Northwestern University Feinberg School of Medicine
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Cancer Isn’t a War or a Battle, but Maybe Cancer Research Is

Aretha Franklin’s death from advanced pancreatic cancer reminds us how misguided the war metaphor is for many cancer patients. As an oncologist in training, I hear so many well-wishers tell their loved ones with advanced, incurable cancers that they are tough and can win their “battle” with cancer by fighting hard and staying positive.

When Sen. John McCain was first diagnosed with glioblastoma, an aggressive, incurable brain tumor, numerous media outlets referenced his toughness and courage to fight such a battle.

It’s difficult to know what to say when someone is diagnosed with cancer and things like “You’ll win this battle” have become the default platitude. Would anyone dare say the Queen of Soul is a loser? I hope not, because dying of a terminal cancer is unfortunately an expected outcome, not a loss. However, the researcher in me does feel like we aren’t winning the cancer research battle fast enough.

The military metaphor for cancer gained popularity after President Richard Nixon signed the National Cancer Act of 1971. With the help of activist and philanthropist Mary Lasker, the American government and public declared war on cancer and dramatically increased funding and activism for cancer research.

War encourages a singular, unified effort against an enemy and encourages sacrifice of unnecessary indulgences to support the cause. This is an incredibly effective strategy and metaphor for cancer research, which is expensive, time-consuming, and mentally and emotionally draining. The “war” maintains strong funding for cancer research and keeps morale high among its “soldiers,” cancer researchers.

However, cancer for patients is not a war because cancer by its nature is a form of ourselves. Cancer forms from our own cells by hijacking normal pathways to make tumor cells that live longer and multiply faster. These cells don’t declare themselves with uniforms and banners, or form lines on the other side of a battlefield. They surreptitiously coexist with normal cells within us. They are us, just in a malignant form. War is an inadequate analogy for the internal complexity of cancer.

The war metaphor also implies incorrectly that surviving cancer is mostly about toughness, fighting hard and staying positive. While a good attitude certainly helps, the greatest predictors of cancer survival are how aggressive the cancer is and the stage.

Many patients with less aggressive or localized cancers will survive their disease no matter how tough they are. Others with aggressive tumors or with Stage 4 cancers know they are dying from the day they are diagnosed. Like Aretha Franklin, these people are some of the most courageous, tough and positive people I’ve ever known. Their deaths are about cancer research failing to find answers in time to save them, not a lack of toughness or will.

On the other hand, the researcher in me finds the war metaphor to be incredibly motivating for cancer research. I see cancer do terrible things to wonderful people on a regular basis. I saw prostate cancer partially paralyze my grandfather from the waist down. Before that, he was a healthy 85-year-old who lived independently and flew from India to America every year by himself to visit us. I’ve had two other grandparents die of cancer.

There are days when I’m not sure if I’m more motivated by my love for my patients or by my hatred toward cancer. That aggression is a powerful weapon for research. The search for better cancer treatments and cures is, in many ways, a battle against a seemingly invincible foe. Fortunately, a massive, international army of doctors and researchers wages that battle every day.

If a friend or family member shares a cancer diagnosis with you, remember that cancer isn’t a battle or a test of toughness. Listening and asking questions are far more important than coming up with the perfect thing to say. If you feel driven to fight cancer, donate or volunteer at a cancer charity. Cancer patients need all the help they can get.