COVID-19 Pandemic Taking its Toll on UK Oncology Staff

Liam Davenport

November 03, 2020

While the majority of UK oncology staff say they have worked well during the COVID-19 pandemic despite changes to their working practices, two fifths report poor wellbeing and over one third have suffered from burnout, suggests the largest national study of its kind since the pandemic struck.

A second study showed that, while the vast majority of oncology staff tested negative for COVID-19 on polymerase chain reaction (PCR) swab tests, antibody testing revealed that around a fifth were seropositive for the infection.

Around a third of those were no longer antibody positive 4 weeks later, suggesting that oncology staff should be regularly tested for COVID-19 infection.

The research was presented at the National Cancer Research Institute (NCRI) Virtual Showcase 2020 on November 2.

Important Insights

Dr Iain Frame, chief executive of NCRI, said: "These studies give us some important insights into levels of infection among oncology staff during the spring peak of COVID-19 and how staff were managing during that time.

"As we see rates of the infection rise again around the world, it’s crucial that we learn lessons to protect oncology staff and cancer patients and ensure patients get the best treatment now and in the coming months."

Dr Susana Banerjee

Dr Susana Banerjee, the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK, noted that, since the start of the COVID-19 pandemic, the oncology community "has been facing rapid changes to help ensure the safety of our cancer patients, while maintaining cancer care".

These affect the delivery of cancer care, daily working practices, healthcare professionals’ personal lives, all of which could affect wellbeing, with potentially "serious negative consequences".

At the European Society for Medical Oncology (ESMO) 2020, in September, Dr Banerjee had presented results from ESMO resilience task force surveys showing that oncology professionals are facing distress and reduced well-being in response to COVID-19 that has worsened as the pandemic has continued.

As reported by Medscape Medical News, the results also revealed that there was significant variability in wellbeing and job performance between countries.

In light of that, Dr Banerjee said that a "national evaluation may also be valuable to guide support" in the UK.

COVID-NOW

The COVID-NOW study involved a series of online surveys conducted in June 2020, alongside semi-structured interviews that looked at wellbeing, burnout, engagement, and work ability.

They also asked respondents about sociodemographic factors, lifestyle, coping and personal resources, and work duties and the psychosocial working environment.

Among 1038 participants, 83% were women, and 87% were white. The mean age was 42 years. The majority (77%) were married, and 41% had dependents aged less than 18 years. In addition, 14% were caring for a family member or friend.

Dr Banerjee noted that 14% of the respondents had a health condition that put them at high risk of being seriously ill from COVID-19.

In terms of their profession, 23% of the participants were doctors, 31% were nurses, 20% allied health professionals, 15% support staff, and 11% pharmacy staff.

They had spent an average of 12 years in oncology, and 71% worked in a specialist cancer unit. The best-represented regions of the UK were London and the South East (38%) and the North West (31%).

The impact of COVID-19 included a change in their primary role since the pandemic struck, reported by 30% of respondents, with 10% saying they had been redeployed.

Eighty-two per cent reported that they had sufficient personal protective equipment to carry out their duties, and 66% felt they were able to do their job without compromising their personal safety.

In terms of patient care, 94% said that patient management had altered, with 38% saying they were able to provide the same standard of care as before the pandemic struck, and 69% saying that patient access to care had been compromised.

Moreover, 60% believed that treatment changes have affected or will affect cancer patient survival outcomes, and 66% believed they have affected or will affect patient quality of life.

The impact of all of these changes was felt differently in different professions. While 42% of all respondents said they had poor wellbeing during the COVID-19 pandemic, this ranged from 33% for doctors to 55% for support staff (p<0.0001).

Overall, 34% of respondents reported burnout, ranging from 32% among nurses to 39% among pharmacy staff, a difference that was not significant.

Levels of reported work engagement varied across professions, ranging from 4.53 on a 7-point scale for pharmacy staff to 4.87 among nurses (p<0.002 for trend).

Self-rated work ability versus their lifetime best ranged from 6.55 on a 10-point scale for allied health professionals to 6.94 for pharmacy staff (p=0.300 for trend).

Coping Strategies

Next, Dr Banerjee displayed data showing that coping strategies may vary between healthcare professionals.

