Working through cancer: Economic precarity and the social meaning of survival for parent-survivors in the United States

Abstract

While US cancer survival rates have improved in recent years, the rising incidence of early-onset cancers means cancer is shifting younger, imposing new generational challenges for survivors and their families. This article explores the experience of a cancer diagnosis during one’s re/productive years by analyzing how parents with dependent children maintain a future amid heightened economic precarity (e.g., loss of stable employment, downward mobility, and a degraded public sphere). By linking physical survival with the social conditions necessary for post-treatment quality of life, we develop a more collectivistic notion of survivorship, where parent-survivors’ efforts to stay employed during treatment serve as an extension of family caregiving in austere times. Reflecting on how the lead authors’ own experience of work and cancer emerged in interviews with 12 parent-survivors, we intervene on traditional team science methods, making space for the autoethnographic voices that underlie interpretations of illness.

INTRODUCTION

It was June 2018, and I (V.B.) was seated braless in an ill-fitting hospital gown that smelled of heated plastic. The sterile stench of the examination room and the melancholy emptiness of the beige walls were accented only by a serene nature scene, and an array of foamboard teaching materials displaying stock images of people embracing and exchanging looks of concern and comfort. “Sure, yes, take the job.” An oncologist tells me matter-of-factly. “Anyway, it sounds like you need it, and what better lesson can you teach your students?” “This,” he adds, motioning in my direction, “this is life.” A tenured professor had just announced she was going on sabbatical, and the department was looking for an adjunct to cover her classes. A week before, I had written to the chair at a different institution over an hour away, asking if they needed any instructors to teach Intro again. They had readily accepted. So, there I was, contemplating the “adjuvant therapy” of squeezing a third course at a second institution into my fall calendar, as blocks of “dissertation writing” were whited out, replaced by “treatment.”

I had expected this conversation with the oncologist to go much differently, thoughtfully preparing my rebuttal against what I had imagined would be a resolute “no” to my question of whether or not I should work through cancer treatment. Resting my eyes on his purple paisley bowtie, I tried to fast-forward several months, imagining life as a doctoral candidate, adjunct, and now cancer patient. Or should I say survivor? Testing the weight of this new label, a cascade of thoughts came pouring in about my age, finances, and the future: how could I not work? I took the job. And did anything but allow students to see “life” as defined by my oncologist. I bought a wig identical to my best hair day and readily accepted the outpouring of complements I received on it from strangers around campus. Work was my only chance at survival.

WORKING THROUGH CANCER

What does it mean to live with cancer in a time of precarious employment, growing debt, and a reduced standard of living? In this article, we examine this question by drawing on data collected from interviews with “parent-survivors” in the midwestern United States (US), a term we develop below to describe the dual (and at times dueling) roles of being at once parent and survivor. Part of a larger, multi-institutional study that aimed to conceptualize young people’s caregiving in the context of a parental cancer diagnosis (Njelesani et al., 2023), the survivor interviews analyzed for this study were designed to elicit survivors’ perceptions of their children’s care during treatment. Often circling back to their own efforts to maintain normalcy in their households, work emerged as a central theme—whether to highlight their ability to endure maintaining employment through treatment, or to express concern about what not working could mean for their family’s future. Given the rising incidence of early-onset cancers globally (Sung et al., 2019), and the increasing number of people who will age with a history of cancer (Hannum, 2017), we attend to the subtle yet significant ways in which parent-survivors frame cancer as something that happens to families—illustrating survival as a collective, social effort rather than an individual experience.

We preface our study with a vignette drawn from the lead author’s experience of being precariously employed as a contingent faculty member during her cancer treatment, which serves as a necessary framework for interpreting our data. Drawing from the tradition of autoethnography (Ettorre, 2005; Wikan, 2000; Zola, 2003), we position her experience of working through cancer as a foundational layer in this study’s design, intended to augment the interactions between authors, participants, and readers. In doing so, we offer a methodological intervention for autoethnography in team science, foregrounding how the tensions, conflicts, and resolutions that anthropologists tease out of the lives of others often reflect the same struggles and syncopated rhythms of our own life trajectories (Herzfeld, 1987). Thus, in telling one of our own illness stories, we show how other parallel stories emerge—where survivorship is “not just the topic, [but] the condition of telling that story” (Frank, 1995, 2). For our purposes here, this story centers around the reconfiguration of cancer survivorship from a social responsibility to an individual one, where survivors are increasingly tasked with discerning for themselves the correct level of self-investment needed to create environments conducive to both immediate and long-term survival. Compounded by the responsibility of parenthood, where one’s primary role is not only to live, but also to give life through the provision of physical, emotional, and material security—a role that cancer directly threatens to impede and transform—we argue for increased attention to a system that refuses to value life outside of productivity, where traits like resilience, grit, and self-reliance are lauded as moral responses to the state’s reduced role in social provisioning.

