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Handbook of Oncology Social Work

@#
Handbook of
Oncology Social Work
Psychosocial Care for
People with Cancer

@#
E d i t e d b y

Grace Christ, DSW/PhD

Professor Emerita, Research Scientist
Columbia University School of Social Work
Board Chair, Social Work Hospice and Palliative Care Network

Carolyn Messner, DSW, ACSW, BCD, LCSW-R, OSW-C

Director of Education and Training
CancerCare
Adjunct Lecturer
Silberman School of Social Work at Hunter College

Lynn Behar, PhD, ACSW, LICSW, OSW-C

Founder, Carol LaMare Initiative
University of Washington School of Social Work
Co-Chair, Advisory Board
Cancer Lifeline

1
1
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Library of Congress Cataloging-in-Publication Data

Handbook of Oncology Social Work : Psychosocial Care for People with Cancer / edited by Grace Christ, Carolyn Messner, Lynn Behar.
pages cm
Includes index.
ISBN 978–0–19–994192–6 (hardcover : alk. paper)
1. Medical social work. 2. Cancer—Patients—Services for. I. Christ, Grace Hyslop. II. Messner, Carolyn. III. Behar, Lynn C.
HV687.H26 2015
362.19699′44053—dc23
2014037065

9 8 7 6 5 4 3 2 1
Printed in the United States of America
on acid-free paper
 Advance Praise for the Handbook of Oncology Social Work
For decades, the Institute of Medicine has released one report after another lamenting the gap between the recognition that
cancer affects the whole person, and our ability to address the human needs of the growing population of cancer survivors and
their loved ones. With the inaugural publication of the Handbook of Oncology Social Work, help is at hand. This long-awaited
volume, written by pioneers in the field of oncology social work, provides a wealth of evidence-based information on how to
deliver cancer care for the whole person—care that encompasses individuals’ emotional, cognitive, social, economic and exis-
tential well-being—in a rapidly evolving health care delivery system. It is clear that the key to our success in enabling individuals
to live fully with, through and beyond cancer, will be the extent to which we actively incorporate and build upon the unique
contributions of oncology social workers to high quality oncology care. Kudos to the editors of and many contributors to this
outstanding volume, a must read for anyone practicing in oncology.
Julia H. Rowland, PhD, Director, Office of Cancer Survivorship, National Cancer Institute, NIH/DHHS
We welcome with great anticipation this comprehensive new Handbook of Oncology Social Work, edited by Christ, Messner and
Behar. The Handbook addresses those issues frequently associated with the social needs of patients including psychological and
bereavement issues. Uniquely, it also includes in-depth chapters on current topics such as identifying distress earlier, approaches
to diversity issues so frequent in our patient populations, and concepts brought about by longer survivorship. Never before has
excellence in care for patients with cancer required as strong a multidisciplinary team as now: this new resource will contribute
not only to social workers, but also to all involved with patients and families in the cancer setting. The breadth of experience of
the editors and authors is clear throughout the book and enhances its value for all health care professionals in oncology.
Richard J. Gralla, MD, FACP, Professor of Medicine, Albert Einstein College of Medicine, Jacobi Medical Center
While there have been significant medical advances and increasing numbers of cancer survivors, the human adaptive challenges
to this disease have in fact become more complex and long term. Social workers are at the forefront of developing, implement-
ing, and evaluating a broad range of psychosocial services for this population. The Handbook of Oncology Social Work offers
educators as well as new and seasoned professionals a wealth of evidence-based information, practice wisdom, and the lived
experiences of patients and families to undergird their teaching and provision of care. It is an indispensable text and resource
for all educators and practitioners in health care.
Jeanette C. Takamura, MSW, PhD, Dean and Professor, Columbia University School of Social Work
The Handbook of Oncology Social Work is an exceptional, state-of-the-art book that clearly addresses the key issues confronting
oncology social workers today. The book emphasizes social work’s strong values for sharing decision-making, helping the most
vulnerable and distressed, and reducing health disparity. It is an essential resource for social workers and other professionals
who want to provide high quality, evidenced-based care to people with cancer and their family members.
Laurel Northouse PhD, RN, FAAN, Professor Emerita, University of Michigan
The inaugural Handbook of Oncology Social Work is truly a social work masterpiece. The editors have gathered the experts in
the field to compile the most recent evidence-based data in terms of screening, assessment, and interventions that can provide
the greatest benefit to cancer patients and their families.
James Zabora, ScD, MSW, Director, Research & Professional Development, Life with Cancer©, Inova Health System;
Assistant Professor of Oncology, The Johns Hopkins University School of Medicine President-Elect, APOS
The field of oncology has seen exciting changes in the past decade offering patients improved treatment options and extended
survival, while simultaneously resulting in substantially more complex care delivery. Optimal support for cancer patients and
their caregivers requires multidisciplinary teamwork, with an oncology social worker being an essential partner. The Handbook of
Oncology Social Work is a comprehensive manual addressing the multiple roles and evolving practice of this specialty. By providing
psychosocial support beginning at diagnosis and palliative care through the end of life, navigating financial issues and ongoing
changes in the health care system, and helping simplify the complexity of the new era of genomic profiling and targeted therapies,
the oncology social worker plays a critical role in enabling patients to optimize quality of life while dealing with the emotional,
social, physical and financial burdens of cancer. This handbook is an invaluable resource for the entire cancer community.
Julie R. Gralow, MD, Professor and Director, Breast Medical Oncology, Jill Bennett Endowed Professorship in
Breast Cancer, University of Washington School of Medicine; Seattle Cancer Care Alliance; Fred Hutchinson Cancer
Research Center
It is extremely rare for there to be a textbook that is simultaneously so comprehensive, well-researched and clinically practical.
The Handbook of Oncology Social Work is clearly the new gold standard for oncology social work. But to say that this textbook
is limited to social workers or cancer alone grossly misses the point. The clinical, educational and research implications of this
monumental accomplishment are relevant for other health care professionals and chronic illnesses. The editors and authors rep-
resent the encyclopedic wisdom and diversity of thinking of many of the foundational leaders in the field and across disciplines.
Significantly, there are also provocative contributions by many evolving leaders in psychosocial oncology that deeply enriches
this “must own” treasure trove of compassionate expertise.
Matthew Loscalzo, MSW, BA, LCSW, Liliane Elkins Professor in Supportive Care Programs, Professor, Department of
Population Sciences; Administrative Director, Sheri & Les Biller Patient and Family Resource Center; and Executive
Director, Department of Supportive Care Medicine, City of Hope National Medical Center
Persons with cancers are confronted with a deluge of information and decisions about their illnesses and the impact on their
lives. Oncology social workers play a crucial role in helping patients and caregivers navigate this sea of choices. The Handbook
of Oncology Social Work encompasses the breadth and depth of expertise and compassion that oncology social workers bring to
individuals and families living with cancers.
Mark G. Kris, MD, Attending Physician, Thoracic Oncology Service; The William and Joy Ruane Chair in Thoracic
Oncology, Memorial Sloan Kettering Cancer Center; Professor of Medicine, Weill Cornell Medical College
The Handbook of Oncology Social Work comes at a perfect time. Since beginning my career 23 years ago, I have seen the challenges
of serving oncology patients and their families become exceedingly complex, with rising incidents of cancer, many more individu-
als living with cancer, and increasing numbers of survivors, many of whom, however, experience a reduced quality of life linked
to treatment side effects. The breadth and depth of the learnings covered in the Handbook is a brilliant blending of the history,
knowledge, wisdom, and experiences of the nation’s oncology social workers integrated with the stories and voices of patients and
families. The Handbook is the manual that every oncology health care team should read.
Moreen Shannon-Dudley, MBA, MSW, LICSW, Director, Supportive Care, Radiation Therapy and Specialty Clinics, Seattle
Cancer Care Alliance
The scope of practice covered in this handbook is essential for any oncology social worker, whether they are new to the field or an
experienced practitioner. The handbook will be required reading for all social work interns and fellows. The sheer number of topics
and authors reflects the great advances we have made in providing psychosocial care for people living with cancer and their fami-
lies over the last three decades. It is written in language that is easily transferrable to practice, which will be helpful to social work
practitioners and others across the continuum of care in oncology. The authorship of this book is astounding! Congratulations to
the many contributors and editors of this wonderful handbook.
Christina Austin-Valere, PhD, LCSW, Clinical Oncology Social Worker, Bienes Comprehensive Cancer Center,
Holy Cross Hospital
Oncology social workers have played a central role in developing the science and art of psychosocial care for people affected by can-
cer. The size and scope of this inaugural edition of the Handbook of Oncology Social Work is a testament to the numerous important
contributions oncology social work has made to the field of psychosocial oncology in the areas of clinical care, education, research,
program development, and health policy. Although the focus is on oncology social work, I am certain that professionals in all other
fields of oncology that involve patient and family care will find it to be an invaluable resource.
Paul Jacobsen, PhD, Associate Center Director, Division of Population Science, Moffitt Cancer Center
This inaugural Handbook of Oncology Social Work codifies in exemplary fashion the wisdom, clinical practice, and art of the oncol-
ogy social work profession. This outstanding publication highlights the variety of challenges experienced by people living with and
undergoing treatment of cancer, cancer survivors, their caregivers, and the bereaved. It provides an overview of multiple topics and
excellent clinical practice guidelines for all oncology disciplines. I congratulate the editors and authors for their vision in creating
this exceptional book, which is an invaluable resource in psychosocial oncology and for all health care professionals.
Edith P. Mitchell, MD, FACP, Clinical Professor of Medicine and Medical Oncology, Program Leader, Gastrointestinal
Oncology, Department of Medical Oncology; Director, Center to Eliminate Cancer Disparities; Associate Director, Diversity
Affairs, Kimmel Cancer Center at Jefferson
In this rapidly changing health care environment, the comprehensive Handbook of Oncology Social Work is a valuable resource for
social workers and members of the health care team who are working to meet the complex needs of people with cancer and their
loved ones. Recognition of psychosocial needs and their impact on outcome has led to mandates requiring assessment of social,
emotional, and financial concerns and protocols for addressing these needs. Social workers are on the front lines in implementing
these new quality measures and in developing programs to assist a growing population. The Handbook defines and describes the
range of interventions used by social workers to meet 21st-century needs and will become the cornerstone of oncology social work
practice.
Diane Blum, LMSW, Former Executive Director, CancerCare; Former Editor-in-Chief, Cancer.Net; American Society of
Clinical Oncology (ASCO)
This comprehensive handbook written for oncology social workers is an important resource for anyone who works with people
with cancer. It is practical, informative and organized in a manner that makes it easy to use. The nonmedical needs of a person with
cancer are vast and always changing, and this handbook strives to address them all. As an attorney in this field, this handbook will
further my understanding of the psychosocial and practical needs of my clients.
Randye Retkin, Esq, Director LegalHealth, New York Legal Assistance Group
The Handbook of Oncology Social Work is truly historic. It is the first book that provides both a comprehensive and deep sense of
the myriad roles and values of social work in addressing the complex issues associated with the number two cause of death in the
United States. Whether seasoned or new to the field, social workers will find this volume a constant companion to increase their
knowledge, skill, and influence on the health care system. Its framework is essential social work—addressing the biopsychosocial
and environmental factors affecting cancer patients, their families, and the settings in which they receive services and benefits.
Beyond social workers, its interdisciplinary focus should speak to physicians, nurses, and other health care providers, as well as
family and professional advocates across the continuum of care.
Terry Mizrahi, PhD, MSW, Professor, Silberman School of Social Work at Hunter College; Co-Chair, Community
Organizing, Planning & Development; Director, Education Center for Community Organizing
Contents

@#

Foreword by Edwina Satsuki Ueharaâ•… xiii

Foreword by Lidia Schapiraâ•… xv
Foreword by Barbara A. Givenâ•… xvii
Prefaceâ•… xix
Acknowledgmentsâ•… xxiii
Contributorsâ•… xxv

Section I @#
Overview of Oncology Social Work
Carolyn Messner
1. Cancer in Contemporary Society: Grounding in
Oncology and Psychosocial Careâ•… 3
Stewart B. Fleishman and Carolyn Messner
2. Oncology Social Work: Past, Present, and Futureâ•… 9
Susan Hedlund
3. Integrating Research and Evidence-Based Practice
With Clinical Knowledgeâ•… 15
Julianne S. Oktay
4. Oncology and Health Care Disparitiesâ•… 21
Anjanette Wells, Darrell Hudson, Lorena
Estrada-Martinez, and Sarah Gehlert
5. Meeting Psychosocial Health Needs: An Institute of
Medicine Report Comes to Lifeâ•… 27
Kim Day

