Annie Bond, 37, was diagnosed with metastatic breast cancer in August 2015. Shortly after sharing her diagnosis, some of her friends sent miracle cures and wigs in the mail. 

“That was weird because I didn’t even know if I was going to lose my hair,” Bond says.

Bond has lived with metastatic breast cancer for over a decade and has lost friends who were not comfortable with the way her life has changed.

“The best thing anyone ever did was just stick around and stay open-minded. Just remember everything that’s true about your friend or your loved one is still true after they’re diagnosed,” she says.

When someone you love is diagnosed with metastatic or stage 4 breast cancer, you may struggle to find the right words or wonder what kind of support will actually help.

A stage 4 diagnosis will drastically change your loved one’s life. Before you try to help, remember that they are still a full, complete person, not just a cancer patient. Continuing to show up can make a meaningful difference as they navigate their life with metastatic disease. Focus on what you can do to help, rather than retreating from the relationship out of fear.

Do: Respect Boundaries

Every person with metastatic breast cancer is different; some people want to share updates, while others prefer to keep their journeys private.

Frances Malinis, 42, who was diagnosed with triple-negative metastatic breast cancer, says she was very selective about who to share information with initially. She knew some people would not handle it well, and others would try to make themselves part of the “drama.”

“Don’t try to get information out of [your loved one] that they’re not already wanting to give. Because what are your intentions? Are you just looking for entertainment?” Malinis says.

Try not to get offended if your loved one seems distant because they may not have the energy or emotional bandwidth to respond to every message you send. 

“One of the main things families can do is to be incredibly patient and understanding with the level of anxiety and fear that patients live with,” says Ian Sadler, PhD, an assistant professor of medical psychology at Columbia University Vagelos College of Physicians and Surgeons.

Do: Try to Educate Yourself About Breast Cancer

Metastatic breast cancer means the cancer has spread to the bones, lungs, liver, or other parts of the body. While it is not yet curable, it is manageable for many people.

“Modern developments in cancer treatment have turned metastatic breast cancer into a chronic disease for many patients,” says Swati Sikaria, MD, an oncologist at a Cedars-Sinai affiliate in Torrance, CA.

Prognosis varies person to person, but new treatments have significantly extended survival rates and quality of life for many people with metastatic breast cancer.

Malinis says some friends would ask how much time she had left, and others would send messages that felt like a eulogy. “I get that they wanted to express their care and love for me, but don’t write me off yet,” she says. 

Do: Provide Practical Support

People living with metastatic breast cancer have to fit frequent healthcare appointments into their schedules. Sometimes, it’s best to offer to help with specific chores or errands rather than saying, “Reach out if you need anything.” 

“As a patient, I don’t really know what I could ask for from people,” Malinis says.

Some useful things to suggest might be rides to and from the doctor’s office, pet or babysitting, house cleaning, meal prepping or grabbing groceries or other household items while running your errands.

Malinis says sending flowers, comfort food, or food delivery gift cards also shows you are thinking of your loved one. If you want to drop gifts off, leave them on the doorstop. Don’t expect to socialize if your loved one does not feel ready to welcome guests. 

Do: Honor Your Loved One’s Independence

If your friend or family member asks you to join them at a doctor’s appointment, show up in a way that honors their independence.

“The support of family and friends is pivotal in the life of someone with metastatic breast cancer, but it’s important to come in with the goal of supporting that individual and not trying to assume control or take over the situation,” Sikaria says. 

If you want to support your loved one, Sikaria says you can:

• Help them write down their questions prior to the appointment.
• Talk to them before the appointment to learn if they even want to ask the oncologist about their prognosis.
• Provide an extra set of ears and take notes during the appointment.
• Trust that the oncologist is developing the best care plan for the patient, rather than offering your own ideas on supplements or treatments.

Don’t: Offer Diet Advice 

You may be inclined to investigate whether diet or other lifestyle factors contributed to your loved one’s diagnosis, but this is not helpful. 

Breast cancer development is complex, and as many as 10% of breast cancer cases are hereditary. Age, being born female, dense breast tissue, and genetic factors all increase risk. While certain lifestyle factors also contribute to breast cancer risk, having a poor diet does not automatically mean someone will develop cancer. 

“All of us will blame ourselves first, so please do not do anything to help us blame ourselves,” Bond says.

Don’t: Pretend Like They Don’t Have Cancer

Metastatic breast cancer is a permanent part of your loved one’s life. You will have to balance acknowledging their disease while also respecting their boundaries.  

“We didn’t ask to have this disease,” Bond says. “It doesn’t mean that we did something wrong, but the truth is the truth, which is that we have this disease forever.”

Even if your loved one is in remission or has no evidence of disease, like Bond, cancer still touches every aspect of their life. 

“I just wish that people would stop expecting us to forget about the cancer and be done with it when we’re metastatic,” Bond says. “Sorry, we don’t get that option.”

PEOPLE