In this article, we examine experiences of cancer diagnosis in the midst of one’s re/productive years, a period of life typically structured by normative expectations around age, household, career, and life stage. As both cancer and austerity destabilize temporal and social orientations—radically reconfiguring how individuals imagine their futures (Frank, 1995; Jain, 2007; Narotzky, 2021; Stoller, 2004)—we explore how the obligation to “work through cancer” is becoming a defining reality for an increasing number of younger adults. We argue that this approach must be grounded in an analysis of the broader context of precarious employment and austerity policies that have defunded welfare and facilitated the global expansion of neoliberal market logics in healthcare (e.g., emphasis on individual “choice” and individual responsibility for illness), as these same structural forces—prevalent not only in the United States but increasingly visible in other national contexts—shape the scaffolding on which cancer survivors are compelled to craft their families’ future lives. However, such an approach must also attend to the everyday work of survival: the various forms of labor that survivors and their families undertake to ensure economic and emotional continuity. While “working through cancer” partly refers to the growing expectation that patients remain employed during treatment (Lawless, 2009), we also use the phrase to encompass a broader range of unpaid care work that families assume to mitigate the burden of illness. This includes the “invisible work” of navigating bureaucratic healthcare systems (Daniels, 1987; Valentine et al., 2023), as well as the active, therapeutic process of “working through” the trauma and grief of diagnosis (Arteaga Pérez, 2022; Skowronski et al., 2019). Beyond universal truisms about the need to provide for one’s children, we argue that it is critical to situate survivors’ experiences within a specific historical moment, one in which ethical commitments to “give life” to one’s family—to provide, protect, and plan for the future—coexist with, and often compensate for, the structural withdrawal of state social supports. We suggest that getting to the heart of austerity policies is essential for understanding how families living with parental cancer work toward survival.

WHEN CANCER BECOMES CHRONIC

More than 50 years after US President Nixon declared a “war on cancer,” the rhetoric of swift victory and a definitive “cure” has given way to a more nuanced understanding of cancer etiology. Beyond concerns regarding the appropriateness of war metaphors in cancer discourse (e.g., “beating cancer,” “losing battles”), alternatives such as “living with cancer” signal a broader shift in the temporality of cancer in the United States, reframing it from an acute to chronic condition. Indeed, since 1991, US cancer mortality—the primary metric of progress—has declined by 33%, increasing the number of survivors from roughly 3 million in the 1970s to over 18 million in 2022 (Miller et al., 2022; Siegel et al., 2024). While undoubtedly a welcome improvement, these trends are tempered by rising incidence in 6 of the 10 most common cancers, especially among younger populations experiencing a surge in early-onset cancers (< 50 years old) that signal a demographic shift to middle-aged adults (Ugai et al., 2022). Forecasted as an “early-onset cancer epidemic,” rates in this group are expected to increase by around 30% between 2019 and 2030 (Zhao et al., 2023), posing new generational challenges for the projected life course of middle-aged adults (e.g., amputations, cardiotoxicity, economic concerns, infertility, and second primary malignancies). Moreover, early-onset cancers are often diagnosed at more advanced stages and treated with more intensive or prolonged regimens (e.g., long-term hormonal therapy), increasing the likelihood of treatment-related sequelae such as sexual dysfunction and fertility loss (Lavafian et al., 2023), cognitive impairment (John et al., 2016), and heightened psychosocial burden (Hamilton et al., 2022). These extended therapies also increase treatment costs, imposing heightened financial strain on middle-aged adults already saddled with higher levels of household debt than preceding generations, who have, likewise, had less time to achieve stable employment (Gruijters et al., 2023; Landwehr et al., 2016).

As more individuals confront cancer prior to or in the midst of milestones associated with US adulthood (e.g., completing education, advancing careers, starting families, or seeing children graduate), greater attention to age, generation, and life stage at diagnosis is essential to understanding how this group navigates illness alongside competing life demands. Prior literature on the life stage–specific challenges of early-onset cancer identifies concealment as a strategy for preserving normalcy and minimizing visible signs of illness (Atkin & Ahmad, 2001). This includes selectively sharing only positive experiences (Hauken et al., 2019) or using humor to deflect questions (Rabin, 2019). Among parents, concealment is also interpreted as a way to protect children by maintaining continuity amid the disruption of illness (Bruce et al., 2020).

