MEDICAL MATTERS:Having cancer is best described as a journey not a battle, writes MUIRIS HOUSTON
“I am not fighting or battling cancer – it is fighting me”
Christopher Hitchens
I CAME across this quote from the late Christopher Hitchens recently. It filled me with both hope and despair. As someone who feels strongly about the use of military metaphors in medicine, I was pleased at Hitchens’s no nonsense statement that he was not battling cancer, but disappointed that he felt the disease was fighting him.
Although it can be traced back centuries, the modern use of military terminology in medicine received a major boost when, in 1971, the then US President Richard Nixon publicly declared “war” on cancer and referred to it as a “relentless and insidious enemy”.
In a recent Personal View column in the British Medical Journal, Natasha Wiggins, a junior doctor working in oncology, offered some insightful views into the military conundrum.
“Since the days of Nixon’s war, advances in medical science have made it clear that cancer is not one but many enemies,” she wrote. “Indeed, the Pulitzer prize-winning oncologist Siddhartha Mukherjee stated, ‘It is a puzzle, you cannot win a puzzle, you can only solve it’.”
Yet we read of the “collateral damage” of chemotherapy to describe the side effects of cancer treatments – a phrase defined as “the unintentional damage or incidental damage affecting facilities, equipment or personnel occurring as a result of military action directed against targeted enemy forces or facilities”.
Clearly military life cannot be distanced from the rest of the world, but do we really need terms like “killer cells” and “vaccine shots” when talking to patients?
Does a fighting spirit protect you against a cancer recurrence? A large UK study suggests it does not: a long-term follow-up of cancer patients at the Royal Marsden Hospital found that a high fighting spirit confers no survival advantage on those who displayed such fortitude.
Wiggins asks: “Are people with aggressive or advanced disease fighting less hard? This “fighting” involves loss of dignity, changing personality and feeling awful. Is there any less courage in facing your fate?
Has someone “given up the fight” if they make an informed choice to decline treatment based on the risks and benefits?”
I think we owe it to the many patients who choose this different route, and others, to rethink our use of language.
We need to find alternative references that don’t explicitly imply such pressure to be positive about the diagnosis, or to fight the disease.
It’s not that we want to lose metaphors in our language around cancer. Provided they are neither sugar-coated nor brutal, metaphors are good.
Metaphors can be vital to the explanation of a disease process because it enables communication of complex theories to someone who may have little scientific knowledge.
Gentler metaphors are vital for those who are feeling overwhelmed, depressed or are simply of a meek disposition.
They may be neither inclined nor able to respond to exhortations to fight back. And unable to respond, it is possible that certain people will feel they have “failed” themselves and their families.
So how can we replace the “battling” concept?
Wiggins offers a somewhat romantic example from a play about mouth cancer: “Death came and gave me a flower, he asked me to hold it in my mouth, he said he would be back for it in six months.”
An alternative approach may be to view the process as a journey. There will be bumps along the road; some parts will be downhill while others will take more effort. The journey will offer alternative routes and it may be appropriate at times to rest for a while.
It must be hard to prepare for the loss of control that having cancer can cause. Your body is changing; the “certainties” of your future life must now be questioned. It is no wonder many people say that they feel better with an understanding of what is happening to them.
But this understanding is so much harder to achieve with the label “my battle with cancer” written across a patient’s forehead.