Young European Oncologists Report High Levels of Burnout

Roxanne Nelson

September 26, 2014

MADRID — A large proportion of young oncologists in Europe are reporting signs of burnout, prompting calls for serious attention to the issue and action.

In the largest survey of its kind, which was presented during a press briefing here at the European Society for Medical Oncology (ESMO) Congress 2014, researchers found that the overall burnout rate among young oncologists was 71%. In addition to personal consequences for the physician, this could potentially affect patient care.

Dr. Susana Banerjee

"The most significant independent factors affecting burnout were the European region and having a good work/life balance and enough vacation time," said lead author Susana Banerjee, MBBS, PhD, a consultant medical oncologist at The Royal Marsden NHS Trust in London, United Kingdom. "As an example, if they did not have adequate work/life balance, they were more than 3 and a half times more likely to develop burnout."

Burnout is characterized by 3 main features, explained Dr. Banerjee. The first is emotional exhaustion, the second is depersonalization, which is characterized by an impersonal approach to treating patients, and the third is a low sense of personal accomplishment, characterized by a loss of meaning and purpose of work.

Burnout is a growing problem in many professions, she noted, and can lead to problems such as anxiety, depression, alcohol or substance abuse, and suicide.

Patient Care and Leaving the Profession

"The survey did not specifically address the effect of burnout on patient care, but physicians who are experiencing burnout are going to find it much more challenging to deliver the most compassionate, highest-quality cancer care for our patients," she told Medscape Medical News. "Those who have burnout will display the signs in different ways, so it may not necessarily affect how patients are treated. But we have to recognize that this is a potential consequence. That is why it is so important to actually address prevention of burn out and recovery."

"We need to address a culture where oncologists are not feeling this way," Dr. Banerjee continued, "because it is an exceptionally rewarding career. We need to do everything we can to make sure we are delivering the highest quality of care."

There is a risk that oncologists who experience burnout will leave clinical practice sooner than planned, and that can have a potential impact on the oncology workforce and, ultimately, patient care. "We are seeing from surveys from the United States that there may be a shortage of oncologists in the near future, and that's why this is such an important issue," she said.

Recent data show that burnout is not unique to young oncologists in Europe. A survey of oncology fellows in the United States indicated that they underestimate the workload they will experience once they enter practice, as recently reported by Medscape Medical News. This unrealistic expectation might contribute to future professional dissatisfaction, burnout, and challenges maintaining a work/life balance, the researchers noted.

The American survey also showed that almost half of oncology fellows experience burnout in their first year of training, although this tapers off slightly as training progresses.

Study Details

Dr. Banerjee and her colleagues evaluated European oncologists for the prevalence of burnout prevalence and work and lifestyle factors. The team used the validated 22-item Maslach Burnout Inventory, which is widely used and is considered a gold standard. They also asked questions that explored work/lifestyle factors.

The 737 responding oncologists, representing all age groups, came from 41 European countries (divided into 6 regions). The group of oncologists younger than 40 years was 81% medical oncologists, 52% trainees, and 62% women.

Of the oncologists in this age group, 71% reported signs of burnout, indicated by depersonalization (50%), emotional exhaustion (35%), and low accomplishment (35%). Nearly a quarter (22%) had requested support for burnout during their training, and 74% reported that they had no hospital access to support services.

The rates of burnout were significantly different across Europe (P < .0001). Rates were the highest in central Europe, affecting 84% of respondents, and lowest in Northern Europe and the British Isles, affecting 52% of respondents.

Scores for depersonalization were higher in men than in women (60% vs 45%; P = .0001), whereas the issue of low accomplishment was greatest in those 26 to 30 years of age (P < .01). On univariate analysis, burnout was associated with specific European regions, the number of oncologists in the workplace, the number of patients seen per week, commuting time, not being in a relationship, living alone, and not having children.

Burnout rates were higher in oncologists who lacked access to support, had fewer hours available for recreation, had inadequate work/life balance, and had inadequate vacation time (P < 0.05 for all). On multivariate analyses, European region, work/life balance, and inadequate vacation time remained independent factors for burnout (P < .01).

"Although it is important to recognize this issue, the ESMO Young Oncologists Committee believes that by no means should these results discourage young colleagues who want to become medical oncologists," Raffaele Califano, MD, chair of the committee, said in a statement. "This specialty remains one of the most fascinating and rewarding, where physicians can make a huge difference in patients outcomes and quality of life."

Dr. Laurence Albiges

In a discussion of the study, Laurence Albiges, MD, from the Gustave Roussy Institute in Paris, noted that there have been other studies looking at burnout in the oncology community. But young oncologist might have specific issues that can help fuel burnout, she noted. "They may have less support, less experience, they may be in the in-patient setting and caring for patients in the terminal stage and at the end of life, and may be concerned about future positions," she said.

The next step is for the medical oncology community to address these challenges, Dr. Albiges said.

The authors have disclosed no relevant financial relationships.

European Society for Medical Oncology (ESMO) Congress 2014: Abstract 10810 PR. To be presented September 28, 2014.

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