Explicating The Valuable Role of Clinical Social Work in Oncology

The integral role of the clinical social worker is essential for a truly multidisciplinary approach in oncology, moving the focus beyond disease-centric treatment to protecting the patient’s complete emotional and psychological well-being.

In an interview with CancerNetwork® at Mary’s Place by the Sea, Kelly Dyckman, MSW, LCSW, a licensed clinical social worker at Navesink Wellness Center, spoke about her role within the oncology treatment landscape. Touching upon the impact of treatment plans, surgeries, and the reality of a cancer diagnosis on a patient’s emotional well-being, she outlined her responsibility in monitoring the functional impact of treatment on the patient’s day-to-day life at home. Without this input, a medical oncologist team may miss crucial cues, such as anxiety spikes before chemotherapy, that may warrant a session or even psychotropic medication.

Furthermore, Dyckman highlighted that the current practice of providing information is often reactive. She argued that for challenging issues like body image changes, sexual health concerns, or changes to identity post-treatment, proactive counseling is far more effective. Finally, she emphasized the impact of effective communication both within the care team and for families. Dyckman asserted that listening to understand, not reply, is paramount for patients undergoing treatment, and she encouraged physicians to ask patients clarifying questions to reach alignment.

How does the role of a clinical social worker integrate with the multidisciplinary teams in an oncology setting?

Being a clinical social worker can be valuable in a care team and a medical team. I am primarily focused on [a patient’s] emotional well-being, and there’s also considerations as to how emotional well-being influences physical health, relationships, [and more]. To have a clinical social work assessment on the patient and the patient’s well-being is important. When we are talking about cancer, in particular, it’s impossible not to consider the implications of treatment, surgeries, and all the different aspects that cancer can have on that person’s individual well-being.

Obviously, the doctor is focused on addressing [and] treating the cancer and doing the best they can to resolve the cancer situation. My responsibility is to consider how that treatment plan is impacting that [patient] emotionally, psychologically, relationally, and what that looks like in their day-to-day life from a functionality perspective. Without that input, the doctor and nurses may be missing crucial cues as to what’s working and what’s not working.

In the past, when I have worked with people in a treatment setting, considering how they are responding to chemotherapy from a physical standpoint, what that looks like emotionally, and what that looks like relationally––how is the patient functioning at home? What does that look like post-treatment? What does that look like pre-treatment? If the doctor and nurse team do not have that information, there may be steps they can offer to support that patient, to assist them in navigating it more effectively.

If anxiety spikes before chemotherapy, [a patient] may need a session with me, or somebody may benefit from psychotropic medication in support of navigating the treatment process. If a caretaker is having a difficult time, resulting in guilt and anxiety by the patient, being able to support that family member and give them additional support resources can alleviate some of the additional stress and anxiety that may have implications for the physical health and well-being of that patient. If we do not have eyes on the human being, we can lose a lot in translation.

What are some effective ways to support patients who are struggling with body image changes, sexual health concerns, or changes to their identity after cancer treatment?

Based on the feedback that I get from many patients, a lot of information is reactive, not proactive. What does that look like for a patient who has surgery, [who is] post-surgery, if they are presented with information that X, Y, or Z may happen? [Patients] may experience body dysmorphia. [Patients] may experience more anxiety after surgery. [They may feel like they are] already hijacked by the fact that they had surgery, so their ability to process and retain that information is going to be compromised. As a result, while the information being presented is valuable, it’s not going to be retained the same way. Many times, providers do not necessarily shy away from offering more information, but if it does not seem like a necessity, they do not necessarily want to do it, whereas the feedback I get from patients is that having this information would have helped a lot.

I happen to be a mom, and I think about my 2 kids, and had my OBGYN not said, “Hey, 2 weeks postpartum, your emotions are going to be all over the place,” I probably would have felt lost, out of control, or like something was urgently wrong. Had she not been proactive, I would have had a hard time navigating those considerations. Because she was proactive in what she relayed to me about the normalcy of my experience, that helped me out a lot. It did not change the emotional implications I was experiencing at the time, [but] it did help me validate and normalize what was going on and know the temporality of it.

When I think about the cancer piece, physicians have a wealth of information to offer, but patients tend to experience that reactively, not proactively. Proactively, it can be more of a conversation and more of a collaboration, whereas reactive can feel almost discouraging to the [patient], almost because there’s so much overload that’s happening at the time. It can sometimes be a disservice to go about it that way.