Section II @#
Cancer Across a Continuum of Care: Clinical
Practice, Opportunities, and Challenges
Brad Zebrack
6. Oncology Social Work Interventions Throughout the
Continuum of Cancer Careâ•… 35
Brad Zebrack, Barbara L. Jones, and Kathryn
M. Smolinski

vii
viii Contents

7. Diagnosis and Initiation of Cancer Treatmentâ•… 43 21. Screening and Assessment of Suicide Risk in
Karen Kell Hartman Oncologyâ•… 147
Mark E. Anderson, Margrett R. Myhre, Donna
8. Sense Making in Living With Cancer as a
Suckow, and Angela McCabe
Chronic Illnessâ•… 51
Paul G. Clark and Sage Bolte 22. Using Telehealth to Respond to Distress in Rural
and Remote Chemotherapy Clinicsâ•… 155
9. Cancer Survivorship: Concepts, Interventions, and
Carole Mayer and Sheila Damore-Petingola
Researchâ•… 57
Penny Damaskos and Carly Parry 23. Next Steps for Psychosocial Screening in
Oncologyâ•… 163
10. Transition to End-of-Life Care in Oncologyâ•… 65
Lynne E. Padgett, Carly Parry, and Stephen Taplin
Deborah Waldrop and Sherri Weisenfluh

Section III @# Section V @#

Psychosocial Challenges of Site-Specific Cancers Social Work Research: Challenges and
Carolyn Messner Opportunities
Karen Kayser
11. The Biopsychosocial Implications of the Site of the
Cancerâ•… 75 24. An Agenda for Oncology Social Work
Carolyn Messner, Caroline Kornhauser, and Rosalie Research: From Bench to Bedside to Trenchâ•… 171
Canosa Karen Kayser

12. Living With a Rare Cancer Diagnosis: A Survivor’s 25. Practice-Relevant Research in Oncology:
Perspectiveâ•… 81 Science Is What You Do When You Don’t Know
Patrick Garbe What to Doâ•… 177
Taryn Lindhorst
13. Working With Men Challenged by Prostate
Cancerâ•… 87 26. Finding Funding for Oncology Social Work
Les Gallo-Silver Researchâ•… 187
Mary Ann Burg
14. The Many Dimensions of Breast Cancer: Determining
the Scope of Needed Servicesâ•… 93 27. Writing Proposals for Foundations and
Roz Kleban and Susan Glaser Governmental Agenciesâ•… 193
Guadalupe R. Palos
15. Hematologic Cancers: Patients’ Needs for Special
Careâ•… 101 28. Opportunities for Social Work Research in
Kate Pederson, Brian Tomlinson, and Lisa O’Brien Oncologyâ•… 201
Carly Parry and G. Stephane Philogene
16. When the Other Shoe Drops: Unique Fears and
Challenges of Recurrent Diseaseâ•… 107
Elizabeth Ezra and Maria Chi Section VI @#
Complex Issues Affecting Quality of Life
and Quality of Care
Section IV @# Shirley Otis-Green
Implementing Distress Screening
29. The Convergence of Oncology and Palliative Social
Initiatives in Oncology
Workâ•… 209
Grace Christ
Terry Altilio and Bridget Sumser
17. Distress Screening Guidelines for Oncology Social
30. Treatment Adherenceâ•… 217
Workersâ•… 115
Brian Giddens
James R. Zabora
31. The Impact of Comorbidities on Cancer Careâ•… 223
18. Development of a National Canadian Program for
Barbara Head
Oncology Stress as the 6th Vital Signâ•… 121
Barry D. Bultz, Matthew Loscalzo, and Shannon Groff 32. Social Work Practice With Families Affected by
Hereditary Cancerâ•… 231
19. Touch-Screen Technology: Using a Problem
Allison Werner-Lin
Checklist for Psychosocial Oncology Screeningâ•… 129
Karen Clark, Matthew Loscalzo, and Barry D. Bultz 33. Pain and Symptom Managementâ•… 239
Terry Altilio and Laurel Eskra Tropeano
20. Distress Screening and Responding in an Ambulatory
Cancer Centerâ•… 137 34. Sexuality and Cancerâ•… 247
Jill Taylor-Brown and Heather Campbell-Enns Sage Bolte and Christopher Anrig
 Contents ix

35. The Oncology Social Worker and Genomics 255 47. Clinical Group Work: Embracing Opportunities,
Allison Werner-Lin Navigating Challenges 333
Erin Columbus and Kate Wakelin
Section VII @# 48. Assessing and Intervening With the Spectrum of
Sociocultural and Economic Diversity: Improving Depression and Anxiety in Cancer 339
Access and Health Outcomes Carole F. Seddon and Hester Hill Schnipper
Yvette Colón
49. Using Cognitive and Behavioral Approaches
36. Working With Sociocultural and Economic Throughout the Cancer Experience 345
Diversity 263 John G. Cagle and Matthew Loscalzo
Yvette Colón
50. Meaning-Making Approaches to Social Work
37. Support for Immigrants, Political Refugees, and Practice in Oncology 351
Patients Seeking Asylum Who Have Cancer 269 Carrie Lethborg and Lou Harms
Amanda Amodio and Upal Basu Roy
51. Schema Therapy With Oncology Patients
38. Gay, Lesbian, and Bisexual Individuals Diagnosed and Families 357
With Cancer 275 Lissa Parsonnet
Kathryn M. Smolinski and William Goeren
52. Practice Issues in Social Work and Psychosocial
39. Transgender Individuals and Families Affected Oncology in Israel 365
by Cancer 281 Shlomit Perry
Max Rorty
53. Oncology Social Work Practice in Integrative
40. Alaska Native, Native American, and First Nation Medicine 371
People: Outreach, Screening, and Assessment 287 Cecilia L. W. Chan and Richard R. Dickens
Karina L. Walters, Teresa Evans-Campbell, Matthew
A. Town, Katie Schultz, Jessica H. L. Elm, and
Section IX @#
Ramona E. Beltrán
Interventions With Families and
41. Access to Medical Treatment for African Americans Caregivers in Oncology
Diagnosed With Cancer: The Current Susan Hedlund
Evidence Base 293
54. Introduction to Working With Families
Karen Bullock and Hannah Allison
in Oncology 379
42. Hispanic/Latino Individuals and Families Susan Hedlund
Affected by Cancer: Outreach, Screening, and
55. Caregivers of Cancer Patients 385
Assessment 299
Ashley Varner
Guadalupe R. Palos
56. Psychosocial Interventions With Couples
43. Working With Chinese Families Impacted
Affected by Cancer 391
by Cancer: An Integrative Body–Mind–Spirit
Karen Kayser and Jennifer L. Scott
Approach 305
Pamela Pui-Yu Leung and Cecilia L. W. Chan 57. Managing Family Conflict: Providing
Responsive Family Care at the End
of Life 399
Section VIII @# Betty J. Kramer and Amy Z. Boelk
Assessment and Intervention With Adults Living
58. Family and Team Conferencing in Oncology 409
With Cancer
Iris Cohen Fineberg
Hester Hill Schnipper
44. Interventions and Ongoing Assessment With People Section X @#
Living With Cancer 313 Interventions With Parental Cancer,
Hester Hill Schnipper and Ashley Varner Dependent Children, and Adolescents
45. Time Enough to Make a Difference: Helping Patients Lynn Behar
Live Well With Advanced Cancer 321 59. Parental Cancer: Developmentally Informed
Hester Hill Schnipper Practice Guidelines for Family Consultation and
46. Integrating Spirituality in Oncology Care 327 Communication 419
Shirley Otis-Green and Reverend Terry L. Irish Grace Christ
x Contents

60. Single Parents Coping With Cancer and Section XIII @#

Childrenâ•… 429 Loss, Grief, and Bereavement
Lynn Behar and Frances Marcus Lewis Mary Sormanti
61. A Parallel Group Program for Parents and 74. Understanding Bereavement: How Theory, Research,
Children: Using Expressive Techniques and and Practice Inform What We Doâ•… 543
Activities to Facilitate Communicationâ•… 435 Mary Sormanti
Krista Nelson
75. Spousal/Intimate Partner Loss and Bereavementâ•… 553
Deborah Carr
Section XI @#
Pediatrics: Assessment and Interventions With 76. Mourning the Death of a Childâ•… 561
Children and Adolescent Cancer Patients—The Nancy F. Cincotta
Unique Challenges of Pediatric Oncology 77. Developing Culturally Informed Research on
Barbara L. Jones Bereavement Interventionsâ•… 571
62. Interventions for Children Under Age 15 Amy Yin Man Chow
Living With Cancerâ•… 447 78. Leading Bereavement Groupsâ•… 579
Lori Wiener and Ursula M. Sansom-Daly Richard T. Hara and Rachel Odo
63. Interventions for Adolescents Living
With Cancerâ•… 457 Section XIV @#
Rebecca G. Block Patient- and Family-Centered Care: Social Work
64. The Family Experience in Pediatric Oncologyâ•… 465 Role and Organizational Models for
Nancy F. Cincotta Psychosocial Services
Nancy W. Newman
65. Helping Siblings of Pediatric Cancer Patientsâ•… 473
Nancy F. Cincotta 79. Patient- and Family-Centered Care: A National
Mandate and Social Work Goalâ•… 587
66. Reaching Out to Culturally Diverse Populations Nancy W. Newman and Cynthia Medeiros
in Pediatric Oncologyâ•… 485
Nancy Contro and Analisa Trott 80. Integrated Interdisciplinary Staff Leadership Model
of Patient-Centered Careâ•… 595
67. Pediatric Cancer Survivorsâ•… 491 Matthew Loscalzo, Karen Clark, and Barry D. Bultz
Kate Shafer and Constance Connor
81. Directing Stand-Alone Social Work Department
68. Pediatric Palliative Careâ•… 499 Modelsâ•… 601
Stacy S. Remke Margaret Weld Meyer and Wendy J. Evans
82. Creating Innovative Cancer Support Programs in
Section XII @#
Community Cancer Centersâ•… 609
Impact of a Cancer Diagnosis Across
Alison Mayer Sachs and Kerry Irish
the Adult Life Span
Tara Schapmire 83. Managing Volunteer Services in Oncologyâ•… 615
Catherine Credeur and Christine Healy
69. Young Adults (20 to 39) With Cancerâ•… 507
Sage Bolte
Section XV @#
70. Parents of Younger Adults With Cancerâ•… 515
Bioethical and Policy Issues in Oncology
Susan Hedlund
Social Work
71. Cancer and Middle-Aged Adults (40 to 64)â•… 521 Gary L. Stein
Cindy Davis and Connie Rust
84. Historic and Current Perspectives on Health Care
72. Cancer and Older Adults (65 Plus)â•… 527 Reformâ•… 625
Tara Schapmire and Anna Faul Gunnar Almgren
73. Working With Families of Older Adults 85. Bioethical Issues in Oncology and the Social Work
With Cancerâ•… 535 Responseâ•… 633
Daniel S. Gardner Gary L. Stein and Jeanne Kerwin
 Contents xi

86. Improving Pain Care Policy: Implications for Social 99. Vicarious Resilience: Sustaining a Career Over the
Work Advocacyâ•… 641 Long Haulâ•… 737
Mary Beth Morrissey Debra Mattison
100. The American Cancer Society’s Contributions to
Section XVI @# Oncology Social Workâ•… 745
Care Coordination, Managing Transitions, and Virginia Krawiec and Greta Greer
Providing Resources
101. APOSW and AOSW: Education and
Carol P. Marcusen
Development of Professional Networksâ•… 751
87. Transitions During Cancer Careâ•… 651 Ann Fairchild, Christa G. Burke, Paula G. McCarthy,
Carol P. Marcusen Stacy Stickney Ferguson, and Katherine Walsh
88. Patient Navigation in Oncologyâ•… 659 102. OSW-C: The Importance of Certification for
Melissa Sileo Stewart and Rian Rodriguez Oncology Social Workersâ•… 757
Virginia Vaitones, Johanna Schutte, and
89. Bridging Increasing Financial Gaps and Challenges
Debra Mattison
in Service Deliveryâ•… 667
Jane Levy and Michele McCourt 103. NASW and Oncology Social Workâ•… 763
Elizabeth J. Clark and Stacy Collins
90. The Importance of Patient Educationâ•… 673
Julie Keany Hodorowski, Carolyn Messner, and
Caroline Kornhauser Section XIX @#
91. Legal Issues That Affect Quality of Life for Oncology Building Resilience in Interprofessional
Patients and Their Caregiversâ•… 679 Practice
Penny Damaskos
Kathryn M. Smolinski and Debra Wolf
104. Building Resilience: A Multifaceted Support Program
Section XVII @# for Professional and Support Staff in a Cancer
Practice Settings: Where Oncology Social Centerâ•… 771
Workers Work Jane Bowling and Penny Damaskos
Victoria Kennedy 105. How Oncology Professionals Manage the Emotional
92. Oncology Social Work Across Sites of Careâ•… 687 Intensity of Their Workâ•… 777
Victoria Kennedy Elizabeth A. Rohan

