Episode 6: Social Work in Oncology

[0:00:00 Speaker 1] We’re a resource for learners, including every member of the live strong cancer institutes on track, educational pipeline, from middle school to residency. We’re growing collection of interviews, talks and experiences the uncover the myths and the uncertainties of cancer and careers and cancer in order to empower and inspire generations of thinkers and leaders. This is cancer uncovered, uneducated in and empowerment podcast by the live strong cancer institutes.

[0:00:34 Speaker 0] I had never been somewhere where we were truly building from the ground up. I mean, when I’m talking from the ground up, there were just no policies and procedures. We were imagining all of that. And I had never worked somewhere where there wasn’t a policy already in place for, you know, X, y or Z. So it was just the very tiny details had to be worked out, and it was exciting, but for sure, a little overwhelming can’t deny that

[0:01:07 Speaker 1] December is a special time for the L. C. I, because two years ago today we opened the doors of the oncology clinic at UT Health Austin. As you just heard, working in a brand new clinic could be exciting. You have a lot more autonomy and flexibility compared Toa working in the hospital that’s been open for decades. But it has its challenges as well. That was Angela Luna. She is the senior clinical social worker in the oncology clinic at UT Health Austin, and she’s been here from the very beginning. However, she came to the L. C. I from New York City, where she worked at N Y use Langone Medical Center for many years, which is a huge hospital. So she has a unique perspective. You’ve heard in previous episodes that the clinic at the L. C. I is home to the innovative call model of whole person care. One crucial piece of this model is that patients received the emotional, mental and behavioral health support that they need in addition to medical treatment. All in one place, Angela provides patients with this absolutely essential type of support, and she does a lot of other things as well. In this episode, we’re going to dive into what it really means to be a clinical social worker and specifically what it’s like working in a new and rapidly growing cancer

[0:02:24 Speaker 0] center.

[0:02:25 Speaker 1] My name is Laura Pavitt, and I am part of the live strong cancer institutes at Del Medical School at the University of Texas at Austin. And this is cancer uncovered before we dive into what the clinic was like when it first opened. Let’s start with the basics. What is clinical, social work and what do you actually dio?

[0:02:50 Speaker 0] Oncology? Social work is its own specific area of, you know, a really large and diverse field. So you know, social workers do all sorts of things in the world. But oncology social workers have specialized training in identifying and meeting the needs of people with cancer and their loved ones. Andi, I’m a clinical social worker, so my training is really around supporting people’s mental and emotional health. Assessing problems and treating these problems and trying thio keep people healthy to prevent a decline in their mental health. I talked to patients and their caregivers other family members, about how they’re really handling all the changes in their lives that are happening as a result of a cancer diagnosis. I might talk to them on D, help them think about how they can improve communication with their Dr or other members of their care team. I talk a lot about resource is with patients, you know, things that I certainly recognize that I can’t support every patient and family member in every way that they need. So their resource is for things in the community that can offer support and just concrete, you know, assistance to address things like financial challenges that air so prevalent when it comes to, um, somebody facing cancer so I can offer any resource is that I know of for that, um, the other thing that I would add is that I do think part of my job, it’s a part that I take really seriously and I take to heart is, um, trying to support other members of the team, my colleagues that, you know, I think the work that we do is really hard. And what is unique about social work is we have a lot of training in understanding and paying attention to our emotional reactions to the work that we do because we know that we’re humans, you know, coming to this work and talking to other humans. So there are all sorts of things that come up when you’re working with patients, and sometimes it’s sadness or anger or, um, all sorts of things. It could be anything. And so I think that I try to help support my colleague’s when they’re in a particularly tough situation or having a hard time, or maybe not able to see something, you know, maybe helping them see another perspective to better understand why work with a certain patient is really, really challenging. That’s the other thing that I think. I’m sure that my clinical social work colleagues across oncology, you know, are doing a lot of that, too.

[0:05:34 Speaker 1] I know that from my own experience, it could be really hard to figure out what you want to do for a career. How did you get interested in this in the first place? And how did you know that this was the right path for you?

