Cancer Patients as Clients of Social Work

Cancer Patients as Clients of Social Work
Introduction

Civilizational diseases, which appear mainly in the most developed countries in the world, are currently a frequently discussed topic. Oncological diseases are included among these. “Cancer is unrestricted and uncontrolled multiplication of cells that have escaped the controlling systems and mechanisms of the body and have therefore acquired the ability to penetrate neighboring and more distant tissues. A healthy cell, after accumulating certain genetic changes and as a result of various influencing factors, changes into a cancerous one, meaning it undergoes uncontrolled division” (Valovičová, 2009, s. 8).

There can be no doubt about the need for social work, as it acts in many areas and is in high demand today also in relation to oncological disease and the oncology patient. The holistic approach points to the multifactorial origin of oncological diseases, provides a comprehensive view of cancer, and thus of its biological, psychological, and social understanding, which gives social work room to operate.

In our effort to define the role and possibilities of the social worker in working with the oncology patient, we relied on an understanding of the client’s bio-psycho-social functioning and the maintenance of this functioning. The oncology patient becomes a social work client in a chronic sense. Let us therefore look at the oncology patient from a bio-psycho-social perspective before and during the disease, from which we will try to derive the action of social work.

In the origins of cancer, genetic predispositions, improper nutrition, and smoking have long ceased to be considered the only causes; risk behaviors such as stressful and conflict situations, fear, frustration, trauma, work overload, workaholism, as well as aggressive and hostile behavior are also included. We also count frequent mood swings, suppression of one’s own emotions, anxiety, self-esteem disturbances, aggression, unemployment, divorce status, sexual deviations, and promiscuity.

Doctors, already in earlier times, tried to understand the origin and development of cancer more broadly than only biologically. “In the 2nd century of our era, for example, Galen observed that melancholic women became breast cancer patients more often than sanguine women. Gendron wrote in 1701 that fear and deep sorrow cause cancer. Guy in 1759 stated that women with hysterical and nervous difficulties are more at risk of cancer; most of all melancholic women, however, who had experienced many catastrophic and painful situations” (Dostálová, 1993, in Kočišová, 2012, s. 135).

A social worker should approach the patient as a bio-psycho-social being, which is based on systems theory that views the person as a whole, a single system. The whole consists of individual parts in mutual interaction, so any disorder in one part is a disorder in the whole system. When looking at a person, health, and illness, one must not only take a biological perspective; psychological and social aspects are also significant.

Žiaková (2005) argues that the boundaries between these factors are not clear-cut and cannot be precisely determined. She emphasizes the significant role of the following pathogenic factors:

• genetic predisposition,
• constitutional predisposition,
• personality and behavior characteristics,
• social support.

The term cancer-prone personality is associated with cancer, meaning a personality inclined to cancer. According to Temoshoková (in Peterková, 2013), this is not a personality type but a style of behavior. Such behavior appears as:

• not expressing negative emotions, especially anger. This is so-called emotional control, characterized by gentle behavior and maintaining an outward impression of calmness, satisfaction, and pleasantness,
• orientation toward others, prioritizing meeting others’ needs over one’s own.

Dobríková (2007) characterizes people with C-type behavior as friendly, willing to help others, and unassuming, with a higher degree of inhibition and conformity. They have more pronounced feelings of helplessness and hopelessness; they endure pain with resignation and give up easily.

A person is constantly subject to life changes and reversals. Human health depends on multiple factors, and psychological and social factors increasingly come to the fore in various illnesses. Currently, stress is emphasized, especially “its approach, the way stressful life events are processed by a person when they occur. In this context, the important role of emotional and social support in getting through life events should be noted, since it strongly affects the negative effects of a stressful situation” (Žiaková, 2005, s. 195). In 1967, psychiatrists Thomas Holmes and Richard Rahe created a stress scale that includes a list of 43 events causing stress, scored from 1 to 100 according to how much they burden the organism.

Table 1: Stressful life situations that burden the organism the most

Source: Holmes, Rahe, 1967

Dostálová (1993, in Kočišová, 2012) summarized the psychosocial factors described by various researchers that may affect the development of oncological disease:

• traumatic childhood experiences, especially the loss of close ones,
• later losses of close persons,
• carcinophobia, an excessive fear of developing cancer,
• loss of a life framework, including the loss of illusion in marriage, career loss, and disappointment in children,
• financial burden,
• loss of life meaning,
• denial of addressing the life situation and escape from ongoing tension.

