The panel discussion was titled, “The language of cancer.” Schwartz Rounds, a multidisciplinary grand rounds-style discussion of “the social and emotional issues [caregivers] face in caring for patients and families,” have a “focus on the human dimension of medicine” (www.theschwartzcenter.org/resources/programs/schwartz-rounds).

The discussion prompts encouraged panelists to consider the effect that the “war” language so often used in reference to the “fight against cancer” might have on those in our care. Beyond the obvious fact that battles have winners and losers, many of us were surprised to learn that when a cancer diagnosis is compared with enemy battle, patients are less likely to participate in screening tests and other behaviors that reduce the risk of disease, and they also are less likely to elect palliative care and other treatment options that might be considered less aggressive.

As I prepared for the panel, I reflected on the words that I use in conversations with my patients. I am careful not to say cancer patients, but people with cancer. I avoid enemy imagery and instead reference the individual journey, path, or experience. I generally don't use the terms remission, cured, or cancer-free, although some of my colleagues do. Because I have seen too many people with recurrent cancer, sometimes many years after therapy, I prefer to say, “as far as we know, the cancer is not active.” Yet my research also revealed other phrases that I had not previously contemplated: salvage therapy, treatment failure, good versus bad cancer, and I heard them anew as my patients and their loved ones might.

A few days later, I saw Darlene for routine follow-up in our integrative medicine clinic. She was found to have recurrent metastatic breast cancer about 10 years after she had been lost to follow up after completing just a few years of the recommended antiestrogen therapy. At our previous visits, we had discussed integrative therapies for vasomotor symptoms and arthralgia commonly associated with aromatase inhibitor therapy. At this visit, Darlene volunteered more detail about ongoing friction in some of her interpersonal relationships, and our conversation shifted to stress management techniques: meditation, journaling, gratitude practice.

Suddenly, she stopped talking. I tilted my head and waited.

“Can I ask you something?”

“Of course.”

“Is Stage 4 cancer the same as metastatic cancer?” She paused. “I know I have metastatic cancer, and it is in my bones. But is that Stage 4?”

“Yes, it is,” I responded. “Metastatic cancer is Stage 4. Why do you ask?”

“Stage 4 just sounds so much worse than metastatic cancer.” Darlene explained, “I know that metastatic cancer means that it has spread somewhere else. But Stage 4 means ... that you've gone through all the other stages ... and now you're going to die.”

“I hadn't thought of it that way,” I admitted. “It is Stage 4, and your cancer has spread, that's true. But your scans show that you are responding well to therapy, and your tumor marker has remained stable. For many women, breast cancer can be treated like a chronic disease for quite a while.”

“I overheard someone say I had Stage 4 cancer, and it surprised me. It hurt my feelings to hear that.”

“Why did it hurt your feelings?”

“He told one of our friends that he was depressed about my Stage 4 breast cancer. Why should he be depressed? He doesn't have cancer!”

I countered. “It is actually very common for family members to feel depressed when their loved one has a cancer diagnosis. It can be scary and overwhelming for them, too.”

Darlene shook her head. “He's just worried that I won't be around to take care of him the way I do now.”

“I can't speak about him, and he is not my concern. My goal is to give you tools and resources to find the power within you to feel as good as possible and to heal.” I added, “Some people are innately resilient, but not all of us are. Finding ways to deal with whatever is thrown at us—reframing how we view situations to see a challenge from another vantage point—that can be a skill. The good news is that these skills can be learned and practiced: the more we practice, the better we get at it.”

“It's a discipline,” she concluded.

The words we choose in conversations with anyone, especially with patients, impart meanings we may not have intended and have greater influence than we imagine. It's up to us to inform and educate, to enumerate risks and benefits of complex therapies, to communicate prognosis without overpromising or stealing hope. With just a few syllables, we can empower patients or dispirit them. The language of medicine is, indeed, a discipline.