Cancer Care During Domestic Violence or Coercive Control

If you share a phone, a computer, or an account with the person who is hurting you, that device may be watched. The National Domestic Violence Hotline warns that internet use "can be monitored and is impossible to erase completely."

If that describes you, calling is safer than browsing. The Hotline says plainly: "If you're concerned your internet usage might be monitored, call us at 800.799.SAFE (7233)."

• Call 1-800-799-7233. That is the National Domestic Violence Hotline, also written as 1-800-799-SAFE. It is free and open 24 hours a day. You do not have to give your name or your address.
• Text START to 88788 to reach the same service by text message.
• Call 911 if you are in immediate danger.

Review hold: This safety-sensitive draft is excluded from public search until an appropriate qualified reviewer checks the wording.

Abuse is not only being hit. The Centers for Disease Control and Prevention describes four kinds of harm from a partner or former partner: physical violence, sexual violence, stalking, and psychological aggression. CDC defines that last one as "the use of verbal and non-verbal communication with the intent to harm a partner mentally or emotionally or to exert control."

This is common. CDC reports that more than 1 in 3 women and more than 1 in 6 men experience contact sexual violence, physical violence, or stalking by an intimate partner in their lifetime.

Cancer hands one person a great deal of power over another. Some of the most damaging control in a sick person's life never leaves a mark. Watch for these:

• Promising to drive you to treatment, then refusing at the door, or leaving you at the clinic
• Hiding your medicines, rationing them, or throwing them away, including pain and anti-sickness medicine
• Cancelling your appointments, hiding your letters, or answering the clinic's calls for you
• Sitting in on every visit, answering for you, and never letting you be alone with a nurse
• Reading your patient portal, or holding your login
• Controlling the money that pays for treatment, or the job the insurance runs through
• Telling you that you are a burden now, or that nobody else would want you
• Using the illness to keep you home and away from friends and family
• Threatening to leave you mid-treatment, or to take the children because you are sick
• Pressuring you for sex when it hurts or when your team has told you to wait

Controlling a sick person's access to medicine and to medical care is abuse. So is using their diagnosis to isolate them. If you have been calling it "he gets stressed about my treatment," you are allowed to call it what it is.

Missed appointments are worth saying out loud. Teams often read them as the patient not coping. If someone is stopping you from getting there, tell them so.

Nobody reading a web page can tell you when it is safe to go. The Office on Women's Health puts it directly: "Many abusers get even more violent after their victims leave. That's why a safety plan, agreed on with others in your life, can help keep you safe after you leave."

So do not treat leaving as a single brave decision. Treat it as something planned, with help, on your timing.

Two more things to avoid. Do not confront your partner with what you have read here. Do not tell them you have been given advice. Both can raise the risk without changing anything.

A safety plan is practical, personal, and built for your actual situation. The Hotline describes plans for three different points: while you are still living with the abuse, while preparing to leave, and after leaving. Each one is different.

Advocates do this every day. The Office on Women's Health notes that advocates at the National Domestic Violence Hotline can help you build your safety plan, free and without giving your name.

A cancer-aware plan may need to cover things a standard plan does not:

• Where a spare supply of your medicines can be kept, and who can hold it
• A copy of your treatment plan, your medicine list, and your clinic's phone numbers
• Who else can drive you to treatment, and how to arrange it without asking your partner
• A safe phone number and mailing address for the clinic to use
• Whether your patient portal password is known to anyone else

Clinics can help, but only if they know. You should not have to engineer the whole thing yourself.

Good clinicians create the opening on purpose. Many will ask a companion to step out for part of the visit, and they frame it as routine: "I see everyone on their own for a few minutes." That wording protects you, because nothing in it points at your partner. If your team does not offer it, you can ask.

Any of these lines work:

• "Can I have my bloods done on my own today?"
• "I need to speak to the nurse about something private."
• "I would like the social worker to call me on Tuesday morning."

Being asked about safety at home is normal practice, not suspicion about you. The US Preventive Services Task Force recommends screening women of childbearing age for partner violence, and gives that a B grade, meaning it has moderate benefit. The Task Force also says screening works best in safe and private settings.

One warning about video appointments. The Task Force notes that a partner may overhear the answers, which can make a video visit less safe than an in-person one. If a video slot is all you are offered, ask for a phone call or a visit in person.

Ask the team to record a safe phone number and a safe address, and to note that letters should not go to your home if that is unsafe. Ask who covers you when your usual nurse is off.

Do not push them to leave. Pushing usually ends the conversation and can cut them off from you, and you may be their only route to help.

Say instead that you believe them, that it is not their fault, and that you will still be there whenever they want you. Offer specific help: a lift to chemotherapy, a spare key, somewhere to keep documents. Keep offering after they say no.

You can call 1-800-799-7233 yourself for advice on supporting someone. You do not need their permission to ask how to help.

• Leaving an abusive relationship — Office on Women's Health, U.S. Department of Health and Human Services
• About Intimate Partner Violence — Centers for Disease Control and Prevention
• The National Domestic Violence Hotline: 1-800-799-7233, text START to 88788 — The Hotline
• Create Your Personal Safety Plan — The National Domestic Violence Hotline
• Intimate Partner Violence and Caregiver Abuse of Older or Vulnerable Adults: Screening — US Preventive Services Task Force