I get it. We do not want to overwhelm patients. We do not want to overwhelm families. At the same time, if there is no normalization or presentation of the possibility of these different things happening, then we may miss those opportunities to get ahead of an issue even before it arises.

What are common communication breakdowns or relationship stressors that arise within a family after a cancer diagnosis, and how do you help families navigate these issues?

Most people listen with the intention to reply, not understand. In the medical world, in particular, this is a major issue. When the patient [or] a family member is hearing information from the oncologist, they are so preoccupied by asking their next question that they may be missing what the physician is actually saying. Many times, it can be beneficial for the physician to slow the conversation down and get a handle on what patients and family members are hearing by asking that question, “What are you hearing me say? What are you understanding?” It’s an opportunity for that medical team to then clarify what is actually happening vs what the person is retaining in that moment based on what they are anxious about, what they are concerned about, [or] what [adverse] effects they were experiencing that week.

There can often be a disconnect in what actually happens in medical appointments. Having been in some of those medical appointments firsthand, I can see it happen immediately. I know that somebody’s brain is floating to: “What’s that going to mean for my hair? What’s that going to mean for my job? What’s that going to mean for my kids?” Instead of actually hearing the physician all the way through, emotions are inevitable in presenting barriers for communication, and if we do not acknowledge the role emotions can have in creating those barriers, that presents a huge challenge. Whether that’s the utilization of social work on the medical team for patients [or] for family members, to work through their understanding, to process that information, or change the style of communication actively in those medical treatment appointments—those are 2 good options.

I also [emphasize] linking families to their own supports. “How?” Because a family member is the second set of ears in that medical appointment. We are trusting that they are in a place where their emotions are regulated enough to process things effectively––sometimes yes, sometimes no. As a result, if there’s not the array of resources that are provided for patients [or] for families, that’s another chance for the communication breakdown to happen. Many family members will also step into the role of “Dr. 2.0” at home. The idea of what they are supposed to be doing, how they are supposed to be caring for patients based on their perception, [may] not necessarily [be] reality. A family member hears, “This person needs to eat more vegetables,” but what the physician really said was, “This person really needs to be conscious of what they are eating during treatment.” My perception of that is different than what the doctor actually said.

People run with that perception. Whether or not that perception is accurate depends on that person’s experience. If we’re not checking in about what is actually happening in medical treatment appointments outside of those appointments, we do not have a great sense of how we can best effectively support that person. Everybody’s interpretation is going to be influenced by their perception, which is influenced by those emotions. If we can slow that process down, break those pieces apart, take the time to digest what’s being said and how it’s being said, and clarify so everyone’s on the same page to recreate that alignment, that tends to be the better scenario.

How do you work with caregivers who are experiencing burnout or caregiver fatigue?

Being a caregiver is an extraordinarily difficult role because not only are you balancing your emotions, but you are also balancing the emotions and the well-being of someone else who means a great deal to you. It’s this constant divide, constant duality, all at the same time. I cannot emphasize enough that while resources for patients exist, they also exist for caregivers. There is no shame or harm in utilizing therapy and utilizing your own support to process your own experience.

Although you are not necessarily the one carrying the diagnosis, you are also a part of what’s happening. Because of that, you are in many ways better off in supporting that patient by addressing your own concerns. If you do not, I can guarantee you it’s inevitable that they are going to come up. On days if you are more stressed, more anxious, [and] more frustrated by what’s happening, the person you are trying to protect is still going to feel that.

What I am getting at is we can either wait for the emotions to pop up on their own, or we can be proactive in addressing them. That tends to be the better outcome. Why? Because there can be safety in exploring the different emotional experiences you have as a caregiver without your behavior speaking for you. Nobody wants to be the one who loses their temper with the person going through chemotherapy. Nobody wants to be the one who snaps at their kids because they left their shoes in the hallway again. But really, it’s not the shoes; it’s about the fact that you’re on the phone with doctors all day long. We know these things can happen, [so] let’s get ahead of them. Let’s not wait for things to accumulate. Let’s utilize the resources that are available, or if you do not know what’s available, have the conversation about what can be. Any time cancer is happening to someone you care about, it’s impossible that it won’t impact you in some way.

Instead of creating the idea that it’s never going to impact you—“I am strong enough that it will not impact [me]”—[acknowledge] it’s going to impact you. A demonstration of strength can be processing the emotions you are having in relation to the events as they are. Resisting that is only going to exacerbate and increase the issue. Supporting yourself is one of the best ways you can support any patient.