Mind your language: 'Battling' cancer metaphors can make terminally ill patients worse

Researchers claim we should change how we talk about the disease

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Media portrayals of cancer as a “battle to be fought” are leading to feelings or failure and guilt among terminally ill patients, experts in language and end-of-life care have said.

Obituaries should not refer to people “losing their battle against cancer” and doctors should also avoid “imposing” the term on patients who may end up feeling personally responsible if their condition deteriorates, they said.

Interviews and analysis of blog posts by patients, carers and health professionals led researchers at the University of Lancaster to conclude that war metaphors were unhelpful for many patients.

While talking about “fighting" cancer could be useful for some, it should be for the patient themselves to introduce the metaphor, said Elena Semino, professor of linguistics and verbal art at Lancaster.

Her study, which was carried out alongside palliative care specialists, analysed 1.5m words of discussion, representing the views of around 200 people closely involved with cancer care.

“We have enough evidence to suggest that battle metaphors are sufficiently negative for enough people that they shouldn’t be imposed on anyone,” she said.

“The battle metaphor applied at the end of life clearly can have harmful consequences for some people who end up feeling responsible for the fact that their illness cannot be treated.”

Use of such metaphors by cancer charities, such as the Stand Up to Cancer campaign, could be useful in motivating people to donate money, but care needed to be taken when applying the terms to individual patients, researchers said.

Another common metaphor, comparing having cancer to a “journey” was found to be less likely to lead to feelings of guilt or failure.

Professor Semino, who carried out the study at Lancaster’s Economic and Social Research Council Centre for Corpus Approaches to Social Science, is now working with the NHS to produce a “metaphor manual”.

“Healthcare professionals in the UK are quite conscious of these things – but we would say that the battle metaphor is not one that that a healthcare professional should ever introduce first,” she told The Independent.

“But if a patient uses it, and it seems to be working well for the patient then there’s no reason to challenge it. If a patient says: ‘I feel a failure because I’m not winning the battle,’ then I think the metaphor should be challenged. [The doctor should say]: ‘It’s not a battle – it’s not you who is losing, we just don’t have the medication to help you'.”

In the media, it had become a cliché to refer to someone who has died as “losing their battle against cancer”, she said. However, she said that numerous examples of people who lived their lives to the full despite their cancer – such as teenager Stephen Sutton – made the idea of defeat inappropriate. 

“The metaphor somehow needs to account for the fact that you can live well with cancer,” she said. “There has to be another way to talk about someone who has died of cancer.”

She said that it was important to begin changing the way we talk about the disease, as survival rates continue to improve and more people find themselves living long-term with cancer.

“Cancer is becoming, in many cases, more like a chronic disease,” she said. “We all need to talk about cancer more as something that we can live with for some time, that we can have a good quality of life in spite of cancer – rather than just as an enemy to defeat.”

Hilary Cross, director of marketing and communications of Macmillan Cancer Support, said: “We know that a person’s experience of cancer is deeply personal to them and we are here to support everyone talk about cancer using language that suits them.

"As an organisation Macmillan has stayed clear of the ‘language of war’ because our research shows that some people can find it difficult, inappropriate or upsetting. But more recently we have found that young people strongly identify with the idea of fighting cancer and often use this language themselves.”

Word worries: Cancer metaphors

‘Losing your battle’

Many patients are unhappy with their illness being discussed in this way. Blame is being put on the dying patient, and there’s sense that they must not have fought hard enough.

‘I’m such a fighter’

Some patients find the self-description of a fighter motivating, the research found. They find a sense of meaning and purpose and identity in their struggle against the disease.

‘It’s a journey’

The academics found that referring to cancer as a “journey” or a “hard road” was common among sufferers, and less likely to cause feelings of guilt if their condition took a turn for the worse.