. Nellis says that people often disclose to their managers versus an HR person. On one hand, it makes sense; this is the person who is closest to their day-to-day work and assigning deadlines and projects. On the other, HR people typically go through some sort of training and are much closer to company policy. It’s helpful to consider if the manager will know what to do or if they can be a helpful ally and advocate in going to HR. When it comes to colleagues, the same rings true; you may decide to share some information with certain people or only a few. It often depends on cancer type and comfort levels. An important rule of thumb is to assess how colleagues have been treated in complicated situations at work.
- Don’t forget that everyone’s different. While some people can’t imagine disclosing, others share a lot of information. Like relationships, the workplace can be another setting to derive support and feel more like yourself.
“Disclosure is a packet, not necessarily a one-time thing,” says Moran. Regardless of the environment or context, “you can disclose a lot or a little right from the start. Just be compassionate with yourself about how hard interpersonal communication is. If you stumble, it’s OK, just trust yourself.