Introduction

It is predicted that by 2050 there will be 13.7 million new cases of childhood cancer worldwide (Atun and Bhakta, 2020). Among all cancers, childhood cancer ranks sixth in terms of health burden and poses a major threat to children’s lives (GBD 2017 Childhood Cancer Collaborators, 2019), and is the leading cause of death for children worldwide. Parents of children with cancer often experience significant upheaval in their lives upon receiving a cancer diagnosis of their child (Saegrov and Halding, 2004; Stenberg et al., 2012). According to Gage and Panagakis (2012), some parents of pediatric cancer patients may view the internet as a valuable tool for gaining social support and connecting with others. These parents, as family caregivers, may experience a lot of psychological and financial pressure during cancer treatment (Hopwood et al., 2020). On the one hand, the diagnosis of cancer in a child places an immense psychological burden on parents, encompassing increased rates of depression, anxiety, grief, and even feelings of guilt and helplessness (Friðriksdóttir et al., 2011). On the other hand, the exorbitant expenses associated with hospital stays, surgeries, chemotherapy, and medication create a significant financial burden, resulting in a poor quality of life for these parents (Crespo et al., 2011). Therefore, there is a need to pay careful attention to the physical and emotional health of this specific group (Cuthbert et al., 2017) and to understand their experiences and inner worlds in caring for children with cancer. However, it’s essential to recognize that interpreting these experiences and emotions involves cognitive processes in which metaphorical language plays a vital role (Gustafsson et al., 2019). Metaphors can be used to describe experiences and feelings that are sometimes difficult to express (Bowker, 1996; Golden et al., 2012). Specifically, in discussion of health issues, especially in the context of cancer, we inevitably resort to metaphors (Almegewly and Alsoraihi, 2022; Magana, 2020; Olsman et al., 2019; Zhang and Wu, 2023).

Metaphors offer cancer patients access to better express their perceptions and feelings, potentially assisting them in finding solace and surmounting challenges encountered during cancer treatment (Skott, 2002). Patients with cancer also employ vivid metaphorical language to detail their experiences (Gibbs and Franks, 2002; Golden et al., 2012; Gustafsson et al., 2019; Skott, 2002). What’s more, studies have demonstrated that the use of journey metaphors can help patients with cancer find deeper meaning in life (Byrne, 2007). Besides, by explaining the unfamiliar in acquainted terms, healthcare workers can use metaphors to help cancer patients better understand their conditions, calm their fears, and motivate them during treatment (Kirklin, 2007). Moreover, acquiring an understanding of these metaphors might allow healthcare professionals to better comprehend and address the needs of parents, enabling them to provide timely and effective support and advice. According to Casarett et al. (2010), patients with cancer tend to perceive communication as more effective when doctors incorporate the use of metaphors. In general, based on the literature mentioned above, it can be inferred that incorporating metaphorical language into health communication has the potential to yield benefits.

However, the above-mentioned research related to health communication has primarily focused on the metaphors used by healthcare professionals and patients. Conversely, to our best knowledge, there has been limited research exploring the metaphors used by cancer caregivers, particularly by parents of children with cancer. In this vein, this study focuses on the exploration of metaphors used by this specific group, parents of children with cancer.

The aim of this study is to investigate the use of metaphors in blogs by parents of children with cancer, with the hope of capturing their patterns of metaphor usage, as well as their experiences and inner thoughts. It is hoped that this research may potentially enable the public and healthcare professionals to provide these parents with effective support and advice, thereby alleviating their stress to some extent.

