Shifting Expectations of Novel Immunotherapy Treatments in Oncology: Practitioners' and Patients' Calibration Work in Conditions of Uncertainty.

Abstract

Immunotherapy cancer treatments stimulate individuals' immune systems to target and kill cancer, with the potential to extend survival time for individuals living with some forms of advanced cancer. Immunotherapies, however, generate uncertainties in relation to predicting prognosis and managing toxicities and the emergence of side effects during and post-treatment. Drawing on interviews with practitioners and patients in an oncology clinic in the United Kingdom, this paper examines how these uncertainties, defined as epistemic and temporal, are articulated and negotiated in a wider context of shifting treatment expectations. Extending theorisation in the sociology of 'low' expectations, this paper demonstrates how practitioners and patients oscillate between high and low expectations of treatment to negotiate uncertainty. Patients are not passive consumers of hope and hype and do not always articulate high expectations of a pregiven and distant future, which requires recalibration in conditions of uncertainty. Instead, both practitioners and patients craft modest and personalised expectations and visions of the future, which at times involve anchoring to the present. Foregrounding both practitioners' and patients' accounts in theorising (re)calibration is important for understanding how expectations unfold and relate to uncertainties and with what consequences for the making of contemporary patienthood in the present.