The language of cancer: ‘Battle words’ can have unintended consequences

Words can carry an enormous amount of weight, and they can impact a person more significantly than one might think.

For example, the use of certain “battle words” when discussing cancer treatment with patients actually could make matters worse for some.

Words such as “fight,” “battle,” “win” or “lose” can generate even more anxiety and stress for a patient who has just been told that they have cancer.

Jeanie Youngwerth

Although research is lacking on the effects the language used by physicians has on patients undergoing treatment for cancer, some experts believe the language of cancer plays a key role in the treatment course.

HemOnc Today asked Jeanie Youngwerth, MD, associate professor of medicine at University of Colorado School of Medicine, about the language oncologists and other health care staff use when discussing cancer treatment with their patients and the effects it may have on patients’ overall outcomes.

Question: Society and the media have portrayed treating cancer as a “war,” a “fight” and a “battle.” What are the implications of these word choices?

Answer: The war analogy implies that people are losers when they die of cancer. It suggests that if a patient fights hard enough that they can be cured of their cancer, but if they do not fight hard enough, they will not be cured. In reality, this is not the case. One of the focuses we have as physicians in palliative care is to celebrate a person’s life when they are living with cancer as well as after their death, as opposed to portraying someone as if they are a loser who has been defeated. Death is a part of our lifecycle — we all are going to experience it. To suggest that someone who dies of cancer is a failure, there are a lot of negative implications for that.

Q: Can the implication that a patient diagnosed with cancer is going into battle affect their outcomes by increasing stress and anxiety?

A: This is something that we are always concerned about. Negative words or messaging may increase stress or anxiety. If someone is given a diagnosis of cancer, does this mean that they are automatically signed up for “a draft” and they are going to war? For patients with advanced or terminal cancer, it is almost as if they are set up for failure. This can be a potentially and incredibly stressful situation to be in, especially when we already know that receiving a cancer diagnosis increases a person’s stress and anxiety and can make people feel more isolated. We want to empower people and give them strength to do the things that are important to them, and it might not always be a fight for an increase in the length of life. There are many types of things that people may be working toward or “fighting” for that are a much more important focus for them.

Q: Is there any recent research into the “language of cancer” that you have found particularly compelling or informative?

A: I wish there were recent research on this topic. In the media, we always hear the war analogy and the sport or marathon analogy. The war analogy can put a person into an almost impossible situation, whereas the sport or marathon analogy is more of an empowering and supportive focus. A person can partake in a marathon pretty much in any way they want, such as a participant, contributing to the development of the marathon or wearing a T-shirt for support. Whatever it might be, it is more a focus of community and empowerment, and it is not focused on being a winner or a loser. I came across a study that looked at these two different analogies that sought to identify whether there were different outcomes, but there wasn’t enough research in this area to make informed decisions about it.

Q: Do you think language should be tailored to the individual?

A: It is very important for the language to be tailored to the individual and what feels right for each person. It is important for us, as physicians, to learn what is right for each person and to not always assume that it is about living longer. Many people just want to have a good day and celebrate what might seem to be the little things in life, which can actually be what makes it a better day for that person. I think we need to have more of a person-centered approach and focus on this as opposed to placing our own biases on the situation.

Q: As a palliative care physician, what is your ultimate goal when approaching treatment regimens or end-of-life care for the patient diagnosed with cancer?

A: In palliative care, one of our leading roles is to help unravel values for any particular person and their priorities, and making sure that we are focusing on this as a medical team. We incorporate a patient’s values into the care of each person and do not force people into roles that do not feel right for them. We need to embrace that every person who receives a diagnosis of cancer has so much courage, regardless of how they choose to approach their treatment.

Q: How important is it for a patient to speak up if they are uncomfortable with their physician using “battle words” when speaking about their cancer?

A: It is very important to encourage people to be their own advocate, but this can be a very hard role. I think a lot of people do not want to go against what their physician is saying, even if it does not feel right to them. If the patient is having a conflict with the words that their physician is using, it can be difficult to go against this. We tend to want to please our doctors. Patients should bring an advocate with them, such as a friend or family member, to appointments to help them advocate for themselves. A lot of times a physician may not realize that they are using words that may be hurtful or harmful to a patient.

Q: What specific advice do you have for oncologists and the cancer care team?

A: It is important to help people define what is most important for them and to not make assumptions that every person wants to be a soldier going into war. To learn what language is important for each person, we need to learn who each person is. This is part of our major role as health care providers.

Q: Is there anything else you would like to add?

A: We need to encourage conversation. As a health care provider, we need to make a safe place for these kinds of conversations to happen and give opportunities for them to occur so that we can talk about what is most important for a particular person. What are their wishes? Their fears? Their hopes and priorities? Ultimately, we should not look at death as a failure. It is a normal part of the lifecycle. We need to recognize that even when people get closer to the end of their life, there is an enormous amount of growth and meaning that can occur, and we should respect and honor people with dignity during this time. – by Jennifer Southall

For more information:

Jeanie Youngwerth, MD, can be reached at UCD Hospital Medicine Group, Leprino Building Mail Stop F782, 12401 E. 17th Ave., Aurora, CO 80045; email: jean.youngwerth@ucdenver.edu.

Disclosure: Youngwerth reports no relevant financial disclosures.