Transcript of Part 1: Why Bladder Cancer Patients May Need an Oncology Social Worker with Dr. Heather Goltz

February 10, 2021

Speaker 1:
This is Bladder Cancer Matters, the podcast for bladder cancer, patients, caregivers, advocates, and medical and research professionals. It’s brought to you by the Bladder Cancer Advocacy Network, otherwise known as BCAN. BCAN works to increase public awareness about bladder cancer, advances bladder cancer research, and provides educational and support services for bladder cancer patients and their loved ones. To learn more, please visit BCAN.org.

Rick Bangs:
Hi, my name is Rick Bangs and I’m the host of Bladder Cancer Matters, a podcast for, by and about the bladder cancer community. I’m also survivor of muscle-invasive bladder cancer, the proud owner of a 2006 model year neobladder and a patient advocate supporting cancer research at the Bladder Cancer Advocacy Network, or as many call it, BCAN. This podcast is produced by BCAN. In these podcasts. I interview bladder cancer patients, survivors, caregivers, and medical and research professionals to bring our listeners insight into topics of interest to the bladder cancer community. Today’s episode is brought to you by FerGene, a gene therapy company, dedicated to creating and delivering innovative solutions to urologists and those affected by non-muscle invasive bladder cancer. We are grateful for their support.

Rick Bangs:
I’m pleased to welcome today’s speaker, Dr. Heather Honoré Goltz. Dr. Goltz is an associate professor of social work at the university of Houston-Downtown and a research investigator at the Michael E. Tobacky VA Medical Center. She is also the chair of the Association of Oncology Social Workers Education Committee. She is a licensed master social worker and doctoral level health educator, with over a decade of experience developing and implementing clinical interventions to improve quality of life and health outcomes of patients and caregivers impacted by complex medical and behavioral health conditions. Welcome Dr. Goltz.

Heather Goltz:
Thank you for having me.

Rick Bangs:
In today’s episode, we are going to talk about a valuable and often underutilized resource available to bladder cancer patients, partners, caregivers, and families, the oncology social worker. Oncology social workers are members of the care team. They have specialized training and support people impacted by bladder cancer in solving and avoiding problems related to that diagnosis. Patients and families are frequently unaware of this resource, or may not know how to find one. We will talk about some of the most common opportunities and how to address them today. Dr. Goltz, let’s start with the concept of medical social work. What is it?

Heather Goltz:
Oh my gosh. I’m so glad you asked. So medical social work is a distinct specialty within the profession of social work. And actually, as a specialty, it’s over 100 years old. It’s like the greatest specialty that no one’s ever heard of. It is sometimes referred to as health care social work. And so, what is medical social work? Medical social workers do a great number of things, but what it distills down to is we assist patients and their families with any health related concerns or problems that they’re experiencing. And we do this by performing a comprehensive assessment of the patient’s biological factors, psychological social factors, the environmental factors, or financial or support needs for the patient, and also their immediate family that impact their ability to have strong and positive health outcomes that improve their quality of life and their wellbeing.

Heather Goltz:
And so, that broadly is the concept of medical social work. We are frontline workers. We are integral members of the healthcare team, but we often work more behind the scenes except for when we need to directly interface with patients or their caregivers to perform our assessments or to work with them on internal or external coordination of various resources. And now I can get more detailed about that, but really we’re there as bridges to resources, as advocates, as educators often to help assist the healthcare teams, the patient care team, in terms of reducing misinformation or providing education on resources.

Heather Goltz:
And so, that’s just in a nutshell some of what medical social work is. I will say that in most medical facilities, whether that’s a comprehensive cancer center, a hospital or a clinic, your medical social worker is going to be a master’s level social worker with at least two years post-MSW experience. And that helps to make sure that that medical social worker has both clinical skills and knowledge and nonclinical skills and knowledge so that we can be that bridge, that educator, that advocate on behalf of our patients and their families.

Rick Bangs:
Okay. So with that as background, what is an oncology social worker?

Heather Goltz:
So with all that in mind, an oncology social worker is someone who develops or enhances provision of psychosocial services to cancer patients and their families. We are the professionals on the healthcare team who are going to serve as bridges between individuals and their families affected by cancer, and resources that are cancer specific within the healthcare agency or healthcare system, and then those external resources within the community, the state and beyond. And that actually, because of the complexity of cancer broadly, and then specific cancer sites means that an oncology social worker has to be very well-versed with kind of the trajectory of a particular, specific cancer.