Doctors were more likely to use an ‘approach’ coping strategy, involving acceptance, planning, positive reframing, and informational and emotional support.

In contrast, support services, allied professionals and nurses were more likely to rely on ‘avoidant’ coping, which is more focused on denial, venting, and behavioural disengagement.

Finally, there were significant differences between professionals in terms of how valued they felt.

Against an average of 68%, 79% of doctors said they felt valued by the public, versus 47% of support service staff (p<0.0001).

Against an average of 66%, 73% of doctors reported feeling valued in the workplace, versus 58% of pharmacy staff (p<0.01).

Dr Banerjee said it will be important to assess any changes in the findings over time, both during the pandemic and after.

"Our results will help guide urgent measures to address wellbeing in the NHS workforce," she said. This is "essential to sustain the oncology workforce and ensure optimal cancer care for patients".

Dr Richard Simcock

In the post-presentation debate, session chair Dr Richard Simcock, Brighton and Sussex University Hospitals NHS Trust, asked what Dr Banerjee’s advice would be "first of all to employers and secondly to individual healthcare professionals as we go into this next phase" of the pandemic?

"The key point", she said, "is highlighting to individuals and organisations the problem.

"We are very good at looking after our patients and that’s our motivation and our drive, but we also need to take care of ourselves, in order to deliver the best care for our patients," she added.

She said taking that seriously, both as individuals and as organisations, "is key".

Dr Banerjee added that the results also clearly showed that "there isn’t a one-size-fits-all approach".

"What may work for one individual support-wise may not work for the next, so we need to have a wide range of access to support, and measures so that we feel less pressurised and driven towards poor wellbeing and burnout."

Staff Testing

In the second study, Dr David Favara, department of oncology, University of Cambridge, UK, and colleagues, collected nasopharyngeal swab and blood samples from patient-facing oncology staff working in three large NHS Trusts in June 2020 and then again 28 days later in July.

They recruited 434 individuals, of whom 58.3% were nurses, 21.2% were doctors, 10.4% were radiographers, and 10.1% were administrators.

Previous symptoms suggestive of COVID-19 infection were reported by 26.3% between February and June, of whom 1.4% had tested positive on polymerase chain reaction (PCR) testing of swab samples prior to June.

Antibody testing of blood samples in June revealed that 18.4% of all participants were positive, ranging from 21.3% in nurses to 8.9% in radiographers, all of whom were PCR-negative in both June and July.

Previous symptoms suggestive of COVID-19 were reported by 38% of seropositive participants, 1.9 times higher than the rate seen in seronegative individuals (p=0.01).

Retesting 400 participants in July showed that 13.3% were antibody positive, of whom 92.5% had been positive in June and 7.5% of whom were newly positive. Nurses had the highest seroprevalence, at 16.5% (p=0.07).

Of those who were seropositive in June, 32.5% became seronegative 4 weeks later, the majority of whom were previously asymptomatic (p<0.0001).

"In light of falling antibody counts and high prevalence in oncology nurses," the team says, "we propose routine regular testing of oncology staff (especially nurses) for SARS-CoV-2 antigen and antibodies until an effective vaccine becomes available.

"Ideally this would be 2-weekly."

Dr Favara added in a release: "Testing for signs of previous infection alongside testing for current infection on a large scale would also help us better understand changes in immunity over time."

The study by Dr Favara and colleagues was funded by the Oncology Department Charity Fund at the Queen Elizabeth Hospital NHS Foundation Trust, the Oncology Department Research Fund at Peterborough City Hospital, North West Anglia NHS Foundation Trust, and the Addenbrooke's Charitable Trust.

The study by Dr Banerjee and colleagues was funded by The Royal Marsden Cancer Charity with a donation from The Lady Garden Foundation.

No relevant financial relationships declared.

NCRI Virtual Showcase 2020: Abstract: SARS-CoV-2 antigen and antibody prevalence among UK staff working with cancer patients during the COVID-19 pandemic. Presented November 2.

NCRI Virtual Showcase 2020: Abstract: The Impact of COVID-19 on Wellbeing and Work Ability in the NHS Oncology Workforce: Initial results of the COVID-NOW Study. Presented November 2.

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