Oncology Social Work a Lifeline in Blood Cancer Treatment

For patients and families facing a stem cell transplant or CAR T-cell therapy, the physical and emotional hurdles can feel overwhelming. At Cleveland Clinic Cancer Institute, all bone marrow transplant (BMT) and cell therapy patients are paired with an oncology social worker early in their journey. This support is crucial for:

• Identifying barriers to treatment and problem solving
• Developing a caregiving plan
• Helping prepare for treatment

Today, ConsultQD had the chance to talk with Certified Oncology Social Worker Jane Dabney, MSW, LISW-S, OSW-C about this crucial work. A stalwart leader in the field, Dabney recently received the Leukemia & Lymphoma Society's Lifetime Achievement Award from the Association of Oncology Social Work.

“Patients with blood cancers can have very different needs from those with solid tumors,” explains Dabney. “Often with a solid tumor, a patient has surgery or chemotherapy or radiation and there is an endpoint to treatment. With blood cancer, especially myeloma, therapy is ongoing. If they’re getting an allogenic transplant, their immune system is compromised for a long time, so often we’re helping patients adjust to what seems like never-ending treatment and helping them with acceptance of a new normal in their life.”

Dabney shared many best practices for patient-centered psychosocial support:

Conducting thorough psychosocial assessments

An initial psychosocial assessment completed by the social worker helps to introduce the role of the social worker on the team, establish a working relationship with the patient and prepare for ongoing work together. This time together allows the social worker to assess and address barriers to care and start to engage the patient in problem solving.

Patient needs can vary greatly. They may need emotional or practical support for their family, help preparing for an extended leave of absence from work or assistance dealing with financial hardships. Building trust may help patients confront uncomfortable issues that could negatively affect their recovery.

The social worker provides supportive counseling focused on:

• Adjustment to illness
• Coping with ongoing treatment needs
• Family coping and discord
• Helping parents in talking to young children about their diagnosis

Social workers also help with identifying and addressing untreated mental health and substance abuse concerns. To that end, Dabney and her team implemented support resources to address mental health, substance abuse and caregiver stress, which are areas that are often overlooked in cancer care.

They also conduct distress screening, which is an ongoing process used to identify social, behavioral and other issues that may impede a patient’s recovery. Beginning screening and compassionate conversations prior to treatment helps to build trusting relationships.

Integrating oncology social work into care teams

In Cleveland Clinic’s BMT and Cellular Therapy teams, social workers are an integral part of the team and regularly collaborate with the medical teams, ensuring that psychosocial care is integrated into treatment. Part of orientation for new nurses and hematologists involves meeting with oncology social workers to understand their role and how they can work together.

Ensuring care continuity

One unique aspect of Cleveland Clinic’s BMT and CAR T social work team is that they follow patients, both inpatient and outpatient. The social workers regularly participate in inpatient rounds along with the medical team. This approach helps with understanding each patient’s medical needs and how their diagnosis and treatment impacts them emotionally. Each social worker continues to follow the same patients once they’re discharged from the hospital.

Providing psychoeducational interventions

Psychoeducational interventions can enhance adherence to treatment and overall well-being. For example, after noticing that patients and family members needed further support preparing for hospital discharge, Dabney led an initiative with inpatient nurses, dieticians and outpatient nurse coordinators to create a post-transplant preparation and education group.

The group gives patients and caregivers a way to learn what to expect at each step in the process and to have their questions and concerns addressed in a relaxed setting. “Patients and caregivers can talk among themselves, build camaraderie and build their confidence in leaving the hospital,” says Dabney.

Building relationships

Dabney highlights the need to maintain a consistent presence with each patient. Social workers regularly see patients, offer emotional support and assess for new needs during the treatment process. These seemingly simple steps help them become a familiar face that patients and families can trust throughout the process.

Supporting caregivers

Caregiver support is essential for any family facing cancer and this can be particularly so when facing a blood cancer, which can involve complex, lengthy treatment plans.

“There’s a trend to perform autologous transplants and many cell therapies in the outpatient setting,” says Dabney. “This puts a lot of critical decision-making on caregivers.”

There are many avenues to build in added caregiver supports. To help further prepare caregivers, the BMT social work team created a patient and care partner agreement that they review with patients and families. Though not legally binding, it is a clinical tool that can help deepen a family’s understanding of and commitment to caregiving and how best to prepare for this role.

Support groups are also very beneficial, giving caregivers a safe space to speak openly and honestly about what they’re feeling. These frank discussions can help alleviate the stress and isolation that may accompany caregiving.

Advance care planning

Having an advance care planning program can foster open conversations around goals of care, enhancing communication and patient rights at critical moments in treatment. “Early on, we meet with patients and talk with them about who they would want to make medical decisions for them if they were unable to do so, and put that into a healthcare power of attorney,” explains Dabney. “A lot of times, that segues into deeper conversations as we build relationships with patients and their families.”

These relationships can help facilitate important discussions, particularly if treatment isn’t going well. “If a physician needs to give difficult news to a patient, there’s a process in place so they’re not going into that conversation alone. Other members of the team, including the social worker, accompany them, and invite the family so they can prepare questions and receive honest information.

“It can be painful but it can be a gift as well for patients to talk with their family and make appropriate, informed decisions,” says Dabney. “It's not always the end result that is most important to the patient and family. It's the process and how you make them feel."

Fostering collaboration

The Association of Oncology Social Work (AOSW) created a Blood Cancers Special Interest Group, which serves as a national platform for social workers working in hematology care. This platform gives social workers around the country a way to collaborate and share resources to address the unique needs of transplant/cellular therapy patients. The American Society for Transplantation and Cellular Therapy found the role of the oncology social worker to be pivotal, so they created a Social Work Special Interest Group within their organization as well.

Empowering professionals

Autonomy is crucial to any oncology social work program. “What I really like about my job is having the freedom to create new programs and processes that help to improve the care and patient experience,” says Dabney. “We’re born problem solvers, so it’s wonderful to be able to design a program or a policy change to help improve a process,” says Dabney.