Cancer Ghosting: What It Is and How to Respond

This podcast is made possible through the support of AstraZeneca.

Jamie DePolo: Hello. Thanks for listening. Our guest today is Kelly Grosklags, an experienced therapist who dedicates her practice to minimizing suffering through her work in oncology, palliative care, and hospice. Kelly is a licensed clinical social worker, a board-certified diplomate in clinical social work, and a Fellow of the American Academy of Grief Counseling. Kelly speaks frequently about end-of-life issues including care, grief, and loss, both in person and on her website, Conversations With Kelly. Her support has helped patients, caregivers, and health professionals cope with depression and anxiety, and transform fear into hope.

Kelly joins us today to talk about cancer ghosting, what it is, why people do it, and how to come to terms with it. Kelly, welcome to the podcast. I’m so delighted to talk to you again.

Kelly Grosklags: Oh, Jamie, always an honor. Thank you so much, and what an amazing topic that we hear so much about, and I’m so glad that Breastcancer.org is giving this attention. 

Jamie DePolo: Well, thank you for speaking on it. I think most people who listen to our podcast know what cancer ghosting is, but just in case, if there are some very fortunate few that haven’t experienced it, could you explain to us what it is?

Kelly Grosklags: So, a lot of times when we hear ghosting we think of like, the dating situation where people ghost us. They don’t return our calls, they don’t show up, they don’t call us back. In cancer ghosting, it’s much the same, but it’s after a diagnosis of cancer, and what it can be is a very emotionally detrimental experience for the person living with cancer, but also their immediate family. The abandonment, I guess is the word that I would use, that you’ll probably hear me use quite often in this podcast because truly what it is, is it’s abandonment. 

But essentially the definition would be those people that…it can be family, but those people that are closest to you or that you consider friends or important people, disappear after you’ve been diagnosed with cancer. 

Jamie DePolo: Okay. Thank you. And from your experience, how common is it? Do you think everyone who’s diagnosed has at least one person that ghosts them? Or is it less common than that?

Kelly Grosklags: You know, based on my experience in my practice or in my career, I would say it’s in the 90%.

Jamie DePolo: Oh, ouch.

Kelly Grosklags: Yeah. It’s high. I know there’s research out there that would indicate less probably, but not much, so, I’m basing it on my practice and who I’ve talked to. I would say it’s in the 90% when we talk about maybe that one person, you know? But there are also a high percentage of people that lose multiple people. It doesn’t often happen in the beginning, and I think we can talk about that also as kind of when to more expect that. But you know, it’s high, Jamie. It’s high, and I would say that that would be often a focus of some of the sessions I’d have with people. Is that, that confusion, the grief, anger, but a lot of confusion. Like how could this happen and why did this happen?

Those are questions that I have some speculation to, but I don’t ever have the firm answer because I can’t talk with that person directly about why have you done this.

Jamie DePolo: Of course. Well, yeah. I’m curious. What is your speculation? Like, why would someone do this? I mean, I could speculate that maybe they don’t know what to say or they’re scared they’re going to say the wrong thing, but…

Kelly Grosklags: That’s right, and so, I want to start by saying I don’t think people are maliciously intended when they do this. That doesn’t mean it doesn’t hurt…

Jamie DePolo: Of course.

Kelly Grosklags: It hurts like crazy. I have talked to some of the people that have ghosted…

Jamie DePolo: Oh, really?

Kelly Grosklags: I’ve got that side of it also and it does come down to I’m scared, I can’t handle seeing them suffer, I am worried…there’s still this thing, even though we’re in 2023, where they’re…people can get worried they are, it’s like cancer’s contagious or something. Like, if I hang out with that person too long this may happen to me. Seeing, especially some of the younger parents with cancer and the younger moms and dads with breast cancer, it can tap into some of those vulnerabilities that we have already about not being around for our children or what if something happened to us? And so, it’s like, there’s a lot of reasons people can do this.

I think one of the main reasons is the fear. The fear of, this is I don’t know what to say, I might say the wrong thing, I don’t want to watch them get sicker, and if it’s somebody living with a terminal diagnosis of cancer, I don’t want to watch them die. And so, they leave for various reasons. Generally, it’s to protect themselves. It has nothing to do with the person living with it, and I think that’s where when people are listening to this, it’s about how, if you’re trying to support somebody who has cancer, how do you yourself get support so that you continue to show up? And it doesn’t mean that one person has to be the end-all for somebody who’s living with breast cancer, but we certainly know that there can be a lot of regrets and a lot of time lost when you ghost somebody that you’ll never get back. I mean, you just…you’ll never get back.

So, I really encourage people if you’re listening to this and you are maybe the one that’s struggling to show up, find ways to support yourself in that.