Heather Goltz:
So there are general oncology social workers, but most of the oncology social workers I know are actually specialists and they work more with specific patients and their caregivers and their families impacted by specific cancers, such as bladder. And part of that is really because having knowledge of the trajectory of a given illness, the specific ways that diagnoses happen and bring people into healthcare settings or healthcare systems, the specific nature of the treatments, potential side effects, how that might impact other aspects of their lives, that is very often unique to the specific type of cancer that a patient may be diagnosed with.

Heather Goltz:
Along that trajectory and thinking about the accompanied continuum of care, the oncology social worker really needs to have a sense of what are their unique both practical concerns going to be. So for instance, if it’s more common with a particular cancer for people to perhaps have their teeth pulled, which often happens with your oral cancers, then the needs of someone like that who now may need to get false teeth, and before they get those replacement teeth, they may need to have special diet, or even with the teeth, they may need to have a special diet. They may need speech therapies because when your teeth change out, it changes the way that your mouth forms words and sounds.

Heather Goltz:
So an oncology social worker who is more versed, not just in medical social work, not just broadly in general oncology social work, but who is specific to more of your oral cancers will know intimately the special needs and the needs for education, the needs for resources, the needs for psychological, emotional, mental health supports that will potentially accompany that patient and their family along their unique cancer journey. So that’s kind of a little bit more about oncology social work.

Rick Bangs:
Okay. Let’s pause for a moment for a word from the Bladder Cancer Advocacy Network.

Speaker 1:
The Bladder Cancer Advocacy Network, BCAN, invites you to join us for our 10th annual Virtual Walk to End Bladder Cancer. Saturday May 1st, 2021 at 11:00 AM Eastern Time. Our virtual walk is an interactive nationwide alternative to in-person walk events that involve thousands of participants walking from the place of their choosing. The overarching walk theme is no one walks alone, as we make people aware that they are not walking alone during their difficult bladder cancer journey, an important reminder during this time of social distancing. Critical funds raised through the virtual walk help BCAN increase awareness about one of the most commonly diagnosed cancers in the US, support hundreds of thousands of people living with this disease, and raise funds for much needed bladder cancer research. The virtual walk will be broadcast on BCAN’s social media channels, and will include compelling videos from bladder cancer, patients, caregivers, doctors, and more. Learn more about the May 1st virtual walk to in bladder cancer at BCANwalk.org. That’s B-C-A-N walk.org, or contact us at (301) 215-9099.

Rick Bangs:
We’re back with Dr. Heather Goltz talking about a valuable and often underutilized resource available to bladder cancer patients, partners, caregivers, and families, the oncology social worker. So how is an oncology social worker helpful for these unique challenges with bladder cancer?

Heather Goltz:
Oh, there’s a great need for oncology social work in bladder cancer. Whether someone is diagnosed with non-muscle invasive or muscle invasive bladder cancer, receiving a bladder cancer diagnosis is a life-altering event. It introduces the need for patient education, various psychosocial supports, specialized care, and assistance navigating health systems. And that’s regardless of socioeconomic status factors that may come into play, issues of geography and proximity to those health systems that may come into play.

Heather Goltz:
In all phases of bladder cancer treatment, healthcare professionals are key to ensuring that bladder patients’ needs are met across a number of dimensions, whether that’s patient clinician communication, activities of daily living, health promotion needs, health system or informational needs, psychological needs. And it’s critical that patients have active participation throughout all phases of treatment and that that care is patient-centered.

Heather Goltz:
So it’s imperative that bladder cancer patients and their caregivers be informed of the impact treatment options can have on their quality of life, their lifestyle, their relationships, the risks and benefits of various treatment options. And if they’re not well-informed and engaged in the treatment process for whatever reason, there’s a great chance that patients could make decisions that really aren’t compatible with their own values or preferences, or that those decisions could negatively impact other aspects of their functioning and their bladder cancer outcomes.

Heather Goltz:
And so, oncology social workers are that essential member of the healthcare team who then works directly and indirectly with bladder patients and their caregivers to assure the team, and ensure the patient and caregivers are able to process their own values and beliefs related to health and wellness, an illness, to look at the available options and to be able to apply those values and beliefs in choosing the treatment options that are going to be most compatible with those values and beliefs and the lifestyle that they have. The oncology social worker is going to be someone who leverages their strengths, any of the available family or organizational or community resources to maintain or even enhance their coping, their health-related quality of life and their overall wellbeing. And we’re going to use a number of clinical and nonclinical tools. Again, not just to focus on the unique needs of that patient or their caregiver or their family. We’re also going to work within the healthcare team to help the various healthcare professionals on that team to have enhanced communication and shared decision-making.

