Language, the Literature, and the Patient

October 1, 2005

The articles and accompanyingcommentaries in ONCOLOGYprovide important clinical informationbut also an opportunity tocall attention to language projectingattitudes and judgments that are unintended,probably unconscious, andgenerally unchallenged. We note thatrecent articles and reviews refer tothe “patient having failed” treatment;patients are identified with their canceras if they are one, and the descriptionof therapy as “salvage” indirectlycompares the human experience oftreating patients to saving, rescuing,or restoring goods.

The articles and accompanyingcommentaries in ONCOLOGYprovide important clinical informationbut also an opportunity tocall attention to language projectingattitudes and judgments that are unintended,probably unconscious, andgenerally unchallenged. We note thatrecent articles and reviews refer tothe "patient having failed" treatment;patients are identified with their canceras if they are one, and the descriptionof therapy as "salvage" indirectlycompares the human experience oftreating patients to saving, rescuing,or restoring goods.Patients become their cancer whenthey are described as "progressing"during chemotherapy. When patientsare described as "failing," it is a tributeto the way the culture of medicinehas adopted this language as if itis an accurate reflection of the treatmentrealities. As palliative care principlesare actively integrated intoongoing oncology care, we discuss"salvage therapy" for many patientswho "fail palliative chemotherapy"and are "in sufficiently good conditionto receive additional therapy."But regardless of performance status,patients, when viewed as unique individualsin the context of values,beliefs, and lives beyond their cancermay engage in a decision-making processthat considers performance statusas only one of many significantvariables.The language that we perpetuatein professional literature and in ourtraining of new clinicians has thepower to portray an accurate, compassionateapproach, rather than theunconscious portrayal of patients asdamaged goods and, in the setting ofprogressing disease, "failures."The Editors ReplyThank you for your correspondence.We recognize the dangerof shortchanging and dehumanizingthe patient by acceptance ofsuch verbiage as "patients havingfailed" and "salvage" therapy. We knowtoo that such jargon is pervasive in theoncology literature. And we havefound that to eliminate it completelyis a challenging and difficult goal.In editing manuscripts for publication,we will often convert a phrase suchas "the patient progressed" to "diseaseprogressed," as a matter of sensitivityas much as for the sake of good andaccurate English. With some papers,however, such editing can be an uphillbattle. There are not always ready andappropriate alternatives, and in manycases we allow that the possibly lesscompassionate term or phrase is thatwhich is most clearly understood andaccepted in the oncology community.That said, we appreciate your letter,and most importantly, the reminderthat patients are people, surelydeserving of more respect and sensitivitythan they are sometimes accordedin the medical literature.

Disclosures:

The author(s) have no significant financial interest or other relationship with the manufacturers of any products or providers of any service mentioned in this article.