Oncology Social Workers Research Articles

Trends in Financial Toxicity for Patients of a Community Cancer Clinic

Background: Rising health care costs - especially those of new medications for cancer treatment - have caused a severe financial strain on patients, leading to significant alteration of lifestyles. Published information regarding financial distress is scant with data only from large tertiary care institutions that may not be relevant to smaller communities. We sought to analyze the extent of financial toxicity over time in a community cancer clinic staffed by two medical oncologists.Methods: Since 2010, a team of two oncology social workers prospectively collected data on financial assistance for patients treated at our community cancer clinic. Data regarding medication assistance is available for 2012-2014.Results: Approximately 500 new patients and 1600 unique follow-up patients are evaluated and treated at the clinic annually. From January 2010 through December 2014, 1,012 requests for assistance were processed. The number of requests increased from 134 in 2010 to 320 in 2014. Most common requests were for medications and financial aid. Trends are shown in the table. Though the number of patients applying for medication assistance increased in 2014, the amount requested was less than previous years because of the influx of specialty pharmacies in the market with their own assistance programs.Conclusions: Financial toxicity for cancer patients is a real issue in the community clinic setting.Requests for financial assistance have increased over time. The number of FDA approvals for new cancer medications seem to correlate with the increase. Studies are in progress to further clarify the financial impact of cancer on patients. TableTrends in requests for assistance and aid and FDA approval for new medications.Requests for20102011201220132014Financial aid6411686101143Service311112733Equipment1311111823Transport312357Medications51534449114Patient cost of medications for which aid requested$731,891$1,554,684$1,253,827FDA approvals for new Oncology medications61181513 DisclosuresNo relevant conflicts of interest to declare.

Initial Experience With an Innovative Pilot Program Evaluating a Multidisciplinary Approach to Supportive Care Planning in a Survivorship Clinic Setting

242 Background: The supportive care and rehabilitative needs of cancer patients are highly varied and complex, and optimal care planning often requires the provision and coordination of multiple modalities. To address these needs, an innovative model for multi-disciplinary evaluation and management within a survivorship clinic was piloted. Methods: Between November 2013 and May 2014, 50 patients who had completed cancer therapy with curative intent were seen in a multi-disciplinary survivorship clinic (MDSC) sequentially by an advanced practice practitioner (nurse practitioner or physician assistant), oncology social worker, and oncology rehabilitation therapist. Data regarding specific care planning resulting from this encounter, compliance with recommended therapies, and patient-reported satisfaction were collected. These data were compared against the remaining cohort of patients (N = 402) who completed curative intent cancer therapy in our cancer program during the same period. Results: Rate of referr...

Self-Efficacy and Mental Health Services Provided by Rural and Frontier Oncology Social Workers

Self-Efficacy and Mental Health Services Provided by Rural and Frontier Oncology Social Workers

Financial Quality of Life for Patients With Cancer: An Exploratory Study

Objective: For people who are experiencing financial hardship, a cancer diagnosis can be devastating. For others, cancer may exacerbate financial stress, thereby influencing their livelihood, their ability to maintain employment benefits including health insurance, manage financial obligations, and participate meaningfully in cancer treatment. This study examined how vulnerabilities in psychosocial situations affect financial quality of life within the larger context of health-care decision making through a survey conducted with a cross-sectional availability sample of 90 cancer patients. Results from the multiple regression analysis found that health insurance adequacy, fewer perceived barriers to care, and reduced financial stress are significant predictors of better financial quality of life in this sample. Oncology social workers and other disciplines involved in psychosocial treatment with patients with cancer must assess and address financial and logistic aspects of life in order to provide comprehensive cancer care that meets all needs. Collaborative coordination with patients with cancer and their families to intervene psychosocially, medically, and financially are critical components of sound psychosocial and medical practice.

Exploring the Relationship Between Fear of Cancer Recurrence and Sleep Quality in Cancer Survivors

Fear of cancer recurrence (FCR) and sleep disturbance are identified as top psychosocial concerns in cancer survivorship, yet few studies have explored the association between these two factors. Using data from a study of 67 cancer survivors, hierarchical logistic regression models examined the relationships between socio-demographic characteristics, FCR, and sleep disturbance. More than half of survivors reported poor sleep quality; those with some college education and those with higher levels of FCR were at greater risk for poor sleep. These findings provide formative data for oncology social workers to implement interventions that target FCR as a strategy for improving sleep.