[0:05:46 Speaker 0] I knew I wanted to be in medicine or in healthcare. I really thought that I wanted Thio go to medical school, be a doctor, the whole nine yards and then early on in my undergraduate career, realized that I was not so strong in really anything that bio chemistry. You know, any of those things which are kind of necessary nuts and bolts. So I realized that I was much better at more of the communication stuff, talking to people, being empathic, trying to figure out you know how to solve problems of a different nature. So that kind of set some ground work for my path to social work and particularly. But as Faras oncology goes, it was really a personal experience that you know, in social work. We have really solid boundaries between our personal and professional lives. It’s important work that we dio, um, but I never mind sharing, and I think it’s important to share that. What brought me to cancer care was an experience with a loved one myself because many of us in this part of the field, not just social workers, but all you know, the colleagues that I come across. Many of us have had these personal experiences, and I think it makes us more sensitive to the challenges that our patients are facing. Um, my aunt died at age 50 Onley of pancreatic cancer, and my mom was my aunt’s primary caregiver at the end of her life, and I spent a lot of time with my aunt in a hospice, residents at the very end, and I just remember being struck by how empathic and strong all of the character members were in this hospice Onda. How they were able to comfort my mom and put her at ease in a way that she hadn’t been throughout my aunt’s illness. And interestingly, I don’t ever remember meeting a social worker. But I figured out that piece later, and I just remember thinking like I could do that. It takes a lot, I’m sure, But I could do it. And Andi, I think about my aunt to in terms of my role, because she really didn’t want to die. She was very strong and independent. So many of the qualities that I have, you know, I know I got from her. But I look back on her experience and realized that she really could have benefited from someone to talk to about what she was holding on to and what she was going through. And she had people around her, you know, who loved her. But she was really suffering emotionally because she wasn’t ready to leave. I wish she had a social worker toe spend some time with at the end, So I think of her sometimes when I’m doing work both with patients and with caregivers because, um, it could be really, I hope, a meaningful experience to have an hour to talk with, somebody who gives you their undivided attention and isn’t afraid to talk about the hard stuff. So I think of her a lot. And you know, that is absolutely what brought me to this work. So figuring out how Thio how to do it and to add kind of social work to the mix was, you know, came a little bit later. But I knew that this was the part of the field I wanted to end up in.

[0:08:52 Speaker 1] It’s really powerful, and I think our listeners will appreciate knowing your story, too, because, like you said, it informs your experience, working with patients and their caregivers, even when it gets hard. Yeah, of course. So now that we know more about what clinical social work is, what you do and why you do it, can you tell us what it was like for you at the very beginning? When the clinic first opened,

[0:09:18 Speaker 0] it was really exciting. I think we all I remember the first day we kind of all met the first initial crew, sort of one of the, you know, But it was also really daunting and definitely intimidating. I mean, I knew what I was getting into, but I also had never been the only one and in my field, in my discipline, I worked other places with big teams of social workers. So I had colleagues to kind of run things by, and I still have that in other places, but not within our clinic. And so I remember feeling a bit unsure. I do remember the first time Elizabeth Quality, who was our medical director of the time. We were in a meeting very early on, and she just we’re talking about a clinical situation or something. And she turned to me and said, Well, Angela, like, what do you think? It was a pretty basic question, and I don’t even remember for the life of me what it was about. But I remember just thinking like, Oh, my God, I don’t know the answer to that. Or do I know the answer to that? You know, I guess I’m now that should be answering this question. And, um, I just I couldn’t remember the last time someone asked for my professional opinion. So that’s a very sad statement. I mean, on the state of social work, I don’t think that’s true everywhere. But it was a very different experience, you know, the first several patients. I mean, they got like, I hope this was their experience, like the Cadillac of Or now I guess you’d say like the Tesla’s of health care. And I remember there would be like 10 of us in there waiting for our turn to see, like one patient that was in So we had Thio kind of step back and say, Is this really serving them or we overwhelming them? But we were so excited. Thio, you know, get started and Thio test things out and you know, So since then, we’ve had to try to think about what are some ways that we can make sure we’re identifying the patients that would most benefit from spending some time with me. You know, we’re working on that, But at the beginning it was very much like everyone saw every patient.

