By Jeanice Hansen, LCSW, OSW-C 

I cannot speak authoritatively about how oncology social work has evolved over the years other than to observe that it has required us to continually adapt to the changing and complex environment of oncology healthcare delivery – especially during a pandemic. The familiar career question, “Where do you see yourself in five years?” quickly became irrelevant. We’re living in an intensified state of uncertainty. Some things haven’t changed much though. We all know about the constant demand to “fix” what appears broken, prove the value of our work, and affect outcomes with limited resources. We do our best to be responsive and effective. In addition, we are learning more about providing trauma informed care, putting DEI principles into action, working virtually, integrating the use of AI to diagnose and treat, and considering LSD and edible cannabis as treatment options for depression, pain and anxiety. Financial toxicity, microaggressions, online learning and the Oncology Care Model have become familiar terms. And, more than ever in our career, we are dealing with the impact of multiple national and international crises and atrocities that affect our patients and ourselves.   

Thinking about evolving oncology SW practice led me to reflect on my own evolution as an oncology social worker, a profession I am strongly aligned with in so many ways. It began with my curiosity about how people are shaped by their experiences and environment. Then I gained knowledge and skills to do the work. But the most compelling part of being an oncology social worker is bringing all of that together as an active, conscious practice of compassionately being with people who are struggling with cancer and mortality, witnessing both their suffering and their resilience. For me, it has been an ongoing cycle of “learning,” “doing” and “being,” integrating new developments and consoling suffering while staying grounded in calmness and creating space for my own well-being and recovery.  

I invite you to reflect on your own professional evolution with me as we consider the confluence of experience, education and exposure that brought us to this place in our career as oncology social workers. I imagine it was an indirect and unpredictable route. It was for me. 

I have held a variety of positions in my 33 years of social work in health-related settings. The last 23 years have been focused on providing oncology support. Joining AOSW early on deepened my professional identity and expertise. I am intrigued by how many of my perspectives, interventions and practice have changed over time as a result of new information and considerations for our work. However, many of the core values remain.  

Early on in my “human service” education, I only had a cursory knowledge of how politics and economics affected policy and practice. I remember an instructor satirically explaining “trickle-down economics” with the colorful illustration of a horse eating the best grain and expelling a few undigested seeds for the birds to consume. That was my introduction to the concept of inequity. Until then, I had no personal understanding of social injustice or oppression. Our family struggled financially, but I never went to bed hungry or was denied services because of discrimination. I had no personal awareness of racism or living in deplorable conditions. 

The Civil Rights Act was never discussed as groundbreaking legislation when I was growing up white in a small farming community. I was only 7. But I became curious about what that meant as my world got bigger. I joined a small group of teens in high school who traveled to rural Appalachia to do volunteer work with those living in poverty. That included helping a Black family rebuild a house out of cinder blocks because theirs had been burned down as the result of a hate crime – a term I had never heard before but recognize all too often now. I loved being immersed in another culture with people who experienced life differently and didn’t look like me.  I met people who faced great adversity with courage, joy and hope. This young girl emerged from that experience as a budding social worker without the formal title.  

After marriage, children and divorce, I formally pursued my interest in social work. Undergraduate studies introduced me to the foundations of social work. And it was spending time with a professor who had medical social work experience that stimulated my curiosity about specializing in that area of social work. 

Shortly after graduate school, I began working in a hospital setting (ER and ICU) at night. I eventually worked on other inpatient units, including oncology. Within a few years, I also lost my sister to breast cancer and another sister to lung cancer. All the education I received didn’t prepare me for witnessing the emotional and human toll of living with loss and dying from cancer. But it did teach me how to compassionately be with people who are suffering without losing myself in the experience. It also taught me to make room for opportunities for joy and laughter in the midst of it. It taught me about resilience and courage. 

So, when the opportunity to work in an outpatient cancer center came up, I had to pursue it. I happened to be reading the powerful poem and book by Oriah Mountain Dreamer called The Invitation at the time. This passage inspired me: It doesn’t interest me who you know or how you came to be here. I want to know if you will stand in the center of the fire with me and not shrink back. “Yes, I can do that,” I thought. And I dedicated this work to my sisters.  

Over the years, I recognized that being with individuals experiencing loss, fear and pain can be emotionally and physically draining, leading to burnout and compassion fatigue. I thought pouring myself into this work was a virtue. The importance of self-care and the need to heal my own suffering became apparent in dramatic ways. I had to support my own well-being in order to help more people. Learning to compassionately care for myself physically and emotionally has offered additional insight and capacity to do this work. 

My evolution as an oncology social worker began as an outward pursuit of knowledge about the emotional and practical needs of human beings facing life-altering experiences and the skills to do what is necessary to effectively address them. Ultimately, oncology social work inspired me to be with people and myself in more authentic and meaningful ways.