Paper short abstract:

Drawing on interviews with patients, carers, and healthcare professionals in Kenya and Tanzania, we explore how socio-economic inequalities shape experiences of cancer and access to cancer care, producing what can be understood as 'social pain'.

Paper long abstract:

Drawing on interviews with patients, carers, and healthcare professionals in Kenya and Tanzania, we explore how socio-economic inequalities shape experiences of cancer and access to cancer care, including timely diagnosis, treatment, palliation, and dignity in survivorship. Even where free cancer treatment policies or insurance schemes exist, the costs associated with diagnostic and other procedures, of travel to seek care, and of filling gaps in state provision, such as purchasing medicines, can be catastrophic. For many, cancer significantly impacts livelihoods and may necessitate sale of assets, further compounding socio-economic inequalities. Furthermore, the cost burden of cancer threatens the ability of patients and those who care for them to perform valued social roles and realise their aspirations, and reliance on family and friends for financial and other support can undermine social relationships and generate stigma and isolation. Those suffering from cancer in Kenya and Tanzania, and the healthcare professionals, family and friends who care for them, often understand the pain produced by cancer, therefore, not only as an individual and medicalised phenomenon, but as something that is fundamentally social. Recognition of ‘social pain’ often informs discussion of palliation in clinical settings, which might involve social workers and spiritual leaders as well as clinicians and medication. Beyond individual treatment plans, however, we argue that meaningfully addressing the pain and suffering caused by cancer in requires understanding how it is produced by wider socio-economic inequalities and structural vulnerabilities.