93. Oncology Social Work Practice in Hospitals and 106. Developing Core Competencies for Interprofessional
Cancer Centersâ•… 693 Teams: A Script-Reading Approachâ•… 785
Louise Knight Patricia McGillicuddy, Karen Gold,
and Mandy Lowe
94. Veterans and Cancerâ•… 701
Louisa Daratsos 107. Schwartz Center Rounds®: Process, Outcomes, and
Opportunities for Improving Interprofessional
95. The Evolving Role for Oncology Social Workers in Practiceâ•… 793
Businessâ•… 707 Margaret S. Wool
Jennifer Mills
108. Maintaining Competent Teams in Pediatric
Oncologyâ•… 801
Section XVIII @# Sima Zadeh, Jayne Phillips, Jeasmine E. Aizvera,
Professional Development and Education and Lori Wiener
Katherine Walsh
Epilogue: Oncology Social Work Leadership: Innovators
96. Supervision and Professional Developmentâ•… 715 in a Changing Worldâ•… 809
Annamma Abraham Kaba and Penny Damaskos Grace Christ, Carolyn Messner, and Lynn Behar
97. Life as an Oncology Social Worker: Career Planning
and Professional Developmentâ•… 723 Index â•… 815
Katherine Walsh
98. Grant-Funded Educational Programs in Psychosocial
Oncologyâ•… 731
Shirley Otis-Green and Sheila L. Hammer
For ewor d by EDW I NA SATSU K I U EH A R A
@#
The Handbook of Oncology Social Work: Psychosocial Care
for People with Cancer is the most comprehensive volume on
the science and art of oncology social work ever published.
This remarkable book, edited with great skill by Grace
Christ, Carolyn Messner, and Lynn Behar, brings together
160 authors—oncology social work practitioners, educators,
researchers and administrators—whose collective expertise
covers the complex, expansive terrain of contemporary psy-
chosocial care of people with cancer and their families.
The publication of the Handbook is especially timely.
The field of oncology social work has experienced dra-
matic growth and evolution over the past thirty years. This
growth is in part attributable to advances in the science of
cancer treatment, which have led to both success in pro-
longing life through more effective treatment and greater
complexity in oncology diagnostic and treatment processes.
As a result, those who are coping with cancer now comprise
a diverse and growing population with a wide spectrum of
needs and psychosocial care requirements. We have long
been in need of a publication that describes advances in
oncology social work practice and science and delineates
key questions and issues facing the field. The Handbook of
Oncology Social Work masterfully meets these needs. The
Handbook’s 109 chapters are far-reaching, addressing such
topics as screening, assessment, and interventions across
the life span and continuum of care; coping with pain, loss,
grief, and bereavement; sociocultural and economic diver-
sity implications for psychosocial care; strengthening pro-
fessional development, education, interprofessional practice
and practice settings; and key issues for research, policy,
and advocacy. In short, the authors of the Handbook cre-
ate a rich reservoir of knowledge for anyone interested in
this large and increasingly important arena of social work
practice and science.
Perhaps just as important, the authors of the Handbook
of Oncology Social Work also succeed in bringing to life the
leadership of social workers in the evolution of humane
and effective oncology care. Since the inception of oncol-
ogy social work practice three decades ago, social workers
have been at the forefront of efforts to identify and meet the
psychosocial needs of cancer patients and their families.
Throughout this remarkable book, the authors document
the success of oncology social workers in advocating for the
integration of psychosocial care into the cancer treatment
system, promoting patient empowerment, patient- and
family-centered care, expanding the reliance on research
findings to inform psychosocial care, and generating
new knowledge through practice-based research. As the
Handbook editors observe, oncology social workers “have
become effective leaders and innovators in ways not previ-
ously imagined.”
The Handbook’s editors view this inaugural volume as
“an opportunity to create a repository of state-of-the-art
information about this specialty, to consider what has been
achieved, and to explore directions for the future.” They
have made the most of the opportunity and in the process
succeeded at much more. The Handbook is a definitive pub-
lication that will guide and inform oncology social workers
for generations to come. It is also a source of inspiration for
all oncology health care professionals who aspire to improve
the efficacy, dignity and quality of care for those who must
cope with the complexity and uncertainty of living with
cancer and chronic illness.
Edwina Satsuki Uehara, MSW, PhD
Professor and Ballmer Endowed Dean in Social Work
School of Social Work, University of Washington
Seattle, Washington
xiii
For eword BY Lidia Schapir a
@#
The care of patients with cancer has evolved swiftly over the
past twenty years as a consequence of tremendous strides
made in basic and translational sciences. We have identi-
fied molecular targets within cancers and developed specific
and tailored treatments that are both more effective and less
toxic than those that came before. Oncologists are proud of
the emerging array of tailored or personalized therapies that
have transformed the landscape of clinical care giving hope
to thousands of patients with diseases previously thought
incurable or refractory to treatment. But the term personal-
ized care has a different meaning to patients and their loved
ones. It means being known and cared for by profession-
als trained to identify and address their unique concerns,
to allay their fears, and to help them navigate the complex
system of healthcare services. It takes a multidisciplinary
team of highly specialized professionals to care for a single
patient with cancer. Social workers are requisite partners in
this enterprise. Their distinct perspective, knowledge, skills,
and commitment to social justice have shaped our models of
clinical care and impacted policies and clinical guidelines.
A patient of mine said she felt buoyed by the connection to
her professional team. She compared her illness to a roller
coaster, adding that her professional caregivers formed a
pillar that kept the roller coaster from crashing. Oncology
social workers are witnesses to the most fundamentally
human aspect of cancer. They are champions and advocates
for the most vulnerable and repositories of stories of cour-
age and resilience in the face of adversity and disability. They
are often informal therapists and teachers for overworked
nurses and doctors who turn to them when they are frazzled
by demands from patients they find unreasonable or diffi-
cult, or when they are simply exhausted from constant expo-
sure to suffering and loss.
The Handbook of Oncology Social Work: Psychosocial Care
for People with Cancer is a comprehensive volume whose
contributors address both the science of caring and the art
of social work practice. The chapters provide instruction
and inspiration and showcase the specialization of oncol-
ogy social workers, the complexity of the challenges facing
patients and families, and the scope of interventions vetted
by research. Social workers constitute the largest segment
of mental health professionals in the cancer workforce, and
the demands for their services are expected to grow with
the aging of the population and the increased numbers of
cancer survivors. Social work has expanded beyond prac-
tice to leadership roles in cancer centers, academic institu-
tions, and governmental agencies. The legacy and success
of social workers is evident in the widespread implementa-
tion of patient- and family-centered care and psychosocial
screening.
When confronted with patients who are suffering, medi-
cal professionals turn to social workers to provide counsel,
solace, and guidance. Oncology social workers debrief with
patients after complex consultations with clinical special-
ists, help them think about trade-offs inherent in treat-
ment choices, and empower them to articulate their needs
and wishes for end-of-life care. Social workers help patients
speak sooner, voice their concerns, imagine an uncertain
future, and find ways of reconstructing normalcy after the
major disruptions a life-altering illness causes. This inaugu-
ral Handbook celebrates the accomplishments and expertise
of oncology social workers and identifies opportunities and
challenges for years to come.
Lidia Schapira, M.D.
Associate Professor of Medicine
Harvard Medical School
Associate Physician
Massachusetts General Hospital Cancer Center
Boston, MA
xv
For eword BY Barbar a A. Given
@#
At a time when major advances in cancer treatment result
in enhanced survivorship, concern for psychosocial care
becomes ever more essential. With increased longevity are
new psychosocial challenges. This Handbook reflects these
important changes and articulates the important role of
the oncology social worker in caring for patients and their
families in our evolving health care system.
The Sections and chapters in the Handbook will be
invaluable to oncology social workers and other psychoso-
cial specialists. The content portrays a greater appreciation
of the cancer experience and provides clear guidance on
psychosocial assessments and interventions. The breadth,
scope, and variation in clinical practice are evident in this
book, and document the value and extensive contributions
of oncology social work to patients and the interprofessional
health care team.
The Handbook provides wonderful examples of the
complexity of psychosocial care offered by oncology social
workers and illustrates the necessity of increased specializa-
tion. Vitally important to helping people deal with cancer
as a chronic illness, social work requires knowledge, skill,
evidence based practice, and compassion. Content on the
continuum of care across the lifespan, survivorship, distress
screening, quality of life, adherence, genetics and sociocul-
tural and economic diversity provides a wealth of knowledge
in psychosocial oncology. Having all of this information
gathered in the Handbook means that social workers need
not look any further for an excellent guide to oncology social
work practice, education, research, and policy.
Oncology social workers have much to contribute to the
psychosocial well-being of our patients and their caregivers.
As the aging population expands, more social workers will
be needed to meet their needs. Social workers are critical
to patients’ access to quality health care in our current and
future health systems. Oncology social workers ensure that
psychosocial care is integrated into patient care.
Social workers will benefit from the outstanding reposi-
tory of scholarship in the Handbook. It will facilitate social
workers’ continued ability to make significant differences
in the quality of cancer patients’ and their caregivers’ lives,
enhancing their access to care.
What a rare opportunity to have such a state-of-the-art
Handbook to provide existing evidence based practice mod-
els of care in psychosocial oncology. Not only is it important
to summarize where we have been and where we are but we
must also look to the future. This book fulfills all three of
these goals. Its editors and contributors reflect the change
in care to ambulatory and community settings away from
hospital settings. They illustrate the many contributions
that oncology social workers make to this system of care
where so much more is expected of patients, their families
and their health care teams.
This book gathers the contributions of some of the best
experts in the field and could not be more timely. Using wis-
dom from this much-needed and outstanding comprehen-
sive Handbook, oncology social workers and other oncology
disciplines will be better equipped to meet the challenges
ahead in providing psychosocial care to people with cancer.
Barbara A. Given, PhD, RN, FAAN
University Distinguished Professor
Director of the PhD Program
College of Nursing
Michigan State University
xvii
Pr e fac e
@#
Grace Christ, DSW/PhD
Professor Emerita, Research Scientist
Columbia University School of Social Work
Board Chair, Social Work Hospice and Palliative Care Network
Carolyn Messner, DSW, ACSW, BCD,
LCSW-R, OSW-C
Director of Education and Training
CancerCare
Adjunct Lecturer
Silberman School of Social Work at Hunter College
Lynn Behar, PhD, ACSW, LICSW, OSW-C
Founder, Carol LaMare Initiative
University of Washington School of Social Work
Co-Chair, Advisory Board
Cancer Lifeline
We are honored to write this preface for the inaugural
Handbook of Oncology Social Work: Psychosocial Care for
People with Cancer. This Handbook provides a repository of
the breadth and scope of oncology social workers’ clinical
practice, education, research, policy, and program leader-
ship in the psychosocial care of people with cancer and their
families. It focuses on the unique synergy of social work
perspectives, values, knowledge, and skills with the psycho-
social needs of cancer patients, their families, and the health
care systems in which they are treated. At the same time,
we recognize and respect the vital importance of interdis-
ciplinary competence and sharing that are fundamental to
providing the best possible oncology care.
@#
Expansion of the Oncology Social Work Role:
“Trail Angels” and “Trail Magic”
The remarkable expansion and evolution of oncology social
work practice over more than 60 years can be attributed in
part to the dramatic growth in the number of adults liv-
ing with cancer due to technological advances in the treat-
ment of cancer in combination with an aging population.
For many people, cancer has become a chronic illness, and
coping with it during all of its phases is more of a marathon
than a sprint, with many ups and downs, challenges and
opportunities, joys and sorrows. All of this requires greater
knowledge and skill for oncology social workers, but also
enormous courage, sensitivity, compassion, thoughtfulness,
creativity, and inventiveness in problem solving.
The metaphor of “trail angels,” first identified on the
2,000-mile-long Appalachian Trail, has relevance to the role
oncology social workers play and to their experience of this
work. Trail angels are individuals who position themselves
at key points (transitions) along the trail to provide help,
housing, transportation, and all manner of sustenance (care
xix
xx Preface
coordination) to the hikers on their journey (Baker, 2012).
The trail angel’s first question to hikers is “What can I get
you right now?” (starting where the patient is). Trail angels
dispense “trail magic” (evidence-based therapeutic support)
when it is most needed, when hikers are beat, downtrodden,
lonely, and hungry and when the weight of their pack and
the miles ahead are crushing their will. The trail angel’s goal
is to do whatever he or she can to help hikers get where they
want to go. Veterans sometimes say they are using the trail to
walk off the war. Listening to the hiker’s story is also impor-
tant (nonjudgmental acceptance). “The hikers cry, they spill,
and they leave. Your job is to listen. This is their cathartic
moment where they verbalize the work they’ve done in their
head on the trail” (Baker, 2012; sense and meaning making).
And you are left as the trail angel (oncology social worker) to
process what you have just experienced, conceptualize your
work, teach it to others, research the interventions found to
be most helpful, and find strength (resilience) to continue
this work and build your career.
@#
Purpose and Structure of the Handbook
The Handbook of Oncology Social Work addresses both the
science and art of psychosocial care. The chapters within
also identify the increasing specialization of oncology social
work related to its unique knowledge, skill base, and role
and the progressive complexity of psychosocial challenges
for patients with cancer. Areas are covered here that are not
addressed in similar depth in other oncology publications.
The Handbook is built on the shoulders of founding
members of the profession whose work has been described
in two seminal oncology social work texts published by the
American Cancer Society, the last one over a decade ago
(Lauria, Clark, Hermann, & Stearns, 2001; Stearns, Lauria,
Hermann, & Fogelberg, 1993). Much of the content about
the oncology social work role of these and other earlier pub-
lications remains sound and relevant to practice today.
To reflect contemporary oncology social work practice, the
Handbook is divided into 19 sections, each with three to 10
thematically connected chapters that address different aspects
of a particular area of practice, education, research, and/or
policy. Each section is introduced by an expert in the field.
Each chapter begins with key concepts and ends with pearls
of wisdom and pitfalls. Case vignettes are included wherever
possible to ensure the integration of patients’ voices and expe-
riences, which are central to oncology social work practice, as
well as references and websites for further learning.
Major topical areas the Handbook addresses are an over-
view of oncology social work; cancer across the continuum
of care; survivorship; site-specific cancers; distress screen-
ing; research; quality of life; genetics, sociocultural and
economic diversity; assessment and interventions with
adults living with cancer, their families, and caregivers;
parental cancer; children and adolescents; pediatrics; adult
life span issues; loss, grief, and bereavement; patient- and
family-centered care; legal and ethical issues; care coordina-
tion; technology-integrated interventions; oncology social
work practice settings; professional development and edu-
cation; and building resilience in interprofessional settings.
@#
Using the Table of Contents
Our Table of Contents (TOC) was intentionally designed as
a guide to what each section contains. The TOC reflects the
topics mentioned previously with greater detail. We encour-
age you to use the TOC to find what you are looking for and
to discover areas that are new to you or that you hope to
learn more about.
The Handbook reflects the wealth of knowledge in psy-
chosocial oncology now. It is the first time these topics are all
housed in one place. It can be used as a reference for difficult
patient assessments and interventions, a new support group
or program, conducting research, writing a grant proposal,
incorporating distress screening in the practice setting, ethi-
cal or legal dilemmas, career paths and resilience, and pro-
fessional growth and support. We hope this book will serve
many purposes for each of you at different points in your own
career trajectory—we want it to be a trail angel for you as you
encounter the different challenges and needs that being a pro-
vider of psychosocial services in oncology can create.
@#
How Many of Us Are There?
Social workers make up the largest number of mental
health providers in the nation in both hospice and pallia-
tive care. Furthermore, it is projected that social workers in
health care settings will experience a growth of 27% over
the next decade, an increase attributed to the aging of our
population (Bent-Goodley, 2014; U.S. Department of Labor,
Bureau of Labor Statistics, 2014). Historically, their provi-
sion of supportive counseling specifically for cancer patients
was documented in a 1995 national survey that found that
75% of counseling for all cancer patients at National Cancer
Institute (NCI)–designated cancer centers was provided
by social workers (Coluzzi et al., 1995). Finally, in a recent
worldwide survey of over 700 professionals working in
pediatric oncology (Wiener et al., 2012), social work was
reported to be the discipline that most frequently provided
services to parents and children in oncology settings.
@#
Development of the Specialty
In 1984, when the Association of Oncology Social Work
(AOSW) was formed, social work was formally organized

