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SAN DIEGO -- While burnout has been recognized as a chronic issue for practitioners working in oncology, it has been exacerbated by the pandemic, with consequences that could extend well beyond its end, according to a presentation here.

"Evidence confirms that oncology clinicians are at risk of emotional distress and burnout during the COVID-19 pandemic, and as we enter recovery," said Fay Hlubocky, PhD, MA, a licensed clinical health psychologist at University of Chicago Medicine, during her keynote address at the annual meeting of the Association of VA Hematology/Oncology.

There is an "ethical imperative" to address the problem, she added, as the well-being of the provider is critical to maintaining the clinician-patient relationship.

Hlubocky observed that if the during the 2003 SARS outbreak is any indication, the current pandemic could have long-term occupational and psychological effects on clinicians. The Toronto workers not only reported significantly higher levels of burnout, psychological distress, and post-traumatic stress in the 2 years after the outbreak, but were also more likely to have reduced patient contact and work hours.

"This is a snapshot of what we are to expect," Hlubocky said.

A Long-Term Problem

Even prior to the COVID-19 pandemic, the medical profession has witnessed burnout rates of about 50%, according to studies cited by Hlubocky, and 45% of American Society of Clinical Oncology (ASCO) member oncologists have reported emotional exhaustion and/or depersonalization.

One from 1990 to 2014, which spanned 14 countries, indicated that 32% of oncologists have high levels of burnout, 51% have screened positive for depression, and 44% have sleep problems.

Why are oncologists particularly susceptible to burnout?

"Patients are in a state of crisis whenever we meet them ... and it impacts us," Hlubocky said.

Beyond work overload and the challenges of a complex, fast-changing field, oncologists are constantly exposed to suffering and death, and can experience compassion and empathy fatigue, as well as moral distress. Furthermore, even if they recognize they are experiencing the symptoms of burnout, there is a stigma associated with mental health that works against seeking help, Hlubocky said.

"Many colleagues tell me, repeatedly, that they feel like they can't ask for help from their institution because of fear of repercussions," she said.

But the consequences of burnout can have profound affects on a providers' physical and mental health -- including the risk for suicide if left unaddressed -- as well as on clinical practice.

According to Hlubocky, burnout can result in increased medical errors, staff turnover and shortages, decreased patient satisfaction, and also carries financial implications.

According to , physician/staff turnover along with lost clinical hours related to burnout costs the U.S. healthcare industry about $4.6 billion annually. At an organizational level, the annual economic cost associated with burnout is approximately $7,600 per physician.

Unsurprisingly, the problem of burnout has been compounded by the pandemic, resulting in abrupt and significant disruptions in cancer care, treatment delays, complicated treatment decision-making, and alterations in the clinician-patient relationship with the introduction of telemedicine, Hlubocky said. She noted that one survey of of 7,500 U.S. physicians found that almost two-thirds said burnout had intensified during the COVID-19 crisis, with one in four contemplating early retirement.

Addressing Burnout

"The organization, without a doubt, has a responsibility and commitment to clinicians' care," Hlubocky said. "Comprehensive, innovative organization interventions are critical for enhancing oncologists' well-being."

She referred to an ASCO paper she coauthored that offered a number of recommendations on how organizations -- as well as individuals -- can address burnout.

Institutional and systemic strategies to reduce burnout can include changing practice culture and ethics, encouraging community engagement with colleagues, promoting a healthy work-life balance, and "really reducing the stigma about asking for help," Hlubocky said.

Organizations can also address the issue by providing more in the way of resources. For example, the that incorporated the use of medical assistants to reduce the administrative burden on clinicians and significantly decreased burnout from 53% to 13%, increased efficiency and productivity, while also cutting patient wait times.

Individual interventions, Hlubocky said, can include education, cognitive-behavioral therapy, work-life balance support, mindfulness-based stress reduction training, communication skills training, and health promotion that focuses on sleep, fitness, and diet.

Hlubocky said that clinicians can address their own well-being as well. This can be done by performing self-assessments to recognize symptoms of burnout in themselves and in others.

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