Screening for Psychosocial Distress: A National Survey of Oncology Social Workers

Oncology social workers are the primary providers of psychosocial care for cancer patients, thus they are well positioned to implement and oversee psychosocial distress screening. A national survey of members of the Association of Oncology Social Work was conducted to examine screening knowledge, attitudes, behaviors, and perceived competency. The findings indicated that most participants screened for psychosocial distress using a standardized instrument and identified institutional and individual barriers to implementing screening. Analyses revealed that social workers who perceived patient benefits from screening and were knowledgeable about guidelines were significantly more likely to implement screening procedures and use a standardized instrument.

Initial experience with an innovative pilot program evaluating a multidisciplinary approach to supportive care planning in a survivorship clinic setting.

242 Background: The supportive care and rehabilitative needs of cancer patients are highly varied and complex, and optimal care planning often requires the provision and coordination of multiple modalities. To address these needs, an innovative model for multi-disciplinary evaluation and management within a survivorship clinic was piloted. Methods: Between November 2013 and May 2014, 50 patients who had completed cancer therapy with curative intent were seen in a multi-disciplinary survivorship clinic (MDSC) sequentially by an advanced practice practitioner (nurse practitioner or physician assistant), oncology social worker, and oncology rehabilitation therapist. Data regarding specific care planning resulting from this encounter, compliance with recommended therapies, and patient-reported satisfaction were collected. These data were compared against the remaining cohort of patients (N = 402) who completed curative intent cancer therapy in our cancer program during the same period. Results: Rate of referral for rehabilitation services (83.3% vs 13.9%, p < 0.01) and compliance with recommended therapy visits (85.7% vs 44.6%, p < 0.01) were significantly increased among patients seen within the MDSC pilot when compared with similar patients who were not seen in this setting. The number of referred therapy modalities was also increased among patients seen in the MDSC pilot, median 2 (range 1-3 modalities) vs 1 (range 1-2 modalities), respectively. Of patients who completed an assessment following the multi-disciplinary visit, 86% scored their overall experience as excellent which was the highest possible score. Conclusions: Patients seen within an innovative pilot program of multi-disciplinary survivorship care planning appreciated increased rates of referral for rehabilitation services, were referred for a greater number of therapy modalities, and were more compliant with recommended interventions than similar patients who were not seen in this setting. This patient cohort also reported high rates of satisfaction with the pilot program.

Sequencing the genome of hope.

234 Background: Hope is widely regarded as essential to the emotional health of cancer pts, yet remains under-studied. We sought to explore the concept of hope and develop a teaching module to educate providers about the importance of hope in optimizing oncology care. Methods: We audio recorded interviews with oncology patients. Questions focused on what hope means, the role it plays in their ability to manage their illness, and ways in which they felt oncology providers could engender hope and positively impact their experience. We also interviewed oncology providers, including physicians, nurses, and social workers. Questions focused on the role they feel hope plays for their pts, whether or not they have received training in how to discuss hope, and tools they use to discuss hope with their pts. Common themes were extracted to form the backbone of a webcast-style teaching module. Results: A total of 24 volunteers were enrolled in an IRB approved protocol. One half of the subjects were pts and the other half were oncology providers (n = 6 physicians, 3 nurses, 3 social workers). Hope emerged as an important element to good quality of life in 12/12 (100%) pts.. The overwhelming majority (11/12, 92%) further expressed that feeling “well cared for” as well as receiving clear, honest information about their disease greatly increased their hopefulness. Hope also was recognized as essential to pts’ wellness and ability to manage their illness by all 12 (100%) of the providers. Although all providers recognized hope as essential to their pts, only the social workers reported that they had received some level of training in how to discuss hope, while the physicians and nurses felt that they had received little to no training. All providers expressed desire to contribute positively to their pts’ sense of hope. Conclusions: Both pts and providers view hope as a vital element in how oncology pts manage their illness. This point of connection between providers and their pts offers a mechanism to enhance the care of patients and impact their overall experience with cancer, yet most providers have little to no training in how to discuss hope. Development of an education module is underway to help increase awareness of the importance of hope and teach providers strategies to better engage with their pts on the subject of hope.

Improving advance care planning for UICC Oncology patients.

