War on fighting talk - why the battlefield rhetoric around cancer is insensitive and unhelpful

Wellwishers have encouraged US senator John McCain to battle against his cancer but they are ignoring that it cannot be overcome by willpower

The battlefield rhetoric around cancer is considered by many to be insensitive and unhelpful, writes Marjorie Brennan

WHEN US senator John McCain went public with his brain cancer diagnosis last month, he received thousands of messages of support on social media, including a tweet from former president Barack Obama: “John McCain is an American hero & one of the bravest fighters I’ve ever known. Cancer doesn’t know what it’s up against. Give it hell, John.”

It was a heartfelt statement, strong on military metaphor, perhaps not surprisingly, given McCain’s long and illustrious record in the US Navy.

However, author Joyce Carol Oates cautioned against the use of such analogies, responding: “Good to cheer on John McCain to ‘fight’ cancer but please keep in mind that illness is not a sport & to be overcome is not to ‘lose’. Those who want very badly to live sometimes die nonetheless. It is not a ‘struggle’ in any meaningful sense but often just unavoidable.”

Of the many people who agreed with her, one former cancer patient stated: “I agree w/this sentiment. When I had cancer I did not feel like a warrior, I felt scared & sick. I wasn’t fighting, I was trying to heal.”

We have become used to seeing military analogies in regards to cancer but such terminology, while seen by some as harmless rhetoric, is considered by many to be insensitive and unhelpful.

Professor John Crown, consultant oncologist at St Vincent’s Hospital in Dublin, believes such
language has served a purpose in terms of investment in research.

“Such language probably wasn’t entirely inappropriate in the context of the ‘war on cancer’, as launched by Richard Nixon in the 1970s, which put a huge amount of federal investment into cancer and the National Cancer Institute. This really did pay dividends, and a lot of research got started that was critically important,” he says.

In terms of dealing with patients on a more personal level, Crown believes the use of such language is not useful. “It is a bit of an anachronism at this stage, I don’t tend to use it. For individual patients, I totally understand the sensitivity about using the word war and I think there is a real move away from using that term. You don’t die from cancer because you didn’t try hard enough. That is nonsense. It is important to realise that cancer is not something we can overcome with willpower.

“Having a positive attitude to cancer may sustain you and motivate you to take treatments which work as opposed to getting very down about it and just withdrawing from treatment. In terms of the effect it has on the bad cells growing in your body, the answer is none.”

Counselling psychologist Dr Sinead Lynch says her doctorate research on how people cope with cancer gave her an appreciation of why we need to consider the language we use around the disease.

“In my research, I found that there was such a stigma about a cancer diagnosis in the 1970s, it became more commonplace to say ‘we can get over this’. Because there’s so much fear attached to cancer, there was a feeling we had to combat that, and the way to do so was to attack. But now, as Crown would say, people are living with cancer the way they live with diabetes or heart disease. In a way we don’t need to have this terminology, we don’t need to say ‘fight it and you’ll live’ because more people are surviving. We need to change our mentality on that.”

One US study found that patients encouraged to “fight” may feel they have to suppress their emotional distress and maintain a positive attitude to avoid upsetting family members — and their doctors.

Lynch agrees: “It inhibits them from allowing themselves to feel what they really feel, which is scared.”

Such language, when used in the context of ‘positive’ thinking, can also result in a person with cancer blaming themselves for their diagnosis. “About three-quarters of participants in my research blamed themselves for bringing cancer on their children or partner or parents,” says Lynch.

“The majority reported self-talk that was problematic, such as ‘I just have to cop on and get on with it’.

“There’s a place for positivity but only if you recognise the suffering. We’re programmed to think ‘that’s painful, I don’t want to go there’.”

This is echoed by the Irish Cancer Society, which avoids the use of words like ‘battle’ and ‘fight’ on its website, stating that it is a positive thing in itself to admit that you feel tired, lonely, anxious, depressed or angry. It advises: “Positive thinking means many things to different people. Certainly it involves facing up to cancer in some way. Because there is no one right way to deal with cancer, people do this in different ways.”

Crown believes military metaphors can be particularly unhelpful to patients with a terminal diagnosis.

“We need to decommission the military terms at this stage. What cancer
patients need is incredible levels of support and we are not good at that. Patients that have metastatic cancer, whose cancer has spread, especially in the case of breast cancer, these are patients who will live for quite a few years, most of the time on treatment, but they will die ultimately. They have particular needs which are often not well met by things like the pink-ribbon movement and all that.

“For these patients, it is not just something where they can say ‘I won my struggle’. This is different, this is someone who has been told they will die from this cancer.

“We tell them we will do our level best to delay that as much as possible, to keep them well and as healthy as we can, with as good a quality of life as possible. Those patients need a huge increase in support.”

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Yvonne Young, group assistant director of nursing, University of Limerick Hospitals Group and National Sepsis TeamWorking Life: Yvonne Young, group assistant director of nursing

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