The pros and cons of keeping your cancer diagnosis a secret

Why someone may not reveal a cancer diagnosis

The decision to keep a cancer diagnosis secret is not uncommon, says Diane Schaab, MS, Behavioral Health Therapist at City of Hope^® Cancer Center Atlanta. Many patients don’t want cancer to define them as someone different than they were before.

“People will tell me the moment they tell someone they have cancer, they are treated differently,” Schaab says. “People don’t want to be treated differently. They want people to talk to them the way they always have. They want people to engage with others the same way. So, a lot of times, it’s not that they don’t want other people to know, it’s not that they don’t care about other people. It’s about what the patient needs. They may need to be treated differently by some and the normal way by most others.”

With a cancer diagnosis, comes many questions. Patients and caregivers may grill their doctors and care team about treatment options, symptoms, side effects and long-term prognosis. Some cancer patients who share their diagnosis with friends and co-workers may be asked as many questions as they’ve asked their doctors.

“The entire day may be inundated with questions regarding cancer,” Schaab says. “People have concerns, and often valid concerns. But asking how the patient is doing or feeling versus just having a normal conversation may result in a person’s whole day taken up by talking about cancer.”

For some, keeping cancer a secret is a business or financial decision. Manhattan public relations executive Melanie Young told NBC’s Today that she feared some clients would “jump ship” if they thought she was too ill to handle their accounts. “I needed to earn a steady income to pay the bills, which piled up during treatment,” she said. Indeed, while she found much support after revealing her diagnosis in 2011, a few clients, she said, “drifted away.”

When it may be difficult to keep cancer a secret

Cancer isn’t always easily hidden. The disease may bring on physical changes that may be difficult to mask and may become obvious to others, especially to family and close friends. This may make cancer a secret that becomes increasingly difficult to keep.

Body changes, especially dramatic weight loss and hair loss, may cause concern among friends and coworkers. And changes may also prompt others to make assumptions about what’s happening without knowing the facts.

“Hair loss may make it clear that something is not right,” Schaab says. “When I talk to patients about hair loss, that’s often what makes it all so real. People may not see nausea or fatigue. But they do see changes to the body, especially hair loss and weight changes.”

Actor Chadwick Boseman battled colorectal cancer in secret for four years before his death in 2020. Toward the end of his life, when his dramatic weight loss was evident in photos and videos, some fans expressed concern for his health, while others body-shamed him or drew conclusions about substance abuse.

"The fact that Boseman had been criticized for his weight loss speaks to how superficially most people view others when their sole basis for judgment is the images they see online," Kelly Coffey, certified personal trainer and health coach, told Insider.com. "It's up to us to remember that what we see doesn't represent anything close to the whole story. It's on us to practice being respectful of and compassionate toward all people and all bodies, always."

When physical changes make it difficult to keep a diagnosis a secret, Schaab says, patients should consider whom they should talk to about their situation.

“That’s where you really have to look at your inner circle and the layers of your circle,” she says. “Ideally, you may want to share with your main supporters—your immediate family, your closest friend or friends, people you see on a regular basis, the people closest to you—because that connection and emotional and social support is a huge factor in healing and recovery and de-stressing. You have to decide what’s best for you. People may notice things are different, but if not sharing is what’s best for you right now, that’s the path you have to take.”

Other celebrities who chose to keep their cancer private

Comedian Norm MacDonald may not have been a household name to some, but since leaving Saturday Night Live in 2009, he was among the busiest performers on television. MacDonald had his own show on Netflix, performed in stand-up comedy shows, was a regular on multiple TV series in person and as a voice actor and he made dozens of appearances on late-night talk shows.

Then he died of cancer on Sept. 14, 2021.

During all those years of public performances and TV appearances, MacDonald was waging a secret battle with cancer. His death was a shock to his many fans and to some family members and friends, who had no clue he had been diagnosed. “He never wanted the diagnosis to affect the way the audience or any of his loved ones saw him,” his co-producer and friend, Lori Jo Hoekstra, said upon his passing. “Norm will be missed terribly.”

MacDonald and Boseman are the latest among many TV and movie stars, authors and other celebrities who kept their cancer diagnoses under wraps. Among others:

David Bowie died of liver cancer in January 2016, 18 months after his diagnosis.

Val Kilmer had surgery for throat cancer and revealed his condition two years later.

Kelly Preston died of breast cancer in July 2020, after a secret two-year battle.

Alan Rickman died of pancreatic cancer in January 2016, about 18 months after his diagnosis.

Kathy Bates was diagnosed with ovarian cancer in 2003 and breast cancer in 2012. She revealed her conditions two months after breast cancer surgery.

It wasn’t until after his death that MacDonald’s family revealed that he had fought a form of leukemia, a complex disease that has many types and subtypes. It also has chronic and acute versions. MacDonald’s family announced that the comedian died of “acute leukemia,” indicating that it likely was acute myeloid leukemia (AML), rather than acute lymphocytic leukemia (ALL).

What’s the difference?

AML, also known as acute myeloblastic leukemia, acute granulocytic leukemia or acute nonlymphocytic leukemia, occurs when the bone marrow overproduces abnormal white blood cells. It is most common in adults, especially men.

ALL, also known as acute lymphoblastic leukemia, occurs when the bone marrow produces rapidly growing lymphocytes that can't mature properly. The disease is most common in children and young adults.

What to do when you don’t want to talk about your cancer

While patients may not be able to keep their diagnosis a secret from everyone, they may be able to control when and with whom they discuss their diagnosis, Schaab says.

Cancer patients should practice a bit of selfishness when it comes to talking about their disease, especially with those they don’t know or don’t know well.

“I have a patient who works in retail, and she’s constantly fielding comments and questions from customers or co-workers,” Schaab says. “People struggle with taking control of that conversation. It’s important to dictate what’s helpful and not helpful. So, we look at some simple statements they can make to acknowledge them, but shut down the conversation when they choose so it doesn’t inundate their day.”

Schaab recommends some go-to responses, such as:

• I’m having a cancer-free day, thank you.
• I’d rather not talk about it right now.
• Thanks for sharing.

“Those statements can be very powerful,” she says. “Try to lead the conversation in the direction that meets your needs. And less is always more.”

If you’d like to learn more about the behavioral health services we offer cancer patients, or if you’d like to talk with someone about your cancer treatment options, call us or chat online with a member of our team.