Since the early 1980s, Michael Bury’s concept of “biographical disruption” (1982) has served as a primary entry point for theorizing how illness upends the taken-for-granted structures of everyday life, disrupting one’s previous sense of being in the world and prompting a re-evaluation of one’s life story. While Bury focused on the singular event of diagnosis, Becker (1997) extended this framework by highlighting the ongoing social disruptions caused by chronic illness, such as loss of work roles and strained family dynamics. Here, we intervene on these theories of disruption by asking how the presence of children in the household alters the meaning of survivorship in an era marked by the loss of secure employment, generational downward mobility, and a degraded public sphere, showing how, for some, maintaining employment becomes a way to forestall disruption not only to their own lives but crucially to their family’s lives. This emphasis on familial continuity complicates dominant survivorship narratives that foreground a neoliberal ethos of individual transformation and biomedical triumph (King, 2006), redirecting analytical attention toward the structural conditions shaping how people ensure survival—for themselves, their children, and their families.

Since the early 2000s, anthropologists have explored cancer survivorship as a form of biosociality (Rabinow, 1996; Rose, 2006), highlighting biomedicine’s discursive authority and the role of corporate partnerships in shaping dominant meanings of survivorship (e.g., positive thinking) both in the United States and increasingly around the world (Bell 2014; Dyer, 2015; Klawiter, 2008). Throughout much of this work, analytical attention centers around individuals’ illness experiences, often overlooking the role of the family (cf. Chileshe et al., 2022; Hunleth, 2017; Hunleth et al., 2022) or, crucially, the manner in which “living as a family” gives rise to an illness context in which meanings become co-produced between parents and children (Årestedt et al., 2014; Newman, 2008).

Attending to illness within the context of the family also highlights how economic, temporal, and institutional structures shape not only the extension of life after cancer but also how it is “lived” as a social activity (Wahlberg, 2009). Such theorization has shown how innovations in biomedical technologies have led to the emergence of “new chronicities,” measured not only by the duration, or quantity, of life, but also the quality, or kinds of lives people can expect to lead post-treatment (Greco & Graber, 2022; Smith-Morris, 2010), where social marginalization and economic precarity shape both the likelihood of developing cancer and the stage at which individuals present for treatment (Bennett et al., 2023). For example, in the wake of Colombia’s neoliberal health reforms, Sanz (2017) described how delays between clinical recommendations and insurance approvals create “arrhythmic” care for low-income patients, desynchronizing the timing of treatment from recommended oncology protocols. Similarly, Tousignant’s (2023) study of liver cancer in rural Senegal—an acutely fatal condition primarily affecting young people in this region—revealed how limited access to treatment and palliative opiates places a profound emotional and ethical burden on the nurses charged with caring for these adults “in [their] prime” (2023, 139).

Other work on the temporalities of cancer has revealed the dissonance between dominant discourses of “hope”—a mode of anticipatory optimism culturally infused by the “progressive efficacy of biotechnical interventions” (DelVecchio Good et al., 1990, 59)—and the stark inequalities that constrain access to healthcare and wellness outcomes across both low- and high-income countries (McMullin, 2016). For instance, in the United States, adherence to the paradigm of “early detection” orients individuals to a system of temporal discipline in which risk management takes shape in 24/7 body vigilance to ward off future occurrence, or retrospective accountability for past behaviors (e.g., smoking). Within this framework, deviation from timely intervention (e.g., late-stage presentation) may be framed as individual failure, obscuring broader causation rooted in political economy and environment (Greenwald, 1992; Jain, 2013; Tousignant, 2023). Such omissions are particularly salient in market-based healthcare systems like the United States, where the right to medical care is increasingly disassociated from other forms of social support required to maintain health and well-being (Kotobi & Sargent, 2023), and where for-profit models dictate when (and for whom) care is delivered (Rylko-Bauer & Farmer, 2002).

A growing literature on financial toxicity in cancer care has examined the long-term economic impacts of diagnosis, especially for younger survivors with less time to establish careers, build financial assets, or start families (Ghazal et al., 2021). Previous work has shown how privatized healthcare systems shift the burden of “patient work” onto households, a dynamic made visible in the rise of crowdfunding platforms in the United States, where access to care increasingly depends on a survivor’s ability to perform culturally sanctioned cancer affects, while obscuring the structural injustices underpinning a free-market system (Do et al., 2024; Lincoln & Kramer, 2024; Paulus & Roberts, 2018).

