ROLE OF SOCIAL WORK IN CANCER PREVENTION AND CANCER CARE

 

Cancer is, to a large extent, avoidable. Many types of cancers are preventable. Others can be detected early in their development, treated and cured. Even with late stage cancer, the pain can be reduced, the progression of the cancer slowed, and patients and their families helped to cope.

The profession of social work has great strength in tools and techniques especially in the areas of community mobilization and in providing psychosocial support that the medical profession doesn’t have. Some other example of the strength of social work will include social action and mass mobilization; understanding of community’s dynamics and eliciting community participation; social welfare linkage and management; counselling, group work and community work for educational purpose and psycho-social support, etc. The tools of social action especially mass motivation, mobilization and participation of the community will be very effective at the preventive level of cancer.

In the Curative level, social work can provide supportive roles to the doctors and patients by providing psychosocial and emotional support which is today, widely accepted as a critical component of medical treatment. It can provide motivational, educational and therapeutic counselling to the cancer patients; it can links patients with necessary resources like funding and treatment aids from the governmental sector as well as non-governmental sectors, etc.

At the rehabilitation level, there is even a greater role for social work by taking care of the palliative unit. At the palliative level, taking care of the psycho-emotional needs is critical not just for the cancer patients but also for their families for any eventualities.

The Government of India under its National Cancer Control Programmes (NCCP) followed four principal approaches in controlling cancer in India. This paper will also follow that approach in exploring the possible roles of the profession of Social Work in Cancer Care and Prevention, with one more heading added, i.e. Policy level.  

1. Prevention
2. Early Detection
3. Diagnosis and Treatment
4. Palliative Care
5. Policy Level

1. PREVENTIVE LEVEL

Prevention should be the key element in any disease control programme. Prevention means eliminating or minimizing exposure to the causes of cancer, and includes reducing individual susceptibility to the effect of such causes. This approach offers the greatest public health potential and the most cost effective long-term method of cancer control.

Cancer prevention at the individual and community level, social worker can take a leading role by ensuring community participation in taking preventive actions, awareness generation at all level from school, neighbourhood, to community.

• The most useful prevention strategy is reduction in tobacco consumption (all forms). Currently about 50% of cancers in men and 20% of cancers in women are related to tobacco use. Social workers can take a leading role in spreading the health implication of tobacco, helping people deal with tobacco addiction, and rehabilitation of tobacco farmers and those whose livelihoods depended on tobacco in one form or the other by helping and generating alternative source of livelihood;
• The social workers can ensure in involving all levels of the population in the educational process regarding cancer. The contents of cancer education should focus on, tobacco control, physical activity and avoidance of obesity, healthy dietary practices, reducing occupational and environmental occupational exposures, reducing alcohol use, immunization against hepatitis B virus, safe sexual practices to avoid human papilloma virus infection.
• Campaigning for a healthy lifestyle, which includes eating plenty of fruits and vegetables, avoidance of alcohol and adequate physical activity, is protective for many of the non-communicable diseases including cardiovascular disease and diabetes, and can be considered as part of the overall health promotion programmes.
• Cancers related to infectious agents such as human papillomavirus and hepatitis B virus can be prevented through vaccination strategies, and social workers can take a leading role in mobilizing the communities.

For the above mentioned prevention measures at the community level, a variety of methods can be employed to educated the community:

• Among School and University student: Conducting drawing and essay competitions, debates, discussions, seminars and street play competitions, etc.
• Among Community organization, Municipal, District and State Health Administration: Organizing Participatory workshops and training sessions.
• In the Mass Media: Participatory programmes on radio and television, descriptive articles in newspapers and magazines,
• Among the General population: Conducting exhibitions and public lectures, conducting street level awareness drive, focus group discussion with community members, health camp, etc.

2. EARLY DETECTION OF CANCER

Early detection of cancer is critical in combating cancer mortality rate. In India, almost 60 – 70 % of cancer patients are detected at advanced stage which reduced the chances of recovery and raise the cancer mortality rate. 

