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    "It is only too easy to compel a sensitive human being to feel guilty about anything."
    Morton Irving Seiden, posted by Daniel

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What should be one's approach to a close friend when the friend is diagnosed with terminal cancer and given two years to live?

What can be said and what should be said?

How does the diagnosed person move from shock and despondency to acceptance and living for each day?

How does a friend help a person with two years to live?
 

sister-ray

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I would sit down and have a heart to heart and ask the person what they wanted me to do, ask them how I can support and help them, Im sure people have different ways of dealing with something like this and have different needs from the people around them, only by talking to the person concerned can you give them the best support possible.
 

HA

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Hi Steve,

I have never gone through having a friend die of cancer so can't be much help. The little I have learned about end of life processess and having terminal diseases is that friends disappear becase they can't handle being "in pain with" their friends or family.

Perhaps just being there as you always have and just being yourself is the best gift you could give.

If you read the different websites on this topic it may help prepare you and give you some understanding.

Common questions on how to help:
http://www.massgeneral.org/cancer/crr/topics/help/questions.asp

http://www.cancerbacup.org.uk/Resourcessupport/Advancedcancer/Dyingwithcancer/Copingwiththenews

http://www.acponline.org/public/h_care/dying-gd.htm

Take care
 

comfortzone

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Hi Steve,

I would treat them as though they are the same person who you have known all these years. I would let them know if they needed to talk about anything you are there for them. Treat them as they are "living" not "dying."

My grandmother, who was my best friend, was diagnosed with ovarian cancer. The doctors told her how long she was supposed to live. My grandmother told them that she would be the one to decide on how long she was going to live. She was told she would only live six weeks. My precious grandmother lived over a year from the onset of symptoms. She lived a year from the time the doctors began to treat her. She was 79 when she died...just a month shy of her 80th birthday. I learned two valuable lessons from my grandmother: never let anyone tell you how long you are going to live or the person who you are. She told me once in the 70s when the women were burning their bras: If I want to be equal, then I am. I don't need to burn anything to be WHO I am. Rambling...sorry...but I learned so much from my grandmother. I miss her just as much now and she passed away over 20 years ago.

Steve...show your friend the same love and respect that you have before. Please know we are here for you.
 

Kanadiana

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TSOW said:
What should be one's approach to a close friend when the friend is diagnosed with terminal cancer and given two years to live?

What can be said and what should be said?

How does the diagnosed person move from shock and despondency to acceptance and living for each day?

How does a friend help a person with two years to live?

My eldest sister was given 2 years as an optimistic prognosis last year ,,, just over 3 months later she was gone.

I let my sister always lead conversations and offered whatever practical help I could ... I did my crying/grieving away from her but she knew we all loved her and were grieving ... mind you we did hold onto each other, wordless but crying, a few times and no words were needed. Sis didn't have a lot of time for coming to terms with things ... it happened very quickly and much of it in the hospital.

Maybe finding out as much as you can about what she's going through will help you know better how to respond and to help her. Anything that helps lessen pain or worries is good. They worry about those left behind and about how their death will effect everyone else, especially if they have family/kids, responsibilities and commitments, pets, whatever. Anything that helps to cope with symptoms and treatments ... and helping take care of their business for them ... and letting her speak whatever she wants to speak.

I miss my sister bigtime and still go to pick up the phone to call her ... :( But I'm glad her suffering ended and she's free of all that.
 

Eunoia

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Hi Steve!
I think you have some really good suggestions here, don't have much to add except a few things I could find. Also, I think that the biggest thing for me would be to live each day to the fullest and if that means telling your friend how much he/she means to you, b/c as others have said you never know if those 2 years will be less or more, and I have known people w/ a terminal illness where they died very quickly and others who defeated the odds, so to say. But I think one of the worst things about death is having regrets, so being aware of the reality of death does help somewhat in terms of not having a guarantee of time.

I guess things would also depend on the age of the person w/ the terminal illness and the illness itself. Like Kanadania said, maybe finding out as much as you can about the illness will give you suggestions in how to repond and what to expect. It's always frightening to venture into unknown territory and cancer or any other illness like that doesn't really tell you what's to come tomorrow.... it just does.

