Chemotherapy Bells and Liminality in Advanced Cancer Care
Bibliographic record
Abstract
Ringing a bell at the end of chemotherapy treatment has become a pervasive practice across cancer centres in Canada and the US. The ritual fails to accommodate the unique position of patients diagnosed with advanced cancer who may remain on chemotherapy treatment up to the end of life. Drawing on 17 months of fieldwork in a Canadian cancer hospital and classical liminality scholarship, I argue that the modern proliferation of cancer treatments produces a liminal space, an ambiguous territory that exists between the hope for a cure and the imminence of death. I show how patients’ liminal status becomes concealed by the bell ringing ceremony. While the ritual is meant to signal transition to reincorporation, it inspires ambivalence on the part of advanced cancer patients precisely because, for them, the end of chemotherapy does not translate as aggregation into the cancer-free world. Witnesses such as nurses, family, and friends should be aware of the bell’s heavy symbolism attached to patients’ uncertain futures and recognize that a myriad of conflicting reactions are possible. The focus on treatment keeps patients in an extended time of illness, preventing them from preparing for the end of life.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.024 | 0.081 |
| Scholarly communication | 0.006 | 0.004 |
| Open science | 0.001 | 0.009 |
| Research integrity | 0.002 | 0.007 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".