Cancer Screening is the application of a relatively simple and inexpensive test to asymptomatic subjects to classify them as being likely or unlikely to have cancer. A screening test in itself will not prevent cancer; it needs to be followed up through a systematic medical approach. Still, this is a relative simple measure for early detection of cancer that can be undertaken even by those who have no advance training in medicine but are familiar with medical processes like medical and health social workers with minimal training about the screening process.

• Opportunistic screening or case finding can be done by the Medical Social Welfare Unit in selected pockets of community based on the populations’ likelihood of getting cancer (this can be determined by many criteria like life-style, community living in industrial areas, or in a waste disposal or waste treatment areas, community whose livelihood are related to radiation or tobacco industry, etc.). This will help not only in early detection but also in increasing the awareness level of the community.
• Clinical breast examination can be made feasible for women above the age of 40 years, which can be carried out by general practitioners besides community mobilizers like Social Workers. Also there are some simple breast self-examination techniques for women which social workers can teach to groups of women in the communities.
• Cancers in accessible parts of the body like the oral cavity may be detected at an early stage or even in a precancerous stage through simple inspection and examination; medically familiar personnel like medical social workers can be trained for this purpose.
• Self-examination of the oral cavity (MSE) and breast (BSE) can be useful methods and each can be propagated widely as a strategy through simple IEC (Informational, Educational Communication) materials, community meeting, focus group discussion, etc. for the early detection of cancer.

3. DIAGNOSIS AND TREATMENT LEVEL

In the Curative level, social work can provide supportive roles to the doctors by providing psychosocial and emotional support to the patients and their families which is considered as a critical component of medical treatment. It can provide motivational, educational and therapeutic counselling to the cancer patients; it can links patients with necessary resources like funding and treatment aids from the governmental sector as well as non-governmental sectors, etc.

At the diagnosis and treatment level, the roles and functions that a social worker can play in cancer care are:

• Motivation counselling to patients to seek medical help and enabling resources for the treatment and providing proper referral services
• Educational counselling to the cancer patients about their medical status, preparing them for future course of treatment and treatment process and the possible outcomes of the treatments.
• Therapeutic counselling to deal with the psychological stress and trauma that can have severe implication on their already weak physical body;
• If the patients and/or the family are in crisis because of the treatment, crisis intervention has to be undertaken
• Emotional support to the family of the cancer patients, and eliciting the involvement of the family in the treatment process
• Providing the cancer patients with various social welfare resources that will enable and enhance their access to better health care and treatment
• Linkage of cancer patients with governmental and non-governmental welfare resources
• Organizing therapeutic and/or peer support group for cancer patients
• Since cancer patients are under extensive emotional and psychological anxiety and stress, organizing recreational and entertainment for them is important
• A diagnosis of cancer and subsequent treatment can have a significant impact on self-concept, the way in which people perceive or react to themselves. Living with cancer may affect personal self-concept (facts about the self or a person’s self-opinion); social self-concept (perceptions of how one is regarded by others); and self-ideals (perceptions of oneself with respect to how one would like to be). Social worker can provide support and counselling for such patients.

4. PALLIATIVE CARE

Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment, and treatment of pain and other problems – physical, psychosocial and spiritual. Palliative care is particularly important in less developed countries where a high proportion of cancer patients are diagnosed in advanced stages when treatment is no longer effective. These patients can be relieved from suffering with relatively low-cost interventions.

The various issues that crop up in palliative care especially in the terminal stages are:

• Physical issues towards the end of life incudes loss of function and curtailment of activity and physical effects to perform activities of daily living, including self-care activities, mobility, physical activities and role activities.
• Psychological issues towards the end of life include fear, distress, anxiety, anger, frustration, disappointment, depression, etc.
• Social issues towards the end of life include disruption social relationships as a result of impaired ability to pursue normal activities and maintenance of social contacts.
• Existential and spiritual issues towards the end of life include confrontation with mortality, the meaning of life, isolation and worth as a person. As patients reached terminal stages, spiritual issues gain importance as determinants of quality of life. Spiritual considerations may also assist the individual to endure present discomforts and, if need be, to face death with courage and dignity.
• Impact of towards-the-end-of-life issues on the family includes general depression, concern about old parents or young children, unclear role and power structures in the family, unclear source of income and means of livelihoods, etc.