I found a few research findings that might be relevant:
- there's been an interesting finding about a "fighting spirit" (Spiegel & Kato, 1996) which is said to prolong life compard to having a hopeless/helpless attitude and difficulty in expressing distress. The latter was related to a shorter survival rate and the fighting spirit included things like having anxiety, depression, guilt- the key was that these emotions were openly being displayed and not "swept under the carpet" or forgotten about.
- Glinder & Compas, 1999 found 2 types of self-blame in people w/ terminal illness: characterological and behavioral self blame. In the first type- which is a stable personality trait, people blame themselves and experience helplessness where as in the 2nd type the blame is directed at specific behaviours (ie. I smoked, which was the trigger). Afer one year, the characterological type of self-blame was associated with more damaging outcomes for the patient.
- Helgeson, Cohen, & Fritz, 1998 found that "support of spouses, family members, and friends can help cancer patients by increasing their access to information, strengthening a sense of personal control, fostering self- esteem, and boosting their feelings of optimism". Protecting a person w/ a terminal illness from reality was not a very helpful strategy (however, perspnally I think and like others have said, the person we're talking about is still the same person as you knew him/her before this, so treating them differently doesn't make much sense, but it's more about trying to figure out how to best be there for them)

I also found the following websites:
http://www.mayoclinic.com/health/grief/CA00041/FORCESSL=false&
http://www.findarticles.com/ (search under “dealing with terminal illness” in “free articles only” and it gives you a bunch of results...)
 

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Thank you my friends for the wonderful insights and resources.

At the present time, my cousin is still trying to come to terms with the diagnosis, and has little patience with people who try to convey feelings of consolation.

His reponse is "It's easy for you to say, you're not the one who is dying".

Another friend who had a similar experience a few years ago had access to support services which helped him and his wife face the reality of the diagnosis, and to make their preparations and plans together in a positive spirit.

Unfortunatley I did not ask my friend much about where such support and counselling services were offered, though we were able to enjoy a wonderful relationship righ up to his final day...he managed to completely accept his situation and approached life in a positive and constructive manner.

I'd like to find out what type of organizations provide this type of support and counselling.

Has anyone had experience with the resources available from the Canadian Cancer Society?

Your kind words and support is appreciated!
 

Daniel

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I'd like to find out what type of organizations provide this type of support and counselling.

In my area, I've noticed support groups mentioned in the newspaper along with other community events like chess clubs, etc. Local hospitals or hospices may certainly know since they often sponsor support groups or educational meetings.

Another link:
Suggestions for Talking with the Person with Cancer - Cancer.org
 

ThatLady

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In my experience, the best thing to do is just to be there for your cousin. There's nothing you can say that will make reality go away, and reality is pretty difficult for him to deal with right now. When he's ready, he'll reach out. The most important thing you can give him is to be there when he does.

I don't know what organizations are available in your area to help your cousin come to grips with his diagnosis. I do hope others from that area will be able to give you some tips in that regard. Having support, both professional and family/friends, is very important to people who are dealing with an incurable disease. Still, the key thing to remember is that he must decide when he's ready to accept that support. He must grieve first, and in his own time.
 

Kanadiana

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Hi again,

I would think that your cousins doc and the local hospital, especially cancer ward, would have a list of good local resources and their contact info for new patients and their loved ones. I would call them. The must have a "Cancer Care Clinic" or somesuch???

There are also support groups ... meeting, also online support groups. I came across many of them when I was searching out information for my sister. Unfortunately I didn't hang onto the links once she passed on. A google search for "cancer support forums" may bring you some good links.

Take care ... remember, this is a blow and a loss to you too. I discovered a lot of loved ones of those dieing of cancer in those sites. And the cancer sufferers themselves, their posts, are astounding to read as they go through their journey with it. Both extremely sad, and extremely inspiring.
 

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I can see that being given a finite term for one's life can bring about a process similar to grieving the loss of a loved one.

There might be denial, anger, resentment before one comes around to acceptance.

What is the psychological dynamic of moving from the initial shock and anger to eventual acceptance?
 

comfortzone

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Steve,

I think it depends upon the situation and person.

For some who grieve, a word can make ripples in the pond of sadness that one experiences while others words are only heard with contempt. Anger as a means to control rattles the rafters of those who walk the road from life to death. Denial...how can it be true...life suddenly accelerates and in a blur of the moment we are left holding our feelings in our hands...wondering what happened. Acceptance...grasping the finality of the words measuring one's life...words...we return to words that create and destroy. I realize these words I type here do not lessen the pain but please know that with each word comes a gentle kindness...to be taken through your day and into your night. Take care Steve! We remain here for you. As always,
 

Kanadiana

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TSOW said:
I can see that being given a finite term for one's life can bring about a process similar to grieving the loss of a loved one.

There might be denial, anger, resentment before one comes around to acceptance.

What is the psychological dynamic of moving from the initial shock and anger to eventual acceptance?

I would guess that the road from the point of finding out that death is coming soon, to acceptance that it TRULY is, is a process of ups and downs of acceptance and denial ... back and forth ... as is true for the grief process for any loss you don't want loss. Sometimes you can accept living with that fact and living now accordingly, and other times you rebel ... and resist ... and again, I guess it all depends on the person. Living and dieing is so individual and personal a thing. Inevitability may hit home and resignation, then inspiration to spend that last times left on accomplishing some meaningful goals or tasks, or unfinished business, while the person still can ...

