John McCain's Tumor Sparks Debate Over Cancer Metaphors

Patient Expert
Gage Skidmore

Editor’s Note: This article is a part of an Op-Ed series, “Second Opinion,” where patient experts share their take on current research, news, and trends in health and medicine. The views expressed in this article do not reflect the opinions or views of HealthCentral.com.

Cancer is a terrifying disease. It kills people from all stations of life with apparent randomness. To help us make sense of it, we make comparisons. Cancer is a battle. Cancer is a journey. Cancer is a fight. We reassure our friends and family with cancer that their bravery and strength will win the day.

Sen. John McCain, R-Ariz., was diagnosed with glioblastoma, an aggressive form of brain cancer, in July 2017. His diagnosis has brought out the battle imagery. Given that Sen. McCain is Vietnam veteran who spent more than five years as a prisoner of war, it is not surprising that many of his well-wishers have used war metaphors to describe his cancer experience.

Former President Barack Obama’s comment on Twitter to Sen. McCain is typical. “John McCain is an American hero & one of the bravest fighters I've ever known. Cancer doesn't know what it's up against. Give it hell, John.”

McCain’s daughter Meghan also spoke of her father as a warrior in her statement about his diagnosis. “Cancer may afflict him in many ways: but it will not make him surrender. Nothing ever has.”

Within hours of reading about Sen. McCain’s diagnosis and seeing messages on Twitter and Facebook assuring him that his courage would help him win his battle with brain cancer, I was seeing pushback from people in the cancer community about the destructive nature of the battle metaphor.

In her CNN article, Why cancer is not a war, fight, or battle, breast cancer survivor Xeni Jardin explains the problem well: “In war, we are taught, there are winners and losers. When breast cancer, a disease for which there is no known cure, progresses to our lymph nodes and shuts down our organs, have we as fighters failed?”

"They did not 'lose their battle with cancer.' They lived the best way they knew how until they died." — Phyllis Johnson, inflammatory breast cancer survivor

We want to believe that cancer deaths are not random. We want to believe that we have control. We tell ourselves and the people we know that a positive attitude can defeat cancer. A positive attitude may make a cancer patient more pleasant to be around, but I know plenty of dead people who had positive attitudes up until their last breath.

Faith metaphors abound for disease. Depending on their faith background, people may describe cancer as a test or an opportunity to reveal God’s power. We may put too big a burden on a friend when we try to reassure her that her prayers and faith will heal her. If her disease progresses, does that mean that she didn’t pray correctly or that God abandoned her? I know too many people whose faith communities have made them feel their faith was insufficient when they didn’t get well.

“You’ll be OK,” people told me when I was diagnosed. “You are a fighter.”

I researched my disease and chose to go with the “big hammer” theory of cancer treatment. My doctors and I consistently chose the most aggressive treatments available at the time for my very aggressive cancer. So if that’s the definition of a fighter, I did battle with cancer.

However, the majority of people diagnosed with inflammatory breast cancer when I was diagnosed in 1998, people who had the very same treatments, have died.

They did not “lose their battle with cancer.” They lived the best way they knew how until they died. No one who dies of cancer is a loser. Nor are cancer patients valiant warriors to be memorialized for special bravery. Cancer patients are just people making the best decisions they can for themselves and their families. Sometimes they decide to go with aggressive treatments even when the doctor tells them there is little hope. Sometimes they decide to forego treatment. Each of these choices requires its own form of courage.

I personally prefer the metaphor of a cancer “journey,” but I know cancer patients who say they might slap the next person who talks about cancer as a journey.

The thing about metaphors is that they can capture only one element of an experience. They express very personal viewpoints about what that experience is like. If the metaphor works for many people, it becomes a cliché and loses its power with overuse.

If you are a cancer patient, choose the metaphor that works for you. If you think of yourself as a cancer warrior, great! Thinking of cancer as a fight gives some people the energy and will to show up in that chemo room, week after week. If you prefer different imagery or no imagery, that’s fine too. If your friends and family are using language that makes you uncomfortable, explain why. Then remember that they are probably new to this cancer language too and are speaking from love and a wish to help.

If you love a cancer patient, don’t rush in with platitudes. Listen! Think about the implications of the metaphors you use. But most importantly of all, be there! Sometimes you don’t need to say a word.

See more helpful articles:

“Comfort In; Dump Out”: The Ring Theory of Knowing What to Say

Beating Cancer: Stuart Scott

Stopping Cancer Treatment: It’s Your Decision

Mothers, Daughters, and Cancer