as a specialty within oncology. This was preceded by
the formation of the Association of Pediatric Oncology
(Fobair et al., 2009). Many authors in this book are also
members of the more recently formed Social Work Hospice
and Palliative Care Network (SWHPN), an organization
that focuses on the biopsychosocial care of individuals
with advanced cancer and other end-of-life conditions
(Blacker & Christ, 2011). Currently, all three organizations
are thriving with over 3,000 members, national and inter-
national conferences, certifications, national networks of
education and training programs, active listservs, and
two membership journals, the Journal of Psychosocial
Oncology and the Journal of Social Work in Hospice and
Palliative Care.
@#
Mandates for Integration of Psychosocial Science
Into the Medical System
The psychosocial challenges for patients and families
have become progressively more complex in ways that are
addressed throughout the Handbook. At the same time,
multiple government reports have clarified the limited
integration of advances in psychosocial science within
the medical care system. Improving this integration was
proposed as a critical way to address the growing com-
plexity of patients’ needs. As a consequence, patient- and
family-centered care and psychosocial screening, two ini-
tiatives long advocated by oncology social workers, have
become regulatory mandates (ACOS, 2014; IOM, 2006,
2007a, 2007b; Joint Commission, 2010). Both initiatives
make up sections with multiple chapters in this Handbook.
Policy and regulatory agencies are increasingly recognizing
the uniqueness of the social work role—its strengths-based
and multisystem approaches—as critical to improving the
quality of care and the integration of psychosocial care
within the medical care system.
@#
Contributions of Social Work to Oncology
The sections in this Handbook reflect unique aspects of
the oncology social work role. Social work plays a criti-
cal role in oncology because of its distinctive perspective,
knowledge, and skills, including (1) expertise in navigating
medical and social systems; (2) a knowledge and skill base
in support, education, and psychosocial interventions with
patients, families, and interdisciplinary teams; (3) commit-
ment to social justice for the most vulnerable, oppressed,
and distressed members of society, including alleviation
of health disparities; and (4) creation of multisystem and
strengths-based approaches. Multisystem interventions
address the patient’s complex challenges at a biopsychoso-
cial, family, community, educational, health care system,
Preface xxi
and practical level. Increasingly, these approaches are rec-
ognized as most effective in reducing patient distress and
improving the quality of care (Lo et al., 2014).
This Handbook details the leadership role played by
oncology social workers in cancer centers, community can-
cer programs, major cancer education initiatives, private
and consultative practices, academic institutions, corpo-
rate and medical institutions, governmental research, and
policy organizations. The oncology social work role encom-
passes direct practice with patients and families; local and
national education for patients, families, communities,
and other disciplines; advocacy for patients; and increased
involvement in psychosocial research and institutional and
policy issues.
References
American College of Surgeons (ACOS). (2014, January 21). Cancer
program standards 2012: Ensuring patient-centered care.
Retrieved from http://www.facs.org/cancer/coc/programstand​
ards2012.html
Baker, B. (2012, September 16). A town that steps up
on the Appalachian Trail: Monson’s “angels” are a
sight for sore hikers. Boston Globe. Retrieved from
http://www.bostonglobe.com/metro/2012/09/15/
trail-angels-lighten-load-for-appalachian-trail-hikers/
CQbzptXzdpUk2w8FCqH0OM/story.html
Bent-Goodley, T. B. (2014). Social work: A profession of power,
passion, and purpose. Social Work, 59(3), 197–199.
Blacker, S., & Christ, G. (2011). Defining social work’s role and
leadership. In T. Altilio & S. Otis-Green (Eds.), Oxford
textbook of palliative social work (pp. 21–30). New York,
NY: Oxford University Press.
Coluzzi, P. H., Grant, M., Doroshow, J. H., Rhiner, M., Ferrell, B.,
& River, L. (1995). Survey of the provision of supportive care
services at National Cancer Institute-designated cancer cen-
ters. Journal of Clinical Oncology, 13, 756–764.
Fobair, P., Stearns, N. N., Christ, G., Dozier-Hall, D.,
Newman, N. W., Zabora, J., . . . Desonier, M. J. (2009).
Historical threads in the development of oncology social
work. Journal of Psychosocial Oncology, 27(2), 155–215.
doi:10.1080/07347330902775301
Institute of Medicine (IOM). (2006). From cancer patient to can-
cer survivor: Lost in transition. Washington, DC: National
Academies Press.
Institute of Medicine (IOM). (2007a). Cancer care for the whole
patient: Meeting psychosocial health needs. Washington,
DC: National Academies Press.
Institute of Medicine (IOM). (2007b). NCCN clinical prac-
tice guidelines in oncology: Distress management. Fort
Washington, PA: NCCN Clinical Practice Guidelines.
The Joint Commission. (2010). The Joint Commission: Advancing
effective communication, cultural competence, and patient-
and family-centered care: A roadmap for hospitals. Oakbrook
Terrace, IL: Author.
Lauria, M., Clark, E., Hermann, J. F., & Stearns, N. (Eds.). (2001).
Social work in oncology: Supporting survivors, families, and
caregivers. Atlanta, GA: American Cancer Society.
xxii Preface
Lo, C., Hales, S., Jung, J., Chiu, A., Panday, T., Rydall, A., . . .
Rodin, G. (2014). Managing Cancer and Living Meaningfully
(CALM): Phase 2 trial of a brief individual psychotherapy
for patients with advanced cancer. Palliative Medicine, 28(3),
234–242.
Stearns, N. M., Lauria, M. M., Hermann, J. F., & Fogelberg,
P. R. (Eds.). (1993). Oncology social work: A clinician’s guide.
Atlanta, GA: American Cancer Society.
U.S. Department of Labor, Bureau of Labor Statistics. (2014,
January 8). Social workers: Job outlook. In Occupational
outlook handbook. Retrieved from http://www.bls.gov/ooh/
community-and-aosicla-service/social-workers.htm#tab-6
Wiener, L., Oppenheim, D., Breyer, J., Battles, H., Zadeh, S., &
Farkas-Patenaude, A. (2012). A worldview of the pro-
fessional experiences and training needs of pediatric
psycho-oncologists. Psycho-Oncology, 21(9), 944–953.
Acknowledgments
@#
We could not have edited this inaugural Handbook of
Oncology Social Work without all our section heads and
authors. We are very grateful to each of them for their
tireless work and wonderful energy and enthusiasm that
made this book possible. We especially wish to thank our
colleague, Stewart Fleishman, MD, for his invaluable assis-
tance and support to us. We also thank Heather Lee Miller,
PhD, and Mark Berens of Miller Berens Group for their
copy editing assistance. We are indebted to our Oxford
team for their unwavering encouragement and support of
our inaugural book.
@#
Dedication to People Living With Cancer
This Handbook has been written to capture the voices of
oncology social workers and of people living with cancer,
their caregivers, cancer survivors, and the bereaved with
whom we have the great privilege to work. Their experiences
have informed this book immensely. Oncology social work-
ers share a common bond to make a difference in the lives
of people with cancer. And it is people living with cancer
to whom this book is dedicated. As you read the chapters
contained herein, listen for their voices.
This inaugural Handbook of Oncology Social Work:
Psychosocial Care for People with Cancer is a repository of
the work of our era and written as a reference for each of
you. These are not easy times for our profession, with grow-
ing global conflicts, poverty, climate changes, and so many
people without safe harbor. As the scientific breakthroughs
in cancer treatment grow, there are many patients who lack
access to oncology care. As oncology social workers, we are
often referred to those patients for whose needs there are
no easy solutions. We hope that in this book you will find
solace, novel approaches to your work, and reflective time
to discover innovative solutions to the challenges that lie
ahead for all of us.
xxiii
Contributors
@#
Jeasmine E. Aizvera, MSSW, LCSW-C, BCD, Assistant
Chief for Performance Improvement CAPT, United States
Public Health Service Commissioned Corps, Social Work
Department, National Institutes of Health Clinical Center,
Bethesda, MD
Hannah Allison, MSW, LCSWA, Graduate Research
Assistant, North Carolina State University, Department of
Social Work, Raleigh, NC
Gunnar Almgren, BA, MA, MSW, PhD, Associate
Professor of Social Work and Social Welfare, University of
Washington, School of Social Work, Seattle, WA
Terry Altilio, LCSW, ACSW, Social Work Coordinator,
Department of Pain Medicine and Palliative Care,
Beth Israel Medical Center, New York, NY
Amanda Amodio, BS, MSW, LCSW, Clinical Social Worker,
Memorial Sloan Kettering Cancer Center, and Consultant,
Refugee Immigrant Fund (RIF), New York, NY
Mark E. Anderson, JD, MSSW, LMSW, Social Work
Counselor, The University of Texas MD Anderson Cancer
Center, Houston, TX
Christopher Anrig, LCSW-R, BA, MSSW, Clinical Social
Worker, Department of Social Work, Memorial Sloan
Kettering Cancer Center, New York, NY; and Lecturer
of Social Work in Psychiatry, Cornell Medical College
Faculty, Ithaca, NY
Lynn Behar, PhD, LICSW, ACSW, OSW-C, Founder,
Carol LaMare Initiative, University of Washington School
of Social Work; and Co-Chair, Advisory Board,
Cancer Lifeline, Seattle, WA
Ramona E. Beltrán, PhD, MSW, Assistant Professor,
Graduate School of Social Work,
University of Denver
Rebecca G. Block, PhD, MSW, LCSW, Assistant
Professor of Medicine/Adolescent and Young Adult,
Oncology Psychosocial Research Leader, Oregon Health
Sciences University, Knight Cancer Institute,
Portland, OR
Amy Z. Boelk, MSSW, PhD, Professor, University of
Wisconsin–Stevens Point Department of Sociology &
Social Work, Stevens Point, WI
Sage Bolte, PhD, MSW, LCSW, OSW-C, Director, Life
With Cancer, Inova Cancer Services, Inova Heath System,
Fairfax, VA
Jane Bowling, BA, MS, MSW, DSW, Retired Director of
Social Work, Memorial Sloan Kettering Cancer Center,
New York, NY
Karen Bullock, PhD, MSW, BSW, Professor, North
Carolina State University, Department of Social Work,
Raleigh, NC
Barry D. Bultz, PhD, Professor and Head, Division of
Psychosocial Oncology, Faculty of Medicine, University of
Calgary and Tom Baker Cancer Centre, Calgary, AB, Canada
Mary Ann Burg, MSW, PhD, Professor, School of Social
Work, University of Central Florida, Orlando, FL
Christa G. Burke, MSW, LCSW, Social Worker,
Palliative Care Team, Barnes-Jewish Hospital,
St. Louis, MO
xxv
xxvi Contributors
John G. Cagle, PhD, MSW, Assistant Professor, School of
Social Work, University of Maryland - Baltimore
Heather Campbell-Enns, PhD, MSc, BEd; PhD
Candidate, Interdisciplinary Cancer Control, University of
Manitoba; and Research Studies Coordinator, CancerCare
Manitoba, Winnipeg, MB, Canada
Rosalie Canosa, MSW, MPA, LCSW, Executive Director,
Cancer Support Team, Purchase, NY
Deborah Carr, PhD, Professor, Sociology, Rutgers
University, New Brunswick, NJ
Cecilia L. W. Chan, PhD, Head of Department of
Social Work and Social Administration,
University of Hong Kong, Centre of Behavioral
Health, Pokfulam, Hong Kong
Maria Chi, MS, LCSW, Clinical Supervisor, Intern
Program Coordinator, CancerCare, New York, NY
Amy Yin Man Chow, BSoSc, MSocSc, PhD, Associate
Professor, Department of Social Work & Social
Administration, University of Hong Kong, Pokfulam,
Hong Kong
Grace Christ, PhD/DSW, Professor Emerita and Research
Scientist, Columbia University School of Social Work,
Seattle, WA
Nancy F. Cincotta, MSW, MPhil, Psychosocial Director,
Camp Sunshine at Sebago Lake, Casco, ME; and Adjunct
Faculty, Icahn School of Medicine, Department of
Behavioral Medicine, New York, NY
Elizabeth J. Clark, PhD, MSW, MPH, Past Chief
Executive Officer, National Association of Social Workers,
Washington, DC
Karen Clark, MS, Program Manager, City of Hope,
Department of Supportive Care Medicine, Duarte, CA
Paul G. Clark, PhD, MSW, Assistant Professor,
Department of Sociology, Anthropology &
Social Work, University of North Florida,
Jacksonville, FL
Stacy Collins, MSW, Senior Practice Associate, National
Association of Social Workers, Washington, DC
Yvette Colón, PhD, ACSW, BCD, Assistant Professor,
School of Social Work, Eastern Michigan University,
Ypsilanti, MI
Erin Columbus, MSW, LCSW, Clinical Supervisor/
Program Director of Online Services, CancerCare,
New York, NY
Constance Connor, BA, MSW, LCSW, Pediatric Oncology
Social Worker, Life With Cancer, Inova Heath System,
Fairfax, VA
Nancy Contro, MSW, LCSW, Director, Bereavement
and Family Guidance Program and the Family Partners
Program, Lucile Packard Children’s Hospital at Stanford,
Palo Alto, CA
Catherine Credeur, MSW, LMSW, OSW-C, Social Worker,
Harold C. Simmons Cancer Center, UT Southwestern,
Dallas, TX
Penny Damaskos, PhD, LCSW, OSW-C, Director,
Department of Social Work, Memorial Sloan Kettering
Cancer Center, New York, NY
Sheila Damore-Petingola, BSW, MSW, RSW, Faculty
Appointment—Lecturer, Division of Human Sciences,
Northern Ontario School of Medicine, Laurentian
University, Lakehead University; and Coordinator,
Supportive Care Oncology Network—NE Region, Health
Sciences North/Horizon Sante-Nord, Northeast Cancer
Centre, Sudbury, ON, Canada
Louisa Daratsos, PhD, LCSW, Psychosocial Coordinator
for Oncology/Palliative Care, VA New York Harbor
Healthcare System, Brooklyn, NY
Cindy Davis, PhD, Professor, University of Tennessee,
College of Social Work, Nashville, TN
Kim Day, MSSA, LISW-S, OSW-C, ACHP-SW, Clinical
Oncology Social Worker, University Hospitals Seidman
Cancer Center, Cleveland, OH
Richard R. Dickens, MS, LCSW-R, DPNAP, Clinical
Supervisor, Mind-Body Project Coordinator,
CancerCare; and Mentor, Leadership Fellowship, Zelda
Foster Studies Program in Palliative and End-of-Life
Care, NYU Silver School of Social Work,
New York, NY
Jessica H. L. Elm, MSW, PhD Student, Research
Assistant, University of Washington
School of Social Work
Lorena Estrada-Martinez, PhD, MPH, Assistant Professor,
College of Public and Community Service, University of
Massachusetts, Boston, MA

