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“More than conquerors”: a qualitative analysis of war metaphors for patients with cancer

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Abstract

Purpose

Meaning-making is fundamental to the cancer experience and communication within cancer care is saturated with metaphors. The objective of this study was to better understand the impact and function of war metaphors among patients with cancer.

Methods

Patients at the Duke Cancer Center were purposively sampled for inclusion based on type and stage of their cancer. Each patient underwent a semi-structured interview to explore their use of metaphors in their lived experience with cancer. Qualitative interviews broadly explored two key areas of interest: (1) frequency and use of metaphors to describe cancer diagnosis, treatment, or survivorship; (2) function and impact of the war metaphor on the patient experience of cancer.

Results

Fifteen participants with either breast, lung, or colorectal cancer were interviewed. Most patients used metaphor themes of journey, war, and mystery to describe their cancer. All patients with non-metastatic disease used war metaphors and described how these metaphors facilitated meaning-making by promoting positivity and situating cancer within a larger life story. The few patients who did not use war metaphors had metastatic disease, and they explained that war metaphors were unhelpful due to feeling a lack of control over their metastatic disease and outcomes.

Conclusion

The war metaphor should remain an integral part of cancer care. Disregarding war metaphors robs patients of an important framework for meaning-making—one that may promote strength, continuity, and resilience in navigating cancer.

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Data Availability

Due to privacy and ethical concerns, neither the data nor the source of the data can be made available.

Abbreviations

CEA:

Carcinoembryonic antigen

GED:

Tests of general educational development

References

  1. Siegel RL, Miller KD, Fuchs HE, Jemal A (2022) Cancer statistics, 2022. CA Cancer J Clin 72(1):7–33

    Article  Google Scholar 

  2. Hommerberg C, Gustafsson AW, Sandgren A (2020) Battle, journey, imprisonment and burden: patterns of metaphor use in blogs about living with advanced cancer. BMC Palliat Care 19(1):59

  3. Semino E, Demjén Z, Demmen J, Koller V, Payne S, Hardie A et al (2017) The online use of violence and journey metaphors by patients with cancer, as compared with health professionals: a mixed methods study. BMJ Support Palliat Care 7(1):60–66

    Article  Google Scholar 

  4. Tate T (2020) Your father’s a fighter; your daughter’s a vegetable: a critical analysis of the use of metaphor in clinical practice. Hastings Cent Rep 50(5):20–29

    Article  Google Scholar 

  5. Sontag S (2001) Illness as metaphor and AIDS and its metaphors. Farrar, Straus and Giroux, London

  6. Nie JB, Gilbertson A, de Roubaix M, Staunton C, van Niekerk A, Tucker JD et al (2016) Healing without waging war: beyond military metaphors in medicine and HIV cure research. Am J Bioeth 16(10):3–11

    Article  Google Scholar 

  7. Southall D (2013) The patient’s use of metaphor within a palliative care setting: theory, function and efficacy. A narrative literature review. Palliat Med 27(4):304–313

    Article  Google Scholar 

  8. Byrne A, Ellershaw J, Holcombe C, Salmon P (2002) Patients’ experience of cancer: evidence of the role of “fighting” in collusive clinical communication. Patient Educ Couns 48(1):15–21

    Article  Google Scholar 

  9. Casarett D, Pickard A, Fishman JM, Alexander SC, Arnold RM, Pollak KI et al (2010) Can metaphors and analogies improve communication with seriously ill patients? J Palliat Med 13(3):255–260

    Article  Google Scholar 

  10. Periyakoil VS (2008) Using metaphors in medicine. J Palliat Med 11(6):842–844

    Article  Google Scholar 

  11. Hui D, Zhukovsky DS, Bruera E (2018) Serious illness conversations: paving the road with metaphors. Oncologist 23(6):730–733

    Article  Google Scholar 

  12. Halperin EC (2017) Military metaphors and the consequences of the language of cancer. Pract Radiat Oncol 7(1):1–3

    Article  Google Scholar 

  13. Trogen B (2017) The evidence-based metaphor. JAMA 317(14):1411–1412

    Article  Google Scholar 

  14. Khullar D “The Trouble with Medicine's Metaphors.” The Atlantic, Atlantic Media Company, 7 Aug. 2014, https://www.theatlantic.com/health/archive/2014/08/the-trouble-with-medicines-metaphors/374982/.

  15. O’Riordan L. “Opinion: The Language of Cancer Needs a Rewrite.” Medical News, MedpageToday, 4 Apr. 2022, https://www.medpagetoday.com/opinion/second-opinions/98021. Accessed 15 April 2022.

