Amelia Frahm was 34-years-old when she was diagnosed with breast cancer.

“I had two young children and a great group of children’s playgroup women friends,” says the children’s book author. But “what I remember most is feeling alone.”

There were relatives who learned about her cancer diagnosis but didn’t call. “I think they were afraid. I lost all contact with them,” she says. And there were friends who did just the opposite, calling, bringing over cakes, showing up when she needed them. But even then, it was sometimes hard to connect, Frahm says: “It is not that other people aren’t friendly, you hold back because you feel so different,” she says.

Cancer survivor Allison Fagundes.

Allison Fagundes, who was diagnosed with papillary thyroid cancer five years ago at age 27, also had social struggles post-diagnosis: “Most people haven’t had cancer, so when they have a friend who gets it, they can respond poorly,” she says, adding: “Dating was a bit of a bust because of it, too.”

Those fraught interactions and damaged relationships led Frahm — upon learning, about a year after her diagnosis, that her husband’s job was relocating the family to Minnesota — to make a request. “The one thing I did not want my husband to do: Tell people I had had breast cancer,” she says.

The long-term effects cancer can have on our social lives
It’s a story you hear often enough among cancer survivors who were diagnosed young: As they fought to beat cancer, their social lives took a beating, with effects that sometimes last for years after treatment has stopped. A new study published today in the journal Cancer confirms this. After following 141 cancer patients ages 14-39 when diagnosed, the researchers concluded that a cancer diagnosis can impair your social life long after your initial diagnosis. (While other studies have also shown that cancer can hinder your relationships with friends, family and peers, this study reveals that these effects can be long lasting.)

Of course, there are more important things to consider, like curing the cancer, but the findings are still upsetting. In the two years following the diagnosis, roughly one in three patients reported consistently low social functioning and in about one in 10 cases, social functioning worsened from the initial diagnosis. Social functioning was measured by looking at the degree to which patients say their physical or emotional problems interfered with usual social life/normal social activities with family, friends, or neighbors.

The reasons we see these negative social impacts on the under-40 crowd are many. The cancer treatments themselves can change the body and brain. For example, some children who have undergone chemo and radiation have gone on to have behavioral problems, lower IQs, weight issues and more, research shows.

Some of the impact stems from the fact that when you’re getting treated — often in locations far from home, and then at home afterwards — you’re not interacting with your peers as normally as you would otherwise, says Lynn Hoffman, who founded the Tomorrow’s Children’s Fund to financially and emotionally support children with cancer and their families. “Sometimes your only friends are your family,” she adds, noting this can go on for years.

Cancer patients also often feel anxiety and depression, both of which impact socialization, says Beverly Hills-based family and relationships psychologist Fran Walfish. “When the individual is lucky enough to emerge in remission the experience can have an impact on the person’s self-esteem and self-image. Some people secretly carry a sense of ‘defectiveness’ or ‘incompleteness’ or being ‘flawed’,” she says. “When we assert ourselves into a social setting we automatically generate the vibe of self-worth.”

And, of course, much of this is because — as many cancer survivors told Moneyish — many people don’t know what to say or do when they hear you have cancer, and so they pull away.

How long might these effects last?
Hoffman says she sees some cancer survivors whose social lives never recover from a diagnosis, even when their bodies have. Her daughter Kara, now 37, is one of them. She was diagnosed with cancer before she was two and had recovered by age 4, but Kara never had many friends growing up.

When Kara entered kindergarten, Hoffman talked to the school about keeping her daughter’s cancer from the other students, out of fear that it might stigmatize her daughter. That worked for a short while, until one day when her daughter was struggling with a math problem in front of the class, and the teacher blurted out “she doesn’t do well with math because she had cancer.” After that, the kids treated Kara differently, Hoffman says. “There was nothing I could do.”

Cancer survivor Paulette Sherman.

Still, most cancer survivors, even if they struggle initially, go on to have robust social lives. And many — like Paulette Sherman who has been breast cancer free for five years now — don’t feel disconnected even when going through treatment: “I was fortunate that a lot of people were pulling for me,” she says “My dad bought me car service vouchers to commute an hour to the hospital during radiation. My husband attended all my chemotherapy sessions with me (8) at the hospital, and my mom paid for an editor for my first book as a gift.”

But for those whose social lives are suffering now, there are things that can be done both by the medical establishment and by the person suffering. Olga Husson, a professor at the Radboud University Medical Center in The Netherlands and co-author of the study suggests doctors should go about “reducing physical symptoms and psychological distress and enhancing social support by interventions in the period after treatment.” Walfish says that therapy and talking about the issues with others can help: “When the patient has the opportunity to identify their emotions and say the feelings out loud it can be a deeply reparative experience,” she adds.

And, of course, if you’re reading this and know someone who is suffering from cancer, be the friend that calls. “You have to pick up that phone and call them,” says Frahm. “There are people that do that and there are people that will not.”