Wendy J. Evans, MSW, MBA, LCSW, Assistant Vice
President, Clinical Services, Cenikor Foundation,
Houston, TX
Teresa Evans-Campbell, PhD, MSW, Associate Professor,
University of Washington School of Social Work,
Seattle, WA
Elizabeth Ezra, LCSW, OSW-C, Pancreatic
Cancer Program Coordinator, CancerCare,
New York, NY
Ann Fairchild, LCSW, Former President, Association of
Oncology Social Work, Deerfield, IL
Anna Faul, BSc, MSSW, PhD, Professor and Associate
Dean, Academic Affairs, Kent School of Social Work,
University of Louisville, Louisville, KY
Stacy Stickney Ferguson, MSW, LICSW, President,
Board of Directors, Association of Pediatric Oncology
Social Workers; and Manager, Education and
Outreach, Patient and Health Professional Services,
National Marrow Donor Program, Be the Match,
Minneapolis, MN
Iris Cohen Fineberg, PhD, MSW, ACSW, OSW-C,
Associate Professor and Associate Dean for Academic
Affairs, School of Social Welfare, Stony Brook University,
Stony Brook, NY
Stewart B. Fleishman, MD, BS, Founding Director,
Cancer Supportive Services, Continuum Cancer
Centers of New York and Accreditation Surveyor
American College of Surgeons Commission on
Cancer Chicago, IL
Les Gallo-Silver, LCSW-R, Associate Professor of Health
Services, Health Sciences Department, LaGuardia
Community College/City University of New York,
New York, NY
Patrick Garbe, BA, Electronic Discovery Specialist,
New York Law Firm, New York, NY
Daniel S. Gardner, PhD, LCSW, Associate Professor,
Silberman School of Social Work at Hunter College,
City University of New York, New York, NY
Sarah Gehlert, MA, MSW, PhD, E. Desmond Lee
Professor of Racial & Ethnic Diversity, and Professor,
Department of Surgery, School of Medicine,
George Warren Brown School of Social Work,
Washington University, St. Louis, MO
Contributors xxvii
Brian Giddens, LICSW, ACSW, Director, Social
Work and Care Coordination, University of Washington
Medical Center; and Clinical Professor University of
Washington School of Social Work, Seattle, WA
Susan Glaser, LCSW, Senior Clinical Social Worker,
Memorial Sloan Kettering Cancer Center, New York, NY
William Goeren, LCSW, ACSW, Director of Clinical
Program, Coordinator of LGBT Program, CancerCare
National Office, New York, NY
Karen Gold, BEd, MSW, Social Worker/Interprofessional
Education Coordinator, Women’s College Hospital; and
Adjunct Lecturer, Faculty of Social Work, University of
Toronto, Toronto, ON, Canada
Greta Greer, MSW, LCSW, BA, Director of Survivor
Programs, American Cancer Society, Atlanta, GA
Shannon Groff, MSc, BSc, Provincial Screening for
Distress Coordinator, Community Oncology, Alberta
Health Services—CancerCare, Holy Cross Site,
University of Calgary, Calgary, AB, Canada
Sheila L. Hammer, MSW, LCSW, Clinical Program
Director, Cancer Support Community Santa Monica,
Los Angeles, CA
Richard T. Hara, PhD, MSSW, Assistant Director
of Field Education, Adjunct Assistant Professor,
Columbia University School of Social Work, New York, NY
Lou Harms, BA, BSW, MSW, PhD, Associate Professor
and Deputy Head, Department of Social Work,
The University of Melbourne, Melbourne, Australia
Karen Kell Hartman, LCSW, MSW, OSW-C, Senior
Clinical Social Worker, Memorial Sloan Kettering Cancer
Center, Commack, NY
Barbara Head, PhD, RN, CHPN, ACSW, FPCN, Associate
Professor, University of Louisville School of Medicine,
Kent School of Social Work, Louisville, KY
Christine Healy, MSW, LCSW, Clinical Social Worker,
H. Lee Moffitt Cancer Center, Tampa, FL
Susan Hedlund, BS, MSW, LCSW, OSW-C, Faculty,
Portland State University, Graduate School of
Social Work, School of Medicine-Oregon
Health & Sciences University; and Manager, Patient/
Family Support Services, Knight Cancer Institute,
Portland, OR
xxviii Contributors
Julie Keany Hodorowski, RN, MA, Clinical Chemotherapy
Coordinator, Memorial Sloan Kettering Cancer Center,
New York, NY
Darrell Hudson, PhD, MPH, Assistant Professor, Brown
School of Social Work, Washington University in St. Louis,
St. Louis, MO
Kerry Irish, BS, MSW, Clinical Social Worker, The
Patrick Dempsey Center for Cancer Hope & Healing,
Lewiston, ME
Terry L. Irish, BA, MDiv, DMin, BCC, Chaplain, City of
Hope National Medical Center, Duarte, CA
Barbara L. Jones, PhD, MSW, Associate Professor,
Assistant Dean for Health Affairs, The
University of Texas at Austin School of Social Work,
The Institute for Grief, Loss and Family Survival,
Austin, TX
Annamma Abraham Kaba, LCSW-R, MSW, Clinical
Supervisor and Program Coordinator, Memorial Sloan
Kettering Cancer Center, New York, NY
Karen Kayser, PhD, MSW, Professor, Renato LaRocca
Chair, Oncology Social Work, University of Louisville
Kent School of Social Work, Louisville, KY
Victoria Kennedy, MSW, LCSW, Vice President, Program
Development & Delivery, Cancer Support Community,
Washington, DC
Jeanne Kerwin, D.MH, Ethics & Palliative Care Program
Manager, Overlook Medical Center, Atlantic Health
System, Atlanta, GA
Roz Kleban, LCSW, Clinical Supervisor/Program
Coordinator, Breast and Imaging Center, Memorial Sloan
Kettering Cancer Center, New York, NY
Louise Knight, MSW, LCSW-C, OSW-C, Director, Harry
J. Duffey Family Patient and Family Services Program,
Johns Hopkins Hospital, Sidney Kimmel Comprehensive
Cancer Center, Baltimore, MD
Caroline Kornhauser, MPH, Education Outreach
Coordinator, CancerCare, New York, NY
Betty J. Kramer, PhD, MSSW, Professor, School of Social
Work, University of Wisconsin-Madison, Madison, WI
Virginia Krawiec, MPA, Program Director, Health
Professional Training in Cancer Control, American Cancer
Society, Atlanta, GA
Carrie Lethborg, PhD, MSW, BSW, Clinical
Leader, Cancer Social Work Coordinator,
Psychosocial Cancer Research, St. Vincent’s
Hospital, Fitzroy; Research Fellow, Monash
University, Clayton; and Research Fellow (Hon.),
Peter MacCallum Cancer Centre,
Melbourne, Australia
Pamela Pui-Yu Leung, PhD, BSW, Director of
Rehabilitation, Hong Kong Society for
Rehabilitation; and Honorary Assistant
Professor and Honorary Research Fellow,
University of Hong Kong, Pokfulam, Hong Kong
Jane Levy, MS, LCSW-R, Director of Patient Assistance
Programs, CancerCare, New York, NY
Frances Marcus Lewis, PhD, MN, MA, BSN,
Professor & Affiliate, Fred Hutchinson Cancer Research
Center; and Endowed Professorship, University of
Washington Professor of Nursing Leadership,
University of Washington & Fred Hutchinson
Cancer Research Center, School of Nursing,
Seattle, WA
Taryn Lindhorst, PhD, MSW, BA, Carol LaMare
Associate Professor of Social Work, School of
Social Work, University of Washington,
Seattle, WA
Matthew Loscalzo, MSW, BA, LCSW, Liliane Elkins
Professor in Supportive Care Programs,
Professor, Department of Population Sciences;
Administrative Director, Sheri & Les Biller
Patient and Family Resource Center; and
Executive Director, Department of Supportive Care
Medicine, City of Hope National Medical Center,
Duarte, CA
Mandy Lowe, BSc, (OT), MSc, OT Reg (Ont),
Director, Education and Professional Development,
University Health Network; Co-Director,
UHN International Centre for Education, University
of Toronto; Associate Director, Centre for
Interprofessional Education; and Associate Professor,
Rehab Medicine, University of Toronto, Toronto,
ON, Canada
Another random document with
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beginning at Constantinople and going on to the Mediterranean. He
visits, one after the other, Greece, Malta, Sicily, Spain, the South of
France; he even goes so far as Chambéry and Lyons. An
opportunity turns up, and off he sets for Paris.
“The innovations made by Joseph II., such as the
introduction of the Register and military conscription, caused
him to be employed as an engineer, and as a member of the
administrative body formed to carry out these different
schemes. His independent character instantly displayed itself
in a sphere where it was no longer repressed by that duty of
blind obedience which is the very being of the Army. He could
now venture to have an opinion and to express it, he could
criticise the root-idea on the form of an enterprise by
displaying its difficulties or foretelling its non-success
(forecasts, moreover, which time has proved to be sound); he
could speak of the violation of national justice, of a legitimate
resistance to arbitrary power. His experiences under fire, his
activity, and his oratorical talent gave him a position among
the malcontents which he had not sought in any way. In
consequence, he ventured on something more than mere
speaking and writing. His travels, his qualities, his
independent and decided character have won for him
friendships and acquaintanceships which have given him the
advantage of never finding himself out of place in any
important centre of affairs. To this he owes that knowledge of
the hereditary prejudices and the sudden caprices of
Cabinets, which when joined to an equal knowledge of the
character of their chiefs, ministers, constitutes diplomacy. To
assiduous study he attributes that understanding of the true
interests of Governments, and of their respective powers,
which constitutes international politics.”
Such was the personage to whom Lady Atkyns and Peltier
entrusted their enterprise. If they looked after him carefully, granted
him only a limited discretion, and took the fullest advantage of his
intelligence and his talents, they would probably make something of
the Hungarian nobleman. This was not the Baron’s first visit to Paris;
he knew the capital well. He had come there at the beginning of the
Revolution, in 1789, and, if we are to believe his own account, “he
saw the results of all these horrors, but was merely laughed at. If all
mankind could have been armed against the Revolution, he would
have armed them!” Moreover, he had kept up many connections in
Paris. By his own account, the Austrian Minister, Thugut, whom he
had formerly met at Naples, had taken him into his confidence. In
short, his friends in London could not have made a better choice, as
he wrote from Amiens to Peltier on the receipt of his proposal.
“I start for Paris at full speed at five o’clock to-morrow
morning. I need not tell you that from this moment I shall
devote myself to the business of which you have spoken to
me, nor need I add that this devotion is entirely disinterested.
If I had not already proved those two things to you, I should
not be the man you require. But, just because I feel that I
have the head and the heart necessary for your enterprise, I
tell you frankly that it can only be carried out at great
expense. The business of getting information—which is only a
preparatory measure—is made difficult, if not impossible,
unless a considerable sum of money can be spent.... I believe
myself authorized to speak to you in this way, because I have
the advantage—rare enough amongst men—of being above
suspicion with regard to my own interests.”[39]
On Wednesday, December 19, d’Auerweck entered Paris, and put
up at a hotel in the Rue Coq-Héron, where he gave his name as
Scheltheim. He instantly set to work to get the letters he had brought
with him delivered at their addresses, and to make certain of the co-
operation which was essential to him. But there was a
disappointment in store; Goguelat, upon whom so much depended,
was away from Paris, and, as it happened, in London. It was
necessary to act without him, and this was no easy matter. The
excitement caused by the trial of the King enforced upon the plotters
a redoubled caution. D’Auerweck got uneasy when he found no
letters coming from Peltier in answer to his own. He went more
frequently to Versailles, and to Saint-Germain, and kept on begging
for funds. On December 25, the day before M. de Sèze was to
present the King’s defence to the Convention, d’Auerweck wrote to
Peltier—
“The persons (you know whom I mean) do not care to
arrive here before Thursday, which is very natural, for there is
all sorts of talk as to what may happen to-morrow.... You
promised me to write by each post; but there can be no doubt
that you forgot me on Tuesday, the 18th, for otherwise I must
have had your letters by this time. One thing I cannot tell you
too often: it is that I consider it essential to take to you in
person any documents that I may be able to procure.”[40]
The documents in question were those which Peltier had alluded
to, some days before, in a letter to Lady Atkyns: “I heard to-day that
there was some one in Paris who had all the plans that you want in
the greatest detail;”[41] and at the end of the month he returned to
the subject—
“I am expecting, too, a most exact plan of the Temple
Prison, taken in November; and not only of the Temple, but
also of the caves that lie under the tower—caves that are not
generally known of, and which were used from time
immemorial for the burial of the ancient Templars. I know a
place where the wall is only eighteen inches thick, and
debouches on the next street.”
It becomes evident that Peltier and Lady Atkyns, almost
abandoning any hope of saving the King, whose situation appeared
to them to be desperate, now brought all their efforts to bear upon
the other prisoners of the Temple.
“If His Majesty persists in his reluctance to be rescued from
prison, at least we may still save his poor son from the
assassins’ knives. A well-informed man told me, the day
before yesterday, when we were talking of this deplorable
business, that people were to be found in Paris ready, for a
little money, to carry off the Dauphin. They would bring him
out of the Temple in a basket, or else disguised in some
way.... I believe that to save the son is to save the father also.
For, after all, this poor child cannot be made the pretext for
 any sort of trial, and as the Crown belongs to him by law on
his father’s death, I believe that they would keep the latter
alive, if it were only to checkmate those who would rally round
the Dauphin. But, in the interval, things may have time to
alter, and circumstances may at last bring about a happy
change in this disastrous state of things.”
The month of December went by in this painful state of suspense.
What anxiety must have fretted the heart of the poor lady, as she
daily followed in the Gazette the course of the Royal Trial! On New
Year’s Day she had some further words of encouragement from her
friend in London. All was not lost; Louis XVI. could still reckon, even
in the heart of Paris, upon many brave fellows who would not desert
him; and besides, what about the fatal consequences that would
follow on the crime of regicide? The Members of Convention would
never dare—never....
Fifteen days later comes another missive; and this time but little
hope is left. The “Little Baron”—this was what they called
d’Auerweck—was not being idle. Peltier had made an opportunity for
him of seeing De Sèze, the King’s counsel.
“This latter ought to know for certain whether the King does
or does not intend to await his sentence or to expose himself
to the hazards of another flight; but there seems to be very
little chance of his consenting to it. Whatever happens”
(added Peltier), “your desires and your efforts, madam, will
not be wasted, either for yourself or for history. I possess, in
your correspondence, a monument of courage and devotion
which will endure longer than London Bridge.... A trusty
messenger who starts to-morrow for Paris affords me a
means of opening my mind to De Sèze for the third time.”
But it was too late. On January 15 the nominal appeal upon the
thirty-three questions presented to the Members of Convention had
been commenced; two days later the capital sentence was voted by
a majority of fifty-three.
On January 21, at the hour when the guillotine had just done its
work, the following laconic note reached Ketteringham to say that all
was over:—
“My honoured friend, all we can do now is to weep. The
crime is consummated. Judgment of death was pronounced
on Thursday evening. D’Orleans voted for it, and he is to be
made Protector. We have nothing now to look forward to but
revenge; and our revenge shall be terrible.”
Think of the look that must have fallen upon that date, “January
21!” The postmark of the letter still shows it quite clearly, on the
yellowed sheet.
Could they possibly have succeeded if the King had listened
favourably to their proposal? It is difficult to say. But it is certainly a
fact, that during the last six months of 1792 there had been on the
water, near Dieppe, a cruising vessel which kept up a constant
communication with the English coast. The truth was that, finding the
Rouen route too frequented, Peltier had judged the Dieppe one to be
infinitely preferable. It was that way that the fish merchants came to
Paris. If they had succeeded in getting the King outside the Temple
gates it is probable that his escape would have been consummated.
But the prison was heavily guarded at that time, and during the trial
these precautions were redoubled.
At any rate, there is no doubt that Louis knew of the attempts to
save him from death. Some time after the event of January 21, Clery,
speaking of the King to the Municipal, Goret, remarked—
“Alas! my dear good master could have been saved if he
had chosen. The windows in that place are only fifteen or
sixteen feet above the ground. Everything had been arranged
for a rescue, while he was still there, but he refused, because
they could not save his family with him.”
There can be no doubt that these words refer to the attempt of
Lady Atkyns and Peltier.[42] The assent of the King had alone been
wanting to its execution.
It is well known what a terrible and overwhelming effect was
produced in the European Courts by the news of the King’s
execution. In London it was received with consternation. Not merely
the émigrés (who had added to their numbers there since the
beginning of the Revolution) were thunderstruck by the blow, but the
Court of King George was stupefied at the audacity of the National
Assembly. The Court went instantly into mourning, and the King
ordered the French Ambassador, Chauvelin, to leave London on the
spot. Some days later war was officially declared against France.[43]
The King’s death caused the beginning of that struggle which was
to last so many years and be so implacably, ferociously waged on
both sides.