These structural and temporal inequities are not only evident in care access but are also embedded in the very systems that classify and define cancer populations. Epidemiological categories often fail to account for shifting perceptions of age and life stage, particularly among middle-aged survivors. For example, the standard adolescent and young adult (AYA) classification groups together individuals diagnosed between ages 15 and 39 (NCI, 2015), collapsing important differences around family life between teenagers and those approaching perimenopause. Compounding these tenuous comparisons, early-onset cancer is defined as a diagnosis between the ages of 18 and 49 (NCI, 2025), leaving definitional ambiguity around people in their 40s considered too old to qualify as AYA, yet too young to pass the threshold for “average-onset” (age 50+). Is someone diagnosed with cancer at 43 considered “young”? It depends on who you ask, or perhaps more appropriately, when you ask this question. Writing about transformations in aging she observed in the late 1970s, Bernice Neugarten (1979) theorized how often in times of intense social change, expectations around the normative timing of life milestones (e.g., education, marriage, parenthood, homeownership) are reshaped, disrupting the assumed rhythm of the life course. Citing unprecedented changes in both biological time (e.g., earlier onset of puberty; longer life expectancy) and social time (e.g., lengthening of education; delayed fertility), she described the emergence of an “age-irrelevant society,” in which asynchronicity across life stages fueled social uncertainty, particularly for middle-aged people struggling to decide the timing of their lives.

Arguably, the ideological and material transformations Neugarten observed nearly 50 years ago have increased, leading to a greater sense of social insecurity, consolidated over several decades of ascendant neoliberalism in which time—that vital raw material from which we produce our everyday lives—is increasingly viewed as a resource to be managed and exchanged (Adam & Groves, 2007). In this context, a cancer diagnosis emerges not only as a personal or medical event but also as a socially embedded condition shaped as much by advances in new cancer therapies as by the speculative logics of biocapital and flexible accumulation (Harvey, 1989; Rajan, 2006). Responding to the retrenchment of state welfare, researchers have drawn upon the concept of precarity to show how capital’s strategic deployment of short-term contracts and labor insecurity eroded the collective voice of labor toward the creation of a more docile and disposable workforce (Standing, 2011). With the implementation of austerity, responsibility for well-being has shifted from social institutions to individual households, forcing societies that once enjoyed higher standards of consumption to contend with stagnant wages, declining living conditions, the erosion of the family wage in favor of dual-earner households, and the intensification of the second shift, as the family becomes the primary shock absorber of social insecurity (Ezquerra, 2014; Fraser, 2009). Below we explore the ways in which economic precarity stimulates a more familial, collectivist understanding of what it means to survive cancer, where the impact of a cancer diagnosis extends beyond individual disruption. In so doing, we address the reproduction of a healthcare system no less precarious than its institutions of higher education, where people are left few acceptable options, but continue to work.

METHODS

The same year that the lead author (V.B.) was having the above exchange with her oncologist in upstate New York, many of the survivors interviewed for this study were also diagnosed. Now herself a mother of two young children, it was impossible for V.B. to not return to her own “before-after year” (Garro, 1992) when she joined the research team during data analysis and began reading the transcripts, filtering the discussion from her own location as a “dual citizen” in the lands of researcher and subject (Sontag, 2001). These memories—once pushed aside to account for academic productivity and professional survival—reemerged as interpretive resources throughout the analysis, where the tensions of surviving cancer amid financial and academic precarity merged with the other survivor narratives, becoming part of the analytic engine that propelled this study forward.

In this sense, this study is not only about how cancer impacts families, but also how cancer impacts research teams—the patterns they are able to see, the forms of suffering they too have endured—and what it means to produce knowledge collectively from within the conditions that we seek to study. This raises critical methodological questions about how researchers’ own embodied experiences of “morbid living” (Wahlberg, 2018) during times of austerity inform and shape team-based interpretation—and their implications for an emergent social medicine that has only just begun to be written by a generation of scholars whose lives have been defined by the new enclosures of structural adjustment, debt, and loss of social provisioning (Federici, 2018).

