What Terminal Cancer Patients Teach Us about Time and Inequality
August 2026
People facing terminal cancer often find that the clocks of hospitals, insurers, and employers are out of step with their own timelines.
In a new article in American Sociological Review, we show how these mismatches shape what people can do in the time they have left, and where money and social connections help or prove ineffective.
We draw on five years of team-based fieldwork in nine cancer clinics and 196 multi-wave interviews with 96 patients facing incurable cancer. Combining ethnography with computational social science, we trace temporal misalignments in and beyond the clinic and connect individual cases with broader patterns in our data. This revealed inequalities not only in how much time people had, but in their capacity to manage and adapt the windows for action.
The burden of reconciling the timelines of disease, daily life, and institutions fell on patients and families. Some patients spent their limited energy working to keep the insurance that covered their treatment. Others drew on wealth and connections to pursue experimental options, enlisted help to manage paperwork, and traveled for care or valued experiences before life’s end. Ultimately, turning wealth and social connections into more time was still conditioned on an effective treatment being available while patients were still well enough to receive it. The irony was that attempts to extend life, a goal for most patients, sometimes meant more time on institutional schedules, eroding the time with family and valued experiences people sought to extend.
In most cases, illness also unsettled the futures people had imagined and forced confrontations with mortality. The effects reached beyond the patient into families, care partners, and clinics. Yet a future worth planning remained a source of meaning for many, even if they would not be in it. One mother joined a clinical trial with her daughters in mind: “I’m not thinking about it [for] me … I would want to know what are the best options for my girls.”
What could ease the time pressures serious illness creates and exacerbates?
Even when medicine cannot extend life, hospitals, insurers, and policymakers might give people back some of their time: schedules that fit patients’ lives, help with coordinating burdensome care across fragmented systems, and relief from work as a prerequisite for medicine.
We are grateful to the people who gave us their most precious time. We hope this work helps make their challenges visible, and easier to address.
Article:
Li, Zhuofan, Daniel Dohan, and Corey M. Abramson. 2026. “Temporal Misalignment and Unequal Agency: What Terminal Cancer Patients Teach Us about Time and Inequality.” American Sociological Review 91(4):545–571. Open access (featured, lead article, Aug).
https://doi.org/10.1177/00031224261448220