Losing friends

Unfortunately, childhood cancer occurs at a time when friendships normally change rapidly. When the diagnosis occurs in elementary school, friendships often depend on what classroom you are assigned to or who shares your lunch table. If you are gone for an extended period of time, the group may welcome you when you return, or the groups may have shifted so that you are now on the outside. When cancer strikes middle-school-aged children, friendships often dissolve. Social groups are forming, peer pressure is at an all-time high, and compassion is often a temporary casualty of puberty. In many cases, high-school-aged adolescents are more mature and understanding, and friendships remain strong throughout treatment.

Friends disappear for many reasons—they can’t think of what to say or are afraid they will cry or say the wrong thing. Or they simply grow unfamiliar with the child who in the midst of a rapidly changing social scene misses huge chunks of time with friends. The friends may even think they can catch cancer. Many survivors have painful stories to tell of lost friendships.

Survivors also lose friends to cancer, and this is very difficult for children and their parents. During treatment, children and teens become extremely close to others going through treatment for cancer. And some of these children and teens die.

Making new friends

Friendships in childhood are fluid; they depend on what class, school, neighborhood, church, or sports team you are involved with. Some survivors renegotiate or rekindle friendships and others make new friends during and after treatment.

Children being treated for cancer also miss key times for socialization and the development of social skills. Further, motivation to initiate new relationships or interact with others may be impacted due to physical issues such as fatigue or cognitive issues. Children whose parents take an active role in encouraging social interactions tend to do better socially. They can ask their child whom they like the most in their class at school and invite that child over to play or watch a movie. They can befriend parents of children with similar interests and invite the whole family over for dinner. Encouraging participation in school, music, church, or athletic activities exposes the child or teen survivor to new groups of peers.

Some survivors worry about making new friends because they don’t want to cause their friends pain in the event the cancer returns. Some survivors blend back into their peer group after treatment while others, even many years later, still feel different. Some survivors feel that they are rejected socially due to their cancer history, while others feel mature beyond their years because of what they have experienced. This can create differences in interests and value systems between survivors and their peers.

Late effects from cancer treatments can create additional barriers. Issues such as skin problems, thin or absent hair, very short height, or amputation may affect survivor’s engagement in social interactions. Additionally, sensory issues like hearing or vision loss, or disrupted social skills from neurological side effects, can impact the ability to interact with peers and make friends.

Cranial radiation at a young age or high-dose radiation to the brain at any age can affect a survivor’s social skills, including ability to attend to socially relevant information in conversations and interpret nonverbal behavior. Parents can help their children by getting them involved in social activities, role-playing social skills, enrolling them in social skills classes, and encouraging friendships with schoolmates. Peer support groups for teen and young adult survivors can provide a safe place to make friends, talk about feelings, and have fun.

Having other survivors as friends

You may find that you don’t get the support and understanding you need from your friends who do not have cancer. Perhaps you need people who are willing to listen without judgment when you talk about your cancer, or you may not like to talk about it at all. You may feel strongly that you need to live a healthy lifestyle to lessen the chances of late effects, and your friends may not respect your decision not to smoke or drink. For a variety of reasons, you may seek out or continue friendships made during treatment with other people who had childhood cancer. This shared experience can create deep and long-lasting bonds.

Dating

Close and intimate relationships are difficult at times for everyone, whether or not they had cancer. Some survivors have a more difficult time starting relationships than others. Whether you are merely looking for some fun or searching for a partner for life, you may find that your cancer history is an impediment. If you missed months or years of middle school or high school, re-entering the dating world can be especially complicated if your appearance is altered by baldness, weight gain, or scars. People you are attracted to may avoid you due to phobias about cancer or because of peer pressure. You may not feel ready to date after enduring the physical pain and social isolation that usually accompany cancer treatment. Or you may just pick up where you left off pre-cancer.