“Its importance is shown by the family environment, especially the dynamics of family relationships. A family characteristic of later tumor progression is a family with no open, emotionally alive relationships, which resembles a large cold room, or a socially isolated family where a lack of social status is compensated by a child, while little attention is paid to the needs of individual family members” (Kočišová, 2012, s. 135).

Bio-psycho-social functioning of the oncology patient

The entry of cancer into a person’s life brings numerous changes in many areas. Along with fear, pain, anxiety, and many questions, the patient’s activity in everyday life, daily rhythm, emotions, and environment also change, becoming more dependent on others.

Gulášová (2009) lists changes commonly found in oncology patients:

1. hypersensitivity in patients, greater emotional irritability,
2. frequent mood swings,
3. negative emotions – fear, worries, depression, depression, even apathy,
4. a sense of inferiority,
5. a sense of devaluation, suppression, and persecution,
6. disruption of interpersonal relationships.

Angelovičová and Máthéová (2012) add insufficient sleep, poor appetite, and reduced or lost sexual drive. “The disease enters the patient’s life and modifies the patient’s future and prospects, that is, the fulfillment of their life meaning” (Mojtová, Sedlárová, Šrank, 2013, s. 25). Depending on psychological and physical capacities, the patient changes life goals and values. “Disease threatens the patient’s life and confronts them with thoughts of death. Another source of anxiety is the treatment itself, its side effects, unclear duration, and uncertain effect. Unmanageable fear and high levels of anxiety may become anxiety disorders and phobias.” (Andrášiová, 2007, s. 45). The patient has an uncertain future, associated with a decline in some competencies, on the basis of which they grieve, feel inferior, which may turn into depression. In patients we encounter sleep disorders, prolonged agitation, nightmares, denial of illness, self-blame, refusal of treatment irrationally conditioned by fear, insomnia, and psychogenic vomiting (Andrášiová, 2007). The disease affects all social roles of the patient: partner, spouse, parent, and role in employment.

Current trends point to a reduced number of multi-generational households, delayed marriages, families where career dominates, and despite technological and globalization advances that should support social contacts, people are becoming increasingly socially isolated. Support from social relationships mitigates or reduces the adverse effects of stressors on health (Holt-Lunstad, Smith, Layton, 2010).

Oncological disease goes beyond the patient’s personality and affects the whole family and surrounding environment. Ironically, precisely at the time of illness, when a person needs social support, social relationships often fail. Partners, parents, family members of oncology patients often cannot cope with everyday care for their loved one, they are under pressure, unable to manage their own emotions and pain, and therefore separation, divorce, and family breakups often occur.

Social Work with Oncology Patients

Social work cooperates with other sectors and is increasingly used in solving a wide variety of human problems and helping people. As the number of oncology patients continually rises, society requires social work involvement in this area as well.

The past period was characterized by efforts to maintain a sectoral division of health and social issues without essential interconnection (Vurm, 2007). According to Plato, “the greatest error in treating illnesses is that there are doctors who treat the body and doctors who treat the soul, although body and soul are one and indivisible.” The patient needs not only medical care but also help in the social domain, therefore these levels must overlap and not be separated from each other. Again, we emphasize the holistic approach.

The diagnosis of cancer, life with awareness of a tumor disease, and the required treatment affect a person not only physically, but also psychologically, and also influence interpersonal relationships. During the course of the illness, the patient must adapt and reevaluate and accept many things. That is why it is necessary to focus on the oncological patient’s problems (Liga proti rakovine Slovenskej republiky).

In one sense, the oncology patient remains a patient for life. Siracká (2003), president of the Liga proti rakovine Slovenskej republike, states that the need for strict monitoring, regular checkups, and diagnostic tests even many years after treatment ends determines not only the patient’s psychological condition but also the patient’s situation in family and society. Patients often go through sad and tragic situations, including discrimination, divorces, patient isolation within the family, and the idea of the “infectiousness” of cancer in the eyes of others.

Working with an oncology patient represents a large psychological burden for the social worker; they carry responsibility for their client and should approach them humanely, equipped with empathy, but must also beware of identifying with the client’s situation and taking over their feelings and problems, because this would worsen the client’s situation. In cancer, neither death nor dying can be a taboo topic. Patients often have questions about death, yet with loved ones and family they do not know how to talk about it. When a person falls ill, these topics touch them much more directly and are experienced in a completely different way. “As each individual is unique and unrepeatable, so is the work with them. A person is a holistic being, which means we must not omit or neglect any component of the bio-psycho-social and spiritual dimension” (Mojtová, Sedlárová, Šrank, 2013, s. 9).