  16. Reisfield GM, Wilson GR (2004) Use of metaphor in the discourse on cancer. J Clin Oncol 22(19):4024–4027

    Article  Google Scholar 

  17. Grant JA, Hundley H (2008) Fighting the battle or running the race? Metaphor analysis of cancer photos in the associated press. Vis Commun Q 15(3):180–195

    Article  Google Scholar 

  18. Vater LB, Donohue JM, Arnold R, White DB, Chu E, Schenker Y (2014) What are cancer centers advertising to the public?: a content analysis. Ann Intern Med 160(12):813–820

    Article  Google Scholar 

  19. Loggers ET, Maciejewski PK, Paulk E, DeSanto-Madeya S, Nilsson M, Viswanath K et al (2009) Racial differences in predictors of intensive end-of-life care in patients with advanced cancer. J Clin Oncol 27(33):5559–5564

    Article  Google Scholar 

  20. Mack JW, Cronin A, Keating NL, Taback N, Huskamp HA, Malin JL et al (2012) Associations between end-of-life discussion characteristics and care received near death: a prospective cohort study. J Clin Oncol 30(35):4387–4395

    Article  Google Scholar 

  21. Wright AA, Zhang B, Ray A, Mack JW, Trice E, Balboni T et al (2008) Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA 300(14):1665–1673

    Article  CAS  Google Scholar 

  22. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA et al (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363(8):733–742

    Article  CAS  Google Scholar 

  23. Temel JS, McCannon J, Greer JA, Jackson VA, Ostler P, Pirl WF et al (2008) Aggressiveness of care in a prospective cohort of patients with advanced NSCLC. Cancer 113(4):826–833

    Article  Google Scholar 

  24. Luker KA, Beaver K, Leinster SJ, Owens RG (1996) Meaning of illness for women with breast cancer. J Adv Nurs 23(6):1194–1201

    Article  CAS  Google Scholar 

  25. Degner LF, Hack T, O’Neil J, Kristjanson LJ (2003) A new approach to eliciting meaning in the context of breast cancer. Cancer Nurs 26(3):169–178

    Article  Google Scholar 

  26. Rashidi E, Morda R, Karnilowicz W (2021) “I will not be defined by this. I’m not going to live like a victim; it is not going to define my life”: exploring breast cancer survivors’ experiences and sense of self. Qual Health Res 31(2):349–60

    Article  Google Scholar 

  27. Williams F, Jeanetta SC (2016) Lived experiences of breast cancer survivors after diagnosis, treatment and beyond: qualitative study. Health Expect 19(3):631–642

    Article  Google Scholar 

  28. Lakoff G and Johnson M (2008) Metaphors we live by. University of Chicago Press

  29. Vaismoradi M, Turunen H, Bondas T (2013) Content analysis and thematic analysis: implications for conducting a qualitative descriptive study. Nurs Health Sci 15(3):398–405

    Article  Google Scholar 

  30. Weber RP (1990) Basic content analysis. SAGE Publications Inc, California

  31. Metaphor Menu for People Living with Cancer A4 Leaflet. https://wp.lancs.ac.uk/melc/files/2019/10/Metaphor-Menu-for-People-Living-with-Cancer-A4-Leaflet.pdf. Accessed 15 April 2022.

  32. Amonoo HL, El-Jawahri A, Deary EC, Traeger LN, Cutler CS, Antin JA, et al. (2022) Yin and yang of psychological health in the cancer experience: does positive psychology have a role? J Clin Oncol 40(22):2402–2407

  33. Amonoo HL, Barclay ME, El-Jawahri A, Traeger LN, Lee SJ, Huffman JC (2019) Positive psychological constructs and health outcomes in hematopoietic stem cell transplantation patients: a systematic review. Biol Blood Marrow Transplant 25(1):e5–e16

    Article  Google Scholar 

  34. Morillo C, Belloch A, Garcia-Soriano G (2007) Clinical obsessions in obsessive-compulsive patients and obsession-relevant intrusive thoughts in non-clinical, depressed and anxious subjects: where are the differences? Behav Res Ther 45(6):1319–1333

    Article  Google Scholar 

  35. Maciejewski PK, Phelps AC, Kacel EL, Balboni TA, Balboni M, Wright AA et al (2012) Religious coping and behavioral disengagement: opposing influences on advance care planning and receipt of intensive care near death. Psychooncology 21(7):714–723

    Article  Google Scholar 

  36. Hopman P, Rijken M (2015) Illness perceptions of cancer patients: relationships with illness characteristics and coping. Psychooncology 24(1):11–18

