COMMENTARY

Burnout and Distress: ESMO Hears How COVID-19 Impacted Oncologists

Dr Susana Banerjee

Disclosures

September 20, 2020

Dr Susana Banerjee, chair of the ESMO Resilience Task Force, reflects on the effect of COVID-19 on oncology professionals.

This transcript has been edited for clarity.

My name is Dr Susana Banerjee. I'm a consultant medical oncologist at the Royal Marsden NHS Foundation Trust, and a reader at the Institute of Cancer Research in London, UK. I'm also the ESMO director of membership and chair of the ESMO Resilience Task Force.

What were the headline findings?

So the impacts of COVID-19 on wellbeing has the potential of serious consequences on work, on home life, and of course, patient care. So the ESMO Resilience Task Force collaboration put together a series of global surveys to see how oncologists, and other oncology professionals, across the world are reacting to COVID-19.

Survey I was between 16 April and 3 May this year, and survey II was between the 16 July and 5 August, and our key outcomes of interest, or wellbeing, or risk of distress, burnout, but also job performance since COVID-19.

What we saw in the first survey was that wellbeing and job performance since COVID-19 varied between countries, and was related to the crude mortality rates of COVID-19. So as mortality rate increases, job performance decreases, and the wellbeing index scores increase, which suggest higher distress or poorer wellbeing. So we also did a series of regression analyses to see if there are other associated factors beyond the COVID-19 crude mortality rate. So for wellbeing, for example, participants with higher levels of perceived self-reported resilience, pleasant working conditions, those who felt valued by their organisations, men, those aged over 40, reported lower distress or better wellbeing. And the converse is true. So for example, those under 40, and women reported higher distress.

Those working increased hours had concerns about training or career development, self-isolating, reduced clinical trial activity, were at higher risk of distress. And in the presentation there are more details regarding the factors associated with burnout and also job performance.

Another important point is that we compared results from survey I and II. So in survey II there were 942 participants, and of interest, there were over 250 that actually were the same participants that completed I and II, and we had that ability in order to do longitudinal assessments.

So in the preliminary analyses, we saw that even within a 3 month interval during the COVID-19 pandemic, more participants were reporting risk of distress - so 25 versus 33% - and also feeling burnout - so 38% versus 49% in survey II. So around 1 in 2 oncology professionals reporting feeling burnt out at work in the latest survey.

But reassuringly job performance actually improved - 34% versus 51% reporting favourable job performance since COVID-19. And in the longitudinal analysis that I referred to similar differences were seen, similar magnitudes of differences.

And the final important point, as part of the mission of the Resilience Task Force survey, is that we asked what do you feel, so what do participants feel would be helpful for you or your colleagues going forward? And there are a number of options - and 86% felt that flexible working will be extremely or moderately helpful. Other resources, including counselling workshops, practical guides, would be helpful.

What did you learn specifically about UK oncologists?

In the ESMO Resilience Task Force collaboration, we haven't gone into details about specific country differences at this stage. But 16% - so around 250 participants - were from Northern Europe and the British Isles. But of specific interest of the UK will be the results of the COVID NOW study.

This study looks at the impact of COVID-19 on wellbeing and workability in the NHS oncology workforce. So I lead that study, and the COVID NOW study is academic sponsored - Royal Marsden sponsored national UK study funded by the Royal Marsden charity and a donation from the Lady Garden Foundation. It is a multidisciplinary study which investigates, again, wellbeing during and after COVID-19 in relation to work, lifestyle and support factors for UK oncology professionals. So it truly is multidisciplinary - so oncologists, nurses, allied health professionals, pharmacists, admin staff. We use a mixed methods approach, two longitudinal studies, collecting quantitative and qualitative data at time points during and after COVID-19. So a series of online surveys of validated items and specific questions, as well as semi-structured interviews with participants.

The results from the first survey, which was conducted in June 2020, of the COVID NOW study have been submitted to the National Cancer Research Institute (NCRI) as an abstract. We are working on the data analysis, and importantly the publication. There were over 1000 participants that we'll be using for their responses of UK oncology workforce that was included. So this does represent the largest UK study to date on the impact of COVID-19 on wellbeing in the oncology workforce, and I hope the results will guide and support measures within the UK oncology professionals and institutions.

How did the pandemic affect you and your patients?

So like all, the uncertainty, the, the unpredictability of COVID-19 was worrying and distressing for myself, for staff, and also our patients. Communication, transparency, good leadership was really important towards us all coping. In particular, given my role in research and gynaecological cancers, there was a period of time when recruitment of new patients in clinical trials was halted in many cancer centres globally, and in the UK. But fortunately, at the Royal Marsden, where I work, clinical trials were up and running again relatively fast. But of course, having patient safety and trial integrity, being paramount.

I personally also needed to self-isolate, given the COVID-19 situation. I was unwell, and I had comorbidities that put me at risk. That was on a personal note, potentially really could have affected me going forward. Thanks to the support of colleagues, of the Trust, I was able to continue having consultations with my patients virtually, continuing my trial-related work, the leadership roles that I have, and importantly, supporting my team, as well as patients.

I've been back at work since June.

Are we in a good place for oncology for the second wave?

So I'm hoping, like all, that we're in a better place than where we were at the beginning. And the reasons for that is that we understand a lot more about COVID-19 and how it's affecting patients with cancer.

And there are lessons that we are continuing to learn through this COVID-19 pandemic, and many of those findings you will have heard at the ESMO Congress.

And I think from the ESMO Resilience Task Force survey it’s been highlighted that wellbeing is important, and it is a priority. Oncologists and oncology professionals have fed back, this should be taken seriously and action should be taken. So I'm hoping that we're better prepared for second waves, both mentally, as well as in terms of patient care.

And so importantly, in the second survey, we saw that job performance - so ability to deliver standard of care and do our job to the same standard as before COVID-19 - has improved. So in terms of patient care, in terms of, at the moment, for a second wave and preparations, I'm hoping that that will be maintained.

The potential issue is at the risk of our own wellbeing and burnout in the future because that's more long-term effects. And therefore we don't want that to happen. We'll learn about that in the subsequent surveys that we plan, but if action is taken by individuals and organisations, so by that I mean institutions as well as societies to help, then hopefully we can, we can maintain wellbeing, reduce burnout, and ultimately optimise patient care.

We must remember that wellbeing and burnout are not new things that are affecting oncologists.

Medscape and ESMO have covered this previously over the years. There was the young oncologists burnout survey published in Annals of Oncology in 2017. So this is a crisis that we're facing at the moment and hence are reporting on that but it's important to remember the long-term beyond COVID-19 impacts on optimising wellbeing and burnout for the future.

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