234 Background: Advance care planning (ACP) in the ambulatory setting is underutilized and poorly documented at the University of Illinois Cancer Center (UICC). A baseline 8 week review noted 8.8% of metastatic solid tumor patients had ACP documentation in the electronic medical record (EMR) by the third visit and 23% in the previous two visits. Our aim was to increase ACP documentation to 75% of UICC metastatic solid tumor patient charts by the third visit through development of a standardized process for ACP discussion and documentation. Methods: A multidisciplinary team of oncology physicians, nurses, social workers (SW), and palliative care created a process map of ACP discussion. A new process for SW consults was piloted over 6 weeks. Additionally, all clinic staff participated in a standardized curriculum for ACP discussions. Post intervention data was prospectively collected over six weeks. Results: Total 94 encounters occurred during the pilot evaluating ACP in metastatic solid tumor patients of which 37/55 (39.4%) had documented ACP discussion. SW consults occurred in 18/94 (19.1%), leading to 18/18 (100%) with Power of Attorney (POA) forms in EMR. Evaluation by tumor subtypes showed 14/21 (66.7%) of gastrointestinal patients had ACP documentation with 9/21 (42.9%) with SW consults leading to 11/21 (52.4%) with POA forms in EMR. Of 39 total thoracic patients, 19/39 (48.7%) had ACP documentation of which 9/39 (23%) with SW consults and 7/39 (17.9%) with POA forms in EMR. Conclusions: UICC successfully piloted the creation and implementation of a process for ACP consults and standardization of ACP discussion and EMR documentation. While our initial aim of 75% a chart was not reached, the piloted process increased SW consults and completion of POA forms, as well as greater multidisciplinary effort and patient engagement. Compared to the pilot period, a multidisciplinary approach and use of the new process did improve ACP documentation. We plan to expand to all metastatic patients. [Table: see text]

ExCEL in Social Work: Excellence in Cancer Education & Leadership: An Oncology Social Work Response to the 2008 Institute of Medicine Report.

ExCEL in Social Work: Excellence in Cancer Education & Leadership was a multi-year National Cancer Institute (NCI)-funded grant for the development and implementation of an innovative educational program for oncology social workers. The program's curriculum focused upon six core competencies of psychosocial-spiritual support necessary to meet the standard of care recommended by the 2008 Institute of Medicine (IOM) Report: Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs. The curriculum was delivered through a collaborative partnership between the City of Hope National Medical Center and the two leading professional organizations devoted exclusively to representing oncology social workers--the Association of Oncology Social Work and the Association of Pediatric Oncology Social Workers. Initial findings support the feasibility and acceptability of this tailored leadership skills-building program for participating oncology social workers.

Bridging the gap between financial distress and available resources for patients with cancer: a qualitative study.

Cancer treatment-related out-of-pocket costs create substantial financial distress for many patients. However, little work has been done to describe available financial resources and barriers to connecting those resources to patients. This was a single-center, qualitative study that used semistructured interviews and focus groups with social workers and financial care counselors. Interview guides were used to elicit feedback from study participants pertaining to the types of financial problems that their patients were experiencing, the process for addressing these issues, patient assistance resources, and access barriers. Four interviews and two focus group sessions (n = 15) were conducted in which four themes emerged among the social work and financial care counselor samples. Participants cited (1) frustration over the lack of financial resources and increasingly stringent eligibility criteria, (2) barriers to providing assistance such as process inefficiencies, (3) limited resources to identify at- risk patients and refer them for services, and (4) inadequate insurance coverage and availability. To bridge the gap between increasing patient need and limited resources, participants suggested development of interventions designed to aid in patient screening and resource identification. Oncology social workers and financial care counselors reported inadequate financial resources and faced barriers to matching appropriate resources with patients in need. Limited social work resources hindered early screening for financial distress. Interventions that focus on screening for early identification of financial distress and identification of resources are needed.

Effects of Age Expectations on Oncology Social Workers’ Clinical Judgment

Objective: This study examined the influence of oncology social workers’ expectations regarding aging (ERA) and ERA with cancer (ERAC) on their clinical judgment. Methods: Oncology social workers ( N = 322) were randomly assigned to one of four vignettes describing a patient with lung cancer. The vignettes were identical except for the patent’s age and gender. Structural equation modeling served as the primary tool for testing the study hypotheses. Results: Significant differences were found in clinical judgment based on patient’s age, and social workers’ ERA and ERAC which affected diagnostic and treatment judgment for all patients. Lack of congruence was also found between the diagnosis and treatment phases of care for older patients. Emotional reaction was more often reported for the younger patient. Conclusion: Results suggest a barrier to “whole patient” care for all cancer patients and a need for student and practitioner training to place greater emphasis on the treatment phase of patient care.

