When Shoshana Polakoff, 40, received an unexpected breast cancer diagnosis three years ago, the mother of three young children needed extra support. Her friends, family and Jewish community in the Washington Heights neighborhood of Manhattan immediately stepped up.

They organized help with after-school childcare, packed school lunches for her kids and sent her little notes of encouragement while Polakoff endured trying cancer treatments.

“I felt pounds lighter and overwhelmed by the chesed that mobilized so quickly,” said Polakoff, using the Hebrew term for kindness. “And the practical help was such an incredible gift.”

Too often, however, friends and loved ones of cancer patients are at a loss for how to respond when someone close to them is diagnosed with cancer.

“Often they feel just as thrown into this new reality as the woman herself and are not sure what to do next,” said Adina Fleischmann, chief services officer for Sharsheret, the national Jewish breast cancer and ovarian cancer organization.

This is especially the case for young people who might never have had a family member or friend diagnosed with cancer before.

Fleischmann — whose organization offers extensive resources for cancer patients, ranging from emotional support, mental health counseling and education to financial subsidies for women and their families facing breast and ovarian cancer — has some guidance for what to say, how to reach out and what kind of help might be appropriate to provide in the face of a friend or family member’s cancer diagnosis.

It’s all about providing chizuk – Hebrew for strength – to the person facing cancer.

1. Establish the “Kvetching Order”

The “Kvetching Order,” based on a concept called the Ring Theory developed by clinical psychologist Susan Silk, dictates that those close to someone struggling with a cancer diagnosis offer only support to the cancer patient, and any kvetching about their own stress outward.

Thus, the person with cancer is at the center of a circle surrounded by a ring of her or his most intimate friends and loved ones. More distant concentric rings include other friends, acquaintances, more distant family and community members.

Colloquially known as “comfort in, dump out,” the Kvetching Order establishes a flow of support directed toward the person facing cancer.

2. Be clear and specific with offers of help

Support can look and feel different to different people facing cancer; each person’s needs and life circumstances are unique. When younger women are diagnosed with cancer — as often is the case with ovarian or breast cancers, where 50% of new diagnoses are in women under age 63 — patients often need extra help managing their responsibilities as parents and/or career professionals.

“Let the woman guide the journey,” Fleischmann says of the cancer patient. “Follow her lead.”

Sharsheret suggests offering concrete, practical assistance, such as offering to take the patient’s child to after-school activities or helping with homework. Maybe offer to come over to help clean the house, do laundry, or pick up groceries and make dinner for the family.

“But give the woman the feeling of control,” Fleischmann said. “Let her be in control of your support.”

Thus, a concrete suggestion like, “Can I bring you pizza for dinner on Wednesday?” is better than a vague offer of “What can I do to help?”

3. Check in often but don’t expect a response

By all means reach out to the person facing cancer. But if they don’t respond to your phone calls, emails or texts, don’t be put off.

“Sometimes the woman may not have the time or energy to respond,” Fleischmann said. That doesn’t mean you shouldn’t continue reaching out. “She will appreciate knowing that you’re thinking of her.”

Polakoff found small gestures particularly meaningful.

“Little things meant a lot,” she said. “Like just a note that said, ‘I’m thinking of you. Have a good Shabbos.’”

4. Leave cancer out of it sometimes and just be with them

Kristen Harvey, who at 23 was faced with an ovarian cancer diagnosis for the second time, said it was important to have friends around her with whom she could talk about the future.

“Just being there was the best thing,” said Harvey, who recently graduated from college and lives in Michigan. “We didn’t need to do anything. I appreciated when people came over and we just hung out and watched a movie.”

Alexis Wilson, a teacher in Jupiter, Florida, said her friendships were essential during her breast cancer treatment. Before starting chemotherapy, her friends threw her a big party to which everyone showed up in different-colored wigs and decorated her yard with signs.

“My friends played a big role,” said Wilson, 39. “I felt like I wasn’t alone.”

5. Continue your support throughout someone’s cancer journey

For some women, “maintenance treatment” can last for many years beyond the active treatments of chemotherapy, radiation or surgery. Women living with metastatic breast cancer, for example, usually continue treatment throughout their lives.

Fleischmann recommends checking in with a woman along every step of her cancer journey: not just the period of active treatment, but also during maintenance treatment, survivorship, and if she is living with metastatic or advanced cancer.

“It’s nice to know my friends and family continued to reach out once I was done with treatment,” Harvey said. “Back to normal doesn’t mean life is ever normal.”

There are often heightened emotional needs around anniversaries of certain cancer diagnoses or treatment dates, Fleischmann said, so marking these dates could be important.

6. Make sure you have your own support system

If you’re particularly close to the person with cancer, you may experience feelings of being overwhelmed yourself. It’s important to take care of your own emotional well-being and not dismiss it in the face of someone else’s more pressing illness.

“As a caregiver, you can be very easily drained without your own coping mechanisms,” Fleischmann said.

Make sure to take care of yourself physically and emotionally so that you have the capacity to attend to your friend or loved one’s needs.

7. Talk to your healthcare provider and safeguard your own health

Even while supporting a loved one or friend with breast or ovarian cancer, it’s important to safeguard your own health.

The BRCA genetic mutation that causes breast cancer and ovarian cancer is much more common among Ashkenazi Jewish women than in the general U.S. population. About 1 in 40 Ashkenazi Jewish women and men carry the mutation, compared to 1 in 400 in the general population. Ashkenazi Jewish men are also at elevated risk for melanoma and prostate and pancreatic cancer.

“Talk to your healthcare provider,” Fleischmann said. “Those whose family members are facing hereditary breast and ovarian cancer should speak with their doctor or genetic counselor to see how this may affect them, too, and learn about appropriate testing and precautions.”

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