Language and Cancer
Once again, I am thinking about language. The real stimulus for these thoughts was unrelated to my work or cancer, but the general topic quickly spills over. I have written before about my dislike for much of the popular language around cancer. For example, Nixon's War on Cancer spawned many military similes and metaphors. We are supposed to battle cancer and people who die are said to have lost their battle. Even suggested guided imagery techniques frequently involve shooting guns or throwing bombs at cancer cells.
The very worst, however, I think is the common phrase: "Ms. X failed Xeloda." Don't you think it should be: "Xeloda failed Ms. X"? One of our doctors is always very careful to phrase it, whether aloud or in his notes, the second way, and I think that is a great example of why he is beloved.
When I talk with patients, I try to be very precise with words. We all know how certain phrases or comments stick in our memories, and I try to be very careful to be thoughtful and accurate. For example, in talking yesterday with a very sick woman who is dying of her cancer, but who prefers not to talk about that reality, I said something like: "If this does not go the way we hope that it will, what......." That opened a floodgate, and she talked.
This is an introduction to a very good essay by my old oncology social work colleague, Diane Blum's, essay in ASCO's Cancer Net. I first knew Diane when she was working at DFCI (then the Sidney Farber Cancer Institute); she later moved to New York and went on to a very wonderful career. Here is the start and then a link to read more:
Choosing Your Words Wisely: Imagery, Metaphors, and Cancer
· Diane Blum, MSW, FASCO
Diane Blum, MSW, FASCO, began her career as an oncology social worker before serving
as the Executive Director of CancerCare and the Chief Executive Officer of the Lymphoma
Research Foundation. Ms. Blum has been a member of the American Society of Clinical
Oncology (ASCO) since 1992 and served as the Editor in Chief of Cancer.Net from 2001 to
I sat down to write about how we use language to describe cancer and its treatment shortly
after I watched the six-hour PBS series, The Emperor of All Maladies. This three-part
program, adapted from the award-winning book by Siddhartha Mukherjee, traces the story
of cancer from ancient times to the present by telling compelling stories of patients and
families affected by cancer and by interviewing several generations of experts dedicated to
understanding and controlling this complex constellation of diseases.
But I watched this fascinating program with another focus: to pay attention to how cancer
was described and the words chosen to communicate its impact. This has been an interest
of mine throughout my career, starting with my early days as a social worker at the Dana-Farber Cancer Institute when I was struck by all the language of war and battle that was used to describe treatment.
The “war on cancer” has been a dominant theme since the early 1970s when President Nixon announced a national commitment to vanquish cancer at the same time as the Vietnam War was being fought. This imagery was so pervasive that in 1978, Susan Sontag wrote the book, Illness as a Metaphor, which challenged descriptions of cancer as an “evil, invincible predator” with “cells that invade the body,” patients who are “bombarded” with radiation, and chemotherapy that is “chemical warfare that destroys to save.”