ONGOLOGISTS BURN--OUT SYNDROME

Substantial proportions of oncologists are suffering from burnout and stress and using alcohol to deal with the emotional strain of treating patients with cancer and the ever-increasing workload pressures, the results of a meta-analysis has revealed.

The research was published online in Psycho-Oncology on February 17.

The meta-analysis, which included data on 4876 oncologists from 14 countries, found that nearly a third (32%) reported high burnout, or emotional exhaustion, and that over a quarter (27%) have some kind of psychiatric morbidity.

The study also found that 42% to 69% of oncologists reported feeling stressed at work, more than 12% of oncologists screened positive for depression, many oncologists suffer from sleep deprivation, up to 30% drink alcohol in a problematic way, and up to 20% of junior oncologists use hypnotic drugs.

In a joint interview with Medscape Medical News, the two study authors emphasized the need to reduce the stigma surrounding stress and the need for support networks for oncologists.

Coauthor Asta Medisauskaite, a PhD candidate at the Department of Organizational psychology, Birkbeck, University of London, United Kingdom, said, "Stress is not a sign of impairment or lack of fitness to practice. It is just a natural reaction to external factors.

"So we really want to encourage this idea of oncologists supporting each other. Peer support, mentoring is really important in this situation," she said.

Coauthor Caroline Kamau, PhD, a lecturer in organizational psychology, also at Birkbeck, University of London, added: "It's pretty serious for a doctor to admit, for example, to having potential mental health difficulties.

"In some countries, such as Australia, if your colleague tells you that, you're obliged to report them as potentially not fit to practice and they would be investigated."

She continued: "With the General Medical Council [the UK register for doctors], it's not as stringent as that, but doctors do fear that they may be investigated and potentially said not to be fit to practice.

"So it's not simply a case of saying that the stigma is just an idea, it's a real fear," she emphasized.

Dr Kamau added: "We're not interested in people stigmatizing distress and seeing this as a problem, but rather simply that it's a normal human reaction and…perfectly understandable."

The authors suggest that peer- or mentor-based support would protect confidentiality and allow oncologists to speak with each other about their levels of burnout and stress, rather than it being discussed in an appraisal situation, in which admissions of stress could be misinterpreted.

Another target for reducing burnout and stress among oncologists is their workload, although the researchers underlined that workload reduction is not feasible in the current climate.

"I think the reality is that the workload for oncologists is going to increase, certainly in the UK, and it doesn't seem like this is something that can be easily addressed," said Medisauskaite.

She added: "While reducing workload seems like the most obvious [target], it's just simply not practically possible. We have new policies about how fast people with suspected cancer should be diagnosed, so unfortunately the pressure is increasing.

"But we can improve the situation by having more people training in oncology and by reducing the rate at which people are leaving oncology," she added.

Noting that previous studies showed that 30% oncologists have thought about leaving the specialty, she said, "We can address the attrition problem but, unfortunately, unless we dramatically increase the numbers of oncologists, the workload is really difficult to reduce."

Details of the Findings 

For their meta-analysis, the authors searched the Thomson Reuters Web of Science databases for studies examining the occupational distress of doctors working in specialties with high rates of patient mortality, such as palliative medicine, oncology, and HIV/AIDS care.

The team identified 663 publications that were eligible for analysis. Of these, 43 studies from 14 countries published between 1990 and 2014 were included because they specifically measured the level of distress experienced by oncologists.

These included 17 studies examining burnout, 11 that looked at psychiatric morbidity, 27 that measured stress, 6 that assessed depression, 5 that focused on sleep deprivation, 4 that determined the prevalence of stress-related conditions or symptoms, and 5 that highlighted substance use.

Meta-analysis that used the PRISMA protocol revealed that 23% to 48% of oncologists had high emotional exhaustion, at an average of 32%, while 12% to 36% had high psychiatric morbidity, at an average of 27%.

Stress at work was reported by 42% to 69% of oncologists. Among the most stressful situations were dealing with the distressed relatives of dying patients, patient suffering and death, and caring for a suffering, dying child.

Between 27% and 34% of oncologists and between 24% and 31% of surgical oncologists had depression. Among junior oncologists, 51% screened positive for depression; 35.2% felt down, depressed, or hopeless; and 42% felt little interest or pleasure in activities.

Disrupted sleep was also common, with 44% of surgical oncologists in one study having abnormal sleep scores and 37% having sleep disorders.

One study also suggested that 30% of surgical oncologists using alcohol in a problematic way, defined as 3 or more drinks on a drinking day or 6 or more drinks on one occasion, while another indicated that 20% of oncology residents took hypnotic drugs. Ten percent of gynecologic oncologists in one study had received a recommendation to reduce their alcohol intake.

Physical ailments related to stress, such as ulcers, gastric problems, headaches, and arrhythmia, were also identified in the meta-analysis.

Oncologists Under Unique Pressure 

Medisauskaite commented that the combination of responsibilities and pressures experienced by oncologists are "unique, in a sense," adding that they are in a "situation where they need to work with patients and relatives during a really sensitive period."

However, Dr Kamau pointed out other specialties in which doctors are also at risk for burnout and psychological distress. "For example, there was a recent study about anesthetists and the levels of stress among them," she said.

"We also know from previous studies that anesthetists are at the highest risk of suicide, so, yes, there are other specialties that are at risk but some of these are for different reasons."

Dr Kamau also noted that their data on practitioners in palliative medicine, which were not included in the current analysis, indicated that they have significantly lower levels of burnout and stress than oncologists.

"So there is something unique about working in cancer care, and I think it's in the way that the mortality rates are so high, even though they are improving," she said. "We would be very interested in seeing further research comparing oncologists with other at-risk specialties."

No funding was reported. The authors have disclosed no relevant financial relationships.

Psychooncology. Published online February 17, 2017.