Another thing, Jamie, is sometimes that relationship maybe needed to end prior to the cancer diagnosis anyways. Maybe it wasn’t a healthy relationship. I think that’s important to say that not all these ghosting relationships are healthy, good-for-the-person-living-with-cancer relationship and so, sometimes it takes something like this to naturally break it. 

So, one of the things I wanted to talk about today also is if you are living with cancer, you know, what are maybe some of the ways you approach this, and sometimes it’s let it be because it may not be a healthy relationship for you. And again, that doesn’t mean it doesn’t hurt. We’re human beings, we don’t like to be abandoned, we don’t like to be rejected, we want to be chosen. But one of the things I really work with people on is trying to decide, is this actually in your highest good?

Jamie DePolo: That makes sense. That makes sense.

Kelly Grosklags: Yeah.

Jamie DePolo: You mentioned timing and I’m wondering, you said it doesn’t always happen at the beginning of the diagnosis, and I’m also wondering, too, about early stage versus metastatic. You know, is a metastatic diagnosis harder for a friend, a loved one to deal with than early stage when somebody’s saying, I could possibly end up cancer-free. So, could you talk a little bit about that?

Kelly Grosklags: So, in general, of course, these are always, you know, generalizations, I often see that in the beginning people are swarmed with, can I bring you food? Can I pick up the kids from school? Can I walk your dog? And when I say in the beginning, I’m talking the first two weeks, like, this isn’t like, this is some, you know, grandiose thing. And I liken it a lot to the grief experience and the bereavement experience, which people feel very supported in the beginning. So, you get a diagnosis, goes around maybe your synagogue or your church or your neighborhood or whatever, and people are showing up. 

In the early stage, yes, I think there is a difference. I think it’s, you know, we’re going to get you through this, we’re going to see you to the end of treatment, and we’re going to do all of this, and with the metastatic community what I hear often is again, in the beginning people come in, but because it can be such a long experience and that’s the good news in many ways, is that metastatic breast cancer, is people are living longer with it, but there isn’t this, we’re going to get you through it until the end of treatment kind of thing.

I wish people could think of it as, we’re going to show up as we can and I’m going to support you as I can. And I think that’s really important is that one of the things that I think ends up happening, is well-intended people over commit in the beginning and then, especially with metastatic or maybe more involved treatment cases where it takes longer, even if it’s an earlier stage, and they can’t follow through with their earlier commitments. 

So, what do they do? Instead of having that conversation about, I know originally I said I’d come over every week, I know originally I said this and that, they just leave. And our society is also, if you’ve noticed, people have a hard time saying no. So, if you send an email to somebody and you have an ask and the answer’s no, you often aren’t going to hear back from them. They’re just going to not respond. And I see that being one of the issues is that people are no longer able to continue to support as maybes, and so, they just disappear, which is much more detrimental than having a conversation with this person or their family and saying hey, some things have changed for me, I am only able to X, Y, and Z. 

That would certainly be my preference. So, sometimes I see people disappear because they don’t want to have an uncomfortable conversation about, I can’t continue to support you in the way that I originally did. 

Jamie DePolo: Yeah, that’s unfortunate.

Kelly Grosklags: So unfortunate.

Jamie DePolo: I guess I’m wondering, too, about the early stage. If somebody goes through treatment, maybe they had a few people ghost them as they got further into treatment after that first two weeks as you mentioned, and then maybe they get to the end of treatment and they are considered disease-free, do the ghosts ever come back? Have you seen that?

Kelly Grosklags: Certainly can. 

Jamie DePolo: And what do they say, like, what…

Kelly Grosklags: Well, oftentimes what I’ve seen is on such a…they get a random text. I’m such a bad friend, I got really busy, you know. There’s various reasons of excuses, okay? Typically, those are motivated by guilt and I guess I would say that I don’t want to shame or judge anybody listening to this, but when it’s motivated by guilt, it’s going to be clunky because I really…I, and I’ve told my patients this for many years, I really only want people in your life that are authentically showing up. I don’t want it for an ulterior motive, I don’t want it because they felt obligated. 

I think the best way for people to have people show up is this authentic way. It doesn’t mean they’re not going to be human together and they’re going to make each other mad and we’re going to make each other sad, but they’re going to stay the course. And I think when you show up from an authentic place of really wanting to do this because you love and care about this person, that tends to be a better way.

But yes, people do come back and I have to say, I don’t really have a fast answer for, should you allow them back or not? I mean, I think, you know, it depends on your history, it depends on how you’re feeling about it. You certainly get to be mad and upset, though, as the person living with cancer. You certainly get to be mad and upset with them, and still let them back in your life. So, there’s space for all of it. It’s not like, either you let them in and you don’t have emotions about it.

