From time to time, when we talk about a cancer patient, we frame their story with a cancer fight metaphor. Some have a problem with that.
Recently, at my “real job,” I wrote about a fairly well-known member of the community who died from cancer. The organization that employed him announced his death on Twitter, saying he died “after a courageous battle with cancer.” In the story I wrote, I continued their cancer fight metaphor, stating that he “lost his battle” with cancer.
The death was not related specifically to breast cancer, but since this is Breast Cancer Awareness Month, it’s worth discussing now.)
It’s a common phrasing we’ve all heard for decades. (More on that in a minute.) I received an email from someone who wanted to point out my “choice of words and the connotation to those whose lives have been affected by cancer.”
The writer included an editorial published in 2015 by the Journal of the American Medical Association. The editorial took issue with that cancer fight metaphor, arguing that the metaphor is “unsuitable and even demeaning to the patient, his or her family, and friends.”
The editorial points out that it was the Nixon Administration, back in 1971, that initiated a “war on cancer” and that ever since, this “battling cancer” language — and worse, references to a patient “losing the battle” — have plagued our language.
No one, they say, should be considered a “loser” in any way during the course of their treatment.
Using the battle metaphor implies that if a patient fights hard enough, smart enough, and/or long enough, he or she will be able to win the war. Unfortunately, and with rare exceptions, patients with metastatic cancer cannot conquer cancer (win the “war”) no matter how hard they fight.
You might have experienced the same initial reaction I did.
That initial reaction was frustration. Rather than taking too deep a dive into the concern, I focused on the complaint itself. After reading a story about a member of the community who just died, the response was to complain about semantics? Really?
I’m only human. In feeling immediate frustration over the complaint and assuming that the person who raised the concern didn’t first mourn the person who died or, perhaps, say a prayer or send positive thoughts to the person’s loved ones, I committed the same error, didn’t I?
I missed the point of the concern because I focused on something else.
In fairness, I also bristled at the part about such wording hurting “those whose lives have been affected by cancer.” Cancer has affected my life. I’ve lost some dear friends and family members to cancer. I wrote about one of them earlier this month in fact. Did this person assume that if I used that battle metaphor, I must not have any life experience with cancer?
It’s easy to feel that kind of frustration these days. Sometimes, it feels as if no matter what you do, someone is waiting to become offended.
Some things, however, might be worth discussing.
Do forms of the cancer fight metaphor send a wrong message?
Consider this guidance from the University of Texas at Austin’s Dell Medical School on inclusive language with respect to general health issues:
Battle language such as “lost their battle with cancer” or “fighting cancer” in relation to health issues should be avoided, as it implies that life is a fight to be won, people who die from a disease did not fight hard enough to survive or only the “strong” will live.
That guidance sounds similar to the editorial from JAMA.
Does referring to someone as “battling cancer” or “winning or losing their fight” with cancer really mean that “life is a fight to be won?” I don’t read it that way; I think it’s a foregone conclusion that we are going to lose the war with death. Life, after all, carries a 100% mortality rate. As you read this line right now, you can only assume that you’ll still be alive four hours from now with the chance to ponder what you just read. We have no guarantees: least of all how long we’ll actually walk the earth.
Does referring to someone as “losing the fight” with cancer imply that they didn’t fight hard enough or “wasn’t strong enough”? I don’t read this in that way, either. Cancer has touched my life, so I have seen people close to me fight incredibly hard. They’ve shown courage and determination I only hope I could muster (while simultaneously hoping I never have to find out).
Would we feel the same way about someone with other illnesses?
If you read about someone “losing their battle with COVID-19,” would you assume that they didn’t fight hard enough? We now have vaccines and booster shots available to prevent severe illness from the virus. As a result, we see a prejudice directed toward those who develop severe illness after they become infected with the virus.
The first thing many of us wonder — even if not out loud — is, “Didn’t they get the vaccine?”
If we learn the person didn’t get vaccinated, some of us feel a little aggravation. We may even blame the victim for not taking that precaution. They may well have had a reason that seemed perfectly valid to them to make that decision.
But if you’ve seen someone spend a long time in a hospital with a severe COVID-19 infection who eventually died, I don’t think you come away from that assuming they just “didn’t fight hard enough.”
A colleague of mine whom I never had the pleasure to meet died a few years back of ALS. Did she die simply because she “didn’t fight hard enough”? If she’d have only fought a little harder after losing the ability to walk and even speak, would she suddenly have been able to do both again?
It doesn’t work that way. Most of us know it doesn’t work that way.
The editorial points out a few alternate conditions of its own.
The editorial selects three other causes of death and asks about whether we use that battle metaphor for them:
When is the last time you said that someone lost his or her fight with cardiac disease? Or with a car wreck? Or with a massive stroke? Patients in those situations have not lost a battle—they have died. T
If you die of a heart attack, are killed in a car wreck or suffer a “massive” stroke, there’s generally not time for a “battle.” Death comes too quickly for any real fight to occur.
If you have a long-term illness like diabetes that might cause longterm cardiac issues, that would certainly qualify. But we don’t usually frame it with the fight metaphor. Why don’t we? I don’t know. I don’t have that answer. But it just seems that it is not, for some reason, done.
But then the editorial almost seems to miss its own point.
The editorial writer claims that when we talk about a battle, we “minimize” the “real issues” cancer patients face.