The survivor narratives analyzed in this study are drawn from the larger Young Caregivers Study (Njelesani et al., 2023), which explored young people’s caregiving experiences in the context of a parental cancer diagnosis. Detailed study methods have previously been reported (Njelesani et al., 2025). Briefly, between November 2022 and August 2023, data were collected from 58 participants across three groups: young people under 18 (n = 10), their parent-survivors (n = 12), and allied healthcare providers (n = 34). Survivor participants were recruited through clinical sites, registries, and community networks in St. Louis, Missouri, and were eligible if they had been diagnosed with cancer in the past 5 years, had dependent children, and had experienced financial strain. Eligible survivors’ children were then invited to participate in separate interviews. Most interviews lasted approximately one hour and were conducted via Zoom (n = 9), by phone (n = 2), or in-person (n = 1). Verbal informed consent or assent (< 18) was obtained, and all interviews were audio-recorded, transcribed, and translated as needed, then each participant was assigned a pseudonym. Participants received a $40 gift card. While most interviews were conducted remotely, we sought to foster a conversational, participant-led atmosphere. Interviews were often punctuated by parents attending to children or completing household tasks, with background sounds and interruptions offering insight into the everyday rhythms of lives that, on the surface, had resumed normalcy. The study was approved by the IRBs at New York University and Washington University in St. Louis.

For this analysis, we focused exclusively on the 12 interviews with cancer survivors conducted in English (n = 10) and Spanish (n = 2). The sample included eight women and four men, primarily aged 41–50 (n = 10). Participants were predominantly Black (n = 5) or White (n = 4), with additional representation from Hispanic (n = 2) and Asian (n = 1) survivors. Although most (n = 10) reported being able to make ends meet, two were not, and nearly all reported experiencing financial hardship due to cancer (one participant did not respond). Most were breast cancer survivors (n = 7), though we also spoke with people with a history of leukemia, colorectal, kidney, ovarian, and thyroid cancers. Interviews were conducted by L.K., S.R., and C.G.R. using a semi-structured guide (Groleau et al., 2006) that began with broad illness narratives and then explored specific care activities children provided during treatment (e.g., chores, sibling care, transportation, financial management, emotional support), as well as any unmet expectations for assistance. Interviewers approached conversations with sensitivity to power dynamics, building rapport through empathic listening and flexibility. Transcripts were uploaded to NVivo and analyzed thematically using open coding, with L.K. and S.R. identifying emergent concepts and assigning codes. V.B. then performed second-cycle coding (Saldaña, 2009) and developed a codebook of patterned responses informed by her experiential knowledge. Regular meetings of the research team occurred to evaluate patterns among the narratives and to continue the reflexive process.

PARENT-SURVIVORS

For the parent-survivors we spoke with, survival—that is, life—did not revolve around any individual sense of biographical disruption but rather hinged on their capacity to forestall such disruption and avoid the potentially dire consequences that even a few weeks of lost support could mean for their families. Esmerelda, a single mother working as a janitor in a nursing home, underscored this collective orientation:

“When someone has cancer, they’re not the only ones affected by it—it affects the whole family. So, when you have your children’s support… tell[ing] me everything will be fine… Family unity… that’s what’s most important.”

— Esmerelda, Hispanic, breast cancer at 48, mother of two (ages 12 and 8)

Esmerelda’s emphasis on “family unity” as her central concern during illness suggests a departure from individualized notions of biographical disruption; rather than framing her diagnosis as a biographical disruption, she framed it primarily as a threat to her family’s cohesion, roles, and collective moral strength. As Esmerelda went on to explain, life’s purpose was reciprocal: “to help each other, to be in solidarity. The purpose [of my cancer] is for my children to be more united with me, and me with them.” She did not just survive as an individual; she survived through and with her children.

Similar to Bell and Ristovski-Slijepcevic’s observation that “when mothers are diagnosed with cancer, one of the first questions they ask is about their children” (2011, 632), the parents we spoke with described cancer as something that happened to their families. As a result, their narratives frequently bobbed in and out of grammatical person, weaving their children’s perceptions with their own, reflexively turning our questions about their children’s ways of caring for them back onto themselves and their role as parents. For example, when asked if his children ever helped with his medical care, Darnell responded:

“Yeah, they was around, but they wasn’t—It’s like their dad is superman…I’m always on point. And now it’s… [switching to third person, from his children’s perspective] not that he’s weak, but… he’s sick. [Switching back to first person] I tried to make it less of a burden on my kids. That was my goal… I was also blessed with some strong kids… It was an easy transition for all of us… [switching to plural] We worked together.”

— Darnell, African American, kidney cancer at 30, father of three (ages 12, 1, and 1 month)

In blending his own voice with that of his children, Darnell illustrates a broader pattern we observed across interviews: parents’ self-perceptions (e.g., being “always on point”) were inexorably linked to the image they fought to uphold for their children. This revealed a recurring tension among survivors—between, on the one hand, a proud acknowledgment of the co-production of care, a coming-together that emerged during their illness (i.e., “we worked together”), and on the other, concern that this care might be perceived as dependence, an inversion of parent–child roles that threatened their responsibilities as parents (i.e., being superman). While Darnell would go on to list several medical tasks his children helped him with, his initial thought was to frame their care as simply “being around”—a mundane togetherness that helped him carry on, rather than a form of treatment-related assistance.