Theoretical framework

This study is based on Conceptual Metaphor Theory, which was first proposed by Lakoff and Johnson in 1980 in their co-authored book Metaphors We Live by, a comprehensive challenge to traditional metaphor theory. According to this theory, metaphor goes beyond being merely a linguistic expression and serves as a powerful cognitive tool (Lakoff and Johnson, 1980). Metaphor enables individuals to grasp complex ideas by mapping elements of a familiar or concrete domain (known as the source domain) onto an unfamiliar or abstract domain (known as the target domain) (Han et al., 2022; Lakoff and Johnson, 1980). The source domain serves as a framework through which one can gain insight and obtain a tangible structure for comprehending a concept or phenomenon in the target domain. On the other hand, the target domain refers to the domain in which the metaphor is applied to understand or describe something. It typically involves subjects that are more abstract, intangible, or complex, such as time, love, or politics. The target domain and the source domain share similarities (Krieger, 2014). Drawing upon the source domain, the target domain can be explored, represented, or communicated through metaphorical expressions, enabling a deeper understanding of complex ideas and experiences.

Lakoff and Johnson (1980) discussed how metaphors shape people’s conceptualization of a phenomenon, often excluding alternative perspectives. They proposed that the use of metaphors may also limit our understanding of a phenomenon, confining it within a specific conceptual framework and excluding alternative ways of thinking. For example, in the case of “Argument is war” the emphasis on the competitive nature of argumentation may exclude cooperative or collaborative aspects. What’s more, since children typically enjoy playing games, the use of game metaphors in cancer treatment can create a playful atmosphere for these children. This allows them to focus on this “game,” approaching cancer treatment in a playful manner. It might soothe their emotions, encourage active participation, and influence the reactions and behavior of these children.

Lakoff and Johnson argued that conceptual metaphors are systematic, where different conceptual metaphors are not isolated but interact with each other to construct a coordinated and consistent system of metaphorical expression (Lakoff and Johnson, 1980). Additionally, different conceptual metaphors are characterized by unity. Different aspects of the same entity can be conveyed through varied metaphorical concepts (Lakoff and Johnson, 1980). While the same tenor (time) may encompass different vehicles of metaphor, they are not contradictory but rather mutually complementary and enriching. The term “vehicle” refers to the metaphorical concept or image used to convey a certain idea or aspect. When employing metaphor to describe time, we can utilize the metaphors “Time is money”; “Time is a priceless commodity”; “Time is a limited resource”. The metaphor “Time is money” emphasizes the value and finite nature of time, suggesting that it should be utilized and managed reasonably, much like money. The metaphor “Time is a priceless commodity” underscores that time’s worth cannot be measured in monetary terms. It conveys the preciousness of time. The metaphor “Time is a limited resource” highlights the restrictions and value of time, necessitating wise planning and allocation. Although these three metaphorical vehicles are employed to explain the same tenor (time), they are interconnected and unified, underscoring the preciousness and importance of time. Moreover, conceptual metaphors have similarities (Semino, 2021), and people make logical connections based on these similarities by relating things that belong to two different categories to each other.

The operating mechanism of Conceptual Metaphor Theory is mapping, primarily achieved through the similarities between the source and target domains. Conceptual metaphors are systematic mappings from the source domain to the target domain (Lakoff, 2014). Mapping refers to the process by which elements from a source domain are projected onto a target domain. It involves establishing connections or correlations between the two domains to understand the target domain in terms of the source domain. The effectiveness of mapping in Conceptual Metaphor Theory relies heavily on the perceived similarities between the source and target domains. These similarities serve as the basis for establishing correspondences and projecting the conceptual structure of the source domain onto the target domain. Based on the similarities, a correspondence between the source and target domains can be constructed to form a “cross-domain mapping”. For example, war metaphors are often used in the health field. In the metaphor of “Cancer treatment is war”, hospitals and operating tables can be portrayed as battlefields, and doctors and cancer patients can be described as warriors. The similarities between the two domains enable the construction of a correspondence whereby cancer treatment can be metaphorically conceptualized as a war.

