After treatment, the question can change. During treatment, people often ask in a specific way: how was the scan, how was the week, how did it go. Later it can get asked in passing, by people who are glad you are through it, and the answer you give can start to sound the same every time. If you have noticed that, you are not hiding anything. You are answering a question that has a few seconds to live.
Why do I keep giving the short answer when it is not the whole truth?
Because you are answering the situation, not the question.
Someone asks how you are in a lift, at the school gate, or at the end of a meeting. They mean it kindly, and they have somewhere to be. What they are hoping to hear, and hoping to hear quickly, is that you are well. So you say something that fits: Good, thanks. Getting there. Back to normal.
These are good answers. They are polite, they are brief, and they work. Nothing has gone wrong when you give one, and giving one does not make you a person who is hiding something. It makes you a person who has read the room correctly.
There is often another layer. After treatment, people can feel an unspoken expectation to be grateful and positive, because they got through it. Saying anything else can feel ungrateful, or like tempting fate. Fine can be the answer that keeps you inside what you feel you are allowed to say.
Why is it harder to tell the people closest to me?
Because they are the ones you most want to protect.
The people closest to you have been through it with you. They are worried about you, and you may find yourself softening the answer so the conversation does not turn into their worry. Researchers who study couples and families coping with cancer call this protective buffering: holding back concerns to shield someone you love.
It often goes both ways. The person who finished treatment says fine to protect their partner or family, and the people around them say fine back, for the same reason. It comes from care. The cost is that two people can end up each carrying a long answer on their own, each believing they are doing the kind thing.
Not everyone has people close by to tell, and that is its own difficulty.
What is the difference between the short answer and the long answer?
The short answer is the version that fits the conversation. The long answer is the version that fits what is actually going on.
The long answer is usually less tidy. It might include being tired in a way that does not have a clear cause, or finding that things look the same from the outside and do not feel the same on the inside. It might include fear of the cancer coming back. It might include being unsure whether you are allowed to say that you are not fine. It might include the slow, patchy way recovery goes, which is hard to describe and harder to see (more on that in Why can't I feel myself recovering after cancer?).
It also takes more to say. The long answer needs a chair, some time, and someone who will listen without trying to fix it by the second sentence, or brushing it aside. A person who is half listening, or who rushes to a solution, or who says that at least it is over, can make it easier to go back to the short version.
Do I have to tell anyone the long answer?
No.
Not everyone wants to give the long answer, and that is fine. For some people, keeping things private works well. They know who they would tell if they needed to, and fine is genuinely the whole of what they want to share. Talking is not automatically better than not talking, and nobody should feel pushed into telling their story because an article suggested it.
The rest of this is for people who have noticed the long answer sitting there and would like somewhere for it to go.
What happens to the long answer if nobody asks for it?
It stays with you, and carrying it can be really hard.
The moments when somebody could really listen are rarely the moments when somebody asks. So you are living with the long answer while mostly being asked for the short one. If you would like to say it and there is nowhere to, that gap can be lonely.
It can also feel dismissive, even when nobody means it that way. Being asked how you are, and then not being given room for the real answer, can feel as though the question was a formality, or as though nobody really understands what this has been like. Sometimes the response really is dismissive, and that is hard in its own way.
And when the short answer is the only one you ever say aloud, it can start to feel like the only one allowed, and the longer version can seem too big or too late to bring up.
Who ends up hearing the long answer?
Sometimes it is not the person you would have picked.
For some people, those one step removed are easier to tell. A physio, a neighbour, a hairdresser, someone beside you on a long drive, a stranger in a waiting room. They have no stake in how it turns out, so you do not have to manage their face. And a conversation that has a natural end, like an appointment or a bus ride, can feel easier to start, partly because you both know it will finish.
It can happen by accident. You say fine, they say really, and one of you decides that today is the day.
When is it worth telling someone how I really am?
When carrying the long answer starts to feel heavy, and it is worth being a little deliberate about it.
If the long answer is mostly tiredness, a patchy recovery, or a sense that everyone has moved on, then it is worth finding one person and one slot. That might be a friend you give notice to ("I would like to tell you how I am, properly, can we have a coffee that is not rushed?"), or a support group.
If a lot of what sits under the fine is fear of the cancer coming back, that is worth looking at in its own right. How do I know if my fear of cancer coming back is normal? covers how to tell an ordinary level of that fear from one that needs help.
If underneath the fine you notice something more persistent, that is a different matter and worth raising with your GP or treating team rather than waiting it out. That includes feeling down or depressed every day, or nearly every day, for more than two weeks, losing interest in things you used to enjoy, feeling hopeless about the future, worry you cannot switch off or trouble sleeping on most nights for several weeks, or fear of recurrence that is taking up a lot of your day. Any new or ongoing physical symptom is always a question for your GP or treating team too. Seeing your GP is a first step towards understanding what is going on, not a promise to take any particular next step. A short answer is allowed in a consulting room as well, so it is worth saying that it is a longer story than it sounds.
Your GP can refer you to a psychologist, ideally one experienced in psycho-oncology, the field that works with the psychological side of cancer and life after it. That referral is often made under a Mental Health Treatment Plan, which gives a Medicare rebate for sessions.
If you cannot think of anyone you could tell, that is worth mentioning to your GP too. It is also part of what the community at the end of this article is for.
If you are having thoughts of harming yourself, contact Lifeline on 13 11 14, or call 000 in an emergency.
Where does this understanding come from?
It is informed by psycho-oncology, the field concerned with the psychological side of cancer and its aftermath, and by research on how people talk about cancer within their relationships. One strand of that research, on what are called social constraints, looks at how other people's responses affect how freely someone feels they can talk about their cancer. It has found that more constraint tends to go along with more distress, though this is an association and not proof of cause, and the link was stronger in people diagnosed more recently (Adams et al., 2015). Another strand looks at protective buffering, where people hold back concerns to protect someone close to them. One study of people having a stem cell transplant and their partners found buffering in both directions, and found that more of it went along with lower relationship satisfaction and poorer wellbeing, including for the person it was meant to protect (Langer et al., 2009). The point about pressure to stay positive draws on the writing of Jimmie Holland, one of the founders of psycho-oncology (Holland & Lewis, 2000).
Research on whether talking about cancer helps is mixed, which is part of why this article does not tell anyone they must. The short answer and the long answer are not clinical terms, just a plain way of describing something people may recognise.
This article is education. It is not therapy, it does not replace an individual assessment, and it makes no promise about how anyone will feel afterwards.
Where can I go from here?
If this sounded familiar, The Cancer Rollercoaster community is free to join. You can read and listen at your own pace, nobody has to post anything, and reading along for months without saying a word is completely normal there. From Monday 23 November, a short free series called The Silly Season, Seriously starts inside it, about managing the Christmas holidays, your energy, and what other people ask of you.
References
Adams, R. N., Winger, J. G., & Mosher, C. E. (2015). A meta-analysis of the relationship between social constraints and distress in cancer patients. Journal of Behavioral Medicine, 38(2), 294-305. https://doi.org/10.1007/s10865-014-9601-6
Holland, J. C., & Lewis, S. (2000). The human side of cancer: Living with hope, coping with uncertainty. HarperCollins.
Langer, S. L., Brown, J. D., & Syrjala, K. L. (2009). Intrapersonal and interpersonal consequences of protective buffering among cancer patients and caregivers. Cancer, 115(18 Suppl), 4311-4325. https://doi.org/10.1002/cncr.24586