Throughout interviews, parent-survivors resisted normative assumptions of care as unidirectional— from parent to child, or conversely, from child to parent, as is commonly associated with illness contexts. Instead, they emphasized that care during cancer was a transition they navigated collectively. When we asked Chesa—a mother of two daughters (ages 20 and 11) diagnosed with breast cancer at 46—whether during appointments providers supported her daughters by addressing their roles in caregiving, she gently corrected us, “Well, actually, [support] is for everybody. Not just for my daughter. My husband was there…It’s for everyone.” She went on to describe her daughters’ care in terms of day-to-day proximity—like Darnell’s reference to his kids “being around”—referring to them as “sympathy-givers” rather than caregivers—a term that, to her, wrongly implied they had disproportionately taken on arduous workloads in the household.

Attending to the subtle but significant ways that survivors pluralized and reframed “life after cancer” to “lives after cancer,” we found that parent-survivors’ survival was deeply entwined with their children’s life trajectories—a relational sense of staying alive for and with their families (Al-Mohammad, 2010). This perspective calls for a shift away from individualistic frameworks that treat cancer as a biographical disruption experienced solely by the patient, toward a more collectivist understanding of survival. As private households increasingly take on responsibilities once managed by the welfare state, such family-level analysis underscores transformations in the moral economy of cancer care, where ethical commitments to “give life” to one’s family—to provide, protect, and plan for the future—coexist with, and often compensate for, the structural withdrawal of state support. We argue that understanding these transformations is critical for understanding what it means to survive cancer today.

A FUTURE WORTH SURVIVING FOR: WORK, LIVELIHOOD, AND THE SOCIAL MEANING OF SURVIVAL

For parent-survivors, conversations about their children’s caregiving often circled back to their own efforts to maintain a livelihood and secure a stable future for their families. When asked if her daughter ever helped out financially, Brooke responded:

“As a parent, that’s the least thing your child should be worrying about—how they gonna take care of your household… During my whole treatment, I worked. Even through radiation, I worked. The only time I was out was the double mastectomy.”

— Brooke, African American, breast cancer at 38, mother of three (ages 19, 15, and 12)

Brooke worked as support staff at the same hospital where she received treatment. She went on to describe how the financial pressures she faced during cancer were intensified by the stark contrast between the corporate value of empathy she was trained to show patients and the relentless collection calls she began receiving even before starting treatment. The dissonance between the idealized notion of “care” Brooke was expected to embody as a healthcare worker and the lack of compassion she encountered as a healthcare “consumer” highlights the limits of institutional cancer care under neoliberal structures that normalize remaining employed through cancer treatment.

Prior anthropological research on the diverse meanings of work in the lives of chronic pain sufferers has shown that contrary to conventional US portrayals of work as amplifying pain, work is often perceived as an analgesic, offering sufferers a vehicle for control over the daily intrusiveness of pain and an arena for conquering personal traumas (DelVecchio Good, 1992). While such observations are useful for outlining how the meaning of work has undergone important generational and class-based changes in American society, “work as a haven from pain” did not fit neatly with many of our participants’ experiences. Tracy, a single mother, outlined this perspective:

“I used to always feel this is such a pity—that I have this cancer and I still have to get up and go to work every day…I should be off. I should not have to work while I’m going through this. My job should still be there when I’m done…Even radiation was done at my job. I would go to radiation on my lunch break. Then go back to work.”

— Tracy, African American, breast cancer at 44, mother of two children (ages 22 and 11)

While clearly resentful of having to work, time off was not mentioned as a viable option, resulting in permanent job loss. In response, work took precedence, and treatment was squeezed into the margins of non-working life. This framing was echoed by other parent-survivors, who cited the rising cost of living, unbudgeted co-pays, and the financial demands of raising teenagers as material reasons for their continued employment. As Tracy further reflected:

I wish there were programs where it was financial help…send a letter to your mortgage or utility companies…the world doesn’t recognize cancer. Cancer is a very serious thing. People die from it all the time. To me it seems like when you’re going through it, especially when you’re over it, you’re fighting to stay alive.ʼʼ

Tracy’s reference to “the world” of abstract financial institutions can be read as an appeal to view financial relief as part of cancer care. By starkly invoking the severity of diagnosis and the possibility of death, she conveys an ambiguous survival—not just the fight to preserve life, but the ongoing struggle to maintain one’s place within it—an act of staying alive.