Methods

Research design

The study adopted the method of qualitative content analysis proposed by Graneheim and Lundman (2004) to examine how parents of children with cancer framed their experiences through metaphors. It is a widely employed method in qualitative research, especially when the phenomenon being studied lacks coverage in previous research or when existing knowledge is fragmented (Elo and Kyngäs, 2008). What’s more, content analysis has the capacity to offer insightful descriptions of individuals’ experiences (Elo and Kyngäs, 2008). Therefore, we chose qualitative content analysis as the approach to articulate and present the unique experiences and perspectives of the parents involved in our study, thus facilitating a comprehensive exploration of the metaphorical expressions used by parents and shedding light on distinctive aspects of their communication. However, it is important to acknowledge that the outcomes of qualitative content analysis are subject to the researcher’s subjective interpretation and intuition, leading to the possibility of varying interpretations among different researchers when analyzing the same data (Graneheim and Lundman, 2004; Sandelowski, 1995). While our study employed qualitative content analysis, we acknowledge that this approach may impact comparability to some extent, serving as a limitation. The study adhered to the guidelines outlined in the Consolidated Criteria for Reporting Qualitative Research (COREQ) (Tong et al., 2007). We gathered and organized as many blogs as possible from parents of children with cancer on the Chinese social media platform, “Little Red Book”. The primary objective of this study is to examine and categorize the metaphors employed in these narratives, followed by an in-depth analysis.

In this study, we ensured familiarity with all common categories of metaphors encountered in everyday language, as well as with the vocabulary related to each metaphor category. Our metaphor identification was conducted on a sentence-by-sentence basis, where a sentence may contain one or multiple metaphors. The first author initially identified metaphors within sentences, pinpointing words indicative of metaphors. Subsequently, for each identified metaphor in a sentence, we determined the source and target domains, established their corresponding relationships, and ascertained the conveyed meaning. The first author rigorously reviewed the identified metaphors and their relationships, and the second author conducted a thorough examination to ensure the identification of all metaphors within the sentences. In cases of disagreement, discussions persisted until a consensus was reached, resolving any issues that arose. For example, the sentence “My daughter is the strongest of warriors, and she will win in the end” exemplifies the use of a war metaphor, where the terms “strongest”, “warriors”, and “win” are all identified as parts of the war metaphor. In this instance, the metaphor suggests a conceptualization of the daughter as a strong and resilient fighter, emphasizing her strength and determination to prevail in the end.

Setting and sample

This study exclusively relied on data from blogs written by parents of children with cancer on the platform “Little Red Book”. To identify the most relevant data, the first author employed a targeted keyword search strategy utilizing key terms such as “parents of children with cancer,” “caregivers of children with cancer,” “guardians of cancer patients,” and “families facing cancer”. Additionally, a snowball search technique was employed by the first author to expand the sample size, identifying additional parents through comments and recommendations made by other parents on these blogs and their preferred blogs. The data collection process continued until data saturation was reached, resulting in the identification of 33 parents who met the inclusion criteria. Subsequently, all textual content authored by these parents was manually curated and managed.

These inclusion criteria included: (a) blogs posted from 2019 to 2022; (b) parents whose children were suffering from cancer; (c) children with cancer aged between 0 and 14 (This age range aligns with the classification set forth in medical research, children aged 0 to 14 are the subjects of pediatric studies.); (d) parents actively supporting their child in the fight against cancer; (e) all the information is voluntarily released by parents and is publicly available.

The final sample consisted of 33 individuals aged 25 to 45 years, including 29 females and 4 males. Children with cancer range in age from one month to 10 years, with neuroblastoma and leukaemia being the two most common types of cancer.

Data collection

The first author sourced first-hand information from the “Little Red Book” and used the keyword search and snowball search to identify 33 eligible parents according to the inclusion criteria and recorded all published information. All the information disclosed by these parents between 2019 and 2022 is publicly available, gathered, and collated by the first author, amounting to a total of 16027 words.

