Cancer Care: Establishing a New Normalcy

Ellen Eisen, MSSW, LCSW, Cindy Rogers, MSN, FNP, and Kim Hardin, MSN, CFNP

When Linda B., a 45-year-old Memphis resident, was diagnosed with breast cancer, she never dreamed how dramatically her life would change. She expected the physical challenges that come with cancer care, but she did not realize how the experience would affect every aspect of her life. Early in the treatment process she realized that she would no longer be able to retain her demanding management job. She then found out that restrictions in her insurance policy would require her to pay thousands of dollars in out-of-pocket expenses. As a result of her treatment, she experienced dramatic weight gain. This weight gain and her inability to be the attentive wife she once had been began to put a strain on her relationship with her husband.

As unfortunate as Linda B.'s situation might appear, cases like this are all too common in a cancer clinic. People who are being treated for cancer typically have many needs that must be addressed beyond the medical care they receive. Cancer and its treatment disrupt the normal state of physical, psychological, social, economic and spiritual functioning of the patient and her family. In addition to their physical health problems, patients often must deal with personal and family issues, work-related challenges and the emotional trauma that accompanies the fight against cancer, not to mention the financial burden the disease often entails.

One of the challenges for a new cancer patient is coming to grips with the fact that they will not ever be the same person they were. For this reason, it is important for the patient—and for physicians and the entire clinical staff—to work toward the establishment of a new normalcy. Patients must learn to live with who they are now and not who they were.

A Multidisciplinary and Comprehensive Approach

The effective management of the changes caused by the diagnosis of cancer and its aftermath require information and resources beyond the scope of traditional medicine. Hormonal changes, weight gain, and the emergence of chronic health problems must be addressed in a proactive manner. To accomplish this, the oncology practice must provide a multi-disciplinary and comprehensive program that encompasses a range of therapeutic expertise. The clinical staff becomes a sort of "care manager" for the patient, coordinating a range of such diverse services as nutritional counseling, weight management, lymphedema care, and meeting the patient's psychosocial needs to the extent possible. Cancer patients often need spiritual support and the oncology practice must be prepared to meet these needs. Patients with a strong religious faith may require that their beliefs be reinforced and others may be seeking spiritual support for the first times in their lives. Because patients and families have varying needs, the supportive services program must be flexible enough to address the issues of people at varying phases of the disease, treatment, recovery and/or dying process. The challenge for the oncology practice is to make the program comprehensive in scope yet adaptable enough to meet the needs of a particular patient.

Examples of the types of services that the clinic must coordinate in addition to traditional medical care include:
  • Nutritional counseling
  • Wellness and fitness counseling and management
  • Financial and insurance counseling
  • Family and marital counseling
  • Spiritual counseling
  • Employment counseling
  • Housing support
  • Transportation support
  • Hospice care
  • Needs Beyond the Patient


Supportive services are typically coordinated by an oncology social worker with experience in personal counseling and case management. Since cancer care does not lend itself to a one-size-fits-all care plan, it is necessary to take a person-by-person approach to case management. One patient may need a wig while another may need help paying a utility bill or arranging for transportation to the Clinic. Social workers can identify points of stress that the patient may not even recognize and diagnose emotional or psychiatric problems that might accompany their medical condition.

The Role of Support Groups

Increasingly, support groups are tailored to the needs of particular groups of people—groups for women with breast cancer or men with prostate cancer and even groups designed for non-patients such as spouses and children of cancer patients. More so than in other types of specialty care, support groups play an important role in the management of cancer patient.

In addition to personal counseling, the care plan developed is likely to include a "prescription" for health and fitness services. Cancer patients who exercise and maintain a healthy diet typically report a better quality of life but maintaining a healthy lifestyle is a real challenge for them. Cancer patients may be limited in their ability to exercise. For this reason, exercise programs must to tailored to the needs and limitations of cancer patients and, ideally, individualized for each patient – whether on site or provided in coordination with some other facility.

Patients like Linda B. face a long and arduous treatment process as they deal with their cancer. But research has shown that the availability of well-designed psychosocial resources and supportive services not only make the treatment process more bearable but actually contribute to the likelihood of a successful outcome for the patient.


Ellen Eisen, L.C.S.W. is the coordinator of patient and family services for The Jones Clinic. She is a licensed clinical social worker who is certified in oncology, specializing in crisis intervention and supportive therapy for cancer patients. Cindy Rogers, M.S.N., F.N.P., and Kim Hardin, M.S.N., C.F.N.P., are advanced certified oncology nurse practitioners at The Jones Clinic. The Jones Clinic was established in Germantown in 1998 by Dr. C. Michael Jones to provide oncology services to patients in Memphis and the Mid-South.