In remission, not realed: Redressing semantic wounds

Public Policy Projects’ (PPP) Wound Care programme has highlighted how chronic wounds suffer not only from systemic neglect but also from a lack of narrative urgency. Non-healing wounds are, as detailed in a recent report, too often sidelined as a specialist concern, despite affecting millions, costing the NHS billions, and exacerbating deep health inequalities. This under-prioritisation is not just about resources: it is also about language. Wounds are framed in technical or passive terms that obscure their severity. If wound care is to be elevated to the system-level priority it demands, then reframing its language and public perception must be part of the solution.

Compare and contrast

In 2007, researchers David Armstrong, James Wrobel and Jeffrey Robbins published a short guest editorial in the International Wound Journal posing the question: are diabetes-related wounds and amputations worse than cancer? Their brief intervention was simple enough. Printed in black and white was the evidence “that persons with lower extremity complications of diabetes have 5-year mortality rates similar or worse than many common types of cancer.”

Such comparisons are not without precedent. Across a wide spectrum of chronic and acute conditions researchers have periodically drawn parallels with cancer to highlight disparities in clinical attention, funding, and cultural narratives. Chronic heart failure and liver cirrhosis are just some notable conditions with mortality rates compared to that of common cancers, while patients undergoing haemodialysis experience mortality rates equal to and beyond many cancer types.

Armstrong and colleagues continued researching, publishing corroborating findings in 2020 documenting five-year mortality of diabetic foot ulcers (DFUs) at 30.5 per cent compared to the pooled mean for all cancers of 31 per cent. Looking at three-year recurrence rates of DFUs compared to cancers, Armstrong et al showed earlier this year that the 58 per cent DFU recurrence rate was “comparable to cancer recurrence rates: breast (25-40 per cent), prostate (30-40 per cent), colorectal (30-50 per cent), and lung (60-80 per cent).”

Should we really compare suffering?

But should we compare disease burdens? The reason Armstrong and colleagues chose this framing was to elevate the perceived severity and, by extension, the funding and research priority of the ‘lesser known’ condition. In the case of DFUs, despite their devastating impact, they rarely command the same public empathy, philanthropic investment, or government research funding as cancer. Cancer occupies a symbolic status in Western consciousness, often evoked as a battle or war.

When comparisons are made to cancer (for example, in the increasing references to long Covid as worse than some cancers for quality of life), they reveal underlying biases in the perception of different forms of suffering. Such comparisons can raise important questions, for example, why does a high mortality rate from cancer prompt widespread alarm and significant resource mobilisation, while an equivalent mortality from a diabetes complication often receives little public attention?

Framing something as potentially ‘worse than cancer’ is a semantic argument, rather than a clinical one. Armstrong et al. make this explicit, emphasising that their interventions serve as a call for “a change in the syntax surrounding DFUs and other associated complications. Considering patients with healed DFUs as patients ‘in remission’ rather than formally ‘healed’ makes it easier for the patient, other clinicians, and policy makers to understand the possibility, or as the data suggest, probability, of a recurrence and to better communicate overall risk.”

Split considerations, polyonymous approaches

Polyonymy, from the Greek polyōnymia (‘poly’ meaning many, ‘onyma’ meaning name), abounds when discussing chronic wounds. Even terms with definitional standards such as ‘chronic’ and ‘acute’ have been subject to scrutiny for their impacts on patients’ understanding of their condition as well as perceptions of patients ‘struggling with’ wounds. Debate over definitional criteria of terminology has spawned a plethora of pseudo-synonyms, categorising wounds as ‘complex’, ‘delayed’, ‘in remission’, ‘non-compliant’, ‘non-healing’ and ‘recalcitrant’. While some prefer to speak of ‘non-healing’ wounds rather than labelling them ‘chronic’, the argument has been extended to question whether common terms like ‘diabetic’ and ‘non-compliant’ may “be stigmatising and are not reflective of a person-centred approach”, ultimately hindering both change and clinical excellence.

What one refers to when discussing their clinical attention is further contested. Is it best labelled as ‘wound care’, ‘wound healing’ or ‘wound management’? Not all wounds will heal, so does this term set up unrealistic expectations in patients with conditions that predispose them to recurrence or incomplete closure? Surely ‘wound healing’ can never be a catch-all? But it is important to emphasise that most wounds can heal, not just be cared for. So ‘wound healing’ can be not just aspirational but imperative. This furthermore implies that ‘management’ is too conservative, suggesting that a stable chronicity of wounds makes them something to live with, not necessarily to resolve.

These sorts of semantic discussions are not uncommon in the world of wound care/healing/management. As shown above, they do not necessarily reflect difference of clinical or professional opinion. Rather, they are indicative of different argumentative strategies placing greater emphasis on different considerations for chronic wounds.

The terminology we use to describe illness and, by extension, the people who live with it, shapes not only public understanding but also policy priorities, research funding, and clinical expectations. Wound care suffers not just from a lack of system urgency, but from a lack of narrative urgency. Cancer, for all its epidemiological complexity, benefits from a culturally codified language: emotive and commendable narratives of battles fought by survivors struggling against the odds. Chronic wounds, by contrast, reside in the margins of discourse, described in terms that are technical, procedural, or passive: ulcers, exudate, offloading, dressing changes. These are not words that stir the heart. But these struggles are no less worthy of acknowledgement.

Describing a DFU as ‘in remission’ rather than ‘healed’ is more than rhetorical flourish

In campaigning for patients with chronic wounds, it can feel that the language surrounding them fails to convey their gravity. The very term ‘wound care’ connotes routine, maintenance, and containment. It’s a far cry from the dramatic, emotive language of oncology. The semantic reframing suggested by Armstrong and colleagues, viewing a treated DFU as ‘in remission’ rather than ‘healed’, is more than rhetorical flourish. It aligns the discourse with established communicative norms from oncology, potentially unlocking both emotional resonance and institutional traction.

Turning words into action

Semantics matter. When clinicians, researchers, or policy advocates choose words like ‘remission’ or ‘recurrence’, they do more than describe. Word choice implies associated choice of action. Some terms will imply a greater need for vigilance, follow-up, and systematised support than others. Translating that beyond the clinic is key to gaining traction in the public narrative. If wound care is to be elevated from a neglected concern to a system-level priority, then both narrative and policy reform must go hand in hand.

Together with committed partners, PPP is continuing to champion the urgent need to reform provision of wound care. That is why our upcoming Wound Healing Forum in London on 9 October will be our most strategic gathering to date: convening system leaders, clinicians and care champions to seize the opportunities presented in this time of rapid change. All stakeholders interested in advancing solutions and ensuring that wound care has a central place in national health reform are urged to join us at the Forum. Together, we can all play our part in shaping the future of wound healing: because the cost of inaction is simply too high.