Data analysis

Grounded in the Conceptual Metaphor Theory as the theoretical framework, this study employed the method of qualitative content analysis proposed by Graneheim and Lundman (2004) to analyze the collected data. The data analysis procedure involved the following steps:

Step one, researchers familiarized themselves with the collected data by reading it three times before starting the analysis. Then, researchers selected one sentence as the unit of analysis. The first author, based on the Chinese text, initially identified sentences containing metaphorical words. The metaphorical words within sentences were treated as open codes. Subsequently, the source and target domains of the metaphors within these sentences, along with their corresponding relationships, were determined. Following this, the first author translated these sentences containing metaphorical words into English, resulting in a total of 2890 words, and ensured the accurate translation of each metaphorical word, as well as the source and target domains and all metaphorical correspondences. To ensure the accuracy of word usage, the translation data were checked and corrected by the second author. In the event that consensus could not be reached, two researchers engaged in discussions until an agreement was achieved.

Step two, the researchers compared the content similarities and differences between metaphorical words to determine which could be grouped together and then manually assigned them to a clearly defined sub-theme and gave the resulting sub-theme an appropriate name, which could be further grouped together into main themes. By taking these necessary steps, the resulting data were expected to be robust and reliable.

Step three, in order to guarantee the credibility and accuracy of the research data, the first author meticulously verified all the initial data and carefully scrutinized all metaphorical correspondences once again. Moreover, the first author meticulously re-examined the classification of these metaphors to ensure that all metaphor types had been identified and that the frequency of all metaphors had been counted. Each identified metaphor was continuously evaluated to confirm the existence of a correspondence and the presence of explicit source and target domains. The second author provided language guidance, and both authors worked in concert to ensure data accuracy.

Step four involves the exploration of metaphorical usage among different individuals. The first author conducted research on the metaphorical expressions used by fathers and mothers of children with cancer in the data, based on the gender information disclosed by these parents, and explored whether there were differences in the patterns of metaphorical use between men and women in our data.

Research rigor

We followed the recommended guidelines for ensuring the credibility, dependability, and transferability of our study, as outlined by Graneheim and Lundman (2004). To establish credibility, a meticulous and comprehensive data collection and analysis process was implemented. All metaphorical expressions were thoroughly examined and discussed by the researchers, with each metaphor’s classification being scrutinized repeatedly. Any disagreements were resolved through extensive discussions. Additionally, to enhance dependability, regular meetings were conducted by our researchers throughout data handling process, ensuring consistency throughout the study. In cases of disagreement, discussions persisted until a consensus was reached, resolving any issues that arose. Furthermore, detailed descriptions of the parents of children with cancer were provided, along with a comprehensive presentation of the findings, thereby enhancing the transferability of the study.

Ethical considerations

Robinson (2001) argued that it is acceptable to include unsolicited website content that is publicly available without ethical review. Similarly, Eysenbach and Till (2001) asserted that obtaining consent is crucial for privately shared information, but for publicly accessible content, it may not be necessary. In addition, Bruckman (2002) further supported this view, stating that using publicly available online information is permissible without explicit consent.

Given that the “Little Red Book” is a public social media platform, and blogs are not protected by passwords, obtaining consent from bloggers may not be necessary. However, we tried our best to get approval from this platform. What’s more, researchers who exercise caution can still ensure privacy by de-identifying online sources and the personal characteristics of bloggers. Therefore, we ensured that all the data concerning the selected parents, such as their names, addresses, social media accounts, phone numbers, and more, remained strictly confidential throughout this study. More importantly, to ensure privacy protection, all Chinese texts were translated into English by the first author and reviewed by the second author, which means that the translated English texts are not searchable, providing even greater protection to the participant’s information. For the analysis of metaphors in this paper, the first author employed W and M to distinguish between women and men, respectively. Additionally, they used numbers to denote age, while lowercase letters x and y helped differentiate individuals of the same sex and age.