The role of the social worker is to help the family and patient deal with the personal and social problems of illness and disability, as well as to provide support during the progression of the disease and the bereavement process if the patient is at the end of life.

• The social worker’s assessment helps define the patient’s and family’s needs from a psychosocial perspective, and helps anticipate problems within the family that may result from dysfunction and financial difficulties, particularly as the family begin planning for the future.
• Social work offer such interventions as referral to needed community services, emotional support (including individual counselling of patients and family members) and bereavement counselling.
• At this stage, social worker can help in finding help and assistance for the patients if there is no one to take care of them, find a nursing home or palliative care unit that can take-care of their personal needs, and helping the family of the patients on how to deal with this physical issues.
• The social worker can help the patients in coping and dealing with the issues of their medical condition, including the possibility of death, ensuring that their personal concern and worries are taken care of as much as possible, and if the need arises, finding spiritual guide and person to interact with the patients.
• The social worker can help the patients in staying in contact with family and friends and other loved ones, explain to the family how he is unable to maintain or reciprocate the relationships, etc.
• Conducting support group for the family, along with therapeutic counselling to cope with the situation.

5. POLICY LEVEL OF CANCER CARE

There are many ways that a social worker can get involved at the Macro level of cancer prevention and cancer care:

• Many types of cancers can be prevented to a large extent through a comprehensive tobacco control programme including education, legislation, and tobacco cessation services.
• Ensuring leadership that create clarity and unity of purpose, and to encourage team building, broad participation, ownership of the process, continuous learning and mutual recognition of efforts made in cancer care.
• Ensuring involvement of stakeholders of all cancer related sectors, and at all levels of the decision-making process, to enable active participation and commitment of key players for the benefit of cancer control programme.
• Creation of partnerships to enhance effectiveness through mutually beneficial relationships, and build upon trust and complementary capacities of partners from different disciplines and sectors.
• Responding to the needs of people at risk of developing cancer or already presenting with the disease, in order to meet their physical, psychosocial and spiritual needs across the full continuum of care.
• Ensuring decision-making based on evidence, social values and efficient and cost effective use of resources that benefit the target population in a sustainable and equitable way.
• Ensuring the application of a systemic approach by implementing a comprehensive programme for cancer with inter-related key components sharing the same goals and integrated with other related programmes and to the health system.
• Seeking continuous improvement, innovation and creativity to maximize performance and to address social and cultural diversity, as well as the needs and challenges presented by a changing environment.

Looking at the prevalent trends in the spread and magnitude of cancer and its non-discriminate penetration of every sections of the society, cancer is already a health concern that needs urgent attention from all sections including policy-makers across the world. According to the World Health Organization, death from cancer and other life-style diseases in the developing world including India is expected to increase 104% worldwide by the year 2020. In India, the total cancer cases alone are likely to go up from 979,786 cases in the year 2010 to 1,148,757 cases in the year 2020.

The profession of Social work, especially medical and health social work must take this opportunity in order to survive and thrive in this fluctuating and complex environment in which it is reduced to a supporting role. Social workers must either accept this challenge to change and re-evaluate the services provided and expand their horizon of works or lose the opportunity to be players in the field of cancer prevention and cancer care.

[This is an extract from my Research Paper titled: Exploring the Role of Social Work in Cancer Care and Cancer Prevention submitted to the Dept. of Social Work, Jamia Millia Islamia (New Delhi) and conducted in BRAIRCH of All India Institute of Medical Science (New Delhi) between September 2011 – March 2012 ]