[0:11:17 Speaker 1] I know you’ve had a lot of experience working at large medical centers and hospitals, which must have been so different than what you just told us about. And now you’ve been here for about two years. What do you really like about working in a new and growing cancer center? And then what are some of the challenges?

[0:11:35 Speaker 0] You know, I think one of the things that is just so cool about being in a new clinic as you truly have an opportunity to do it better. You know, all of us have experience in so many other settings. And we’ve seen the pitfalls of health care, the way the ways that it doesn’t serve people and that people feel like just these numbers and cog in the wheel. You know, when they go to these big centers for care. And so I think what’s so cool is that it’s been truly an opportunity to say no, this is how I want to do it. This is how I think we should be. Evaluating patients needs from a social work perspective. And nobody, you know in our clinic says Well, I disagree. You know, everyone says sure. Okay, you know, you take that on. Sure. On DSO it’s very, very cool toe have that opportunity to just try new things and to say like I’ve had experiences, we’ve seen data that says, You know that this other way doesn’t work So let’s try it this way. So, yeah, there are challenges, I think, for all of for our entire clinic because, you know, there’s a reason why I think the health care systems out there are the way they are. It’s easier. It’s faster. It’s less expensive. You know, all of those things are kind of the default for a reason. And so we definitely struggle. And, ah, lot of the challenges that we have with, um taking care of patients. They’re not social work specific, but things like, you know, how quickly can you get care for a patient, you know, have things sort of happened that they need to have happened. It may not be the standard for things to move so quickly in in a setting that isn’t about treating just really sick people. That’s a challenge for sure, because we’re not our own cancer center and we don’t have our own infusion center, and so to be like Tiny is wonderful because you can spend my time on all of these things, but you start to figure out all the small details like I was sort of alluding to earlier and that can people really exhausting and take away from your ability to do what you signed up for right? Which is to take really good care of patients. But when you’re having to deal with all of these kind of bureaucratic things, or like, well, I can’t, you know, put this in the medical record because it won’t let me, you know, it’s just like it’s just those frustrations definitely add up into, ah, bigger challenge.

[0:13:57 Speaker 1] Now, with all of these benefits and challenges in mind, there have been a lot of changes over the last couple of years. When the clinic first opened, our providers only saw patients with gastrointestinal cancers. We have now expanded to see patients with many different types, including him. It’ll logic, malignancies, gynecologic cancer, head and neck cancer, lung cancer and, soon, breast cancer. So overall there are just many more patients, and Angela is still the only social worker. On top of all this. We’ve also been in a pandemic for the last nine months, which is almost half the time the clinic has been open. So a lot of these patients. Appointments are now in telemedicine. What has all of this been like for you? We’re

[0:14:45 Speaker 0] just facing the limits of just how many hours there are in a day. And how many hours do you spend at work? You know, working with patients and doing documentation and talking to each other about patients? There just isn’t the same amount of time to take that same kind of care of every single patient. Eso we’ve had to work smarter. I think I don’t I hope, and I don’t think that the care has suffered. We’ve just had to really carefully about how to maximize our time and our time with patients, and we work on that every day, really. And then we’ve kind of shifted to this virtual world bond. Honestly, from a social work perspective, it’s been better than ever for me, a za professional social worker. I have spent more time with patients on Zoom than I think I ever spent in the clinic. We’re seeing that or I’m seeing that patients are willing to prioritize a visit with me for some counseling, um, in a way that they couldn’t before and we started to see that. You know that patients were they didn’t feel well and to ask them to come into, you know, downtown Austin into our clinic to park and to pay for parking and toe, you know, kind of leave your car and go into the clinic and get to the clinic and wait for your appointment. I mean, just on and on and on. The number of steps that it took to make that happen. Um, it was just too much. And so patients weren’t, um if if they’d accept the first visit, they didn’t really want to schedule something for follow up. And in this virtual world, I’ve gotten to know our patients, I think way better and been able to do better work with them. So it’s been awesome. It’s something that we’ve been advocating for for a long time and for various reasons, you know, haven’t it hasn’t really been seen as feasible or as a priority, but in our work especially, and that’s something that social workers do like. We advocate for the people that can’t really fit in this one box. And so we’ve been think forever, especially in our field that people who are really sick and not feeling well, a better ways to access their care. And this is one of them. And we can stay part of their care for longer to because we could potentially see them, you know, when they’re really not doing well and maybe transitioning, you know, about to transition to hospice or at the end of life and were able to stay involved in a different way. So I’m excited about that possibility for our clinic. Thio, hold on to some of that in some form or fashion s O that it may be, you know, as much as possible and option for patients going forward even when things were better out in the world.