When asked what forms of assistance made life easier for their families during treatment, parents struggled to identify any, instead expressing the need for more governmental programs to help with daily living expenses. However, those making such requests often distanced themselves from associations of welfare, reflecting varying views on the legitimacy of public assistance. Warren, who reported being unable to make ends meet and being turned away from work opportunities because of his colostomy bag, expressed it as follows:

“If they had a program that helped people pay rent—I ain’t sayin’ they have to pay it all—but when they know a person has problems standing all day…[cancer] ain’t something I did to myself. It just happened.”

— Warren, African American, colon cancer at 45, father of three children (ages 19, 9, 9)

Warren’s call for rental assistance was immediately tempered to avoid being perceived as asking for too much. Returning back to his original idea, he outlined the legitimacy of financial support for cancer patients, clarifying that, in contrast with the situations of healthy people who used public assistance, cancer was not self-inflicted. Other parent-survivors voiced similar perspectives on financial assistance during cancer. Brooke, described above, posed it as: “Maybe, a biweekly check?…like people that’s on welfare, but—don’t call it ‘welfare’ for people [with] cancer.” Moments later, she returned to this theme:

“So—I’m one of these people—I work hard to get to where I am in life…Susan Komen—they only want to help low-income people…People in middle-class…why should these foundations not help everybody? As times change, a person could go from making all this money [to] not…because now they got to…pay their medical bills?”

Fearing a lapse in her employer-provided health insurance, Brooke took only 2 weeks off during treatment. To offset costs, she contacted several major cancer nonprofits but was denied assistance because she earned just above the income threshold. Frustrated by the means-testing used to define need, her comment on “changing times” echoed other parent-survivors’ feelings of institutional abandonment—despite working hard to attain a middle-class life, poverty remained only a few medical bills away.

WORK AS CARE

Across the interviews, practices of remaining employed throughout treatment were often framed as a kind of moral strength, a personal fortitude in which work became an outlet for maintaining normalcy and continuity within their households. Parent-survivors’ desire to shield their families from the full weight of their illness led to practices of containment (Greco, 2023) in which survivors sought to downplay their symptoms, adopting hardened qualities of resilience, toughness, and stoicism. In this framing, maintaining paid employment was not described as extraordinary, but simply living up to the basic responsibilities of parenthood.

For Esmerelda, described above, this meant returning to her physically demanding job cleaning rooms in a nursing home after only a few weeks off:

“I am a single mom. I have my children, and I work for them, and for me…I have to help my kids make it through life and aside from that, fight against a sickness, fight to overcome it. The strength I have comes from my kids, they’re not so small anymore, but they still need me.”

By collapsing the boundary between her waged work and care obligations, Esmerelda situated work not just as an income-generating activity, but as a form of caregiving in and of itself, where paid labor was not distinct from mothering—it was mothering. Framing her decision to work during treatment as “for them” illustrates how parent-survivors navigated cancer in the midst of parenthood—for them, continuing to work was an act of care. Feminist scholarship has long theorized the role of social reproduction in the creation of value, showing how caregiving serves as the necessary precondition for all other forms of economic production and human survival (Federici, 2004). Nancy Fraser (2016) has further outlined how capitalist societies institutionalize women’s subordination by relegating socially necessary reproductive labor—that is, the care and human labor that sustain our bodies and constitute us as social beings—to the domestic sphere, where its social importance is naturalized into the non-economic coinage of love, virtue, and familial obligation. Less scholarship has explored the reversal of this framing, where waged work in the context of illness functioned as an extension of care.

Across the interviews, parent-survivors expressed love and obligation to their families by showing they could tolerate their illness through continued work. This was evident in the short, no-nonsense responses of Mike, a 47-year-old White father of three who was undergoing treatment for colon cancer, and whose resolute insistence that his adolescent daughters remain unburdened led him to withhold his diagnosis from them. Subliminally speaking as if to his daughters—who were not present during the interview—he explained: “This is on dad,” before returning back to the interviewer to confirm, “This isn’t on them.” Similarly for Darnell, described above, the imperative to work was not solely tied to parenthood, but also to being a man and to his sense of responsibility to live up to a multigenerational expectation of fortitude through illness that his aunt modeled for him when she went through cancer:

“My aunty was in [my] same position. I didn’t know she was on dialysis. She was so healthy. I never knew until she got older. I stayed with her 70 percent of my life…the whole time she was gettin’ up, goin’ to work, doin’ everything. I never knew…I’m like, man, my aunty can do it. She was a 34-year-old woman. I was a 30-year-old man. I have to be strong. I have to have the same strength she had, if not more…I used to get mad at people when [they asked], “You tired?” I used to flip out: ‘Tired?! I’m not tired!’ I was motivated to keep going, a ‘don’t stop’ mentality…brought on, too, by my kids.”

