When my mother-in-law was dying of ovarian cancer, a couple she considered to be dear friends sent her a note.

She'd spent much of her adult life sharing Saturday night dinners and sagas of child rearing with this supposedly sophisticated pair, so she expected a sweet message. Instead, they wrote this: Watching you change and suffer is too painful for us, so we can't see you anymore.

Nothing like breaking someone's heart as they're dying.

While being the ultimate fair-weather friend is one of the worst things one can do when someone has cancer, there are other faux pas that people with the best of intentions commit all the time.

"People mean well, but when someone's diagnosed with cancer, nobody knows how to handle it," says Carolyn Bray, a Providence woman who recently battled neck and breast cancer.

To complicate matters, a gesture that helped one person may backfire with another because every cancer case is different. Treatments, side effects and, especially, personalities vary.

"Some people want to be treated with care, and some don't want to be treated differently at all," says Dr. Lowell McRoberts, a psychiatrist who sees patients at Rhode Island Hospital's Comprehensive Cancer Care Center.

So, what's a well-meaning friend or relative to do?

DON'T TELL HORROR STORIES

Cheryl Hammond, a friend of mine who's in the middle of breast cancer treatment, says she can't believe that people think it's helpful to tell her about someone who had a breast cancer recurrence -- but it's happened several times.

Bray says people often told her cancer horror stories, too, especially about how sick she'd be during chemotherapy. Fortunately, she ended up with only mild side effects.

"I was needlessly frightened," she says.

In fact, everyone I spoke to said that one of the most common - and worst -- blunders is to tell a story that's nothing but discouraging.

"The number-one rule is don't ever tell a cancer story that has a bad or sad ending," says Catherine McGrath, a Massachusetts breast cancer survivor who has developed several products to help people undergoing cancer treatment.

People don't mean to be so insensitive, according to the experts.

"It's one of the ways loved ones manage their own anxiety," says Sue Van Ness, a cofounder of the Hope Center for Cancer Support in Providence. "Often they distract it by telling a story of someone else."

Or, Dr. McRoberts says, they're trying to connect with the cancer patient in some way.

"A horror story is a loss of your own, so they think telling it connects them since the patient has just revealed something intense of their own," he says. "It's well-intentioned, but it doesn't usually tend to work out very well."

In other words, don't do it.

Stories with happy endings, however, can give people hope.

"The most helpful stories are about people who are longtime survivors," Hammond says.

Another thing cancer patients don't appreciate is unsolicited advice, such as suggestions to see a nutritionist or seek a second opinion, according to Ann Webster, director of the Mind Body Cancer Center in Boston.

DON'T DISAPPEAR

But worse than hearing the wrong thing is hearing nothing at all, Webster adds.

"Patients will say, 'I really thought Sally was my best friend, but since I got cancer, Sally won't call me anymore,' " she says.

My friend Hilary Farrow, who lives in Providence and survived treatment for leukemia last fall, says the most hurtful part of her recovery was the silence from a few people she'd been friends with since childhood.

"No card, no call," she says, adding that she's sure they knew she was sick.

People disappear, Webster says, because they don't know what to say or can't deal with the reality of cancer.

That's understandable, says Van Ness, of the Hope Center for Cancer Support, but vanishing is the worst way to handle it. It's better to tell them you have trouble dealing with hospitals or cancer or watching them suffer, but emphasize that you still care about them and want to be part of their lives. Then, she says, offer to do something that feels more comfortable, such as mowing their lawn or organizing food deliveries.

DON'T OVERDO IT

Trying too hard to help can actually hurt. McGrath remembers feeling "inundated" with well-wishers after her diagnosis.

"Everybody who was anybody in your life comes out of the woodwork," she says. "It's overwhelming. You can't carry that many people."

Some of the well-wishers, she suspected, called out of curiosity or to be part of the drama. She sometimes felt that in exchange for a meal, people expected a complete medical update, which she wasn't necessarily ready to give.

"What you're trying to do is keep your life as normal as possible," she says. "You're trying to keep the crisis and drama down."

She offers this guideline: "If they don't typically talk to you on a weekly basis, they should not call," she says.

Instead, she says, they could send a simple card wishing the patient well and including a phone number or e-mail address where they can be contacted when the patient is ready.

Farrow appreciated getting calls from people she hadn't heard from in years, but was also grateful when they left a message and didn't oblige her to call back.

"Because I didn't have the energy," she says.

Even people the patient talks to every day can mess up -- mainly by not letting them speak openly or insisting on false cheer.

"Don't say, 'Don't worry, you're going to be fine,' " says Angela Boothman, a Warwick woman who has been free of breast cancer for 10 years. "Listen when they say, 'I'm afraid I'm going to die. I'm afraid of what's going to happen to my children.' "

Van Ness says clients at the Hope Center often complain that either the person with cancer or a close family member refuses to discuss it, particularly when treatment isn't going well.

"I encourage people on either side to frame the talk: 'I need to talk to you about this. Can you listen? I know it's hard for you -- it's hard for me, too,' “ she says.

Offering to listen -- but not pushing -- whenever someone needs to talk about cancer can be a relief, patients say. And the best thing to say when you're at a loss for words, according to Van Ness, is simply that you feel badly about what they're going through.

GIFTS

When McGrath was recovering from breast cancer surgery in Massachusetts several years ago, her 7-year-old daughter came to visit her in the hospital. The little girl looked at her mom, focused on the IVs and bruises, and got a horrified look on her face. McGrath called her sister.