Results

The analysis of the dataset yielded a total of 181 instances of metaphorical expressions, with game, war, journey, and plant metaphors being the most commonly used by parents of children with cancer, accounting for 132 metaphors. These metaphors were subsequently categorized into four overarching themes: game metaphors, war metaphors, journey metaphors, and plant metaphors, each with distinctive subthemes. The themes and subthemes are shown in Table 1 and are presented in detail with examples in the following section. Table 2 illustrates the distribution and frequency of the four main types of metaphors used by parents of children with cancer. In addition, this study also revealed that these parents often employ mixed metaphors to describe their experiences, so the analysis of the mixed metaphors was included in the study as well.

Table 1 Themes and subthemes.
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Table 2 Distribution and frequency of instances of the four main types of metaphors.
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As shown in Table 2, game and war metaphors occupy an uncontested niche, followed by journey and plant metaphors. And the number of game and war metaphors far exceeds that of the other two, probably owing to the difference in the objects to which they are applied, and to the habitual usage of the language.

Game metaphors

Game metaphors are considered first, as they are found to be most commonly used among parents of children with cancer. The game metaphor can be seen as a distinctive form within the broader spectrum of war metaphors. While game metaphors and war metaphors share similarities, in our study, we believe game metaphors possess unique characteristics when describing the experiences and coping strategies of parents with children undergoing cancer treatment, thus warranting independent exploration. Expressions from the domain of game are monster, warriors, round, level, and beat, etc. It’s important to note that we determined whether “warrior” is a game or war metaphor based on contextual cues. In our study, game metaphors were employed by these parents to articulate their experiences of accompanying their children through cancer treatment. Two subthemes were produced: cancer as a monster and treatment as a game.

Cancer as a monster

In the excepts below, cancer is described as a monster to be defeated in the game. Children, parents and medical workers are all portrayed as warriors fighting against the monster. Injections and chemotherapy can be used as weapons against the monster, and physical examinations can help to better observe the monster’s condition.

Yesterday, my boy suddenly asked me, what is cancer? I told him that cancer is a monster, and we are all warriors who want to defeat the monster. Upon hearing this, he immediately said that we should fight the monster together. (W42)

Mom and doctors will be cheering with you and we can beat this monster. (W39)

Treatment as a game

Game metaphors, however, do not always refer to fighting monsters. Some parents use them to describe the treatment process as a game, in which medical professionals are the commanders and children and their parents are the players. Cancer and physical pain are seen as obstacles in each round of the game. Injections and chemotherapy, on the other hand, are depicted as remedies that assist us in achieving success in the game. Faced with difficulties and challenges at every round of the game, parents and children need to work together and move forward through each round to earn the final victory.

Today, after nearly five months of chemotherapy, we have won the first round in the game and I believe we can brave the next round. (W27)

There is no obstacle that we cannot solve. Dad and doctors will be with you bravely through all the rounds of this game. (M29)

In the above examples, in order to ultimately win the game, doctors, children, and parents take on their respective tasks to break through the difficulties and clear the game obstacles.

War metaphors

While game metaphors can be regarded as a kind of war metaphors, representing a unique perspective, it’s essential to explore other variations of war metaphors, which remain pervasive and are used by almost all parents. In our study, war metaphors mainly referred to expressions such as soldiers, weapons, strategies, battlefields, defeat, and fight, etc. Two subthemes were generated: the treatment of cancer as a war and battle with bad thoughts and emotions, which are discussed in detail in this section.

The treatment of cancer as a war

We find that war metaphors are used by almost all parents in our data to describe cancer treatment. In the stories they share, hospitals and operating tables are depicted as battlefields and beds as base camps, while medics, children and themselves are portrayed as soldiers. Medicine and medical instruments are used as weapons of war, and treatment plans are described as strategies for war.

