If you know the person well, and I presume you do since he came to you with a very personal issue, you should not only say "What can I do to help?" but be specific about what kind of help your are willing to offer. "Can I cover for you at work for a few days so you can be with your son/daughter?" Can I prepare a meal for your family so you can all get together and talk about the situation?" "Would it be helpful if I baby sat for the caregivers so that they can take a break?" Whatever is appropriate to the situation. Let them know you are there for them.

"I am very sorry to hear that. I truly hope he improves. Treatments are tremendously more effective than they were not that long ago, and if they haven't, perhaps look into getting additional opinions from St. Jude's, City of Hope, and if possible an Oncology group that utilizes Watson's treatment data bank."

Something along those lines. Giving thoughtful and helpful suggestions to consider, that gives them something hopeful to ponder, and pursue. A purpose-filled distraction is great for the worried mind.

Lastly, stressful challenges cause us to develop a type of mental tunnel vision. It can be crippling and lead to depression. One of the best things one can do is make a thorough list of all the things that can be done to change or prevent an impending negative outcome.If we attack the list and complete all that we can, generally failure can be accepted more readily, as we've eliminated all things within our control.

These are the thought I try to consider when someone is seeking an empty prayer from me.

I've read all the comments and they have been helpful to me. i also have a had a hard time knowing what words to use. I will try some of the ones I've read. Thanks for the help.

I feel for you

I'm sorry you're going through this, it's there anything I can do to help you? #actualhelpinsteadofprayer

"I'll pray for you" is something Christians regurgitate to get them off the hook of actually doing something helpful such as babysitting other kids for the parents with a sick child, or cooking a meal, or taking someone to the doctor and myriad of other things that actually require some effort.

How can I help you?

The best replacement for praying, which is a zero effort and zero return, is something like "how can I help?". Even if there is nothing immediate, the offer should be open-ended, so if they think of something later, you are still available. It goes without saying, if you ask that question, you have to be prepared to help. That avoids "mushy stuff" and goes direct to empathy, and helping.

I'm thinking of you. you're in my thoughts.
good luck.

depends on the circumstances really, just try be tactful, show empathy for their plight.

Positive thoughts

"I'll think for you!" is my general response (when appropriate).

I'll just say, Very saddened to hear about this. Hope things your out. Not much more to add.. for me anyway.

I say don't replace it. You know your meaning of pray. Me personally when I say pray it means wishing things were better

Depends on the situation I guess

I usually just go with I hope everything works out.

My hopes for healing.

My late wife had brain cancer which only affected her speech. We live within a large and connected community and she wanted people to visit her in her last days. She sent out a request with "no tears and no prayers". I discovered that some would answer saying prayers was just something people said (a sort of reflex). My response was "so you don't really mean what you say?"
Christians using pity to get get prayers is, to me, a form of proselytizing like trying to make us say 'Merry Christmass" (the original form was Christ's Mass since Christianity was Catholic for 1,500 years) and then getting upset when we don't give the proper reply. There are lots of replies in the other comments. Good for you hanging tough.

This is what I say. You'll be in my heart and I am sending you and your whole family as much love as I can. Sometimes though, I say I'll pray for you because prayer by definition is just having internal thoughts so it's not a lie and you know what you mean. And it's comforting to them. In the end it's all about taking care of other humans. At least for me and comforting them how we can. I have only said I'll pray for you maybe twice because of the situation but I didn't feel guilty about it like I would have before, because I knew how I meant that remark.

Why does there have to be a replacement? Why doesn’t “SHIT!! That sucks man!” work?

Who determined all of this?

I need to speak to a manager.....

You pray for me I'll think for you is a good one..

I tell the truth and say "I don't pray" and proceed to lift his spirits in some other fashion like trying to make him smile and making him see that life doesn't end there.

"Tell me how I can help." It's offering direct action; I also like "I'll be thinking of you" or "I'm sending you love and hugs."

If they ask me to pray for/with them, I would respond with "Of course, but I was thinking about something more concrete. Can I: take your kids awhile/bring a dinner for your family/take care of [something] for you?" I don't actually pray but I do try to keep them in my thoughts to wish them well on an ongoing basis, although as someone pointed out, it's not the person you spoke with that needs "prayer" as much as it's the grandchild. Nonetheless the grandparent is suffering too, so I would still try to make an offer of concrete help for the family if possible.

Things like, “I’m so sorry, this is an impossibly hard position to be in. I’m here to listen or just sit in silence if you don’t want to be alone or need to talk...” stuff around the specifics. Optimism, realism, even healthy pessimism can be used.

I tell people that they are "on my heart" and I will be supportive of listening to them when they need to talk.