Effect of oncology social workers’ expectations regarding aging on clinical judgment

Effect of oncology social workers’ expectations regarding aging on clinical judgment

Communication as a Part of the Supportive Treatment in Cancer Care

Interpersonal communication skills as part of the supportive care in cancer won new dimensions by demonstrating the association with enhanced ability of patients to cope with the disease, to enhance trust in health care providers, compliance with treatment and to reduce emotional distress and psychosocial burden. Besides empathy the effective patient centered communication is based upon perceptual and behavioral skills of caregivers. Doctors, nurses, and oncology social workers have to achieve skills to listen to patients complains and to respond to his/ her support needs. The aim of the present paper was to perform a meta analysis of published data dealing with principles and methods of the assertive doctor patient communication within the supportive care of patients suffering from emotional and social dysfunctions. The data of interpersonal communication skills in oncology presented in the current literature were collected using electronic databases and were elaborated in form of meta analysis of 24 selected publications. Active behavioral approach involves the understanding of the nonverbal indications of patients needs, preferences, and expectations, the evaluation of patients nonverbal expression of fear, uncertainty, irritability, depression and apathy or even the unwillingness to disclose his/ her concerns. Recognizing these and other concerns (marital and sexual problems, physical and cognitive functioning etc.), caregivers should respond these concerns in verbal form of psychosocial support. Skills in the interpersonal communication can be learned by clinical experience and theoretical preparation. Developing the communication skills including the perception and behavioral style is particularly important in clinicians early medical teaching. The implementation of communication skills into undergraduate and postgraduate study programs in medicine, nursing, and other paramedical subjects is still in infancy, although the professional communication with cancer patient and its family members is associated with clear and important outcomes of care approved by clinical research and recognized by cancer professionals.

How effective is telephonic case management of cancer patients undergoing active therapy?

e17519 Background: The Cancer Support Program (CSP) of Optum provides patients and their caregivers with telephonic case management by experienced oncology nurses, social workers and appropriately-trained physicians. Goals include reducing emergency department visits and hospitalizations, and helping patients comply with treatments and more effectively manage symptoms. The intent of this study is to evaluate the effectiveness of CSP from both quality and financial perspectives. Methods: The study used a case control approach to compare participants and non-participants of the Optum CSP program. Propensity score method was applied to adjust for baseline differences between the two groups. The study population consisted of cancer patients (N=8,833) enrolled in commercial health plans through self-insured employers. The patients were referred into CSP between July 2009 and June 2011. Outcomes of cost and hospice days were estimated with generalized linear models. We also compared the group of CSP participants (N=3,716) to active cancer patients enrolled in a general CM program (N=2,867) on the topics the nurses discussed with patients. Results: For program participants who were under active treatment and survived at least 6 months after referral , medical cost per patient per month during the six month of engagement was reduced by 9.8% (95% confidence interval [3.7%, 15.6%], p-value 0.002). The decedent’s cost during the last 3 months of the life was reduced by 19.9% (95% confidence interval [2.8%, 34.1%], p-value 0.025). Average hospice days of all deceased CSP participants increased by 42.3%, (95% confidence interval [13.9%, 77.8%], p-value 0.002). CSP nurses, all of whom had cancer management experience, addressed 56 topics of cancer-related support compared to only 11 for general CM nurses. Among the topics that both groups addressed, 35% of the topics were addressed 10% or more frequently by CSP nurses, including “Cancer Treatment Choices Outlined” and “Education Provided: Cancer Medications” etc. Conclusions: We conclude the Optum CSP program is effective in reducing medical cost, promoting use of hospice and providing cancer-specific patient support for a population of cancer patients under active treatment.

The Distress Thermometer: a rapid and effective tool for the oncology social worker