[0:17:23 Speaker 1] I was glad that Angela brought up access and that a part of her work is advocating for people who don’t fit in one box. We’re in a time when structural racism is being challenged, but there are still disparities in health care, including an oncology. I asked Angela what roles social workers have in terms of supporting diversity and inclusion in the clinic environment.

[0:17:49 Speaker 0] In terms of what we do in health care, social work. It’s the same as what I do in oncology, which is really try to enhance the voices of people that aren’t at the table. So that could be like a patient or a family member who is just not comfortable talking, you know, with the medical team for any reason. But often there could be cultural differences, differences in language, just comfort level with the medical system, you know, maybe some lower health literacy. And so I’m able to kind of step in and be a bridge between the patient and the team and bring their voice to the table, especially in health care. And, you know, our clinic, I think, does this way better. But it doesn’t mean that it still doesn’t come up where there are a lot of patients to see in a day and the clinic is busy. And maybe it’s harder to take that extra step to slow down and have a conversation with an interpreter or include a family member. Right now, to be very frank, you know, the population that we serve, they tend to be insured people, so it doesn’t mean that people with health insurance are all also very resource rich, but they tend to be people with more resource is than people who are uninsured. So something that we’ve been really advocating for as a whole clinic because we all really bought into this mission when we speak started in this clinic is that our end goal is to be able to really reach a much more underserved population. That’s a goal of ours. For sure. It just takes some significant resource is to be able to provide care for, you know, uninsured or under insured people, and I don’t get the sense we have them. Yet.

[0:19:30 Speaker 1] It’s interesting that another reality of a new clinic is that it takes a while to accrue. The resource is to be able to see the patients you set out to sea in the first place, patients who might need these wraparound services even more than others. While we may be on the right track, there’s still a lot of work to dio. This topic deserves a lot more time, so make sure you catch our episode next month as well, because we’ll focus completely on health disparities. The clinic continues to grow and we just heard that one of the ways the clinic will change in the future is to see a more diverse patient population beyond this. Angela, where do you think the clinic is heading? And where would you like to see it go? One

[0:20:17 Speaker 0] of the things that really drew me to the clinic when I interviewed and then started was this idea that we were going to be able to provide services to people with cancer that went far beyond our clinic walls. So not just, you know, medical appointments and visits with a social worker, but really lots of offerings, you know, outside of the clinic, things like, you know, support groups and educational opportunities for patients and families, even social events, especially for our young adults and caregivers, which air to really specific populations that we have pledged to take care of and to build, you know, programming and support for them. It’s something that these air to groups that air really often overlooked. And so, in terms of where the clinics headed, I’m hoping that one day in the future, I don’t know how distant, but you know, somebody will maybe take that into account when they’re choosing where to get treated for their cancer, that it’s not just of course, you need the highest caliber of medicine possible, and an academic medical center is a great place to get that. But I’d love to see the psychosocial offerings that we have become a part of a patient sort of calculus, their decision making when they decide where they want to get their care, like they look at us and say, Hey, you know, I heard from my friend that their mom, but was a caregiver of so and so got really good care, you know, as a caregiver at the l. C I. So that’s my goal, and vision is to really be ableto provide that to the community. If I’m dreaming big, we’d have more staff, and we’d be able to prove that somehow investing in more staff is a good investment that it helps. I don’t know with the things that people care about, like patient outcomes, patient experience, maybe even save a little bit of money, because to do the work that we’re that we mean to requires a lot of people. I think we’ve seen that. And you know, the challenge is figuring out how to try to maintain that same level of care with fever resource is because it’s not like every time we get 10 new patients, we get a new social worker or a new edition. Or, you know,

[0:22:29 Speaker 1] it’s clear that Angela is extremely passionate about this work, has a lot of goals for the future and supports her colleagues emotional balance. In the meantime, I asked her how she takes care of herself.