Any one but Lady Atkyns would have lost heart, but that heroic
woman did not allow herself to be cast down for an instant. Amid the
general mourning, she still cherished her hopes; moreover, those
who had been helping her had not abandoned her. The “Little Baron”
was still in Paris, awaiting orders, but the gravity of the situation had
obliged him to leave the Hotel Coq-Héron, where his life was no
longer in safety. Well, they had failed with the King; now they must
tempt fortune, and save the Queen and her children. The lady at
Ketteringham was quite sure of that.
“Nothing is yet decided about the Queen’s fate” (Peltier had
written to her at the end of January), “but it has been
proposed at the Commune of Paris to transfer her either to
the prison of La Force or of La Conciergerie.”
Then Lady Atkyns had an idea. Why should she not go in person
to Paris and try her chance? Probably the surveillance which had
been so rigorously kept over the King would be far less severe for
the Queen. And one might profit by the relative tranquillity, and
manage to get into the Temple, and then—who could tell what one
might not devise in the way of carrying the Queen off, or of
substituting some one else for her? She never thought of all the
dangers around her, and of the enormously increased difficulties in
the path for a foreign lady who knew only a little French. Peltier, to
whom she confided her plan, tried to dissuade her.
 “You will hardly have arrived before innumerable
embarrassments will crop up; if you leave your hotel three
times in the day, or if you see the same person thrice, you will
become a suspect.”
But his friend’s persistence ended by half convincing him, and he
admitted that the moment was relatively favourable, and that it was
well to take advantage of it, if she wished to attempt anything.
Unluckily, things were moving terribly fast in Paris. There came the
days of May 31 and June 2, the efforts of the sections against the
Commune, civil war let loose. In the midst of this storm, Lady Atkyns
feared that the whole affair might come to nought; her arrangements,
moreover, were not completed. Money, which can do so much,
decide so much, and which had already proved so powerful—money,
perhaps, was not sufficiently forthcoming. Suddenly there is a
rumour that a conspiracy to favour the Queen’s escape has been
discovered. Two members of the Commune, Lepitre and Toulan, who
had been won over to the cause by a Royalist, the Chevalier de
Jarjays, had almost succeeded in carrying out their scheme, when
the irresolution of one of them had ruined everything; nevertheless,
they were denounced.[44] Public attention, which had been averted
for a moment, now was fixed again upon the Temple Prison.
And the days go by, and Lady Atkyns sees no chance of starting
on her enterprise.
We come here to an episode in her life which seems to be
enveloped in mystery. One fact is proved, namely, that Lady Atkyns
succeeded in reaching Marie Antoinette, disguised, and at the price
of a large sum of money. But when did this take place? Was the
Queen still at the Temple, or was it after she had been taken to the
Conciergerie? The most reliable witnesses we have—and they are
two of Lady Atkyns’ confidants—seem to contradict one another.[45]
A careful weighing of testimony and an attentive study of the letters
which Lady Atkyns received at this time lead us to conclude, with
much probability, that the attempt was made after the Queen had
been transferred to the Conciergerie; that is to say, after August 2,
1793.[46]
 Some days before this Peltier had again brought her to give up her
resolve, assuring her that she was vainly exposing herself to risk—
“If you wish to be useful to that family, you can only be so
by directing operations from here (instead of going there to
get guillotined), and by making those sacrifices which you
have already resolved to make.”
It was of no use. The brave lady listened only to her heart’s
promptings, and set out for Paris. If we are to believe her friend, the
Countess MacNamara[47]—and her testimony is valuable—she
succeeded in winning over a municipal official, who consented to
open the doors of the Conciergerie for her, on the condition that no
word should be exchanged between her and the Royal prisoner.
Moreover, the foreign lady must wear the uniform of a National
Guard. It was Drury Lane over again! She promised everything, and
was to content herself with offering a bouquet to the Queen; but
under the stress of the intense emotion she experienced on meeting
once more the eyes of the lady whom she had not seen since the
days at Versailles, she let fall a note which she held, and which was
to have been put into the Queen’s hand with the bouquet. The
Municipal officer was about to take possession of it, but, more
prompt than he, Lady Atkyns rushed forward, picked it up, and
swallowed it. She was turned out brutally. Such was the result of the
interview. But the English lady did not stop there. By more and more
promises and proceedings, by literally strewing her path with gold,
she bought over fresh allies, and this time she obtained the privilege
of spending an hour alone with the Queen—at what a price may be
imagined! It is said that she had to pay a thousand louis for that
single hour. Her plan was this: to change clothes with the Queen,
who would then leave the Conciergerie instead of her. But she met
with an obstinate refusal. Marie-Antoinette would not, under any
pretext, sacrifice the life of another, and to abandon her imprisoned
children was equally impossible to her. But what emotion she must
have felt at the sight of such a love, so simple, so whole-hearted,
and so pure! She could but thank her friend with tearful eyes and
commend her son, the Dauphin, to that friends tender solicitude. She
also gave her some letters for her friends in England.[48]
 On leaving the Conciergerie, one thought filled the mind of Lady
Atkyns: she would do for the son what she had not been able to do
for the mother—she would drag the little Dauphin out of the Temple
Prison.