Heather Goltz:
Health literacy is a really big problem in the US. And it’s not limited to just folks with high school or lower educational attainment. You can have lower health literacy or limited health literacy and have a college or graduate education and not be able to really fully understand and then apply all of the medical terminology, the medical-ease that happens and happens very quickly in healthcare encounters and healthcare settings. And so, the oncology social worker is going to help reduce or remove that particular barrier and smooth out patient provider communication, and also removing other barriers to quality of care, identifying potential gaps in service, whether that’s health insurance, or perhaps the need for additional professionals to be brought onto the team. For instance, physical therapy or speech therapy, occupational therapy, respiratory therapy.

Heather Goltz:
And I know we’re talking about bladder, but there are times when working with an oncology social worker, you don’t just have someone who can help you with the primary presenting problem, we call it that. The primary presenting problem would relate to bladder, but in doing our assessments and working with patients and caregivers and families, we may uncover other needs where we can help be that bridge or that linkage to other services. For instance, social security disability, or Medicare or Medicaid, or, for instance, nutritional supplementation, food banks, rental and other housing assistance, transportation. And so, really we help ensure that patients’ needs for supportive care are addressed across the cancer continuum. And we provide assurances to the other health professionals on the team that the patient can have as smooth a journey throughout those phases of treatment and care and throughout their cancer journey as possible.

Heather Goltz:
And we may do that, because medical social workers and oncology social workers, we sometimes go by different titles within organizations, and those may correspond to more specialized roles of case managers or patient navigators or patient advocates. But in the case of the oncology social worker, we are still applying that specialized oncology knowledge skills, those aptitudes, those competencies towards the work of improving health and wellbeing and outcomes for our patients. Also, our work is not limited to individual patients. We also can work with the caregivers. Often what will happen when we perform our comprehensive bio-psycho-social spiritual assessment, I referred to that earlier. That assessment helps us provide a context to what’s happening with the patient and meaning to various issues or problems that patients identify when they’re first accessing bladder cancer care.

Heather Goltz:
Often in a number of at least the comprehensive cancer centers and cancer hospitals, some of the tools we use may take the form of, for instance, the National Comprehensive Cancer Network, the NCCN, distress thermometer and problem list. And what happens is that tool helps us to identify what specific problems, whether those are symptoms, physical or emotional symptoms, or potential practical problems, such as transportation or concerns with housing or childcare, or insurance or other financial needs, needs with work or school, et cetera. So that problem was still help us very quickly identify a number of concerns and unmet needs. And then the distress thermometer itself helps us, through working with the patient, understand the level or the degree of distress that those problems are causing our patient. And usually the higher, the score, the higher the number of potential unmet needs that that patient and their loved ones may be experiencing.

Heather Goltz:
So in addition to working with the patients, sometimes that assessment, and sometimes that distress thermometer or problem list, help us to uncover maybe relational dynamics or needs within relationships. And we are able to then work with not just the patient, but their caregivers, our partners, and use some of those clinical skills I talked about in terms of providing non-pharmacological interventions, counseling, stress management, trauma management, trauma care therapy. I’m actually also a sex therapist. And so, if the assessments or the problem list uncovers issues with sexual symptoms, issues of sexual functioning, sexual bother, then I have a clinical set of skills that I can use to work with patients and/or, or both, their partners in order to enhance or improve sexual functioning and sexual wellbeing.

Heather Goltz:
And so, there’s a lot that oncology social workers have to offer to patients and their caregivers in addition to the more routine medical social work or general oncology social work skills with advocacy, bridging, brokering aspects of care, and so on.

Rick Bangs:
Wow, Heather, thank you so much for that answer. We’re going to go ahead and wrap up part one of this interview. And I really look forward to continuing this conversation in part two.

Speaker 1:
Thank you for listening to Bladder Cancer Matters, a podcast by the Bladder Cancer Advocacy Network, or BCAN. BCAN works to increase public awareness about bladder cancer, advance bladder cancer research, and provide educational and support services for bladder cancer patients. For more information about this podcast and additional information about bladder cancer, please visit BCAN.org.