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Receiving a cancer diagnosis profoundly affects patients, requiring thoughtful consideration throughout the entirety of their health care journey. One of the most modifiable yet impactful aspects of care is the language used by the patient’s care team. Research suggests that patients’ perceptions of care are shaped as much by communication style as by clinical interventions. For example, phrases such as “Nothing more can be done” may unintentionally convey hopelessness, while reframing the statement as “We still have options to help with your comfort and quality of life” can maintain dignity and empowerment.1,2 Oncology professionals, therefore, have an ethical responsibility to reflect intentionally on their language and shift their communication practices to heal rather than harm.
A study by Westendorp et al. explored communication by oncologists regarding the delivery of diagnosis, prognosis, and decision-making, and revealed how language can be unintentionally harmful, particularly in this patient population.3 For example, statements such as “You must start your chemo within a certain time frame” may be perceived negatively, as the phrasing does not foster a team dynamic, especially if there is no explanation included for the urgency. Continuing with the concept of time frames, practitioners must be mindful when discussing the prognosis of a given pathology. Westendorp found that tailoring prognostic information to the patient, rather than speaking generally about the given disease, was better received by the patient.3
When looking specifically at multiple myeloma, one systematic review highlighted the need for personalized care within this patient population due to the chronicity of the pathology. The review emphasized the physical, emotional, and social impact this disease had on patients and recommended that health care professionals incorporate an understanding of the patient experience into treatment.4 While suggestions for supportive strategies were offered, specific words or communication styles were not identified.
Although numerous qualitative studies exploring harmful communication in health care have been conducted,1–3 there is still limited understanding regarding which specific words or phrases may be perceived as harmful within oncology care. The purpose of this article is to provide a detailed exploration of the lived experience of a patient diagnosed with multiple myeloma, highlighting nocebic language used by health care professionals. Through this analysis, key terminology that negatively impacted the patient’s health care experience will be identified, and alternatives will be provided both as a framework and to encourage clinicians to engage in effective dialogue with patients when diagnosing and treating all cancer types. Additionally, examples of “words that harm” and “words that heal” are included to serve as a framework for providers to improve patient-centered word choices.
Patient Description
A 78-year-old woman was diagnosed with multiple myeloma complicated by an incomplete spinal cord injury. In June 2023, she presented with new-onset numbness and tingling in her lower extremities. She was taken to the emergency department, where CT imaging revealed lesions in the vertebral column and skull. Surgery was performed to remove the spinal lesions, and a biopsy was obtained. The patient remained in inpatient rehabilitation while awaiting the results of the biopsy, which were eventually provided in a troubling manner. Specific phrases and language that were used in this patient case study are presented in Table 1, along with suggestions for alternative ways to communicate more effectively based on how the patient perceived the impact of the conversation on their care.
Discussion
Shifting communication from harmful to healing language (Table 2) requires self-awareness, training, and team reflection. Oncology care is inherently multidisciplinary, and consistent messaging across providers—physicians, nurses, physical therapists, social workers, and so forth—is essential to avoid mixed signals that can confuse or distress patients. Embedding communication training within continuing professional development, onboarding processes, and team huddles can help cultivate a culture of mindful communication. Cancer programs can also integrate structured tools, such as reflective practice groups, standardized patient role-plays, or communication checklists, to reinforce best practices.
Conclusion
In health care, there is often an emphasis on the technical skills of medicine: examination techniques, diagnostic testing, and pharmacological treatments. While this reflection highlights specific elements of a given case, it is important to recognize that communication styles should also be individualized to the patient, as each patient’s experience is unique. A cancer diagnosis marks only the beginning of a patient’s health care journey, and when the news is delivered poorly or without adequate support, the experience becomes more difficult, as demonstrated in this patient case study. Patients with cancer commonly report that friends and family can make remarks that have a lasting impact on their social support and relationships; a theme commonly reported among individuals diagnosed with multiple myeloma.5 Therefore, it is imperative that clinicians and medical staff do not do further harm or add to this impact; they must remember that language is not neutral in oncology care.
Language has the power to heal or to harm. By committing to patient-centered communication, oncology professionals can build trust, enhance patient outcomes, and promote dignity during one of the most vulnerable times in patients’ lives.
Kathryn Mullen Mechtly, PT, DPT, graduated from Ithaca College’s Doctor of Physical Therapy Program in 2025. Angela Reynolds, PT, DPT, NCS, CBIS, is a residency-trained neurological physical therapist and clinical assistant professor at Ithaca College whose research focuses on neurorehabilitation, interprofessional education, and community-based care. Tim Reynolds, PT, DPT, OCS, CSCS, completed an orthopedic residency and spine fellowship through Cayuga Medical Center and is currently an assistant professor at Ithaca College, teaching anatomy and physiology courses to undergraduate allied-health students.
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