Reframing the Fight: Veteran Identity and Combat Metaphors in End-of-Life Cancer Care

Key Message : This case explores the role of military metaphors in cancer care, illustrating how combat framing can both empower and complicate care for veterans at the end of life. We explore the impact of the military framework on the patient and the provider, and propose strategies for its therapeutic use.

Abstract:

Background:
Combat metaphors are invoked in cancer discourse by patients and providers (1), though their impact is complex and context-dependent. While these metaphors can aid meaning-making (2) and agency (3), existing literature highlights potential disempowerment with “loss” (4). Consequently, these metaphors are increasingly deemphasized (5).

However, some veterans may find military framing familiar, even comforting. This case explores the intersection of metaphor and identity in navigating the “losing battle”, and the influence on attitudes and decision-making for both veterans and providers alike.

Case Description:
MC is a Navy veteran admitted with metastatic breast cancer, with four admissions in two months for starvation ketosis and cancer-associated pain. Despite her decline, she is charming and forceful in her optimism, convinced that her oncologist would resume chemotherapy if she simply asked again.

MC consistently applies a martial framework to her illness. When confronted with discussions of prognosis, she gives no ground, deflecting toward past victories: her service, her grueling struggle for housing, her hard-won command of her comrades' respect. Tense bedside visits become the battlefield, and her youth, vigor, and charisma all contribute to the aura of a warrior. As countertransference, clinicians demonstrate extraordinary desire to “fight” for her: one oncologist briefly offers inpatient chemotherapy as a ”Hail Mary”. Our team invests exceptional time and vulnerability, hoping to trade it for a moment of her own.

As death becomes imminent, she negotiates a tactical retreat: she no longer asks for her oncologist’s opinion. Still, she maintains her pride as a veteran until her passing, knowing her death is not defeat.

Conclusion:
Combat metaphors can be “double-edged swords”; while risking fatalism, for some veterans they foster agency and dignity. Such metaphors may also provoke powerful countertransference in providers; when used judiciously, balanced with other alignment strategies, they can be powerful tools of connection.

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2. Bodd MH, Daniels NC, Amonoo HL et al. "More than conquerors": a qualitative analysis of war metaphors for patients with cancer. Support Care Cancer. 2022 Dec 27;31(1):87. doi: 10.1007/s00520-022-07552-y. PMID: 36573958.
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