Talking about cancer: Professor grapples with language of the ‘battle’
NEW HAVEN — What are the right words to say when it comes to cancer? There is no easy answer. But a local English professor is studying the use of metaphors in oncology to get a better understanding as he battles with the very concept of battling cancer.
“It’s really common for cancer patients to use certain metaphors. Very common is a violence metaphor, where patients talk about being a cancer warrior, battling cancer, cancer invading their bodies,” said Southern Connecticut State University English professor Bob McEachern.
“Given how often patients use that kind of language, I was curious how often oncologists use that same language,” McEachern said.
Thirteen years ago, McEachern was diagnosed with follicular lymphoma, a rare and slow-developing blood cancer. He said he no longer uses some of the most common metaphors to describe the experience, because none seems appropriate. Even a term like “cancer survivor,” he said, is loaded with emotion, context and conflicting attitudes.
“The experience is so complex — physically and emotionally and spiritually — that it’s hard to find a word that encompasses all of that,” he said.
However, as a teacher of technical writing even prior to his diagnosis, McEachern has made it a goal to do just that. He is in the process of gathering “one million words’ worth of stories” from oncologist narratives — such as personal stories in published journals, podcast appearances and essays — to document the most common ways cancer doctors describe the experience of cancer, in an effort to better understand how to do so appropriately.
McEachern said there is a newly heightened sensitivity in the field of oncology as medical providers seek to use suitable and appropriate language with patients, without using metaphors that can quickly spin out of control. By examining the use and prevalence of metaphors as they exist, McEachern said he believes it can help to increase understanding and improve communication between doctors and patients.
“If a patient says, ‘I’m a patient warrior and I’m battling cancer,’ it gives them control they may not have otherwise,” he said. “If a treatment doesn’t work, the patient can feel guilty like they didn’t fight hard enough and you’re dealing with that emotional baggage on top of the emotional baggage that comes with having cancer.”
Another common metaphor used by patients and oncologists is cancer as a journey.
“It’s like being on a particular path, walking side by side with their doctors,” McEachern said. “Some find it very empowering, and others really don’t like it. With something like a journey metaphor, it’s usually considered very positive, and for many cancer patients the experience is anything but positive.
“You’ll hear them say things about how this isn’t a journey and there’s nothing good at the end of this the way there would be if they were traveling,” he said.
Tara Sanft, an oncologist in the Yale New Haven Health system and the chief patient experience officer of the Smilow Cancer Center, who teaches communication workshops to doctors and nurses in the health system, said everyone’s experience is different.
“It’s impossible to predict who appreciates metaphors of fighting or surviving and thriving, who appreciates ‘unity’ terms like a journey or a process, and who feels like this is a medical thing that happens and it’s treated and that’s it,” she said. “We don’t call people survivors of diabetes or warriors of diabetes. Different diseases are talked about in different ways.”
Despite having more than a decade of experience as medical director of a survivorship
clinic where she listens to patients directly as they share their thoughts, fears, experiences and concerns, Sanft said even she says things that upset some of her patients. What is especially important once that happens, she said, is that medical providers listen to their patients and accept feedback.
Overall, Sanft said she does not believe there is a one-size-fits-all approach to how oncologists should speak. She said active listening is important, as is protecting and emphasizing the humanity of every patient.