The psycho-oncology and social work services recognised that a cancer diagnosis and treatment can result in considerable emotional consequences for patients, yet the referral rate to both services was extremely low. Only very visibly distressed patients were being referred to the service. The "Distress Thermometer" (DT), a distress screening tool, was introduced as a pilot project with day care and inpatient oncology patients of St Vincent's University Hospital, Dublin, in an effort to improve the identification, management and treatment of psychological distress in oncology patients. The purpose of this paper is to evaluate the effectiveness of this new intervention. The Psycho-oncology service in conjunction with the Medical Social Work Department and Nursing Management at St Vincent's University Hospital, Dublin, initiated a Distress Education Management and Training Programme (DEMP). The initiative involved providing a training programme for oncology nursing staff and the introduction of a distress-screening tool for patients. In 1998, the DT was developed and validated for evaluation of distress (and depression) in cancer. It was adopted into recommendations made by the US National Comprehensive Cancer Network. The DT is a simple, self-report, pencil and paper measure consisting of a line with a 0-10 scale anchored at the zero point with "No distress" and at scale point ten with "Extreme distress". Patients are given the instruction, "How distressed have you been during the past week on a scale of 0-10"? Patients indicated their level of distress with a mark on the scale. Patients scoring 4 or above were regarded as requiring intervention. The DT includes a problem checklist. The patient is asked to identify those problems from the checklist which are contributing to their score. The use of the DT was evaluated through interviews with patients and professionals. Patients who scored four or above (38 per cent of patients), were seen by the Oncology Social Worker for psychosocial assessment and mental health triage. Patients who scored above a certain level (usually above 12/20) in the clinical range on the Hospital Anxiety and Depression scale (3 per cent) were referred to Psycho-oncology. That 38 per cent of oncology patients required intervention from a specialist service accurately reflects international findings on the rate of distress among cancer patients. Assessment of cancer patients' distress levels in a structured and planned manner with a Distress Thermometer, as recommended by best international practice, works very effectively and should be considered for all cancer out-patients This will have implications in terms of staff that will be required to manage such a service. This was the first time that this internationally recognised tool was used to such an extent and to positive effect in an Irish context.

Abstract ADV07: Cancer simplified: A web-based learning system for newly-diagnosed patients.

Abstract Mission Statement: Improving the quality of care for cancer patients on the East End of Long Island by establishing the Nations’ largest free cancer counseling center with a regional focus. Initiatives: We provide psycho-social counseling to approximately 300 newly-diagnosed cancer patients each year with a professional staff that includes two oncology social workers, a clinical psychologist with a PhD and a registered nurse. We also author a unique book - Coping with Cancer on the East End - which is a “where-to-find-it” guide to regional cancer care resources. Poster Description: It will focus on a relatively new initiative at Fighting Chance which is called “Cancer Simplified.” This is, in essence, a “sister website.” It serves as a web-based learning system about the “ABCs” of cancer, using a PowerPoint platform and is intended for newly-diagnosed patients with a high school reading level. Cancer simplified aims to demystify the basic concepts of “what is cancer” using depiction instead of jargon-laden explanation. A deck of power point slides is augmented by a set of videos portraying Fighting Chance patients discussing their “cancer journeys.” Finally, a third element, known as “Easy Read,” drills into some of the largest cancer-helpful websites (like the ACS and NCCN) and takes the visitor directly to the most user-friendly pamphlets embedded in that site. Citation Format: Duncan Darrow. Cancer simplified: A web-based learning system for newly-diagnosed patients. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr ADV07. doi:10.1158/1538-7445.AM2013-ADV07

Oncology Social Worker Is First Ever to Lead the Association of Community Cancer Centers

Oncology Social Worker Is First Ever to Lead the Association of Community Cancer Centers

An Exploration of Xhosa Speaking Patients’ Understanding of Cancer Treatment and Its Influence on Their Treatment Experience

Cultural beliefs often influence people in seeking appropriate health care. In South Africa, misperceptions and fear about medical interventions contribute to the fact that many indigenous people prefer to make use of traditional healers. This qualitative study explores Xhosa patients’ perception of cancer and cancer treatment modalities, and their need for support. Language creates an image of the unknown to which people attach meaning. Oncology social workers play an important role in educating people about cancer and the treatment thereof, as doctors seldom have time to deal with the psychosocial aspects of cancer. Health care providers need to be sensitive to patients’ perceptions to render the best possible cancer care.

An Analysis of Social Work Oncology Network Listserv Postings on the Commission of Cancer's Distress Screening Guidelines

This is a qualitative study of listserv postings by members of the Social Work Oncology Network (SWON) in response to the Commission on Cancer's 2011 guidelines for distress screening of cancer patients. Archived listserv postings for the period of December 2010 to November 2011 were deidentified and a sample was derived by a list of keywords for the analysis. Aims of the study included describing the general categories and themes of the postings devoted to the new distress screening standard and examining the process of facilitation of mutual support and information exchange by oncology social workers in response to the new screening standards. During the 12-month timeframe there were 242 unique listserv postings sampled for the analysis. Oncology social worker (OSW) discussion of the distress screening guidelines remained a constant topic over the 12 months, and major themes that emerged from the data included processes of implementation of distress screening in cancer centers, screening policies and protocols, screening tool choice, and oncology social worker professional identity. The SWON listserv members used the listserv as a mechanism to post their requests for information on screening, to share their experiences in the beginning stages of implementing the guidelines, and to build support for legitimizing oncology social workers as the lead profession in the implementation of the guidelines in member cancer centers.