T

he metaphor was inevitable.

Moments after the news of Sen. John McCain’s brain tumor reached the internet, he was being pinned with the badge of the cancer warrior.

None other than Barack Obama joined in on Twitter:

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Tweets from others, like @zhiemie506, invoked the war metaphor and the military record of the former Navy fighter pilot and prisoner of war more directly: “John McCain is as real as rain. He has a true adversary in Glio, but remember, they tried to kill him in ‘Nam and failed. He’s a warrior!”

And while arguably no one in the U.S. is more well-positioned to wear the fierce cancer fighter label than McCain, some patients and survivors say it exemplifies how even well-intentioned observers can rely on stock phrases that can sometimes do more harm than good.

Others say this warrior mentality helped them persevere through grueling treatments and stretches of self-doubt that might have otherwise stripped them of the will to live.

STAT asked those who have experienced cancer, lost a loved one to cancer, or have treated patients with cancer for their views.

Dannagal Goldthwaite Young (@dannagal)

Assistant professor of communication at the University of Delaware and widow of Michael Young, who died of a brain tumor in 2006.

“When you’re in it and starting in the process, I do feel like it’s a necessary thing to tell yourself that this is a battle and you’re so tough. The problem, though, especially as things get complicated, is that you start to have these moments of doubt and think, ‘Maybe it doesn’t even matter how tough or strong or tenacious my loved one is? What if that’s the case?’

“For me, having lost my husband, it’s frustrating to hear publicly people saying to John McCain, ‘If anybody can beat this you can — you’re so tough. Not that it’s intentionally hurtful, but it does leave those of us who’ve lost a loved one thinking, ‘Was my loved one not tough enough? Did he not fight hard enough?’

“I understand where people are coming from, but we have to be mindful that there are people who lost family members who were just as tough. But it’s random. And no one wants to think it’s random. There’s no agency in random.”

Dr. BJ Miller (@bjmillermd)

Hospice and palliative care physician, former executive director of the Zen Hospice Center in San Francisco, and co-author, with Shoshana Berger, of the upcoming book “How To Die: A Field Guide,” to be published by Simon & Schuster.

“I get it. … If you don’t want something in your life, name it as an ‘enemy’ and go to war with it. This will allow you to marshal all sorts of extraordinary energy. The problem is, all too often, it’s not a battle you can win, and then you’re left with the fallout of your own making. You’ve set yourself up to be a ‘loser’ on top of everything else. This is especially crazy when it comes to going to war with death, a war everyone who has ever lived, has lost.

“This comes up at clinic all the time and all I do is catch these rhetorical dead ends and call them out and suggest that people be careful with their language because the way we feel often follows the words we choose and the words we choose take us down paths we don’t want to be on.”

Liza Bernstein (@itsthebunk)

Health care consultant and patient advocate who, in May, blogged about the cancer warrior metaphor from the standpoint of one who has experienced breast cancer three times — most recently in 2011.

“I absolutely self-identified as a warrior. When I was in treatment I had this mantra that felt, to me, like a war cry when I was sitting there getting those chemicals put in my body and that toxic radiation streaming at me. I was like, ‘Kill those cells but don’t kill me. Kill those cells but don’t kill me’ under my breath the whole time.

“So to me, there’s an aspect of the warrior terminology and war metaphors that absolutely worked for me. But there came a point where I realized there was something incredibly destructive about just being that warrior. Those metaphors allow no room for the concept of healing or recovery.”

Dr. Diane Meier (@DianeEMeier)

Vice chair for public policy and professor of palliative medicine at the Icahn School of Medicine at Mount Sinai in New York.

“For some people, there’s a need to take on that warrior or fighter role, because they do it for their children or others in their family: They want their children to see they’re doing everything humanly possible to stick around. That’s very understandable. And the task is to support people to do what is their path. Whatever that is.

“It’s also very important for the general public to realize that the warrior metaphor places responsibility and potentially blame on the patient. If someone feels like crap and they’ve had enough of this and the family member, with very good intention, says, ‘You’re a fighter, you can beat this,’ that’s basically saying, ‘You’re not fighting hard enough.’ They are. They’re doing the best they can.

“The best the rest of us can do is be with them, and just listen. Not say anything.”

