Neither Hazel nor Augustus has control over their cancer. Despite all the research and treatments, there is no guaranteed way to prevent and eradicate cancer. Fate seems to control whether a person is healthy or sick.
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An Imperial Affliction
The phrase an imperial affliction means suffering sent by a higher power. The title of Peter Van Houten's book (which plays an important role in Hazel and Gus's lives) emphasizes the inability of humans to escape suffering.
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Power
Cancer
Long life
The characters seem to agree with the Greek idea that one's destiny is shaped by the stars. Hazel says she and Augustus are star-crossed lovers and Van Houten writes that the fault [is] in our stars.
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Gus's cigarettes are a way for him to metaphorically control his own fate. The unlit cigarettes allow him to play with death without dying as a result. They give him confidence, but don't change the reality that he has no control over his death.
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