Did she return to England immediately afterwards? Probably. For

one thing, she had not lost all hope, and, like the rest of her friends,
she did not as yet fear instant danger for the Queen’s life. This is
proved by a note from Peltier, written in the course of the month of
September, which reveals the existence of a fresh plan.
“They must set out on Thursday morning at latest; if they
delayed any longer, the approach of the Austrian troops, and
the movements which have taken place at Paris, might, we
fear, determine the members of the Convention to fly and take
with them the two hostages whom we want to save. One
day’s, two days’ delay may make all the difference. If they are
to start on Thursday morning, and go to Brighton and charter
a neutral vessel, they have only Monday, Tuesday, and
Wednesday to spend, day and night, in getting everything
ready. First of all, we must get some louis d’or, and sew them
in their belts. Then we must get some paper-money, if it’s only
for the journey along the coast to Paris, so that they may not
be suspected.... We must have time to prepare passports that
will do for the three persons who are to go. These passports
must be made to look like the letters that Mr. Dundas is
sending for the Jacobins who are being deported from
France. They are thus less likely to be suspected.... The
Temple affair is all arranged; but, as to the Conciergerie one,
nothing is known as yet; the last letters from the Paris agents
are dated July 26th. We are sure that the persons interested
have taken measures, but we do not know what they are. It
would not be a bad plan to have some money in reserve for
this purpose. It would be dreadful to think we had missed our
chance for the sake of two or three hundred louis, which
 would make 1500 guineas. Therefore each man ought to
carry on his person about 450 louis, or 200 double-louis,
because about 50 louis would be spent in paper-money.
“There will also be a line of communication between France
and England, by means of M——, who resides near Dieppe,
on the coast, and who up to now has received and passed on
constant communications. We shall have to know of all the
movements either of the armies, or of the fleets, so as to
direct our operations accordingly.... Circumstances have
made it very dangerous to employ foreigners, since the
Decree of August 5 has banished them from France. But what
difference is there between doing a thing one’s self and
causing it to be done? The glory which one shares with others
is glory none the less so long as the great purpose is
attained.... How can I be sure if this plan does succeed, it will
not be displeasing to the lady who would have liked to carry
off her friends with her own hands, and then to lead them in
triumph, etc., etc.?... But as we are concerned, not with an
opera, but an operation, the best proof of affection will be to
sacrifice that glory and that joy. And, besides, that lady will not
then be running the risks which formerly made existence
hateful to me. If my friends perish in this affair, I shall at least
not have to listen to a son’s and a mother’s reproaches for the
loss of their Charlotte....”[49]
It is clear from these lines that the communications established
with the Temple and outside it were still kept in working order against
a favourable opportunity. The agents in question were probably
those who have been already mentioned, two of whom were the
bodyguards of the Queen. But Lady Atkyns’ money had also had its
effect, even among those “Incorruptibles” which the Revolution
created in such numbers; and the events which we shall now read of
can only be explained by the co-operation, not only of one or two
isolated persons, but of a quantity of willing helpers, cleverly won
over, and belonging to a circle in which it could scarcely have been
hoped that they were to be found.
 In the midst of all this, the Baron d’Auerweck (whom we last saw in
Paris), judging, doubtless, that his presence there was unavailing,
went back to London. The situation in France was more than critical.
The formation of a fresh Committee of Public Safety, the activity of
the Revolutionary Tribunals, in a word, the Terror in full blast,
rendered any stay in Paris impossible for already suspected
foreigners, and our Baron made haste to bring to his friends all the
latest information.
Peltier, who was impatiently awaiting him, on communicating his
arrival to Lady Atkyns, wrote thus:—
“My heart is too full of it for me to speak to you of anything
but the arrival of my friend, the Baron d’Auerweck. He left
France two days ago, and is now here, after having run every
imaginable risk, and lost everything that could be lost.... We
have the Paris news from him up to the 23rd; the Queen was
still safe then. The Baron does not think she will be sacrificed.
Danton and the Cordeliers are for her, Robespierre and the
Jacobins against. Her fate will depend upon which of the two
parties triumphs. The Queen is being closely guarded—the
King, hardly at all. The Queen maintains a supernatural
strength and dignity.”[50]
It was in London itself, at the Royal Hotel, that Lady Atkyns
received these lines. She had hastened there so as to be better able
to make inquiries.
But the Decree issued by the Convention, on October 3, ordering
the indictment of the “Widow Capet,” give a curious contradiction to
the assurances given by d’Auerweck. After all, though, who could
dare to forecast the future, and the intentions of those who were now
in power? The ultra-jacobin politicians knew less than any one else
whither Destiny was to lead them. Had there not been some talk, a
few weeks earlier, of getting the Queen to enter into the plan of a
negotiation with Austria? So it was not surprising that illusions with
regard to her reigned in Paris as well as among the émigrés in
London.
 Eleven days later Marie-Antoinette underwent a preliminary
examination at the bar of the Revolutionary Tribunal. The suit was
heard quickly, and there were no delays. Of the seven witnesses
called, the last, Hébert, dared to bring the most infamous
accusations against her, to which the accused replied only by a
disdainful silence. Then came the official speeches of Chaveau-
Lagarde and of Tronson-Ducoudray—a mere matter of form, for the
“Austrian woman” was irrevocably doomed.
On the third day, October 16, at 4.30 a.m., in the smoky hall of the
Tribunal, by the vague light of dawn, the jury gave their verdict,
“Guilty”; and sentence of death was immediately pronounced. Just
on eleven o’clock the cart entered the courtyard of the Conciergerie
Prison, the Queen ascended, and, after the oft-described journey,
reached the Place de la Revolution. At a quarter past twelve the
knife fell upon her neck.
All was over this time—all the wondrous hopes, the last, long-
cherished illusions of Lady Atkyns. The poor lady heard of the
terrible ending from Peltier. Her friend’s letter was one cry of rage
and despair, more piercing even than that of January 21.
“It has killed me. I can see your anguish from here, and it
doubles my own. My anger consumes me. I have not even
the relief of tears; I cannot shed one. I abjure for ever the
name of Frenchman. I wish I could forget their language. I am
in despair; I know not what I do, or say, or write. O God! What
barbarity, what horror, what evils are with us, and what
miseries are still to come! I dare not go to you. Adieu, brave,
unhappy lady!”[51]
Many tears must have fallen on that treasured sheet. And still, to
this day, traced by Lady Atkyns’ hand, one can read on it these
words: “Written after the murder of the Queen of France.”
Were all her efforts, then, irremediably wasted? She refused to
believe it. And at that moment two fresh actors appeared on the
scene, whose help she could utilize. From the friendship of one, the
Chevalier de Frotté (who came to London just then), she could
confidently hope for devoted aid. The other, a stranger to her until
then, and only recently landed from the Continent, was destined to
become one of the principal actors in the game that was now to be
played.