Liz Salmi (@TheLizArmy)

Senior multimedia communications director at Beth Israel Deaconess Medical Center in Boston and member of the board of directors of the National Brain Tumor Society. Salmi was diagnosed in 2008 with a malignant brain tumor at the age 29, and finished treatment in April 2011.

“At first, I wanted nothing to do with that warrior language. Now that I’m nine years post-diagnosis, and I know many people with cancer, the way I look at it is, everybody gravitates to what make sense to them.

“I think what’s helpful to people who are friends and family of someone newly diagnosed is to not force a label on somebody, and immediately say, ‘Oh, you’re a warrior or fighter!’ An individual might not feel that way yet or identify with it. Give people some space and time to come up with what they want to be called.

“Talking about cancer with a person sounds scary, but you can bring it up. Say it might be none of my business, but I want to know how you’d like to be referred to. Look at their Facebook posts about it, and what they start identifying as.”

Dr. Ira Byock (@IraByock)

Palliative care physician and professor at Geisel School of Medicine at Dartmouth and chief medical officer at Providence Institute for Human Caring in Torrance, Calif.

“The battle metaphor often disserves us, and yet when a family member or close friend is seriously ill, it sure as heck feels like the right metaphor, and I fall into it myself. A disease is threatening the life of someone I love and it sure as heck feels like a battle. And we are fighting the disease and fighting for life.

“I’d say first and foremost let’s all lighten up. This is just terminology and it does — it’s easy to fall into it because there’s a lot of that metaphor that resonates with people’s emotional experience.

“So let’s, while we search for another metaphor, let’s be gentle with another. It’s just a metaphor, and metaphors have value, but they’re not a substitute for the reality. The reality is we’re all mortal and we need to be gentle and loving with ourselves and with one another.”

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  • President Nixon declared the “War on Cancer” back in the 1970s. The metaphor stuck. Some “battles” have been won, butut we’ve yet to win the war overall. Sometimes, it feels as though cancer is a “medical Vietnam.” I was diagnosed with low-risk prostate cancer (Gleason 6) in 2010. I declined the aggressive treatment–prostatectomy–that a urologist pushed on me. I declined. So I call myself a “conscientious objector to the War on Cancer.” I was lucky. I did nothing and cancer never advanced. The war metaphor is tired and overused. Did I actually win a battle against cancer?

  • When my wife was being treated for a glioblastoma, we never felt like the warrior or fighting metaphors were right for us. For me in a fight there is a winner and a loser. And while my wife died almost a year ago, she was not a loser and the cancer was not a winner. She just did what she needed to do to get from one day to the next with grace and strength.

  • I don’t like the military language at all; especially, as one of the responders pointed out, because it blames the victim, and it is a fight we will all lose. I would prefer to accept my illness, live well with it and good make use of the time I have remaining. No battles for me. My illness will help me to leave this life, I hope with much gratitude and graciously. I intend to “go gentle into that good night” indeed.

  • Bob, thank you for a much needed discussion re: understanding of life, cancer, death,…. Maybe if we, as a world, had an understanding of death, we would understand the insanity of war.
    Carol, RN and widow

  • As someone who has had major 3 cancers so far (and a couple of minor skin ones) I really hate the entire war metaphor. This is not a war, I am not a warrior and I am not “fighting” a war. I am doing/taking treatment that may or may not work and I actually have very little to do with that outcome.

    As someone in the article pointed out then if you are having a tough time it becomes your fault that you aren’t “fighting hard enough” (a corollary is that entire crap about attitude and if yours isn’t good then it is your fault you aren’t getting better – sorry but cancer is an emotional earthquake and just like grief where you don’t tell someone to have a good attitude when they are grief stricken neither should cancer patients be told this).

    Cancer is what I have (and one that I have has no cure) and it is not who I am. Please don’t tell me who I have to be just because I have cancer. We don’t to this to people who have had strokes, heart attacks, etc. Why do this to people who have or have had cancer?

    • I so agree. I too have had 3 major cancers and still living with one hanger on. I have also had a major heart attack. I am not fighting a war. I am not even fighting to live. The drugs I have taken have kept me alive so far,when they stop working,I die. Not a war at all.

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