    Article  Google Scholar 

  37. Phelps AC, Maciejewski PK, Nilsson M, Balboni TA, Wright AA, Paulk ME et al (2009) Religious coping and use of intensive life-prolonging care near death in patients with advanced cancer. JAMA 301(11):1140–1147

    Article  CAS  Google Scholar 

  38. Amonoo HL, LeBlanc TW, Kavanaugh AR, Webb JA, Traeger LN, Jagielo AD, et al. (2021) Posttraumatic stress disorder (PTSD) symptoms in patients with acute myeloid leukemia (AML). Cancer 127(14):2500–2506

  39. Nipp RD, El-Jawahri A, Fishbein JN, Eusebio J, Stagl JM, Gallagher ER et al (2016) The relationship between coping strategies, quality of life, and mood in patients with incurable cancer. Cancer 122(13):2110–2116

    Article  Google Scholar 

  40. Costanzo ES, Lutgendorf SK, Rothrock NE, Anderson B (2006) Coping and quality of life among women extensively treated for gynecologic cancer. Psychooncology 15(2):132–142

    Article  Google Scholar 

  41. Nelson AM, Amonoo HL, Kavanaugh AR, Webb JA, Jackson VA, Rice J et al (2021) Palliative care and coping in patients with acute myeloid leukemia: mediation analysis of data from a randomized clinical trial. Cancer 127(24):4702–4710

    Article  Google Scholar 

  42. Gustafsson AW, Hommerberg C, Sandgren A (2020) Coping by metaphors: the versatile function of metaphors in blogs about living with advanced cancer. Med Humanit 46(3):267–277

    Article  Google Scholar 

  43. Ellis LM, Blanke CD, Roach N (2015) Losing, “Losing the Battle With Cancer.” JAMA Oncol 1(1):13–14

    Article  Google Scholar 

  44. Demmen J, Semino E, Demjen Z, Koller V, Hardie A, Rayson P et al (2015) A computer-assisted study of the use of violence metaphors for cancer and end of life by patients, family carers and health professionals*. Int J Corpus Linguist 20:205–231

    Article  Google Scholar 

  45. Parikh RB, Kirch RA, Brawley OW (2015) Advancing a quality-of-life agenda in cancer advocacy: beyond the war metaphor. JAMA Oncol 1(4):423–424

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Duke University School of Medicine, 8 Searle Center Dr, Durham, NC, 27710, USA

    Monica H. Bodd

  2. Duke University, Durham, NC, USA

    Nikki C. Daniels

  3. Brigham and Women’s Hospital, Boston, MA, USA

    Hermioni L. Amonoo

  4. Dana-Farber Cancer Institute, Boston, MA, USA

    Hermioni L. Amonoo

  5. Harvard Medical School, Boston, MA, USA

    Hermioni L. Amonoo

  6. Oregon Health and Science University, Portland, OR, USA

    Tyler Tate

  7. Duke Cancer Institute, Durham, NC, USA

    Kris W. Herring & Thomas W. LeBlanc

  8. Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, NC, USA

    Thomas W. LeBlanc

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  1. Monica H. Bodd
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  4. Tyler Tate
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  6. Thomas W. LeBlanc
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by MHB, NCD, and TWL. The first draft of the manuscript was written by MHB and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Monica H. Bodd.

Ethics declarations

Competing interests

TWL has received honoraria from AbbVie, Agios/Servier, Astellas, BMS/Celgene, BlueNote, Flatiron, Genentech, GSK, and Pfizer; TWL has received speaker fees from AbbVie, Agios/Servier, and BMS/Celgene; TWL has received research funding from American Cancer Society, AstraZeneca, Duke University, Jazz Pharmaceuticals, NIH, and Seattle Genetics. The other authors have no relevant conflicts to disclose.

Ethics approval

This study received approval from the Institutional Review Board at Duke University School of Medicine (IRB Pro00107967).

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

TWL has received honoraria from AbbVie, Agios/Servier, Astellas, BMS/Celgene, BlueNote, Flatiron, Genentech, GSK, and Pfizer; TWL has received speaker fees from AbbVie, Agios/Servier, and BMS/Celgene; TWL has received research funding from American Cancer Society, AstraZeneca, Duke University, Jazz Pharmaceuticals, NIH, and Seattle Genetics. The other authors have no relevant conflicts to disclose.

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Bodd, M.H., Daniels, N.C., Amonoo, H.L. et al. “More than conquerors”: a qualitative analysis of war metaphors for patients with cancer. Support Care Cancer 31, 87 (2023). https://doi.org/10.1007/s00520-022-07552-y

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