Let’s Stop Talking About „Battling Cancer“ -BB

Cancer is not a war. It’s not a battle to be won. Cancer is a disease that plays by its own rules and does not always respond the way it is supposed to.

The recent diagnosis of Democratic congressman and civil-rights icon John R. Lewis of Georgia  with stage IV pancreatic cancer, has predictably led to many articles and conversations on the “fight” against cancer he has to prepare to wage. His is a diagnosis that can be treatable, but is not curable with the current treatment options that are available.

Similarly, Alex Trebek, the long-time host of TV game show Jeopardy, publicly discusses his “battle” with stage IV pancreatic cancer.

Yet it is unfair to call a diagnosis and the treatment plan a fight. This indicates that when the cancer does what cancer often does, and the patient either succumbs to the illness or to complications from the disease or treatment, he or she did not fight hard enough, or has given up.

This type of rhetoric can be damaging to patients, their families and their caregivers. If a patient sees cancer treatment as a battle that must be fought, they can feel they have not done enough if the treatment does not work, or if they cannot tolerate the side effects of treatment.

Physicians use these metaphors as well, and that can lead to a patient feeling they are letting others down when cancer does not respond to therapy.

As an oncologist, I have had patients use this language to describe their diagnosis, and I have also had those who cringe when a family member mentions the “battle” ahead. Recently, a 32-year-old woman with metastatic colon cancer shared with me that she had stopped attending family functions. The constant “war analogies” made her feel like she wasn’t doing enough to “fight” when she was trying to survive and thrive while enjoying her life with her young children and undergoing treatment.

By talking about beating cancer and fighting cancer, it can give the impression that the patient is not trying hard enough to get better, and that is why the cancer is “winning.”

Cancer care has come a long way in the last several decades. Immunotherapies and novel agents along with clinical trials and new drugs coming down the pipeline give hope that we will eventually be able to extend more metastatic cancer patients’ lives by years as we have with certain tumor types.

The length of cancer survival has increased slowly for all cancer combined, an indication of improved prevention, early detection, screening and treatment options. However, the fact that this is not always the case should not reflect negatively on those who are receiving the treatment.

Psychologist David Hauser at Queen’s University in Ontario, Canada, published a study earlier this year that suggests “battle metaphors could have a negative impact on how individuals think about cancer, and those thoughts could undermine people’s intentions to engage in healthy behaviors.”

His work with Norbert Schwarz at the University of Southern California found that military metaphors resulted in healthy individuals rating cancer treatment as more challenging than when these treatments were described with journey metaphors, or no metaphors. These battle metaphors also resulted in people being more fatalistic.

After reading battle metaphors, people responded to questions with answers indicative of a feeling that getting cancer was an inevitability for the patients who were diagnosed, no matter what behaviors they engaged in. 

Battle metaphors can put a great deal of pressure on the newly diagnosed patient. Individuals describe feelings of letting friends and family down when they are not seen as constantly “fighting the cancer.” Words such as “living” with cancer make it easier to go through the ups and downs that are inevitable when living with a cancer diagnosis without feeling the constant need to be proving the ability to fight.

Undoubtedly, there must be time following a diagnosis for hope and for realistic discussions on goals of care, life expectation, and decisions made on how to live and thrive with cancer. Approaching cancer care with hope and informed decision-making and a plan are essential.

It is absolutely true that patients have different preferences and methods that help them to cope with and manage the news and treatment of a cancer diagnosis. Some patients feel using fighting and battle terminology helps them galvanize themselves and gain a sense of playing an active part in their treatment and taking some control against the disease. 

However, when others place the impetus to “fight” and “beat” cancer on the patient, an already emotionally and physically exhausting process can be made even difficult.

Unfortunately, cancer is not an opponent that can stomped out by sheer will, determination or persistence. A study published in 2015 by scientists from the Johns Hopkins Kimmel Cancer Center concluded that 66 percent of the variation in adult cancer risk across tissues can be explained by “bad luck,” and are beyond anyone’s control. The metaphor of a “battle” does not consider the such randomness.

It is essential that physicians communicate openly and honestly with patients on the disease, treatment options and prognosis. Open dialogue and communication are key to a successful doctor patient relationship, and essential when developing plans after an initial diagnosis of cancer.

But battle metaphors can easily be removed from our discussions—unless that is the patient’s preference. Not many people would say a patient was fighting a battle against a stroke or a heart attack, so putting such massive responsibility on a patient newly diagnosed with cancer is a losing proposition.

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