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Friday, June 1

Oncology Social Work: Serving People with Cancer and Their Families Worldwide

The Evolution of Oncology Social Work 

Oncology social work is the practice of our profession within the medical community—specifically with those affected by cancer—and aimed at improving the quality of life. Cancer is now a global epidemic. Men have a one in two chance of developing cancer while women have a one in three chance. There are 12 million cancer survivors living in the United States, and it is estimated that 1,638,910 people will be diagnosed this year (American Cancer Society, 2012). Oncology social work is “designed to promote the patient’s best utilization of the health care system, the optimal development of coping strategies and the mobilization of community resources to support maximum functioning” (Association of Oncology Social Workers, 2001). As the number of those facing cancer has risen, so has the field of oncology social work.

Oncology social work was born out of the specialty practice of medical social work and built on the foundation laid by Ida Cannon and Harriet Bartlett at the turn of the century. The early days of medical social work began at Massachusetts General when Ida Cannon (who was a nurse) identified that treating the medical condition of a patient and not addressing the patient’s social environment was ineffective (Cannon, 1923). Two decades later, as the practice of oncology treatment was evolving, hospitals nationwide identified that social workers were necessary to meet the psychological and environmental needs of cancer patients (Holland, 2004). During the 1970s, oncology social work and meeting the emotional needs of the cancer patient gained momentum as various hospitals and individuals became the first leaders of the psycho-oncology field.

Oncology social workers began to spring up at hospitals throughout the country. Within the field of medical social work, this new sub-specialty of social workers found that the needs of cancer patients were unique, as were the practice skills. Most facilities employed one oncology social worker which led to a phenomenon referred to in the field as “the lone ranger.” As a mode of practicing good self care and attaining continual improvement of clinical skills, oncology social workers began to network with one another. Oncology social work evolved to recognize the importance of continuing education specific to cancer and end-of-life. The field also identified the importance of research to demonstrate the impact of psychosocial interventions to the medical community. Research and significant findings provided the credibility that physicians, nurses, and other health care practitioners require. As in all areas of social work, research is the method in which to continually improve clinical skills and outcomes for those we service.

Practicing Oncology Social Work

The term “cancer” often invokes fear and anxiety, which in turn leads people to ask why anyone would want to do such work. Being surrounded by life and death each day takes a certain set of skills. It also takes a certain type of social worker. The challenges are just are numerous and very real. Positions can be difficult to obtain, not only because a master’s degree in social work is required, but because cancer centers and organizations are looking for experience and clinical certification. This makes it hard to initiate the career, which is compounded by each facility having usually only one oncology social work position. A significant portion of the oncology social work positions lie within the in-patient case management departments of hospitals. Case management and discharge planning carries a high stress level. Given the current trend in health care of holding the discharge planner responsible for getting the patient out of the hospital in the least amount of time, hospital social workers are put in a position which adds stress to the patient’s current situation. Reflective of the economy and most any area of social work practice, an oncology social worker’s caseload can be heavy and overwhelming. In the midst of practicing during the Affordable Care Act era, oncology social workers are challenged with guiding patients and obtaining resources when laws and regulations are changing. There are constant changes in medical advancements which drive constant adaptations by the oncology social worker. External forces such as the economy crisis, changes in Medicaid coverage, practicing in an increasingly litigious society, and servicing patients who are not legal citizens are all current obstacles which need to be overcome. Above all, the biggest challenge facing the field is clinician burnout or compassion fatigue. “Oncology social workers are prime candidates for compassion fatigue, especially when their empathy is not balanced by a flexible approach to the work and the ability to work toward their own goals, not those set by others” (Stearns, Lauria, Hermann & Fogelberg, 1993). Self-care, work-life balance, and peer support are essential to developing a successful oncology social worker. Oncology social workers give a piece of themselves every time they lose a patient, and there are times when coping with their own grief of losing someone who meant something in their lives. Watching individuals suffer can be the hardest part of this work.

While the challenge of such intense work is daunting, the rewards of such a career far exceed any of the downfalls. In working with people who are facing death, one cannot help but be changed and learn quickly what is important in life. A very special patient who was dying once said to me, “You are the only one left in my life who looks at me and really still sees me.” That was the first patient I lost, and I often say that it was the work that changed my life. Doing this work, the oncology social worker has the opportunity to learn the lessons of true forgiveness, love, spirituality, and integrity. The oncology social worker is the individual who facilitates processing Erikson’s ego integrity versus despair. Being part of the process fosters an individual’s growth and beliefs of the world around them. The clinician also receives the gratification of being in the midst of a crisis and being able to tangibly help solve a problem or provide crisis intervention. An oncology social worker can help obtain medications, financial assistance, or help create a safe home environment in addition to a large number of other resources. Oncology social workers may go home at the end of the day with the knowledge that their patient may have relief of pain because of a resource they identified. Helping strengthen a family or a couple who are falling apart creates a feeling of success and fosters a sense of control in a disease which takes so much from so many. When survivors come back to their physicians for follow-up in the years following treatment, the oncology social worker bears witness to the success and triumph that comes with winning the battle. When a child does this, there are few greater feelings. Because the oncology social worker is present through the course of treatment, they get to view people gain back the ability to walk or talk. There are so many powerful moments, such as when a child who stopped walking stands up because of receiving proton therapy treatment; or when an adult can say thank you when a few weeks prior they could not speak; or even when a young adult survivor who underwent chemotherapy comes back to the center to ask about schooling to become a social worker. These moments bring euphoria and pride. These patients at that moment are true survivors, and the social worker played a part in that.

The number one question I have experienced is people asking, “How could you do that work every day?” My response is simple: “How could I do anything but this work?”

REFERENCES

• American Cancer Society. (2012). Cancer Facts & Figures 2012. Retrieved from http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-figures-2012
• AOSW. (2008). Oncology Social Work Tool Box. Washington DC: AOSW.
• Cannon, Ida. (1923). Social Work in Hospitals: Contribution to progressive medicine, Volume 2. New York: Russell Sage Foundation.
• Holland, Jimmie. (2002). History of pyshco-oncology: overcoming attitudinal and conceptual barriers. Psychochosocial Medicine, 64, 207.
• Stearns, N. Lauria, M., Hermann, J., & Foeglberg, P. (1993). Oncology Social Work: A clinician’s guide. Atlanta, GA: The American Cancer Society.

Maureen Brinkman, LCSW, OSW-C, is manager of patient services at Procure Proton Therapy Center in Warrenville, IL, as well as the Illinois representative for the Association of Oncology Social Work (AOSW).