In oncology units around the world, patients are invited to ring a bell when they complete cancer treatments. This ceremonial chime may be accompanied by balloons, tutus, and cheers to signal relief, triumph, and closure. But as cancer care evolves, so does the understanding of what this bell ritual means, who it serves, and its unintended toll.

The bell tradition began in 1996 at MD Anderson Cancer Center in Houston, Texas, adapted from a naval tradition by Admiral Irve Le Moyne, who rang a brass bell after completing radiation treatment for his cancer. From there, cancer centers nationwide began installing bells as a way for patients to mark the end of radiation or chemotherapy.

The experience of diagnosis and treatment can strain and exhaust individuals and families. As a right of passage (Van Gannep, 1909/1960), the bell becomes a symbol to mark the transition from one social status (beginning treatment) to another (completion). A shared ritual, like the bell, is intended to unite survivors and their caregivers in celebration, and provide hope for others still in treatment. The cancer bell provides a structural means for recognition, and often, emotional release. But like any ritual, when narrowly defined or restrictive to a particular group or focus, it can also isolate.

In many cancer treatment centers, the bell is a prominent fixture. The question becomes, “Does it bring hope or ring in further despair?”

Healthcare providers and staff now recognize potential downsides of the bell. For some patients, the traditional definition of treatment "completion" may be unattainable. This inadvertently draws a line between those who get to ring it and those who don’t. Patients with metastatic cancer, on lifelong medication, or managing late-stage disease, could........

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