Chemotherapy stands as the front line defense and a powerful weapon in the war, and a wide array of strategic combinations await my daughter. My daughter is the strongest of warriors, and she will win in the end. (M31)

Treatment is a war. Three rounds of chemotherapy provided a guarantee of victory. The masterly art of the chief physician secured the smooth victory of the war. Next, we should continue to clear the field and eliminate the enemy. (W35)

As shown above, cancer treatment is described as a war. Cancer is personified as an enemy. In the face of enemy attacks, medics, patients and families worked together to hold the battlefields and build a lifeline of defense.

However, cancer treatment is an arduous, long battle with no certain outcome, and patients may be forced to coexist with the enemy (cancer) for an extended period. In this way, some parents and their children may struggle with accepting treatment failures, viewing doctors as “traitors” of the war, as in the following example:

Cancer has taken a heavy toll on our family. The boy cried and told me that he would not fight again, and that the doctor was a “traitor”. (W43)

Battle with bad thoughts and emotions

In addition, war metaphors serve a wider purpose beyond describing the cancer treatment as a war. They can also be used to depict the battle against negative emotions. Many parents sometimes employ war metaphors to convey how they have prevailed over bad thoughts and emotions and how they actively strive to seek a meaningful and fulfilling life.

I must defeat these bad emotions, and live bravely. (W29)

In this case, the enemy is no longer cancer, but negative emotions. These parents of children with cancer are soldiers in a lone battle against negative emotions, with the goal of finding hope and enjoying life.

Journey metaphors

Journey and plant metaphors are also evident in our data, although they are less common than game and war metaphors. A journey is a complex process involving various aspects such as travelers, departure points, directions, roadblocks, and final destinations. By following the right path, most travelers will eventually reach their destination. Expressions from the domain of journey are road, path, pass, move forward and go through, etc. Below we examine journey metaphors related to the following subthemes: life as a journey, treatment as a journey, and the psychological journey.

Life as a journey

Some parents draw on journey metaphors to depict their lives as moving forward on some kind of journey, a journey where they are uncertain about their destination.

Not knowing what to do with my life, I wandered aimlessly along the road. (W32)

It is clear that the lives of these parents have undergone a significant shift since their child fell ill, leaving them confused and unsure about their future.

Treatment as a journey

In addition, cancer treatment is also portrayed by most parents as a journey that children and parents embark on together in their quest to cure cancer. The start of a child’s cancer treatment is the beginning of their journey, whereas the difficulties and challenges they encounter during the treatment represent the obstacles along the way. The child’s physical recovery is the end of their journey.

Treatment is a long journey with many obstacles ahead. I have no idea how long we can move forward, but we do not want to give up. (M38)

Although cancer treatment is a time-consuming and expensive process with uncertain outcomes, most parents choose to persevere, hoping for a brighter future for their children.

The psychological journey

Besides, journey metaphors are also employed to describe a psychological journey. In the next example, this mother chooses to redirect her mental and emotional faculties, seeking an optimistic and joyful path forward.

I want to put negative thoughts aside and try to move forward on a positive and happy path. (W34)

Plant metaphors

Similarly, plant metaphors frequently appear in the narratives of some parents, marking them as the most interesting and distinctive metaphors in our study, particularly due to their profound connection with the parent-child relationship. In our study, plant metaphors serve as a tool to reveal the inherent characteristics of children and are also reflected in the field of medicine, particularly in oncology. The related expressions are thrive, grow, root, blossom, and remove, etc. Two subthemes were identified: human body as a plant and tumor as a plant.

Human body as a plant

In plant metaphors, the child’s body is often depicted as a plant. Similar to a plant’s growth process, child-rearing is a slow and arduous endeavor that requires plenty of time, effort, as well as the removal of obstacles to growth. And a plant needs to be patiently fertilized and watered to ensure proper growth and eventual flourishing.

Mom will be there for you to grow, break ground, sprout, blossom and thrive.(W30)

I patiently fertilized my child and want him to take root and flourish. (M40)

The above example illustrates that even though children suffer from cancer, parents still expect their child to grow and thrive.

