Cancer and Social Work

The word cancer is fraught with meaning for each person diagnosed with cancer, their loved ones, and their caregivers. Although heart disease is the major cause of death in the United States, the public perception of cancer includes death, fear, stigma, lingering suffering and pain, loss of control, helplessness, and economic ruin. Many people in the United States have limited or no health insurance. This fact compounds access to early detection and treatment of cancer.

Progress in the Treatment of Cancer

Scientific advances in cancer treatments coupled with earlier detection have led to increases in survival rates. With the advent of targeted treatments and precision medicine, healthcare teams can now select treatments tailored to the individual patient’s cancer. Innovations in side effect management have made it possible for some persons with cancer to live active lives while receiving cancer treatments, some of which can be delivered in the outpatient setting, thus reducing time away from family, friends, and work. For example, some cancer patients take pills to treat their cancer and see their oncologist for follow-up appointments. Adherence, or taking one’s pills on schedule, is an important part of cancer treatment.

Management of pain related to cancer or its treatment is vital to quality of life and requires a multidisciplinary team of experts in palliative medicine. The goal is to provide pain management throughout the cancer experience, including end-of-life and hospice care.

The Cancer Patient Population

A diagnosis of cancer is a life crisis for the person living with cancer and his or her family members, partners, friends, and coworkers. Fear, sadness, anger, uncertainty, and isolation are common emotions. Some patients may experience a collapse of their social network, with friends, family, and colleagues not knowing what to say or do. The hallmarks of the cancer experience include feelings of vulnerability and uncertainty, coupled with fear of recurrent disease. Many patients and family members report the sense of being on a roller coaster while living with cancer. However, there are numerous anecdotal examples in which patients and cancer survivors report that the cancer experience provided an opportunity for personal growth or career change.

People living with cancer may have visible, as well as invisible, scars. The site or location of the cancer can compound the individual’s response. Although well people believe that they are going to live “a long time into the future,” cancer patients are forced “to confront their own mortality.”¹

From the point of diagnosis, patients and their families are beset with a variety of treatment choices. There is a need to get credible information quickly. There are many opportunities for psychosocial interventions and services to assist patients and families as they encounter the challenges of living with cancer. Social workers play a key role by providing practical help, counseling, resource information, educational workshops, and support groups, and finding sources of financial assistance. All of these services can help people cope with cancer.

Social Work’s Contribution to People Living with Cancer

The recognition that social workers could contribute to the care of the medically ill occurred in the early 20th century. These medical social workers usually worked in hospital settings, with the goal of helping patients and families make social and emotional adjustments to illness. They also assisted with practical issues, including financial problems, transportation, and planning for post- hospital care, and worked with policy-makers to advocate for the specific needs of the medically ill.²

In the mid-1970s, with the increase in cancer hospitals and oncology centers within medical settings focusing on the treatment, care, and cure of cancer, oncology social work emerged as a subspecialty of medical social work. Its goals are very much in keeping with those of medical social workers, except that the focus and arena of practice are dedicated to social work services specific to cancer patients.

The Association of Oncology Social Work (AOSW) is a nonprofit, international organization dedicated to the enhancement of psychosocial services for people with cancer and their families.³ Created in 1984 by social workers interested in oncology and by existing national cancer organizations, it has more than 1200 current members. These members embrace the AOSW mission “to advance excellence in the psychosocial care of persons with cancer, their families, and caregivers through networking, education, advocacy, research, and resource development.”

Psychosocial Oncology

Oncology social work includes a wide scope of clinical practice, education, research, policy, and program leadership in the psychosocial care of people with cancer and their families. Oxford University Press recently published a book specifically focusing on oncology social work and its role in the psychosocial care of people with cancer, the Handbook of Oncology Social Work: Psychosocial Care for People with Cancer, edited by Grace Christ, Carolyn Messner, and Lynn Behar.⁴ With 160 contributors and 108 chapters divided thematically into 19 sections, this handbook equips the reader with all that is known today in oncology social work. It deals with patient- and family-centered care, distress screening, genetics, survivorship, care coordination, sociocultural and economic diversity, legal and ethical matters, clinical work with adults living with cancer, cancer across the life span, caregivers and families, pediatrics, loss and grief, professional career development, leadership, and innovation.

References

1. Mullan F. Vital Signs: A Young Doctor’s Struggle with Cancer. New York, NY: Farrar Straus & Giroux; 1982.
2. Lauria MM, Clark EJ, Hermann JF, Stearns NM. Social Work in Oncology: Supporting Survivors, Families, and Caregivers. Atlanta, GA: American Cancer Society; 2001.
3. Association of Oncology Social Work. www.aosw.org/. Accessed January 4, 2016.
4. Christ G, Messner C, Behar L, eds. Handbook of Oncology Social Work: Psychosocial Care for People with Cancer. New York, NY: Oxford University Press; 2015.

 

Dr Messner is a Director of Education and Training, CancerCare; Fellow, American Psychosocial Oncology Society; Fellow, New York Academy of Medicine; and Former President, Association of Oncology Social Work.