Another reason people come back is because cancer may have impacted them personally in their own family since their friend was diagnosed, or their cousin. And all of a sudden they’re realizing what is needed to get through this. And I think that is a very common and human reaction. We don’t know what we don’t know, and it’s sometimes I see people letting those people in a little easier than just yeah, I got really busy and my kids, you know, they were in karate and it just really got crazy and I couldn’t come around. And sometimes sarcastically, you know, we like to joke and say, did they have karate 24 hours a day, seven days a week, you know? So, you know, I can get kind of snarky sometimes like that.

But I think it’s important to know that there’s space to let people back in, but you’re not obligated to. And maybe you don’t let them in right away, maybe you see, okay, are they going to reach out to you once and drop it or are they going to reach out to you a couple times? Does their apology feel authentic? I always tell people, particularly women. I think women are very in tuned and very connected to intuition. And I say, pause and listen, like, internally when you ask yourself, is this person good for me? Is this person a good person to have in my life?

And we may not like the answer, but I think it’s important to listen. And I also think human relationships go through a lot of stuff throughout the course of time. It’s so important that we allow ourselves to change our decisions, make different decisions about who and who isn’t in our life. 

So, I know that was a long answer. I do see them sometimes come back. I also see them when they don’t. It can get really awkward, especially if you live in the same…you go to the same school, your kids go to the same elementary school and you’ve been best friends, and then you’ve got to see them at drop-off and school concerts. And then it’s this energy everybody is spending to avoid it, and you know, again, nobody wants to have a difficult conversation so, we just avoid. 

Jamie DePolo: Right. Right. You said something about making sure that the friendships are authentic and having authentic people in your life if you’re living with cancer or you’re being treated for cancer. One thing that occurs to me, I think it might be important for friends to know that being authentic doesn’t come with a certain frequency. You know what I mean? So…

Kelly Grosklags: Right.

Jamie DePolo: …if somebody can only be there once every six weeks but is authentic, I think sometimes people feel like I should be doing more, and maybe that contributes to, like you said, to the ghosting?

Kelly Grosklags: That’s exactly it, Jamie. I think because we live in a society that’s very quantity-driven, like more is better. I’m really glad you brought that up. Most people would say, I’d rather rely on somebody every six weeks that I know they’re going to show up, than guess if the person’s going to show up every day. I mean, it truly, like, what that person who’s consistent and authentic in how they show up and support is invaluable. Truly, even if it’s every six weeks. It’s absolutely invaluable. So glad you brought that up because this isn’t about who shows up more, this is about how do you show up. And how is the connection, and how safe. 

Safety is a big word I use in relationships with cancer like, how safe do you feel in this friendship or in this family relationship or with this co-worker or whatever? How safe do you feel? And I don’t mean physically being beaten up, I’m not talking about that. I’m talking about do you trust? Do you have the ability to be vulnerable with them? All those kinds of things I think is really important. If you don’t feel safe or if you feel like you can’t be yourself, again, I think it’s worth looking at.

The ghosts, the ones that ghost people often get the blame, and sometimes that’s very appropriate, but I also want people to take accountability for who do they allow in their life, who do they let come in, and who do they let stay because that is something we can control.

Jamie DePolo: Of course, and before we get into ways to potentially deal with cancer ghosting; we’ve kind of talked around it but could you talk a little bit about the feelings you’ve seen people who have been ghosted express? Because I do feel like, we need to as you said, let people know it’s okay to feel whatever you’re feeling, angry, sad, I’m sure it runs the gamut, but what is most common in your experience?

Kelly Grosklags: I would say the two things that I see the most are anger and confusion. The anger is generally the initial, and then often as we talk it through it ends in tears. So, under anger tends to be grief and fear, and so, if we unpack it and we go down under, what is under anger? Oftentimes it’s grief and fear, and that’s what I like to work with people around. Like, what is that? Because I think the anger is really, really, really important to express, especially for women who don’t have a lot of, growing up, didn’t get a lot of affirmation and encouragement.

So, we deal with the anger, and then we unpack it. And we go down deeper layers, and it ends up in tears. Just pure sadness and grief, and then confusion and almost like, surreal like, I never thought… I think the thing I hear a lot from women with breast cancer and men with breast cancer, is I never thought this person would leave and I’m absolutely thrilled this person showed up. So, it can be this dance, but the things I see the most are anger and confusion. I mean, and then again under that, that sadness, that just pure sadness.

Jamie DePolo: Okay. So, then, how do you counsel people to deal with cancer ghosting? I know you mentioned, think about whether this was a good person to have in your life. And then I imagine if the person felt like it was a good person, that makes it even harder. So, how do you, how do you help people?

Kelly Grosklags: So, one of the ways is I just really want them to voice it out loud. I want them to say it. I want them to sit with the feelings, I want them to be with it. There’s also this dynamic that if the person really helped them in the beginning, somehow they’re not allowed to have these feelings because well, they helped me in the beginning, and so, I really should just be grateful and not have these feelings. 