Patients deal with and sometimes overcome nausea, pain, fatigue, and weight loss. They suffer the isolation that comes with a diagnosis. For those with potential curative disease, they live with the fear of recurrence and impact of chronic adverse effects.
They almost lost me here. “Dealing with” all of those things involves “battling” them. I can’t think of a better word. Staying on top of all of those adversities and overcoming them even for a few months still seems like having gone through a war.
The editorial claims saying a cancer patient has “lost their battle” ignores all of the challenges they overcame in their journey. I respectfully disagree. If they die of cancer rather than “lose their battle” with it, doesn’t that likewise ignore all that they overcame?
As my dear friend Lynne said after a new treatment regimen showed tremendous results, she was not beating cancer. Cancer would beat her. She knew that. She insisted that we not lose sight of that.
After she died in December, no one thought of her as a “loser.” No one.
The editorial then comes back with this:
When a person runs a marathon, we credit them for their training, commitment, and aspirations. We never declare anyone from the second-place to last-place finishers in a marathon to be losers.
That’s an apples-to-oranges comparison in my book. Yes, it’s true we don’t consider those who run a marathon without finishing in first place to be a “loser.” But while their training, commitment and aspirations are truly impressive, I’d argue that most people don’t label them “winners,” either. We admire their efforts and dedication. But we don’t attach a “winner” or “loser” label to them.
The cancer equivalent of successfully completing a marathon isn’t a winner or loser: the term would be survivor.
This brings me to some seemingly absurd definitions already at play.
Many years ago, my dad was diagnosed with prostate cancer. Fortunately his doctor caught it early and from the start, the prognosis looked good. He had surgery to remove the prostate and the doctor said he believed the cancer had not spread beyond the gland.
I made mention of dad being “a cancer survivor.” Dad corrected me right away. Technically, to be considered a “survivor,” you must go several years — five or seven, I don’t remember which off-hand — without cancer reoccurring or spreading before they consider you a survivor.
Well who is they? How did “they” come up with that? When you leave the hospital after surgery to remove a cancerous tumor that is believed not to have spread beyond the point of surgery, that, to me, makes you a cancer survivor.
That magic timeframe came and passed years ago and Dad has officially been a survivor for quite a long time now.
We might be overthinking this whole “losing the battle” thing in a similar way. I suggest there’s a big difference in this context between “losing a battle with cancer” and being a “loser.”
We’re not talking about a football game. There’s no winner and loser here. You won’t find a scoreboard. When the patient “loses” their battle with cancer, who wins? If you get right down to it, you can’t claim cancer is the winner. The cancer living in the patient dies with the patient. So there’s literally no winner.
That, to me, is why “losing a battle with cancer” doesn’t make someone a “loser” nor does it imply that they’d still be alive if they’d only “fought a little harder.” I just don’t believe that’s how most people look at it.
Clearly, not all families agree with this movement.
A guest post at a physician’s website claims that journalists “seem incapable of writing an obituary without resorting to the ‘lost fight’ metaphor.” But in fairness, this isn’t an issue only with journalists.
Go to Google and search for obituaries and the phrase “courageous battle.” The first few results that came up — from a variety of places — were all focused on cancer.
Paul in Virginia died “after battling Acute Myloid Leukemia for the last year.” Chad in Florida died “after a courageous battle with cancer.” (His obituary doesn’t specify the type of cancer, which isn’t anyone’s business anyway.) Patricia in Michigan died “after a courageous two-year battle with stage-four bladder cancer.” Mary in Pennsylvania died “after a courageous battle with pancreatic cancer.”
The list literally goes on and on. While some groups blame journalists for this language, there’s an important point about obituaries to consider. Journalists don’t write the obituaries you see in that section of the newspaper. The dear departed’s family writes the obituary.
If they felt their loved one was slighted by the use of the battle metaphor, would they really use it? Wouldn’t they choose a different way of saying it? Of course they would.
In fact, there are families who seem to find a kind of nobility and admiration in expressing, through the “courageous” cancer fight metaphor, what the loved one overcame during the course of the disease, even if they knew going in that they would ultimately not survive it.
I wonder if doctors and patient advocates reach out to the families who’ve just posted what they intend as a loving tribute to their family member who just died from cancer to chastise them for their choice of wording.
Somehow, I doubt it.
Still, I will do my best to avoid the cancer fight metaphor in the future.
Given that some people seem to look at it as insult, despite the fact that many people with absolutely zero ill intent use the phrasing, I’ll try to avoid it in the future. I’m happy for the reminder about the controversy. Really.
I’ll do my best to be sensitive to the fact that some people will interpret it in a manner that was obviously not what the writer intended.
I will do my part.
At the same time, I will hope that those who chose to interpret it with a negative connotation will at least attempt to recognize that this is not the intent most people have. I don’t know of any writer who ever set out to badmouth a person who dies from cancer as being a “loser” with such phrasing.
When we have controversies over word choices like this, we should ask people on both sides to be a little patient with the other.
Obviously, this is not a black-and-white issue. There is a lot of gray area in terms of how people interpret the phrasing. If there weren’t, families themselves wouldn’t use it. You also wouldn’t be able to find t-shirts and other accessories for cancer survivors with messaging like, “I beat cancer.” A Google search finds plenty of them, too.
A little patience might help alleviate some of the hard feelings so many seem to experience. Maybe that would allow more time to be spent looking for ways to eliminate cancer to begin with. That way, we wouldn’t have to worry about “winners” and “losers” and how we refer to those cancer takes from us each year.