Unsettling the treatment imperative? Chemotherapy decision-making in the wake of genomic techniques

Sep 24, 2026

Uploaded by awa

Social scientists argue that a treatment imperative shapes experiences of biomedicine, a pattern seen in oncology where hopes coexist with persistent fears around cancer. In early breast cancer care, genomic decision-making tools enter routine practice and may suggest that chemotherapy is unsuitable for specific disease profiles. Qualitative interviews and observations using gene expression profiling are used to examine how tool fallibilities create room for genomic testing in decision-making, and how patient expectations can sustain the pursuit of the “right” treatment.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages19

Reading Time48 min

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Introduction

The treatment imperative in cancer care

DOI: 10. 1111/1467-9566 .13637 ORIGINAL ARTICLE Unsettling the treatment imperative? Chemotherapy decision-making in the wake of genomic techniques Emily Ross1 | Anne Kerr2 | Julia Swallow3 | Choon Key Chekar4 | Sarah Cunningham-Burley5 1Department of Sociological Studies, University of Sheffield, Sheffield, UK 2School of Social and Political Sciences, University of Glasgow, Glasgow, UK 3Centre for Biomedicine, Self, and Society, Usher Institute, University of Edinburgh, Edinburgh, UK 4Faculty of Health & Medicine, Lancaster University, Lancaster, UK 5Usher Institute, University of Edinburgh, Edinburgh, UK Correspondence Emily Ross, Department of Sociological Studies, University of Sheffield, Elmfield Building, Northumberland Road, Sheffield S10 2TU, UK. Email: [e.ross@sheffield.ac.uk](e.ross@sheffield.ac.uk) Funding information Wellcome Trust, Grant/Award Numbers: 104831/Z/14/Z, 219725/Z/19/Z Abstract Social scientists have argued that a treatment imperative shapes experiences of biomedicine. This is evident within oncology, where discourses of hope are tempered by persistent fears surrounding cancer. It is within this context that genomic decision-making tools are entering routine care. These may indicate that a treatment is not appropriate for a particular disease profile. We draw on qualitative interviews and observations centred on gene expression profiling to consider the implications of this technique for the treatment imperative in early breast cancer. Influenced by sociological perspectives on medical technologies, we discuss how fallibilities of established tools have forged a space for the introduction of genomic testing into chemotherapy decision-making. We demonstrate how high expectations shaped patients’interpretations of this tool as facilitating the ‘right’ treatment choice. We then unpick these accounts, highlighting the complex relationship between gene expression profiling and treatment decision-making. We argue that anticipations for genomic testing to provide certainty in treatment choice must account for the sociocultural and organisational contexts in which it is used, including the This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2023 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for the Sociology of Health & Illness. Sociol Health Illn. 2023;45:1063–[1081.](1081. wileyonlinelibrary.com/journal/shil)[ wileyonlinelibrary.com/journal/shil](1081. wileyonlinelibrary.com/journal/shil) 1063 powerful entwinement of chemotherapy and cancer. Our research has implications for sociological perspectives on treatment decision-making and clinical expectations for genomic medicine to resolve the ‘problem’ of overtreatment. KEYW ORDS breast cancer, chemotherapy, gene expression profiling, genomic medicine, treatment decision-making, treatment imperative INTRODUCTION A consequence of bioscientific development has been the expansion of treatment options available to patients and the need to negotiate a range of test results, prognostic predictions and professional recommendations in treatment decision-making. Sociologists have shown that the shifting landscape in which patients make individual treatment choices is shaped by a wider‘imperative to treat’, notably in cancer where discourses of positivity and hope proliferate (del Vecchio Good et al., 1990) . In recent years, genomic analysis of tumour profiles has begun to drive research investment in oncology, and these techniques are becoming visible within the UK National Health Service (NHS) (Day et al., 2017; Kerr et al., 2021) . Genomic analyses may determine that an available treatment is unsuitable for a particular cancer type according to its molecular profile, or that an intervention’s side effects outweigh its

FAQs

What treatment imperative is examined in the article?

The article examines the “imperative to treat” in cancer care, where medical discourses and clinical standards create pressure to pursue treatment across different ages and stages.

How do genomic decision-making tools relate to chemotherapy choices?

Genomic analysis of tumour profiles can indicate that an available treatment is unsuitable for a molecular disease profile, potentially shaping experiences of whether chemotherapy should be accepted or declined.

What does the study find about gene expression profiling and certainty?

Although gene expression profiling may offer temporary relief and moments of certainty, it does not fully mitigate the treatment imperative; expectations and broader care and organisational contexts still shape decision-making and reflection.

Sep 24, 2026

Uploaded by awa