So, the less we judge our feelings, the better off it can be. The less we judge what’s coming up for us, because those are involuntary. Those are things that come up because this is truly how we’re feeling. And so, I think it’s important to acknowledge that these things are coming up for us and that we are entitled to feel these things. 

So, that’s one of the places I start. The second place is, I will have them write it out. I will have them write a letter that may not get ever sent, to the person who’s ghosted them. And this is…and what I say to them is, this letter is an opportunity to express everything you are feeling, and don’t hold back. Like, do not hold back.

And sometimes what I have also found is that ghosting can be like, these are people that maybe have disappointed them in the past and that this might be just the straw that broke the camel’s back. Like, yeah, you know, my sister, she just, she’s done this multiple times when I’ve needed her. I’ve always been there for her, she hasn’t been, you know, whatever. But sometimes I will ask them to write a letter and if people are listening and experiencing this, I would also encourage you to, to try this. Just as a way to get it out. It’s important to get this out, get this outside of us because these big emotions are very valid but they also can interfere with our healing and treatment and all these things. And so, I want people to get it out. 

I also will say to people, is this somebody you want to put the energy into? Is this somebody that matters? Again, these are questions I can’t answer, and if they say yes, I’ll say, okay. We’re going to walk through how to have a conversation with them about this, and you can do it in email, you can do it in text, you can do it on the phone, you can do it in person, whatever way feels comfortable. And you’re going to keep it simple. I have really missed you. I am really confused why you’re not coming around. I am very sad, and I’m also angry. I felt I could count on you and I feel very, very abandoned. And those are all the things we say, we use the I statements, and we keep it simple. Not, you’re a terrible friend, you’re a terrible person. You told me you were going to do this, you lied to me. That’s tempting, but that gets us nowhere, right? 

And so, we own it. And I’ll tell you, I’ve seen remarkable things come out of those conversations. And then it often is calling, there’s crying, there’s, I’m so sorry, I didn’t know this. I don’t know how to be with you. I’m having a really hard time. Every time I see you, you look sicker. When you lost your hair, that was really hard for me. It’s hard for me to watch you throw up, it’s hard for me…you know, all those things, and again, I have compassion for that.

Yes, it is, it’s hard to watch somebody you love suffering. But from those conversations, Jamie, can come very beautiful healing. Now, one of the risks in having that is the person won’t respond. They will ghost you again. And it’s that kind of secondary trauma. Again, I say to people, is this a risk you want to take? And most of the time it’s yes, it is, or no, they’re horrible and I needed to get them out of my life for whatever.

Now, even if that’s true, you get all your big feelings, even if they are a horrible person and it was time for them to be done in your life, you get to have your grief. I mean, I think that that’s really important. Just because we decide somebody can’t be in our life doesn’t mean we’re not going to be sad about it, you know? So, I think that’s just a really important thing to acknowledge.

Jamie DePolo: Of course. Have you ever seen anyone sort of be proactive with ghosting? In other words, kind of thinking that it’s going to happen and talking to people and saying look, you may feel like you’re going to say the wrong thing to me or maybe you don’t want to see me when I’m bald, but I really need you, and have a conversation that way? 

Kelly Grosklags: Boy, I haven’t a lot but I certainly talk with people in the beginning that this is something that could happen. And I’m hoping from this podcast that may happen when people are diagnosed. I will also say that one of the things, and I think this is what deters people from doing it, nobody thinks that it could actually happen to them. Like, they think their people are so in it and so dedicated and so loving that they would never ghost them. They would never, and that’s why it’s so painful when it happens because it feels so sudden. It feels so like, how could this have happened to me? I never imagined this.

I would love to see people be more proactive in, hey, I heard this is a thing, or somebody in my support group talked about this happening, you know, and I just want to bring this up to you guys. I really want to have open communication. You’re allowed to struggle, you’re allowed to have these feelings, but I want to make sure you talk to me about them rather than leave me.

Jamie DePolo: That makes sense. 

Kelly Grosklags: Yeah. 

Jamie DePolo: It makes sense. 

Kelly Grosklags: It’s so sad, and we’ve talked already about the various reasons people leave, but people have often said to me, I mean almost always, I never imagined they would do this.

Jamie DePolo: Yeah. Kelly, thank you so much. I think this has been so helpful. Your compassion just makes me feel so good whenever I talk to you. So, I thank you so much for your insights on this and I’m sure it’ll be very helpful to people.

Kelly Grosklags: And I just really want to thank you, and I also just really want to encourage people, just be true to yourself, you know? Just be true to yourself because when we’re not, then we ghost ourself. 

Jamie DePolo: Right. Right. 

Kelly Grosklags: And that’s one of the most tragic things. So, wishing everybody truly the best connections out there, and thank you so much.

Jamie DePolo: Thank you.