Your friend has been diagnosed with cancer but you're the one freaking out: What can I do? How should I act? Is it OK to talk about it? What's "normal" now?

It's hard to know how to respond when someone you love — someone your own age — is diagnosed with cancer. It can be frightening, confusing, and may bring on some heavy thoughts about life and death. You might even struggle with the temptation to pull back from your friendship so you can avoid the uncomfortable feelings you have. But your friend needs you now more than ever. So what should you do?

It's normal to have to difficult feelings; don't try to brush them off. Try to think a bit about what you're feeling. You'll expect to feel sadness, of course, and fear, and maybe anger. But it's also natural to feel some surprising emotions like disappointment or embarrassment.

Of course you don't want to burden your friend with your feelings. But you need support, too. So try to find someone you can turn to — like a parent or school counselor. Once you have a way of dealing with your own feelings, it will be easier not to let your emotions or fears get in the way of being a good friend.

Here are some ways you can help.

Be Prepared

You probably know that your friend could lose hair as a side effect of cancer treatment. But you may also notice emotional and physical changes in your friend. Some things that you may see happen include:

Vomiting and nausea. Try not to be hurt if the double-chocolate brownies you baked with such love sit untouched on the plate. Your friend may not feel like eating — at home or out. In fact, someone with cancer may not feel like going out at all if he or she is worried about throwing up in public. You might want to reassure your friend that you know this is a possibility and that you realize it's a side effect of cancer treatment.

Weakness, fatigue, and lack of endurance. Cancer treatments can make even the smallest things a big struggle — like walking up stairs or carrying schoolbooks. Your friend may suddenly become too tired to talk on the phone or be unable to walk around the mall. Let your friend take things at his or her own pace, though. Don't automatically assume people with cancer won't want to go out or that they should stay home. Let your friend make the call, but be understanding if the exertion proves too much.

Embarrassment. Your friend may be even more self-conscious about having cancer because he or she can't do what other people do or look the way they look.

But your friend's not the only one who may feel awkward. Be prepared for your own feelings, too: Some people can feel uncomfortable about being seen with a friend who has no hair or looks physically different. We all feel temporary embarrassment at times — who hasn't cringed at something a friend does or wears? The good news is, we get over it.

Difficulty keeping up in school. Your friend may fall behind in school. Cancer treatments can sap a lot of energy and teens getting chemotherapy or radiation may struggle academically. People can also feel disconnected and left out of things when they miss school a lot.

Emotional Support

So what can you do to help your friend? Here are some ideas.

Be there. OK, so this is obvious, but it's also critically important. Teens with cancer often feel isolated and alone, especially if they're in the hospital or away from school for long stretches of time. Visit as often as you can. Fight the urge to stay away because you feel awkward or wish this weren't happening. Even if you aren't sure what to say to your friend, just being there to show your support will mean so much. If distance or your schedule makes it hard to be there in person, stay in touch by sending notes and cards and by emailing, IMing, phoning, or texting.

You can also offer to drive other friends to the hospital or set up an email list or an online social network group so your friend can stay connected.

Talk about it — and listen. Friends going through tough times like to talk about it. Listen, ask questions, and do some basic research on your own so you can understand more about the type of cancer and what your friend might be feeling. Don't be afraid to ask questions of your friend's family, the doctors, and other cancer patients.

Be patient. People with cancer, understandably, are often sad, anxious, and afraid. On top of that, some treatments have side effects like fatigue or mood swings. If you show up to visit and your friend seems distant, angry, or less than enthused, try not to take it personally. Don't give up; your friend is going through a lot. Come back again tomorrow and chances are things will be better.

Keep it real — but keep it positive. It can help to talk about the future and to make plans in a realistic, compassionate way. Don't shrug off your friend's fears or concerns about death, but do try to offer realistic specific examples of other people — famous people, people you know — who have survived this type of cancer. (No examples come to mind? Do a Web search!)

Practical Support

"If there's anything I can do..." is a nice thing to say. But families of teens with cancer often say that the more specific the offer, the better.

Here are a few things you can offer to do:

Be the point person. Help your friend's family spend less time updating people by phone or email — offer to relay messages to friends, teachers, and others on a regular basis. Make sure you have the phone numbers and email addresses you need, and then create a list so you can text or email everyone at once when there is news to report.

Go a little nutty. Don't be afraid to be silly. Humor can be an excellent distraction, so consider showing up with joke books, Mad Libs (remember those?), Silly String, comedy DVDs, weird little toys — anything you think your friend would like. If your friend is feeling low on energy, which is common during treatment, bring in the fun and turn up the silliness.

Make a care package. Talk with your friend's parents about what foods your friend can and can't have — and what foods might be favorites right now (when people are sick, their tastes can change). Or put together some fun, escapist stuff for your friend to do while alone, perhaps fast-read novels or games like Sudoku. Wrap up your package and bring it to the hospital or your friend's home.

Step in with siblings. If your friend has siblings, spend some time with them. They probably feel a lot of the same things you do, so you might be able to help each other through it.

Help out with schoolwork. Offer to help your friend with homework — everything from passing along assignments to tutoring your friend or working together if it's appropriate. Even something as simple as taking really good notes (or asking someone else to do so if your friend is not in your class) can be a huge help.

Create a blog. Have friends and family members contribute to a blog — or, offline, fill a small notebook — with funny or meaningful stories, quotes, and trivia from your friendship. Be careful not to give it a tone of "these were the last good times," but instead let it be a fun reminder of how much your friend means to everyone and how eager you are for his/her recovery so you can keep making memories! Consider adding pictures and making it look like a celebrity magazine about your friend. Give it as a gift so your friend can read it when feeling down.

Take care of yourself. Your friend's cancer will take a toll on you, too, so try to be aware of your own emotional needs. Consider keeping a journal as well as talking with a trusted adult about the impact this has on you.

The bottom line: The most important thing is to be there for your friend, in whatever way feels natural.

Reviewed by: Dora A. Temple, LCSW
Date reviewed: November 2011