"Get one of my husband's shirts, tear it down the sleeve and Velcro it up so I don't look so sick," she told her.

Her invention later became the Jacki, a top full of pockets for drains, openings for radiation access and sleeves with spaces for IV tubes. Besides beating a bathrobe for hospital-wear, it spares patients from having to change in and out of baggy hospital gowns during day-long treatment sessions.

McGrath sells the Jacki through her Web site, AnEasierRecovery.com and in some hospital gift shops. Any proceeds she earns from the business go to her nonprofit company, A Little Easier Recovery, which will pay for practical things such as maids and laundry service for cancer patients.

The Jacki costs $124, and it's usually purchased by family members as a group gift, McGrath says. But she says there's no need for people to buy expensive presents. Some experts even say it's a bad idea.

"Avoid giving huge gifts that embarrass people," says Diane Passantino, an oncology social worker at Rhode Island Hospital's Cancer Care Center. "They feel obligated to send a thank-you note or reciprocate, and it just adds more pressure to their life."

Flowers are nice, but not all cancer patients can enjoy them. If their immune systems have been wiped out by chemo, they often can't fight off any germs that might be lurking in the buds.

Liz Lambert, an oncology clinical nurse specialist at Miriam Hospital in Providence says gifts don't have to be "sick gifts."

"Give whatever you'd give them for their birthday," she says.

Her suggestions include CDs to play during treatments (many hospitals provide portable CD players) or inspirational books, such as those by Bernie Siegel, on tape.

Farrow liked receiving care packages with lots of little things in them, such as journals, CDs, socks and books. Bray treasured a friend in Pennsylvania who sent a card every day for weeks.

McGrath also sells a Been There Bag, full of things that helped her during cancer treatment. She says some of the best presents for cancer patients include: thank-you cards, stamps and a great pen; soothing lotions or bath gels for skin that gets dry from chemotherapy; a juicer and a juicer cookbook; a teapot with licorice and ginger teas for nausea and tickets or gift certificates to get people out of the house.

"You can go to five CAT scans, but you can't go to the movies because you're too tired," she says. "But you have to."

FAVORS

If you're coping with cancer, you don't have to scrub your bathtub. That's where friends looking to help can come in.

"We know all the chores that have to be done," Van Ness says. "Ask the person, 'Can I do the laundry for you or run the vacuum around? You don't need to use your energy for those types of chores. You need your energy for your healing."'

The key to being helpful without making the patient feel helpless is to offer favors you'd be doing anyway.

"You can say, 'I bring my dry cleaning in every Wednesday. If you want me to bring yours, just leave it on your doorknob,' " McGrath says.

Similarly, driving kids to Sunday school when you go to church or bringing them to basketball practice if they play on the same team as your child might not make the person with cancer feel as if he or she is imposing. Another idea: rent an extra video when you're at the store.

"If someone picked up a movie on a Friday night that was a new release and I just got back from a day of treatment -- that was awesome," McGrath says. "It kept the kids busy and happy."

McGrath made a list of her favorite things so when her sister or husband fielded phone calls, they could tell people specifically what she liked. Keeping a list of preferred books, movies or ice cream flavors, for example, guides people when they're trying to help. That way, someone can tape your favorite show if you miss it because of a treatment, or drop off a carton of your favorite ice cream if you're losing a lot of weight that week.

FOOD

Speaking of food, those who have been there say cancer patients usually eat small bits throughout the day instead of three big meals. Delivering something that's nutritious and easy to digest and heat, like soup, might be a good idea. Plain meals that kids will eat, such as pizza or cold cuts and rolls so they can make their own sandwiches, are much better than gourmet meals, McGrath says.

Even if patients aren't eating much, food contributions can help them nourish their families.

"I couldn't take care of my husband like I wanted to, so it was for both of us," Farrow says of the homemade food she received.

She was also touched and grateful when several friends and relatives brought boxes of pastry that she could offer other visitors.

An effective way to help the patient and involve people who have asked to help is to organize a group food delivery. The leader draws up a schedule and assigns a night to everyone who offers to cook. Meals are then delivered in disposable containers, so the family doesn't have to wash casserole dishes, at a set time. Friends are usually warned about food allergies and aversions, and told not to stay to chat unless expressly asked.

GESTURES

An especially helpful friend told Angela Boothman that she wasn't going to call and ask how she was feeling. Instead, she was going to call and ask her to go to lunch, just like she used to before the cancer diagnosis.

"If I was tired, she would say, 'Can I take you for a ride?' " Boothman remembers. "She'd come over with a flower or a loaf of bread."

Despite the little offerings, Boothman's friend was making a gesture that said: I'm here for you. This is what cancer patients seem to want most.

"Just go and sit and be with that person," Webster says. “They don't want to be alone with what they're going through."

Bray was touched when people from her church said they were praying for her, and when friends gave her rides and stayed with her during chemotherapy treatments. Hammond hasn't taken anyone up on her offer to sit with her during a treatment - she usually listens to healing music or reads - "but I like the offer," she says.

Sticking by someone who's sick isn't always easy. McRoberts says cancer patients' moods can be unpredictable.

"Some days they want everyone to know how badly they feel and some days they want to be left alone," he says.

That's why it's especially meaningful when people hang in there.

"When loved ones stuck around, it meant so much to their recovery," he says.