I think it's an up and down road to death for most people ... one minute you aren't ready, the next you are, the next you aren't ... and so forth ...

By the way .... within that journey when people know their death is coming soon, some even feel relief ;) .... we're human. We want to continue what we like, and stop what we don't. For some, death is wanted as surcease from a too painful existance. Understandable.

I hope I'm not sounding too weird here ;)
 

ThatLady

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The grieving process is as unique as the person experiencing it. It's different for different individuals. Some people pass through the various aspects of grieving quickly, while others take more time. Your cousin is still struggling through the anger phase. How long he'll take to complete each phase and come to acceptance cannot be predicted, in my experience. The only thing you can do is to be there for him, listen, and offer unconditional support. He may yell at you, or turn away from your offers of help. That's part of the process and should not be taken personally.

He's been dealt a nasty blow, and it will take him time to cope with it in his own way. He's fortunate to have you there, beside him.
 

David Baxter

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Most peop;le mistakingly believe that Elizabeth Kubler-Ross was speaking of grieving for someone else who has passed away when she wrote of the five stages of grief. Actually, her work was with the terminally ill - the five stages are about people coming to terms with their own impending deaths.

That said, medicine can sometimes be wrong, too, or at least sometimes people defy the best predictions of medical science. A man I know slightly was given 1 to 2 years to live after a diagnosis of leukemia. That was about 15 years ago and he's still going strong.
 

Daniel

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BTW, the late musician Warren Zevon, in his video documentary Keep Me in Your Heart, was understandably always a little scared or anxious of dying no matter how well he was coping with his 3-month prognosis. He coped mostly by staying busy, finishing his last music album and spending more time with friends and family. Like many other cancer patients, he lived significantly longer than his initial prognosis.
 

sister-ray

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Lou Reed lost two friends to cancer and he wrote a album about it, called" Magic and Loss", its well worth a listen. Its a very honest, open, moving and profound piece of work, covering all the guilt, rage, loss, and resignation etc I know some people who hate this album but others, who like me have got such alot from it when they have lost someone close or are supporting someone who is dying. It may not work for everyone but I thought it was worth sharing.
 

HA

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Steve,

I just saw this new website in the Hospital News paper today:
Whether you are a patient, a caregiver or a health care professional, this is the place to find information, tools and community resources for the Greater Toronto Area.
Caring to the End from Princess Margaret Hospital, Toronto.

I had recently met a man who has lymphoma and started a support group in Toronto as non had existed. That was a few years ago so I would also suggest finding a support group for the specific cancer that your relative is dealing with.

I also just remembered that "systematic desensitization" is an excellent psychological treatment for the nausea experienced from cancer drugs. The patient is not automatically offered this treatment, as far as I know, but would need to ask for and possibly pay for it.

Behavioral treatment for the anticipatory nausea and vomiting induced by cancer chemotherapy

GR Morrow, and C Morrell

Abstract

The nausea and vomiting experienced by one in four cancer patients in anticipation of chemotherapy is probably a learned response to treatment. To determine whether behavioral approaches for altering learned responses might be useful treatments for these symptoms, we compared the effects of "systematic desensitization" (a behavioral treatment in which relaxation is learned as a response to situations in which patients have had anticipatory nausea and vomiting) with those of counseling and of no treatment. Sixty ambulatory cancer patients with anticipatory nausea and vomiting before their third and fourth chemotherapy treatments were randomized equally to the three groups. Significantly more patients receiving desensitization reported no anticipatory nausea before their fifth and sixth chemotherapy treatments than patients given counseling (P less than 0.05) or no treatment (P less than 0.01). Desensitized patients also reported significantly less severe anticipatory nausea (P less than 0.01) and vomiting (P less than 0.05) and a shorter duration of anticipatory nausea (P less than 0.01). We conclude that systematic desensitization appears to have an antiemetic effect in cancer patients who receive chemotherapy, and may be useful in the management of these problems.
http://content.nejm.org/cgi/content/abstract/307/24/1476

All the best
 

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HeartArt!

Thanks for the resources associated with Princess Margaret Hospital, Toronto as the rest of the family lives there and I will pass along the info.

Your interest and additional information is appreciated.
 

SS8282

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Hi Steve,

Have you heard of the song 'Live Like You Were Dying' by Tim McGraw? Among other things, it's about appreciating the things you have, the people you are with, doing stuff together. Maybe it's too soon for (your cousin?) to hear, but it might help you help him. Somehow, the song helped a friend of mine whose sister past away from cancer earlier this year. It brought them closer together, and added a bit of peace and happiness.

You and your family will be in my thoughts and prayers. Take care.
 
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