The Language of Cancer

Hester Hill Schnipper, LICSW, OSW-C Program Manager, Oncology Social Work, Emeritus

AUGUST 01, 2018

A Passel of Pet Peeves

The language of cancer is complicated. Let's start with all the multi-syllable words that are completely new to most of us. Many drugs, especially new chemotherapy drugs, have names that seem incomprehensible and may even be a mixture of letters and numbers. When we talk with our doctors, it is sometimes hard to follow everything they are saying as they may lapse into medical talk that seems pretty different from everyday English.

If we read our medical charts or reports from a scan or MRI, they can be completely dense and opaque and scary. Radiologists who write those reports have a vocabulary of their own, and some of the simpler words are very emotionally loaded. If, for example, we read: innumerable lung nodules, we panic. It is probably wise not to read any of these reports before talking with your doctor who can translate. Sometimes the phrases that seem the most frightening to us are actually pretty minor.

Then there are the words that are commonly used by doctors and nurses in their notes. My biggest complaint is the all too frequent: Ms.X failed Taxol. Isn't it immediately obvious that is backwards? Ms. X did not fail Taxol; Taxol failed her?. Every time I have read a note that contained this phrase, I have tried to speak personally with the writer to draw their attention to the unfortunate wording. I don't know how often people have changed their habits, but I have been working on it.

Equally common is the first line of many physician notes, especially when someone is in the hospital. The note opens this way: Mr. W is an unfortunate 43 year old man....." I hate this one, too. That adjective is not needed and seems to be an attempt to separate the clinician writer from the patient. It does not, to me at least, come across as empathetic, but more as a negative judgment.

Another example is Goals of Care. This one is used to describe a conversation, usually a difficult one, with a patient who is very ill. From the doctor's perspective, the goal of the discussion is to understand and assess the current situation and speak honestly about the possibilities. What it usually means is that it is time to talk about stopping active cancer treatment and concentrating on comfort and quality of life. Let's call it that.

Finally, there is the ubiquitous cancer journey. This one is not a medical phrase, but seems to have become very popular among many people writing about cancer. Cancer and its treatment is nothing like any journey I have ever chosen. I prefer to travel to interesting and beautiful places, to pick my companions and to be mostly in charge of my time. I can't begin to imagine what this is supposed to mean.

Then there is another whole area of cancer vocabulary that is best illustrated with the verbs have and had. Earlier this week, I met with a lovely couple who spent much of our hour talking about this word choice. The patient says have cancer; her spouse prefers had. This seemingly minor difference sums up a very big chasm in their experiences, their perspectives and their views of the future. It is rather like the cancer survivorphrase. I have never liked that one because I am mildly superstitious and don't want to tempt fate by putting my cancer in the past. It also can seem to separate luckier people who are doing well from others who are quite ill with cancer. 

Please think about all of this and share your thoughts and, perhaps, your cancer vocabulary pet peeves, with us at the BIDMC Cancer Community.