For Darnell, his aunt’s ability to silently endure set a lasting precedent for how their family navigated cancer. Unaware she had been on dialysis until adulthood, he sought to live up to her legacy of strength—especially as a younger man. Quick to shut down any suggestion of weakness, his determination to be strong was rooted in a desire to match his auntie’s quiet endurance. Like Esmerelda, Darnell cites his motivation and ability to endure as for his children, revealing later in the conversation that he also never discussed cancer with his children, “I just kinda wanted to shelter everybody.” Brooke likewise described protecting her family by controlling who knew about her illness:

“During my whole cancer treatment, I worked. Even through radiation. I worked…you wouldn’t [have known] that I went through chemo if I wouldn’t have told you. I only missed two days…I drove myself to appointments. I sat there by myself…no need to overwhelm people.”

Brooke’s insistence on handling work and appointments alone gave her relief in not overwhelming her family. For parent-survivors, working through cancer was less about extraordinary resilience and more about reaffirming and reciprocating care—shielding their children, as best they could, from the material and emotional impacts of the diagnosis, quietly and on their own terms.

CONCLUSION

In our conversations with parent-survivors in St. Louis, economic precarity was not experienced as a backdrop, but as a determining factor in how illness was managed and ultimately survived. When asked to reflect on how their children supported them through treatment, parent-survivors repeatedly returned to their own roles as providers, adopting attitudes of fortitude meant to shield their family from the impact of their diagnosis. Such strategies echo the practices of “biographic containment” that Cinzia Greco (2023) observed among working-class women in southern Italy who minimized their cancer diagnoses to juggle other problems in their families’ lives. For the parents in our study, working through treatment was similarly framed—not as exceptional but as the least one could do while raising children in a context of failing institutions, where even minimal forms of social support are meanstested, designed for only the most desperate.

Cast in this light, employment through cancer treatment can be understood within a broader moral economy of care, in which the capacity to contain one’s suffering while continuing to provide signals not only familial love, but social legitimacy as both parent and survivor. In the US, these moral imperatives are reinforced by a political economy that links families’ healthcare access to a parent’s full-time employment and promotes waged labor as a primary measure of productivity and social worth. The same cultural ethos that upholds individual responsibility for financial risk management (e.g., saving for retirement, purchasing supplemental cancer insurance) also shapes the therapeutic environment. In this setting, survivors are tasked with ensuring not only their own post-treatment quality of life, but also the ongoing stability and well-being of their children—demonstrating how the clinical terrain of oncology is shaped as much by social, economic, and political forces as by the biology of disease (Livingston, 2012). For the parent-survivors in our study, the decision to work through cancer was rooted in a familial, collectivist understanding of illness that reflected an acute awareness of cancer’s impact beyond their individual biographies.

As the likelihood of confronting cancer during the child-rearing years continues to increase, we argue for greater attention to how age, austerity, and re/productive responsibilities inform treatment decisions and future-planning strategies. Across this study, we have shown that the burden of survival is not borne by survivors alone, but extends to families and, ultimately, to all of us—each implicated in systems that hold individuals responsible for structural failures. These same systems—that valorize squeezing radiation into lunch breaks and scheduling chemotherapy for non-teaching days—have cast an ever-greater number of us into a pool of contingency, expected to model resilience within institutions that systematically withhold care. In the neoliberal university, as in other domains that rely on flexibilized labor, the abdication of institutional responsibility shifts the burden of risk onto precarious individuals, forcing those facing life-threatening illness to fight not only for their lives, but also for their futures. For many precarious academics, those futures include families deferred in anticipation of a stability that remains elusive.

Forced to confront cancer without the protections of permanent labor contracts, paid leave, or any guarantee of post-treatment return to work, our bodies become sites of knowledge—of illness and austerity—that cannot help but imprint themselves upon our studies, shaping the questions we ask, the solidarities we build, and yes—returning to the oncologist’s question posed in our opening vignette—the lessons we teach. By asking what social conditions make continued employment during cancer treatment both necessary and normal, we show how work translates into an expression of care, a means through which those living with cancer protect their family’s future, and place within it. In doing so, we foreground the shared conditions of precarity across different domains—healthcare, family, labor, academia—and argue for a rethinking of survivorship as a collective, rather than individual, endeavor.