Therapeutic Values in Cancer Care

Cancer is more than just a cluster of diseases. Beyond patho-physiological variations, it has been mobilized by experts and laypeople to make sense of a wide variety of phenomena. The regional variability and socio-historical situatedness of experiences of cancer have been widely published in recent decades (Bennet et al. forthcoming; Dein 2006; Livingston 2012; Manderson et al. 2005; Mathews et al. 2015; McMullin and Weiner 2009). Many scholars in medical anthropology have championed a research approach that foregrounds the voices of and practices carried out by people affected by cancer, enquiring into how diverse populations (do not) seek diagnosis, (do not) undergo treatments, and attempt to carry on with their lives with and despite cancer (Hunt 1998; LoraWainwright 2013; Manderson 2005; Mulemi 2010; Porroche-Escudero 2014; Stacey 2013; Vindrola Padros 2011). A focus on the dynamics structuring clinical cancer care has revealed the porous boundaries between clinics and their socio-political environments (Van Der Geest and Finkler 2004). This has included unpacking the ways in which wider sociocultural arrangements inform the narrative structure of clinical experiences (del Vecchio Good et al. 1994, 1994; Mattingly 1998); the negotiation that takes place within the doctor–patient relationships (Bell, 2009; Fainzang 2016; Høybye and TjørnhøjThomsen 2014); the translation of knowledge practices into therapeutic technologies (Gibbon 2007; Gibbon et al. 2014; Keating and Cambrosio 2011); and the impact of the political economy of health that affords different possibilities of care (Day 2015; Iriart and Gibbon forthcoming; Livingston 2012; Mulemi 2008; Sanz 2017). The promise of technoscientific developments is slowly but continuously informing ethnographies of cancer care. Novel therapies enabled by the discovery of candidate biomarkers (Arteaga 2021), and through the blurring between clinical drug trials and therapy, are starting to modify the temporality of cancer treatments and the clinical pathways that patients go through (Cambrosio et al. 2018; Keating and Cambrosio 2011). Such dynamics are transforming the ways in which cancer is experienced in different milieus, reconfiguring forms of pain and suffering, and shaping the efforts people make to understand what is happening to them and what they are expected to do in and through surviving cancer (Day et al. 2017; Jain 2013; Kerr and Cunningham-Burley 2015; Stacey 2013; Steinberg 2015). Nevertheless, this promise of improved health outcomes is intertwined with precariousness. Tensions arise when considering what treatments are made available and for whom (Jain and Kaufman 2011). Transnational research networks that circulate biomedical resources to sites where hospital infrastructure is missing create impermanent solutions (Caduff et al. 2018; Gibbon et al. 2014; Mika 2016; Petryna 2013), and many cancer types and geographies are left behind in terms of funding allocation for research and access to therapeutics (Bell 2014; Caduff and Hollen 2019). Furthermore, some people affected by cancer may not want to seek biomedical treatment at all or prefer to stop it altogether due to its economic or emotional costs and/or its iatrogenic effects. This tension is what Benson Mulemi understands as a core “treatment ambiguity” in Kenya through which anti-cancer treatment increases rather than alleviates suffering (Mulemi 2010), and Julie Livingston provocatively poses with the question “Leg or Life”? (Livingston 2012:91). The moral dilemma that this question captures is deciding whether to compromise someone’s ability to earn income, work, and fulfil everyday responsibilities for a couple more months or years of life. To cut off a leg is to transform the intimate social body in which the patient is embedded, demonstrating not only that some cancer treatment alternatives might be as harsh as the disease itself, but also that cancer and the consequences