Alberta Cancer Foundation

The Battle Metaphor

Illustration by Spencer Flock.

Matthew Miller was 22 years old when he was diagnosed with stage 3 Hodgkin’s lymphoma and began a six-month course of chemotherapy. The entire experience — his body’s reaction to the treatment, his emotions, whether he would live or die — felt beyond his control, yet everyone kept praising him as a fighter and encouraging him to keep up the battle. They meant well, but their motivating words actually made Miller feel disempowered.

“When people said I was a fighter, I had to put on a brave face when I didn’t feel brave,” he says.

Later, after the death of a close friend whom he’d met in a cancer support group, Miller thought more about those words and what they implied. His treatment had worked, but his friend’s outcome was different. Had he somehow earned his restored health? Had she somehow failed?

“Since I’m a survivor, I’m a ‘winner,’” Miller says. “But if the disease takes someone’s life, they’re a ‘loser.’ They didn’t ‘fight’ hard enough.”

Miller, who works for the Alberta Cancer Foundation as a development assistant, isn’t the only one who thinks applying war-related language to cancer is inaccurate at best and damaging at worst. For decades, many people with cancer and their supporters, as well as medical professionals, psychologists and researchers, have discouraged these terms and metaphors, suggesting alternatives such as “journey with cancer,” or using neutral phrasing like “undergoing treatment” rather than “fighting cancer.” Nor is it just a matter of preference or opinion. A 2019 Queen’s University study found that battle metaphors make people perceive cancer treatment as more difficult. They were also shown to have a disempowering effect by increasing fatalistic beliefs about prevention and making people less likely to pursue cancer screening.

Despite efforts to shift away from martial language when talking about cancer, it is still commonly used. Jeopardy host Alex Trebek, who has pancreatic cancer, shares the latest on his “cancer fight” in the headlines. Obituaries memorialize people who have “lost their battle with cancer.” The language of war is sprinkled through copy for cancer charities, fundraising events and support organizations. Health and wellness publications describe new drugs that “fight cancer.” Social media is peppered with hashtags like #cancerwarrior and #fightcancer.

Battle metaphors aren’t limited to cancer but pervade medicine. Hippocrates, the Greek physician who is considered the “father of medicine,” wrote about the “violence of disease” more than 2,000 years ago. We talk about the body’s “defense” mechanisms, suffer “attacks” of symptoms and order “batteries” of tests.

Dr. Elie Isenberg-Grzeda, a psychiatrist specializing in psychosocial oncology at Sunnybrook Health Sciences Centre in Toronto, says using war-related language in medicine is a very human response to our fear of disease and death. Metaphors allow us to simplify and comprehend complex diagnoses, and battle metaphors may give us a false sense of control over our fate: if we’re fighters, it follows that we can be victors.

Martial language also has a purpose of serving in the larger conversation about cancer. Isenberg-Grzeda says metaphors can help unite us around shared ideas and against common foes, which is why they’re so often used (to significant effect) in cancer awareness and fundraising efforts. The Canadian Cancer Society invites you to “Be a Cancer Fighter” by hosting a fundraising event. Survivors, friends and family participate in the annual Enbridge “Ride to Conquer Cancer,” a cycling event that benefits the Alberta Cancer Foundation. (The Foundation notes that the franchise event is an exception to its brand guidelines, and it works hard to avoid militaristic language and focus on more positive, collaborative words such as “facing cancer.”) Isenberg-Grzeda adds that U.S. President Richard Nixon officially declared “war on cancer” back in 1971, with a bill that substantially increased funding for cancer research.

“The fact they chose that marketing strategy was not by accident,” Isenberg-Grzeda says. “People are happy to rally around this enemy.” The battle metaphor becomes more problematic when it’s removed from the realm of fundraising and applied to the individual experience. Like Miller, Isenberg-Grzeda says battle metaphors are inherently judgmental, implying winning or losing, triumph or surrender. “It’s a pretty awful legacy to attach to somebody who died from cancer,” he says.

Moreover, cancer is a diverse and complex disease with a wildly varied treatment process. In this context, reducing the disease to a simple, conquerable foe is misleading. “Not all cancers are curable by the time they are diagnosed,” says Isenberg-Grzeda. “The most important inaccuracy [of the battle metaphor] is that people are left thinking that cancer is ‘beatable’ when often it’s not.”

So, what should a supportive friend or family member do? How do you know if your words are supportive or harmful? Isenberg-Grzeda says the best rule of thumb is to follow the patient’s lead: “Don’t use metaphors until the patient uses them first.”

Finding the words

If you’re reaching for a metaphor when talking about cancer, ask someone who has experienced it what works for them. Here are some possible alternatives (with commentary from Matthew Miller).

Cancer journey

“That’s the one I use. It helps capture the entire experience. Journeys can suck, and it doesn’t cover that up.”

Marathon

“I like that it ties into just how difficult and long [cancer treatment] is, but also about how you have to maintain the course and move forward one step at a time.”

Dancing with your disease

“A friend of my mom’s who has cancer talks about it this way. She also describes [her illness] as a cloud or a storm in the distance. It’s always there, but it’s not necessarily raining right now.”