Oncologist Distress and Burnout Has Increased During COVID

Liam Davenport

September 14, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Oncology professionals are facing distress and reduced well-being in response to COVID-19 that has worsened as the pandemic has continued, shows a set of surveys.

The research also found that men over age 40 and those who feel valued by their organization were at lowest risk.

The internationally-based research will be presented Saturday at the ESMO Virtual Congress 2020, which will be held digitally this year due to the COVID-19 pandemic.

In the largest COVID-19 surveys of oncology professionals to date, more than 1500 individuals responded to an online survey in April and May, followed by 900-plus respondents to a second round in July and August.

Susana Banerjee, MD, PhD, chair of the ESMO Resilience Task Force and an oncologist at the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK, provided a look at the research during a pre-meeting press conference.

She told reporters that COVID-19 "is impacting on well-being, burnout and job performance," with the main predictors of resilience and change to work hours.

Banerjee also said the results showed the "risk of distress and burnout has increased," during the COVID-19 pandemic, although job performance "has improved" from the start of the public health crisis. "Urgent measures to address well-being are essential," she commented.

On a positive note, Banerjee told Medscape Medical News that oncology professionals have nevertheless seen increased recognition by institutions of the need to improve well-being and reduce staff burnout.

"It's also very reassuring," she added, that the participants felt that measures such as counseling and support services, alongside flexible working hours, "could be useful."

"But there's certainly much more room for improvement," Banerjee said, noting that a survey of burnout in oncology conducted several years ago in young oncologists showed "it was quite clear that more support was needed."

Banerjee said that, with more than 25 million confirmed cases and over 840,000 deaths worldwide, the COVID-19 pandemic has "changed our world."

"The entire oncology community has been facing rapid changes to help ensure the safety of our cancer patients, [while] maintaining their cancer care," she continued.

These include changes to patient management plans, the way care is delivered, and daily working practices, alongside changes in oncologists' personal lives.

"The impact of COVID-19 on well-being has the potential for serious negative consequences on work, home life, and patient care," she summarized.

Survey Details

The ESMO Resilience Task Force conducted two surveys to determine the impact of COVID-19 on oncologists and other oncology professionals across the globe.

Survey invitations were disseminated via email and across social media, including the OncoAlert network; Survey I was conducted between April 16 and May 3 and Survey II between July 16 and August 5.

Survey I had 1520 participants from 101 countries (67% in Europe, 17% in Asia, 5% in North America, and 5% in South America). Just under half (45%) of the participants were younger than age 40, 51% were women, and 71% were of white ethnicity.

The majority (70%) were medical oncologists. Trainees represented 22% of respondents while 58% had completed their training more than 10 years previously.

About two thirds (67%) of the respondents said they had seen a change in their professional duties as a consequence of the COVID-19 pandemic, and 78% experienced increased concern for their personal safety.

There were significant differences between countries in terms of the level of self-reported well-being and job performance during the pandemic (P < .001).

When the researchers tallied the results with the crude mortality rates for COVID-19 from the World Health Organization, they found that oncologist well-being and job performance was significantly associated with mortality rates in their country (P < .05).

Banerjee explained that "as the mortality rate increases, job performance since COVID-19 decreases and well-being index scores decrease, which suggests higher distress and poorer well-being."

Logistic regression analysis indicated that greater well-being, or lower distress, was significantly associated with higher self-reported resilience, being older than age 40, being male, having pleasant working conditions, and feeling valued by their organization (P < .05 for all).

Conversely, worse well-being was associated with increased working hours, concerns over one's training or career, self-isolating due to COVID-19 symptoms, reduced clinical trial activity, and dietary changes (P < .05).

Feelings of burnout were significantly associated with increased working hours and out-of-hours work, and concerns over one's training or career, whereas self-reported resilience, pleasant working conditions, and feeling supported by the government were all associated with lower burnout (P < .05 for all).

Worse job performance since the arrival of COVID-19 was linked to worries over the impact on research activities, the crude mortality rate, more hours working from home, and reduced clinical trial activity (P < .05).

Things Worsen and Working From Home Valued

To find out how oncologist well-being and job performance has changed over the course of the pandemic, the team compared the results of Survey I with 942 responses to Survey II, identifying 272 paired responses.

This showed that the risk of distress on the Employee Well-Being Index increased significantly between Survey I and II, from 25% to 33% (P < .0001), and the number of participants reporting feelings of burnout increased from 38% to 49% (P < .001).

Conversely, job performance increased significantly between Survey I and II, from 34% to 51% (P < .0001).

Finally, the surveys asked what resources respondents felt would be helpful for them or their colleagues.

Workshops or courses on well-being, burnout, and coping strategies were rated as extremely to moderately useful by 81% of respondents, whereas 79% pointed to counseling and psychological support services and 73% to practical guidebooks or self-help resources.

Banerjee noted, however, that flexible working hours, including working from home, was the most commonly desired change, "with 86% feeling this would be extremely or moderately helpful."

During the press conference discussion, Stefan Zimmermann, MD, ESMO Press Officer and head of outpatient immuno-oncology at Centre Hospitalier Universitaire Vaudois, Switzerland, noted the survey showed "young women were found to experience higher levels of distress." He asked whether this was "surprising."

Pilar Garrido, MD, PhD, associate professor of medicine at Universidad de Alcalá, Madrid, Spain, responded that it was "a pity but not a surprise at all."

She said that the Women for Oncology group at ESMO conducted a survey of their own in June that looked at potential inequalities between men and women in facing the pandemic.

The results showed that "women spent more time on hospital tasks in comparison to men, but less on personal care."

An "interesting point" was that "the time they dedicated…to taking care of children was similar but it means that women dedicate the same time to taking care of children, more time to the hospital, and less to personal care."

Garrido suggested that this may "be a reason" why female oncologists were at higher risk of distress in response to the COVID-19 pandemic than their male counterparts.

As for next steps, Banerjee said that the third survey in the series will be conducted in 2021, "one year on from the start of the COVID-19 outbreak."

"We hope our future surveys will be completed by more oncologists around the world so we're able to look more specifically at specific country differences in more detail," she added.

Banerjee also noted that the ESMO Resilience Task Force "will be looking into developing specific interventions so that we can further help and support [oncologists] during the pandemic and, importantly, beyond."

No study funding was declared. Banerjee declares honoraria/reimbursement from AstraZeneca/MSD, Tesaro, GlaxoSmithKline, Clovia Oncology, Amgen, Merck Serono, Mersana, Ganmabs, Immunogen, Pfizer, Roche, Seattle Genetics, and Nucana; and research grants from AstraZeneca, GlaxoSmithKline, and Tesaro.

ESMO Virtual Congress 2020: Abstract LBA70_PR. To be presented September 19, 2020.

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