Changing the Way We Talk About Cancer

Last summer, our nation mourned the death of beloved singer/songwriter Aretha Franklin. The news hit especially hard here in Michigan, where the star grew up. I followed along with the tributes that honored her legacy — but that also described, over and over, how she had "lost her battle with cancer." 

As director of the PsychOncology Program at the U-M Rogel Cancer Center, this type of language has always struck a chord. Often, when the media talk or write about cancer, they use militaristic language. Phrases such as "lost their fight" or "the war on cancer" are common. 

The militaristic language used to describe cancer speaks to years of thinking about the disease with a fighting kind of spirit. The media uses it; the American Cancer Society has used it; and the Obama-Biden Plan to Combat Cancer was an example of a recent call to action. In our day-to-day work with patients, however, these terms aren't in our lexicon. This raises the question: Is the gap in the language that is used a problem? What is the impact on patients and families? 

In fact, this language can have a negative effect on the emotional state of patients with cancer. Many people who have cancer already struggle with day-to-day activities, so asking them to take on their disease in a militaristic way can make it even more difficult. The phrase "losing their battle" presents connotations of failure. It can make a person whose cancer-related death is imminent wonder: If I had done something differently, would I have "won" the battle? 

This language may impact patients in terms of palliative care, too. Sometimes families feel that it's a sign of giving up to not try more active treatments, to not "soldier on." 

It has always struck me that the language that is used for cancer is a different vocabulary than we use for dealing with other illnesses. Why and how did this come to be? One rarely hears that someone "lost their battle with heart disease." Some of the combat-derived language could be rooted in the fundraising efforts behind cancer, to bolster support for donations to research — a worthy goal, to be sure. And in the context of philanthropy, maybe this type of language is indeed very helpful. 

It is important, though, to examine how we use such language and terminology. Words matter. Partnerships between patients, clinicians, and the media could be helpful. Communicating in a language that is sensitive, caring, and supportive could alter what the headlines shout out. 

With my patients, we talk about how to live with cancer and chronic conditions. These days, many people live long and productive lives with cancer. I often encourage my patients to set achievable goals and to draw on support from friends and family. For example, it is always important to focus on relationships, getting enough sleep, exercising, assessing and treating distress and emotional problems, and following a healthy diet. We should encourage our patients to live as well as possible. 

The needs of individual patients can be varied, not just in how they live their lives with cancer but also in the language that resonates with them. For some, referring to cancer as a battle could be motivating: a warrior trying to slay a dragon. It is time, however, that we consider the people who might feel burdened by it and offer some alternative terminology, such as "living with cancer." And at no time should we refer to someone losing his or her battle with this disease. That's why we are putting together a team at the Rogel Cancer Center that will develop a strategy for addressing this issue, working in conjunction with the Patient and Family Advisory Committee. We need to remember that we are not talking about a skirmish in a war or a basketball game between rivals; we are talking about the entirety of patients' lives. 

Michelle Riba, M.D., is the director of the PsychOncology Program at the U-M Rogel Cancer Center and associate director of the U-M Depression Center.