When first told about cancer, many people want to "fight." Many cancers are curable, although some are not, but it is nearly universal that the first response is "do what it takes" to win. It's not just the person with cancer who feels this way; it's their friends and family as well. Time changes these attitudes in a significant number of people, especially patients. Some people facing a terminal illness use their experience to accept comfort care. Especially if the fatigue causes prolonged bed rest, patients may not feel they are living life so much as merely being there. They alone may feel all the problems going on: fatigue, anxiety, depression, getting IVs, tests, and more exams. For some patients, more therapy may be associated with more, not fewer, problems, but they may not want to raise these issues with others. These differences among patients and family members may prevent honest discussions as time goes on, in part, because some family members may want the opposite to what the patient wants. They want the patient to keep fighting.

Some patients find that anxiety and depression can worsen their fatigue and pain, and that, in turn, the fatigue and pain make the anxiety and depression worse. That may push patients to want to talk about their new feelings, but, equally if not more often, patients may not want to raise the issues because they don't want to cut off ties to others. Breaking down this difference of opinion before it becomes a barrier may need to begin with a confidential talk between a patient and a health care professional or perhaps a friend or family member. In general, patients should determine their own fate.

As a friend or family member, 

1. Let the patient talk without fear of isolation.

2. Listen.

3. Think about what you would want.

4. Respect everyone.