Tumor as a plant

Additionally, plant metaphors can illustrate the growth of tumors, comparing their progression to the development of plants. Tumors also spread and metastasize in a manner reminiscent of the dispersal of seeds, as demonstrated in the following example:

Doctors said the tumor had spread to all parts of his body quickly and there was little hope of survival. (W41)

Doctors said surgery was needed to remove the root of the tumor. (W26)

Mixed metaphors

Throughout our research, we noticed that some parents’ narratives often involve more than one metaphor, expressing their unique experiences and emotions. The following example shows that a mother employs both war and journey metaphors to portray the treatment process as a journey in which parents and children unite as brave soldiers to conquer the enemy and reach the final destination.

There has been too much suffering on the way to treatment and we are all brave soldiers. Mom and you will cheer together. (W31)

In a similar vein, the game metaphor presented in the following expression also involves a plant metaphor, showing the father’s positive expectations for the child to defeat the monster and grow up healthily.

We can beat this monster in every round of this game and thrive and blossom like other children. (M31)

The use of the four metaphors, war, game, journey, and plant, varies across the blogs. Game and war metaphors are the most frequently used, appearing in nearly all of the parents’ utterances, except for five. As exceptions to the general trend, three parents use journey metaphors predominantly, while two parents use plant and war metaphors in equal proportions. It is also noted that two parents show a dominance of plant metaphors, with no use of war or game metaphors.

Furthermore, this study also explores the use of metaphor among different genders. The final sample consisted of 33 individuals, 29 females, and 4 males. Table 3 displays the frequency of the four metaphors used by men and women.

Table 3 The frequency of the four metaphors used by two groups.
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As illustrated in Table 3, war metaphors occupy a prominent niche in male texts, whereas game metaphors are more common in female texts. In addition, women tend to use fewer journey metaphors than men proportionally, and there is a slight variation in the use of plant metaphors between the sexes. Therefore, these findings may indicate that there are gender-based differences in the use of metaphors. However, given the small number of male participants, drawing definitive conclusions on gender differences based on this limited sample size presents challenges. It’s important to acknowledge that the disparity in gender representation may affect the generalizability of our findings.

Discussion

Metaphors are not only a cognitive tool, but they can also influence and shape the way we perceive the world around us (Lakoff and Johnson, 1980). Metaphors have been the focus of existing studies. However, previous research has mainly focused on the use of metaphors by healthcare workers and patients. This study differs from the previous ones in that we examined the use of metaphors by parents of children with cancer, which has not been well studied before.

By analyzing blogs written by these parents, we identified the metaphors used by parents of children with cancer. Our findings suggest that metaphors associated with game and war occupy a critical place in our data. Although journey and plant metaphors occur less frequently, they are still significant and deserve further study. We also found that parents often use mixed metaphors to better express their unique and profound experiences. In our study, these parents, who are often under significant stress, will resort to the aforementioned metaphors to help them to better express their emotions and experiences, thereby relieving pressure and regaining hope for a brave life.

One significant contribution of our study is the emphasis on the use of game metaphors. A body of research literature on cancer metaphors has frequently centered around war and journey metaphors (Harrington, 2012). Our study, however, highlights the use of game metaphors by parents of children with cancer. Game metaphors are generally considered a specific form of war metaphors, based on their conceptual similarities. Both games and wars involve elements such as competition, fight, and solider. However, in our study, we advocate for separating the discussion of game metaphors from that of war metaphors. Incorporating game metaphors into cancer treatment might help create a relaxed and enjoyable atmosphere for children. This allows them to focus on this “game,” easing their emotions and encouraging active cooperation with treatment. In this context, game-based metaphors may be a valuable tool in helping children navigate the challenges of cancer treatment.

