PERSPECTIVE ON CANCER : Patients Need Semantic Cease-Fire : Not only do the war metaphors do a disservice to care-givers, but they also encourage society to shun victims.
Former Sen. Paul Tsongas kept cancer in the news in 1992, from his assurances during the presidential primaries that he was free of lymphoma to the news in November that he was suffering from a recurrence to, this month, his hospitalization from side effects of a new round of chemotherapy. A flurry of dispatches during the primaries described his personal “war,” including his bone marrow transplant eight years ago. The story of that expensive, painful and highly experimental treatment inspired other cancer victims and reflected the professional optimism of medicine’s leading “cancer-fighters” concerning the larger “war on cancer.”
Now, however, Tsongas’ latest setback reminds us that this disease is still a very difficult “enemy” to defeat. Perhaps it’s time to stop thinking and talking about it in such predominantly military--and often misleading--terms.
A semantic cease-fire may be hard to arrange because it’s almost impossible to find media or medical coverage that does not refer to our national “war” on the disease--declared by President Nixon in 1971--with its accompanying “armies of invading cells,” “mutinous cells,” “cell-kill ratios” and on and on. Indeed, even some critics of the cancer research Establishment contend that its methods are making us “lose the war.”
Such terminology has long been deployed by medical researchers, clinicians, public health advocates, even victims of various diseases, all seeking greater recognition of a disease and money for research, treatment or prevention. For example, campaigners against tuberculosis--the killer disease of the 19th and early 20th centuries--warned that America was threatened by “forces of contagion,” the medical equivalent of the “Hun hordes” whose menacing behavior in Europe became the propaganda basis for U.S. entry into World War I.
However effective it may be politically, the problem with this approach, then and now, is that it can backfire on individuals. Victims of TB came to be feared as much as the disease itself. And today, people afflicted with cancer, which is not even contagious, often find that their condition elicits fear and anxiety rather than sympathy and understanding among friends, co-workers or employers. Much-needed relationships, not to mention jobs, have been lost as a result. The presence of any life-threatening disease may, of course, cause some to shrink from this reminder of their own vulnerability and mortality. But the relentless depiction of cancer as an insidious “Alien”-like enemy, growing within and conquering its hosts, clearly exacerbates this tendency and affects the emotional responses of even the most rational among us. People are taught to “live with” heart disease and other life-threatening illnesses, but must always “battle against” cancer, even when many cancers have become essentially chronic conditions.
War metaphors also contribute to a misleading picture of who provides care to cancer patients and their families. By focusing on the high-tech medical “battlefield,” (the research lab or latest experimental unit) and its “generals” (scientists and physicians), media accounts overlook the nurses, medical social workers and hospice staff who spend endless hours with patients and their families, helping them deal with the physical, emotional and even financial consequences of the disease.
The focus on the frustrating and sometimes futile effort to treat tumors is not adequately balanced by rigorous and systematic attention to care-givers’ advances in treating the human beings who have those tumors. These central participants in the health-care team have designed impressive support groups for cancer patients and their spouses; ways of managing pain and depression; patient services in the home and community and, finally, bereavement counseling for survivors when the “battle” is lost.
Perhaps the most worrisome thing about the use of military metaphors in dealing with cancer (as well as other diseases) is the kind of black-and-white, all-or-nothing mentality they encourage. In real wars, countries are asked to sacrifice essential societal resources so that the enemy can be defeated. Because we’re engaged, we’re told, in the functional equivalent of war, our society is asked to devote more and more health-care resources to the pursuit of “victory”--defined as the ultimate cure--rather than to a more balanced approach that also includes prevention, health maintenance, early detection and long-term care of the chronically afflicted.
In reality, some preventive strategies and early detection, coupled with prudent conventional treatments and good patient support systems, seem to have the greatest potential of reducing the number of new cancer cases or bringing about remissions. Our health care system, individual cancer sufferers and their care-givers would all be better served by a conception of this disease that emphasizes the complexity of its treatment and cure.
