Brea C. Lipe, MD, is a professor of medicine and clinical director of the multiple myeloma program at the James P. Wilmot Cancer Center of the University of Rochester Medical Center in New York.
I have always loved the words and stories contained within books. I would even say that my love of books has propelled much of my success in life, serving as an escape, inspiration, reimagination, or education. I make a conscious effort to honor this personal legacy by continued reading and reflecting on stories that capture my mind and enlighten my view of the world.
A recent book I read, Babel, or the Necessity of Violence by R.F. Kuang, directed my lens toward language in the context of my clinical work. Babel is set in a fantastical world where words have literal power and are wielded by the heroes to change their world. The imaginary world within Babel highlights the meaning and impact of the words we use as clinicians and hematologists.
Words are my tool to craft patient relationships that lead to better lives.
For example, I have had many hour-long discussions on a disease diagnosis, prognosis, treatment options, and side effects in which the only question the patient asks is, “Am I getting chemotherapy or immunotherapy?” I used to wonder whether patients had been listening during the previous hour of our conversation; I now see this question as an attempt by patients to somehow harness the power in these words. I can think of no other profession where the daily vernacular — cancer, cure, death, chemotherapy — is more powerful.
“Chemotherapy” is derived from the German word chemotherapie and largely credited to German chemist Paul Ehrlich because of his work on treatments for infectious diseases in 1904, which later won him a Nobel Prize.1 The word is of Greek origin, with chemio meaning “toxic” or “chemical” and therapia meaning “treatment” or “care.” Literally, the word means “the chemical treatment of disease.”2 “Immunotherapy,” meanwhile, borrows from the Latin word immunis, meaning “exempt.”2 This type of treatment was first recorded in 1891 when William B. Coley became the first to harness the immune system to effectively treat sarcoma.3
Chemotherapy is the term used for conventional treatments that directly target cancer cells, while immunotherapy indirectly kills cancer by activating the immune system. Practically speaking, though, chemotherapy often evokes traditional side effects like hair loss, nausea, and cytopenias. Immunotherapy is sometimes perceived as a gentler, more natural approach that harnesses the body’s own immune system. Either treatment can cause fatal complications or be incredibly well tolerated. Ultimately, when talking to patients who are trying to understand me during a time of heightened emotion — in a language they often don’t speak, about topics they may have little knowledge of — the true power of these words can get lost to semantics and preconceptions.
Understandably, my patients aren’t usually interested in my etymologic analyses when they ask if they are getting chemotherapy or immunotherapy. Knowing this, I can appreciate the reciprocal power of words and the importance of truly hearing what is being said. It is often in the spaces between the words of their questions where my patients need my translations and effective communication.
“Am I getting chemotherapy or immunotherapy?” usually means any or all of the following:
- I have Googled this topic and have a list of questions.
- I want to verify that you are a qualified doctor.
- I want to make sure I’m getting the best or the newest treatment.
- I’m worried about side effects.
- I don’t want to live like my beloved family member who died from cancer 20 years ago.
- I’m scared and trying to gain some control over this conversation.
There can be comfort in our fancy scientific jargon and the intellectualization of language, but during these initial patient meetings, simple language is often the most powerful and allows the foundations of trust and rapport to be laid. In hearing the words spoken and not, I must craft a response that answers all the unspoken questions while also providing enough technical information to facilitate some health literacy and informed decision-making.
I recognize that for some cancers, the distinctions between chemotherapy and immunotherapy are technically clear. However, in blood cancers, many of our most used drugs have multiple effects and can both target tumor cells and alter host immunity. In myeloma, toxicity and tolerability must often be considered over the span of the many years a patient may be on therapy. So, semantics aside, our words must retain power through cultivated understanding that endures the many hardships of a longer life lived with cancer. “Cancer” is among our most powerful words; for many people, it signifies past traumas, lost family members, preconceived notions, misinformation, and its dramatic portrayals in popular media. What powers do we harness when we, as practitioners, use such words, and what harm or benefit can be realized when we combine such powerful words with scholarly skill? When we empower these words for our patients through compassion, understanding, and education while being receptive to their own words, what enduring magic can we create together?
Words, though, aren’t always enough to answer the unasked questions, and no amount of book loving will grant anyone actual superpowers. Still, words are my tool to craft patient relationships that ultimately lead to better lives lived, theirs and mine. Once my patients leave their appointments, I hope my words linger as an invitation, an outstretched hand, to a true sense, a fundamental belief, that the real power is within them. They can do this cancer thing; we will do it together.
Brea C. Lipe, MD
Associate Editor
References
- Kaufman, SHE. Paul Ehrlich: founder of chemotherapy. Nat Rev Drug Discov. 2008;7:373.
- Merriam-Webster.com. Updated December 25, 2023. Accessed January 8, 2024. https://www.merriam-webster.com/dictionary/chemotherapy.
- Zhang Y, Zhang U. The history and advances in cancer immunotherapy: understanding the characteristics of tumor-infiltrating immune cells and their therapeutic implications. Cell Mol Immunol. 2020;17:807-821.
The content of the Editor’s Corner is the opinion of the author and does not represent the official position of the American Society of Hematology unless so stated.
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