Our research makes a distinctive contribution by placing a significant emphasis on plant metaphors. The emergence of plant metaphors is rooted in people’s familiarity and experiences with various features of plants. According to Wang (2010), the use of plant metaphors to describe children has a long history in Chinese culture, depicting them as small trees, seedlings, or seeds and symbolizing them as the blossoming flowers of the nation. Plant metaphors serve to highlight the inherent characteristics of children. On one hand, the growth of plants requires external environmental support such as sunlight, rain, and nurturing, analogous to the care and guidance provided by parents for the growth of their children (Wang, 2010). For example, in our study, despite facing the challenges of cancer, parents maintain the expectation that their child will overcome these adversities and prosper. What’s more, plant metaphors are also reflected in the field of medicine, particularly in oncology, where they are commonly used to describe various aspects of tumor growth. Tumors exhibit some characteristics of plants, and the metaphor of “ tumor is plant” also underscores the robust vitality of tumors (Hou et al., 2017). In short, the use of plant metaphors in the context of cancer narratives may provide a powerful and evocative tool for parents to express their complex emotions and expectations to their children.

In addition, the study shows that almost all parents use war metaphors to describe their experiences. War metaphors are ubiquitous in almost every industry, and medical care is no exception (Fuks, 2009). It may inspire a tenacious fighting spirit and take defensive actions, as well as mobilize people to respond to emergencies (Montgomery, 1991). Therefore, the use of such vivid and intuitive language may allow these parents to encourage their children to actively fight cancer. However, war metaphors also have negative effects. Bodd et al. (2022) argued that war metaphors have a negative impact on patient’s emotional well-being. While the use of war metaphors may be effective in certain situations, it is imperative to exercise caution while using them and to consider their potential negative effects, and adjust the use of metaphors accordingly.

In addition, our results also indicate that the choice of metaphors may be influenced by gender, which is at odds with the findings of Hommerberg et al. (2020). In our research, we observed that female parents tend to utilize more game metaphors, whereas male parents predominantly employ war metaphors. However, it’s important to note that due to the limited sample size of our study and the significant gender imbalance, it’s possible that we may not be able to draw accurate conclusions.

Overall, our study bridges a gap in previous research on metaphors by focusing on the metaphors used by parents of children with cancer, and provides a new research direction for later research on metaphors. Insight into how these parents use metaphors may shed light on their inner world, helping them to relieve stress in feasible ways and providing effective support for them in a timely manner.

One limitation of our study is the imbalance in the number of male and female parents in our sample. We recorded far more female parents than males, presumably because female parents prefer to share their experiences online. Therefore, further research on metaphors should strive to balance the gender ratio. What’s more, in our study, sentences containing metaphors have been translated into English. We have made every effort to ensure the accuracy of translating metaphorical words, as well as the source and target domains. Despite thorough checks in our manual identification process, there may still be some subtle errors. Furthermore, the present study does not examine how the use of metaphors is related to the age of the parents, and it would be interesting for future research to explore this relationship. Additionally, investigating how metaphors used by parents of children with cancer evolve as the cancer progresses could be a fruitful area for future research. However, we must acknowledge that our study was limited to blogs posted by parents on the Little Red Book, so our sample may not be representative of the entire population. Nonetheless, our investigation in terms of metaphors for this specific group is still significant and informative.

Conclusion

In this study, parents of children with cancer are inclined to use various metaphors to articulate their experiences, with game, war, journey, and plant metaphors being the most frequently employed. An intriguing finding of our study is the use of mixed metaphors by these parents to convey a nuanced blend of emotions, experiences, and perspectives, highlighting the multifaceted nature of their experiences and the richness of the metaphoric language they employ. In addition, our study sheds light on the importance of exploring and understanding the metaphors used by these parents, which may offer insights into the emotional experiences of these parents, potentially facilitating effective support and guidance from both the public and healthcare professionals. This, in turn, may help alleviate their stress. Future studies involving a more extensive sample size are warranted to explore differences in metaphor use with regard to age and gender. Another angle that remains to be explored is how caregivers of older cancer patients use metaphors to describe their experiences.