In the movie The Giver, the young protagonist Jonas asks a poignant question: "Father, do you love me?"
His mother overhears this and immediately scolds him for using the word love, a word that's forbidden in their dystopian society. "Jonas, precision of language. Please!" she says.
Then, his father responds by affirming that he enjoys Jonas and takes pride in his accomplishments. The father chooses his words carefully, and love is not one of them.
There's something to be said for choosing one's words carefully. The word love means something. The word curable means something too. To patients, curable means, Oh good! I'm not going to die from this disease. To clinicians, it often means something else entirely.
People have started to throw around the word curable when referring to stage IV colorectal cancer (CRC), and I'm not convinced this is prudent. For example, a patient education on UpToDate says, "Up to 30 percent of people may be cured if metastases in the liver can be completely removed."
That can't be right, I thought. Stage IV means the cancer has spread. The cat is out of the bag. The horse is out of the barn. Optimistically, I wondered, What am I missing? Is there something I don't know yet?
Curious to find out where that statistic came from, I did some research. According to a published in February 2023, "...resection of isolated liver metastasis can be potentially curative in CRC with 5- and 10-year survival rates of approximately 40% and 25% respectively" (emphasis added). Put another way, the odds of surviving for 5 years after being diagnosed with metastatic CRC are worse than a coin toss. From a patient's perspective, these numbers are a far cry from what they think it means when they're told their cancer is curable.
The root of this discrepancy stems from the definition of the term. In the scientific literature, cure is typically defined as being in complete remission for at least 5 years. This tends to generate promising results and exciting headlines, but ultimately, it's misleading for patients. To patients, cure means "there are no traces of your cancer after treatment and the cancer will never come back." Indeed, this is the of cure according to the National Cancer Institute.
Author, professor, and podcaster Kate Bowler, PhD, is well known for writing about her experience of being diagnosed with stage IV colon cancer in 2015. As I write this 8 years later, the homepage of her provides the following update: "After years of being told I was incurable, I was declared cancer-free." Notably, the word cured is conspicuously absent.
At the end of the day, patients deserve precision of language. If what oncologists and surgeons are talking about is long-term disease-free survival, then that's exactly what they should say. Although this phrase (long-term disease-free survival) has a specific definition within the realm of clinical trials, we've already seen how easily the definition of a word or phrase can be modified as needed. Instead of telling patients their cancer is curable, talking with them about long-term disease-free survival can help paint a more accurate picture of their prognosis.
By providing a clearer understanding of the journey ahead, including the inevitable uncertainties, clinicians can empower patients to make more informed decisions and manage their expectations. Meanwhile, clinicians and patients alike can continue to hold on to hope. Writer, historian, and activist Rebecca Solnit , "Hope locates itself in the premises that we don't know what will happen and that in the spaciousness of uncertainty is room to act."
A patient's treatment plan is full of such actions. Practicing precision of language doesn't preclude aiming for a cure. Rather, it's a more candid way to go about it.
Shannon Casey, PA-C, is a physician assistant and former assistant teaching professor in the Department of Family Medicine at the University of Washington. She writes at .