Language, the Literature, and the Patient

The articles and accompanying commentaries in ONCOLOGY provide important clinical information but also an opportunity to call attention to language projecting attitudes and judgments that are unintended, probably unconscious, and generally unchallenged. We note that recent articles and reviews refer to the "patient having failed" treatment; patients are identified with their cancer as if they are one, and the description of therapy as "salvage" indirectly compares the human experience of treating patients to saving, rescuing, or restoring goods. Patients become their cancer when they are described as "progressing" during chemotherapy. When patients are described as "failing," it is a tribute to the way the culture of medicine has adopted this language as if it is an accurate reflection of the treatment realities. As palliative care principles are actively integrated into ongoing oncology care, we discuss "salvage therapy" for many patients who "fail palliative chemotherapy" and are "in sufficiently good condition to receive additional therapy." But regardless of performance status, patients, when viewed as unique individuals in the context of values, beliefs, and lives beyond their cancer may engage in a decision-making process that considers performance status as only one of many significant variables. The language that we perpetuate in professional literature and in our training of new clinicians has the power to portray an accurate, compassionate approach, rather than the unconscious portrayal of patients as damaged goods and, in the setting of progressing disease, "failures." The Editors Reply Thank you for your correspondence. We recognize the danger of shortchanging and dehumanizing the patient by acceptance of such verbiage as "patients having failed" and "salvage" therapy. We know too that such jargon is pervasive in the oncology literature. And we have found that to eliminate it completely is a challenging and difficult goal. In editing manuscripts for publication, we will often convert a phrase such as "the patient progressed" to "disease progressed," as a matter of sensitivity as much as for the sake of good and accurate English. With some papers, however, such editing can be an uphill battle. There are not always ready and appropriate alternatives, and in many cases we allow that the possibly less compassionate term or phrase is that which is most clearly understood and accepted in the oncology community. That said, we appreciate your letter, and most importantly, the reminder that patients are people, surely deserving of more respect and sensitivity than they are sometimes accorded in the medical literature.