[0:22:42 Speaker 0] I mentioned that I what I love about our professional discipline is that part of our training is how to take care of ourselves. So this is something you learn in school. It’s that important. If you’re going to be talking to people all day, you also need to figure out how to make sure that you have sources of rejuvenation and things like that S O. I know. And my family and friends know that when I get home from work, I usually don’t want to talk. I love to talk all day at work and then when I get home some quiet time, so I know I need ah book and a cup of coffee is like my Zen. So I lot of recharging in that way. I e a joke and laugh a little bit that I never watched much TV until I became a social worker. And then let me binge this. You know, sometimes you do need time Thio just kind of detached and take a minute. So I watch a lot of TV in the past 10 years. You know what’s really wonderful about the work, and it is again, like a cliche. But I think it’s just so true is that doing this work helps you keep things in perspective. And so what you learn from patients, you know, we meet people all the time that have waited their whole lives, their whole working lives, to say, like go on this big vacation when they retire or all these different things and then they get sick. And so we have. You know, I think I’ve really tried to incorporate that into my life and to know that every day matters and that really helps kind of informed my outlook so that I don’t really get burnt out.

[0:24:17 Speaker 1] Thank you so much, Angela, for sharing your experiences and insight and wisdom with us today. I looked up the projected career outlook for sale Shorter’s and according to the U. S. Bureau of labor statistics. Employment of social workers in general is expected to grow by 13% from 2019 to 2029 by 14% for health care. Social workers in particular thes air both much faster than average compared to other careers, which is a good sign for people who are interested in this field. So my last question for you is this. What would you want to tell students who are considering a career in social work?

[0:24:58 Speaker 0] I would tell them that social work is a wonderful career path for people who like people who care about people. Do you know, if you enjoy talking with people and getting to know kind of what drives them and what their life is like? And you know what’s going on in their world? I think it’s a great job for you because you will meet so many different people from all walks of life. It’s hard work with not a lot of pay, often times and not a lot of recognition. I mean, I talked about that earlier. You know, if you’re somebody who really needs a pat on the back about your work and what you dio, um you don’t necessarily get that in this field. I feel appreciated by my colleagues at this place. But it’s been a long road to get here. And I would say that to what I’m talking about. This wonderful job that I have has been, you know, a decade in the making. I have worked in a lot of different places, and it was necessary to get that experience in different settings and toe learn kind of more broadly, how to practice social work. So I think that, you know, it can be sort of a long arc, you know, to get where you B and you have to be motivated to get your own, you know, kind of extra training. In order to have the extra skills you need. Thio set yourself apart, but the work can be really rewarding. And if you hope to make a difference, I think you definitely can in this work. And it’s not on Lee people who are good at the sciences and can treat the illness that can make that difference. You can really make a difference by being someone who can support someone through their mental health challenges as well and support their

[0:26:39 Speaker 1] emotional health as well. It If you have questions for Angela Luna or if you have other cancer questions that we can uncover, please email us at Livestrong cancer institutes at del med dot utexas dot e. D u. And please make sure institutes is plural. You can find out more about the live strong cancer institutes at del med dot utexas dot e d u and about the live strong Cancer Institutes clinic at ut health austin dot warg. You can also follow our chair and director Dr Gail Eckhart on Twitter at S Gail Eckhart Eckhart is spelled E c k h a r D t. If you enjoyed this episode, please make sure to subscribe. I am Laura Pabbott and this is cancer uncovered. Thank you for listening.