The holistic approach does not represent only a comprehensive view of the patient in terms of bio-psycho-social aspects, but it also applies to care, which is oriented not only to the patient but also to their family, their problems, and mutual relationships.

The family plays a significant role, as mentioned several times. In this area as well, the social worker engages and ensures it functions, because “at a time when one family member is seriously ill, the entire family system enters a crisis. Communication in the family stalls and people become isolated because they try to shield one another from bad news... the social worker usually does not work with a dysfunctional family structure, but with a functioning family trying to cope with an abnormal situation” (Kasanová, 2009, s. 57).

Drisko (2000) argues that the social worker’s task is to understand the inner, subjective world of the individual, but at the same time to understand the context in which the individual is situated. The social worker must be equipped with exceptional sensitivity to others.

On the basis of these findings, we would emphasize the use of sociotherapy in social work with oncology patients. “Social therapy is a process based on dynamic interaction between client and social worker. In this process, it is a conscious effort to shape clients’ beliefs, convictions, attitudes, emotions, and behavior” (Levická, 2003, s. 90). Sokolowska (in Levická, 2003, s. 90) understands sociotherapy as “an activity that provides a sick or disease-threatened person with enough opportunities to create social contacts that are favorable for maintaining or recreating appropriate social behavior. The main task of sociotherapy is to strengthen, restore, and maintain a patient’s interest in real social life and real social relationships.”

The social worker working with oncology patients should act directly in hospitals and treatment centers, where the need is most immediate and where they can be truly present. Through sociotherapeutic conversations, the social worker maps current needs of oncology patients and actively listens to them, while being equipped with genuine empathy.

Cancer brings difficulties in various life areas, changes social roles, causes not only physical but also psychological and emotional pain, and treatment procedures often evoke fear and anxiety in the patient. Social work helps the patient cope with uncertainty and the diagnosis. Without coping with these difficulties, a patient can end up socially excluded. Social work helps and supports the patient in being reinserted into social roles and life. The result of sociotherapy is successful adaptation to the situation in which the person finds themselves and stabilization of their social networks. “It is often said how demanding it is to be an oncology patient and to manage treatment, but it is equally demanding to be a family member and to cope with everything the disease triggers, not only in the patient but in the closest environment” (Gregussová, 2012, s. 9). Sociotherapy is therefore appropriate. It is not focused only on the patient, but also on their family and wider social environment.

Zakouřilová (2008) claims that sociotherapy is aimed at supporting communication, and obtaining information and motivation from the patient. Kredátus (in Žiaková, 2005) sees sociotherapy’s goal as the correction of attitudes that changed for the person with the onset of disease and the crisis they are experiencing.

The oncology patient is often withdrawn, refuses to communicate, and is passive. A social worker can use sociotherapeutic activities such as art therapy, music therapy, art-based occupational therapy, and bibliotherapy to activate such patients. These activities reduce pain, support emotional well-being, have a relaxing effect, and reduce anxiety.

Conclusion

In this article we attempted to point out the need for social work in the field of oncological disease. Cancer has a broad impact not only on the patient themselves but also on their family and environment, giving social workers a broad scope of action.

Just as one must view the person and the oncology patient holistically, as one whole, so should medical staff and social workers act. These professionals should form one integrated team, which would bring oncology patients more effective treatment and improved quality of life.

A social worker can, on the one hand, engage in prevention and thus act to prevent the emergence of risk factors that influence the development of cancer; on the other hand, they can provide professional help once the oncological disease has emerged and should not focus only on the patient but also work in the patient’s family. The influence of the social worker can help an oncology patient develop an appropriate attitude toward illness and, through coping strategies, teach the patient to deal with stress, fear, and negative emotions. Many studies have confirmed that the family positively affects adaptation to illness, its course, and treatment, and motivates the patient. A social worker can support and strengthen such social support, and in its absence, help to replace it.

A social worker working with oncology patients should operate directly in the patient’s environment, and such work is missing in Slovakia. The incidence of malignant tumors rises each year, making it absolutely necessary to begin working in this area.

Authors: Mgr. Lucia Ištvánová prof. PhDr. Eva Žiaková, CSc. List of Bibliographic References

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