The New Social Worker Vol. 20, No. 2, Spring 2013 | Page 11

and other professionals, so they can successfully assist patients in the transition.
To successfully transition, patients need
consistent and specific support from their
doctors, nurses, social workers, and any
other components of their professional
support team. Patients can receive the
much needed support during this adjustment period from survivorship services
offered by professionals. That being said,
there is an ever-growing need for cancer
treatment centers to offer services specific for survivors and promote sustainable changes in the services available.

Survivors can face unique psychological challenges along the way. Fear of
recurrence is very common among survivors, and minor physical problems can
often trigger the feeling that the cancer
has returned. For patients, knowing what
is “normal” and what should be reported
to a doctor can be difficult. Typically this
fear lessens over time; however, certain
events such as a diagnosis anniversary or
follow-up exams can heighten anxiety. For some survivors, the feeling of
uncertainty can become overwhelming
and lead to struggles with depression
and anxiety. They may also struggle with
feelings of anger, isolation, guilt, and low
self-esteem. Support groups and counseling can help survivors cope with these
and other difficult emotions.

Treatment consists of specific physical problems and challenges, even after
treatment. Different treatments cause
different side effects, and patients may
experience them in their own way. In
particular, such side effects as fatigue,
changes in skin texture, or nerve changes
in the fingers or toes (also known as neuropathy) can take months to heal. Some
side effects can even be permanent and
require lifelong management. They can
even show up months or years later, and
these are known as late effects. Treatment
can also exacerbate existing conditions,
such as diabetes or heart disease. It is
also common for some survivors to have
a part of their body surgically altered
or removed as a part of treatment. To
cope with any side effects and maximize
physical abilities, providers should offer
a wide range of supportive care and
rehabilitation services.

Coping with the lifelong challenges
around sexual function and reproduction
that remain long after the cancer is gone
can bring about difficult emotions for patients. As a result of physical or emotional changes, patients may find it difficult

to be intimate with someone. Treatment
can also cause infertility in both men
and women, and no longer being able to
produce a child can bring about feelings
of anger and grief. Giving patients all of
their options regarding preservation of
reproductive tissues, breasts, or genitals
and effectively preparing them for any
possible losses is critical for a successful
transition into survivorship.

Cancer has an impact not only
on the survivor but also on his or her
relationships and support system.
Patients can feel alone and isolated,
and so become alienated from others.
Cancer changes how people relate to one
another; some people become closer,
while others become much more distant.
Families can become overprotective, or
they can feel like they have exhausted
their ability to be supportive. Support
post-treatment can often be much different from what a patient hoped for
or expected. In addition, relationship
challenges that were put on hold during treatment can resurface. Offering
counseling and similar services can assist
a survivor in recognizing and working
through these changes, and ensure they
get the support they need.

Returning to work can be a sign of
a patient regaining a sense of a “normal”
routine and lifestyle, and most survivors
need their employment to survive. Although survivors can be just as productive as they were prior to treatment,
many often feel they are treated differently or unfairly and are fearful of asking
for extra accommodations if needed.
There is a lot of apprehension and
embarrassment when survivors return to
work and feel that coworkers may view
them as less able. However, information
is available to help patients transition
back into the workforce, and there are
laws and regulations that prohibit discrimination, such as the Americans with
Disabilities Act. Key players in avoiding
discrimination and advocating for the
client include the employer’s human
resources representative and an oncology
social worker.

Financial challenges go hand in
hand with returning or even not returning to work, as the cost of cancer can be
exponentially high. Even patients who
are fortunate enough to have health
insurance are left with costs that accrue
quickly. Often, survivors have already
lost income because they were not able
to work as much or at all during treat-

ment, making it difficult to pay both
medical and household bills. It is a critical part in the role of the oncology social
worker or patient navigator to connect
patients with national and local organizations that offer financial information,
advice, and support.

Spirituality can be a critical part of
coping and healing throughout the cancer experience. Many survivors struggle
with questions of why they had cancer or
why they survived. For some, spirituality and faith are sources of comfort and
strength. Others may find themselves
examining long-held beliefs or religious
values as they try to make sense of their
experience and find new meaning in life.
There can often be a lot of anger and
resentment, even a sense that they have
been betrayed by their faith. Patients
who did not have strong religious or
spiritual beliefs beforehand may have
new questions or be confused about what
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