FOOTNOTES:
[29] Albert Sorel, L’Europe et la Revolution Française, vol. ii. p.
382.
[30] Forneron, Histoire Générale des Émigrés, Paris, 1884, vol.
ii. p. 50.
[31] Abbé de Lubersac, Journal historique et réligieux, de
l’émigration et déportation du clergé de France en Angleterre,
dedicated to His Majesty the King of England, London, 1802, 8vo,
p. 12. (The author styles himself: Vicar-General of Narbonne,
Abbé of Noirlac and Royal Prior of St.-Martin de Brivé, French
émigré.)
[32] Count d’Haussonville, Souvenirs et Mélanges, Paris, 1878,
8vo.
[33] Gauthier de Brecy, Mémoires véridiques et ingenus de la
vie privée, morale et politique d’un homme de bien, written by
himself in the eighty-first year of his age, Paris, 1834, 8vo, p. 286.
[34] Sorel, L’Europe et la Révolution Française, vol. iii. pp. 288,
289.
[35] On October 21, 1765, at Gonnord, Maine-et-Loire, Canton
of Touarcé, arrondissement of Angers.
[36] Letter from Peltier to Lady Atkyns, dated from London,
November 15, 1792.—Unpublished Papers of Lady Atkyns.
[37] “In case of our not being able to find M. Goguelat, I have
my eye upon a very useful man whom I have known for many
years, and who was, indeed, a collaborator in some of my political
works—he is the Baron d’Auerweck, a Transylvanian nobleman, a
Royalist like ourselves, of firm character, and very clever.”—Letter
from Peltier, Dec. 3, 1792.
[38] In two autobiographical memoirs, one written at Hamburg,
June, 1796, and annexed to a despatch from the French Minister
there, Reinhard (Archives of the Foreign Office, Hamburg, v. 109,
folio 367). The other was written at Paris, July 25, 1807 (National
Archives, F. 6445). Both naturally aim at presenting the author in
the most favourable light.
[39] Letter from Baron d’Auerweck, December 17, 1792. It is
addressed to Peltier under the name of Jonathan Williams.—
Unpublished Papers of Lady Atkyns.
[40] Letter from d’Auerweck to Peltier, Paris, Hotel Coq-Héron,
No. 16 December 25, 1792.—Unpublished Papers of Lady
Atkyns.
[41] Letter from Peltier to Lady Atkyns, London, December 7,
1792.—Ibid.
[42] Narrative of the Municipal, Charles Goret, in G. Lenôtre’s
book, La Captivité et la Mort de Marie-Antoinette, Paris, 1902,
8vo, p. 147.
[43] February 1, 1793.
[44] On this plot, see Paul Gaulot, Un Complot sous la Terreur,
Paris, 1902, duodecimo.
[45] These are the Chevalier de Frotté and the Countess
MacNamara.
[46] In the narrative of the Chevalier de Frotté, who mentions
the Temple Prison (published by L. de la Sicotière, Louis de Frotté
et les Insurrections Normandes, vol. i. p. 429), we consider that a
somewhat natural confusion has arisen. It is, in fact, very difficult
to assign any date earlier than August 6 for an attempt at the
Temple; for on that date there is a letter from Peltier addressed to
Lady Atkyns at Ketteringham, and there can be no doubt that if
the lady had already left England, Peltier would have been aware
of it. On the other hand, the letter published by V. Delaporte (p.
256), and given as written at the end of July, 1793, must be
subsequent to August 2. These phrases: “They will not promise
for more than the King and the two female prisoners of the
Temple; they will do what is possible for the Queen; but
everything is changed, and they cannot answer for anything, and,
as to the Queen, they can say nothing as yet, for they have tried
the Temple Prison only”—these phrases plainly show that the
Queen was no longer at the Temple then. Finally, since in his
letter at the beginning of August Peltier once more tried to
dissuade Lady Atkyns from coming to Paris, it seems rational to
conclude that the lady had not yet carried out her plan.
 [47] The testimony of the Countess MacNamara was obtained
by Le Normant des Varannes, Histoire de Louis XVII., Orleans,
1890, 8vo, pp. 10-14, and he had it from the Viscount d’Orcet,
who had known the Countess. Although we cannot associate
ourselves with the writer’s conclusions, we must acknowledge
that whenever we have been able to examine comparatively the
statements of Viscount d’Orcet relating to Lady Atkyns we have
always found them verified by our documents.
[48] It has been sought to establish a connection between this
story and the conspiracy of the Municipal, Michouis (the “Affair of
the Carnation”), aided by the Chevalier de Pougevide, which
failed by the fault of one of the two gendarmes who guarded the
Queen. There may be some connection between the principal
actors in these simultaneous attempts, but we admit that we have
been unable to get any proof of it. It was necessary to take so
many precautions, to avoid as far as possible any written
allusions, and to veil so impenetrably the machinery of the plots,
that it is not surprising that the documents, curt and dry as they
are, reveal to us so few details.
[49] Note in Peltier’s handwriting.—Unpublished Papers of Lady
Atkyns.
[50] Undated letter from Peltier to Lady Atkyns.—Unpublished
Papers of Lady Atkyns.
[51] Unpublished Papers of Lady Atkyns.
 CHAPTER III
THE ODYSSEY OF A BRETON MAGISTRATE

On December 8, 1740, in the Rue de Montfort, at Rennes, there

were great rejoicings in one of the finest houses of that provincial
capital. Monsieur Yves-Gilles Cormier, one of the rich citizens, had
become the father of an heir the night before; and this heir was to be
named Yves-Jean-François-Marie. The delighted father was getting
ready to go to the Church of Saint-Sauveur (about two steps from his
abode), there to present his son for the Sacrament of Holy Baptism.
He had invited to this solemnity his relative, Master (Messire)
Jean-François Cormier, Prior and Rector of Bazouges-du-Desert,[52]
and his neighbour, the Director of the Treasury in the States of
Brittany, M. de Saint-Cristan. Madame Françoise Lecomte, wife of
the Sieur Imbault, Chief Registrar of the Chamber of La Tournelle, in
the Parliament of Brittany, and Dame Marie-Anne Lardoul were also
among the guests, who enhanced by their presence the splendour of
the ceremony.[53] When the bells rang out the cortège was entering
the church porch; shortly afterwards it reissued thence, and went
towards the house attached to the Treasury of Brittany, where Mme.
Cormier (formerly au Egasse du Boulay) was impatiently awaiting
their return.
The Cormiers were a family highly respected at Rennes. By his
own labours, Yves Cormier had made a fine fortune, which placed
him and his above any kind of need. Four years later a second child,
a daughter this time, was born. She was given the names of
Françoise-Michelle-Marie.
Yves-François grew up, a worker like his father, a sage follower of
parental advice, and both intelligent end gifted. After leaving school
he entered the Law Schools at Rennes, and before he was twenty
he had got his degree and been entered (on August 18, 1760) as a
barrister. Less than a year later the position of Crown Counsel at
Rennes falling vacant, the young barrister applied for it, his youth
notwithstanding, and obtained it (by Lettres de provision) on August
10, 1761.
This was a rapid advance in his career, and his parents might
justly be proud of it; but fortune meant to lavish very special favours
on the young magistrate, for on October 27 in the following year,
another position falling vacant in the same department—that of
Crown Prosecutor—Yves Cormier, exchanging the sitting magistracy
for the standing, obtained the place. Crown Prosecutor at twenty-
two! This was a good beginning.
For fifteen years he practised at Rennes. That town was going
through troublous times. The arrival of the Duc d’Aiguillon as
Governor, and his conduct in that position, created an uproar in the
ancient city, jealous, as it had always been, of its liberties. The states
proclaimed themselves injured in their rights. Led by La Chalotais,
they obstinately fought against the claims of the King’s
representative, the Duke d’Aiguillon. And there ensued an
interminable paper-war—pamphlets, libels, insults—which did not
cease even with the imprisonment of La Chalotais and his followers.
Ancient quarrels against the Jesuits were mixed up with these
complaints of the encroachments of Royal; and the angry Chalotistes
ended by accusing them of being the cause of all their misfortunes.
It was naturally impossible for the Crown Prosecutor to escape
being mixed up in a business which caused such rivers of ink to flow,
and created such an endless succession of lawsuits. A police report
accused him “of having ‘done a job’ in the La Chalotais affair.” But he
had only played a very passive part in it. His name only figures
once[54] in the voluminous dossiers so meticulously rummaged
through of late years; and that is in a defamatory pamphlet (which,
moreover, was torn and burnt by parliamentary decree), denouncing
him as a participator in those Jesuit Assemblies, upon which the full
wrath of the Breton parliamentarians descended.[55] The utmost one
can say is that Cormier perhaps inclined towards the Duc
d’Aiguillon’s party, which, moreover, his position as Crown
Prosecutor more or less obliged him to do.
Was it at that time that he began to pay repeated visits to Paris?
Very likely. At all events, from 1776 Yves Cormier practised only
intermittently. His father was dead. He lived with his mother on the
second floor of the Rue de Montfort house. Tired of bachelor life, the
young magistrate, who was then entering his thirty-sixth year,
resolved to marry. He had met in Paris a young lady from Nantes,
who belonged to a family of rich landowners in Saint-Domingo. Her
name was Suzanne-Rosalie de Butler; she was a little younger than
he, and had rooms in the La Tour du Pin Hotel, Rue Vieille-du-
Temple.
On July 10, 1776, in presence of notaries of the Du Châtelet
district, M. Cormier and Mademoiselle de Butler signed their
marriage contract.[56] By a rather unusual clause, the future husband
and wife, “departing in this respect from the custom of Paris,”
declared that they didn’t intend to sign the usual communauté de
biens, but that each would retain as his and her own property
whatever they brought to the marriage.
The husband’s property consisted of his appointment as Crown
Prosecutor at Rennes, and, further, of different lands and estates
which his father had bequeathed to him, at and near Rennes, and,
finally, in “his furniture, linen, wearing-apparel, etc., which were
stored in his place of abode.” The magistrate’s wardrobe was
remarkably well stocked, to judge by the enumeration we give below.
[57] It must have been a difficult matter to choose between the
“winter, spring, autumn, and summer garments;” the breeches of
“velvet patterned with large flowers,” or with “little bouquets”; the
coats of purple cloth, grey cloth, embroidered gourgouran, black-
and-olive taffetas, or green musulmane! And then there were jewels,
and there were carriages for one person called désobligeantes, to
say nothing of hats, frills, and lace cuffs.
Nor did Mlle. de Butler fall in any way below this standard. Her
father, Count Jean-Baptiste Butler, deceased, had bequeathed her,
in joint tenancy with her brother, Patrice, a rich state in Saint-
Domingo, one of the most flourishing colonies at that time. This state
was the farm and dwelling-house of Bois-de-Lance in the parish of
Sainte-Anne de Limonade, “with the negroes, negresses, negro-boys
and negro-girls; pieces of furniture; utensils, riggings, horses, beasts,
and all other effects of any kind whatever, being on the said estate.”
This document recalls the state of slavery in which the Colony then
was. By a second marriage Comte de Butler had had a son, Jean-
Pantaléon, who was thus the half-brother of the future Mme.
Cormier, and who had also some liens on the property in question.
[58] Suzanne de Butler further brought her husband some estates in
France, arising from her father’s succession; and a very complete
array of household furniture, which was enriched by articles in
“mahogany, tulip-wood, and the wood peculiar to the island,” etc.
The marriage was celebrated some days later. Once settled at
Paris, it became difficult for the Crown Prosecutor to keep his
appointment at Rennes. Nevertheless, he did not resign it until
January 23, 1779. Two years earlier their first child had been born, a
boy, who was baptized at the Madeleine in Paris, and named Achille-
Marie. The parents were probably at that time living in the enormous
house which Mme. Cormier bought in the following year, No. 15 in
the Rue Basse-du-Rempart. It was a handsome house with a
courtyard and several entrances.
On March 10, 1779, arrived another son, who was called Patrice,
after his maternal uncle. His godmother was a sister of Mme.
Cormier, married to a former naval officer.
The management of his own estates, and, more particularly, those
of his wife, occupied the greater part of Cormier’s time in the years
preceding the Revolution. Of middle height, inclining to stoutness,
with greyish hair and an energetic type of face, the sometime Breton
magistrate was quite a personality, for he spoke remarkably well,
and, besides being most intelligent, had a real gift of persuasion. The
times that were now at hand seemed likely to provide him with a
prominent position on the revolutionary scene.
We know that, in view of the elections to the States-General, a
Royal Ordinance of April 13, 1789, had decreed the provisional
division of Paris into sixty districts.[59] A year later this mode of
division, being no longer useful, was replaced by a division into forty-
eight sections—those sections which, from August 10 onwards, were
to exercise so potent a political influence. Cormier was active from
the very first. The section of the Place Vendôme had scarcely been
formed before he occupied a prominent position therein. We see him
first as Commissary of the Section, then as President of its Civil
Committee. The General Assembly held its meetings in the old
Church of the Capuchins in the Place Vendôme; and Cormier, whose
home was close by, took part in the deliberations. He would have
played a more active part if other business had not taken up most of
his time.
Amongst the numerous monarchical clubs which then sprang up in
Paris, one had just been founded whose members, for the most part
rich planters from Saint-Domingo, used to meet in the Place des
Victoires, at the Hôtel Massiac. Their object was to counterbalance
what they held to be the pernicious influence exercised by a new
society originating in England. This was the Friends of the Blacks,
and had for its principal object the amelioration of the coloured race.
[60] The movement, begun by Wilberforce across the Channel, met
with many adherents in France, for it accorded well with the new
ideas of enfranchisement and liberty proclaimed by the National
Assembly. This very soon became clear to the landowners of the
Leeward Islands, who lived on the labour of their slaves, and whose
whole well-being depended on their continued existence as such.
Saint-Domingo was then in a state of astonishing prosperity. The
sugar plantations and the cultivation of indigo and cotton had made it
one of the chief colonies. If Wilberforce’s theories were to prevail
there, it was all over with the planters and the white people, who
formed the minority of the population.
Founded on August 20, 1789, the Hôtel Massiac Club intended to
oppose with all its strength the current of sympathy for the blacks,
which threatened to overflow the Assembly. Its members meant to
prevent at any cost the concession of rights to the mulattos
inhabiting the island, which would be the preliminary to granting