Healthcare professional burnout is a severe problem that manifests as depersonalisation, emotional weariness, and a lack of accomplishment. This article addresses the prevalence, risk factors, clinical features, long-term adverse effects, management and prevention of burnout in oncologists.

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Definition

Traditionally, burnout has been defined as an occupational-related syndrome characterised by physical and emotional exhaustion, cynicism and depersonalisation (sense of detachment or disengagement), and a low sense of professional accomplishment.

These three-dimensional signs of burnout exist along a continuum characterised by distinctly unique symptoms as well as an overlap of symptoms. It has been described in the International Classification of Diseases 11th Revision as an occupational phenomenon which results from chronic workplace stress that has not been successfully managed.

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Prevalence

The field of Oncology has substantial cognitive, emotional, and administrative demands due to the need to deliver highly complex cancer care. Although there is significant variability in studies conducted globally, burnout has been consistently shown to be a serious problem amongst oncologists, with prevalence ranging from 20% to 70%. According to systematic reviews and meta-analyses of research done in the last few decades, burnout affects at least one in three oncologists.

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Risk Factors

1. Certain personal risk factors linked to burnout include being a woman, being younger than 55, being a junior physician (resident, fellow, or physician with less than five years of training), and having years of experience, and single, unmarried physicians.
2. Personality characteristics identified as independent risk factors for burnout include compulsiveness, neuroticism, conscientiousness, and type A behaviour.
3. Externally based, environmental, occupational, and organisational risk factors specific to oncology identified as contributing central causes to burnout include increased time in direct patient care, lack of control over everyday duties, heightened administrative obligations, use of electronic medical record systems, restricted decision-making, ambiguous employment requirements, absence of social support, and the evolving health care system.

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Clinical Features and Long-Term Adverse Effects

Traditionally, the burnout process occurs in 12 nonspecific, dynamic stages ranging from a compulsion to establish oneself to a development of multiple behavioural and mood changes, causing the final burnout syndrome.

In fact, it is due in part to this gradual development in exhaustion symptoms that burnout has been difficult to detect, identify, and intervene early on, therefore resulting in long-term enduring health consequences for the individual personal consequences such as chronic health conditions (heart disease, stroke, or obesity) or mental health conditions (depression, anxiety, substance use, and suicide).

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Prevention and Management

ESMO resilience task force has suggested the prevention and reduction of burnout under 3 broad themes - high-quality information and training can help support the practice and development of oncologists and cancer care, dedicated strategies and resources should be developed to safeguard the psychological and physical health of staff and activism and advocacy for the discipline of oncology and the well-being of the workforce.

I will highlight some of the practical and most useful measures based on the recommendations made by leading oncology societies like ESMO and ASCO.

1. Opportunities should be provided to healthcare practitioners (HCPS) to be involved in the planning of their work as the participation of employees in the planning and management of workplace organisation has been associated with improvements in job satisfaction.
2. Accessible and consistent career supervision and mentorship at all levels is highly beneficial in reducing apprehensiveness about the various aspects of one’s career planning.
3. Dedicated, protected time for mentors and supervisors is necessary for optimal implementation and sustainability.
4. Access to education and training through journals, online learning materials, podcasts, webinars, preceptorships, research methodology training, continuing medical education, and leadership development programmes leads to assurance about career development.
5. Concerns around job security and salary should be addressed to identify possible solutions.
6. Provision of virtual opportunities and continued flexible working hours, and the ability to work from home are additional factors which promote well-being and maximise productivity among HCPS.

There has been a progressive increase in job demands amongst oncology HCPS due to increasing patient numbers, more therapy options and complexity, and better survival outcomes, which leads to further healthcare resources being required to address survivorship concerns and chronic toxicity.

More personnel are required in all areas of oncology healthcare, including physicians, nurses, allied health professionals (AHPS), and administrative and managerial personnel. A planned and dedicated effort to recruit people at all levels of care will help to improve working conditions for all.

Respecting time off and work-life boundaries is essential for enabling people to enjoy their free time and family time without thinking about work or getting calls from coworkers. HCPS should have time and space to socialise with colleagues to debrief, discuss clinical matters, and share experiences. This can foster teamwork, combat loneliness, and help reduce stress. Feeling supported, respected, and listened to by those in leadership positions also contributes to a pleasant working environment.

Improvement in effective working environment include improved IT systems, sufficient IT support, changes to the physical environment of respective workplaces, including access to outdoor spaces and well-designed indoor spaces with ventilation, fresh air, natural light, artwork, and adjustable temperature control are essential components of modifiable factors which go a long way in promoting well being.

Offering psychological resilience training is a crucial part of protecting employees' health and ought to be taken into account in addition to the other suggestions. Incorporating such resilience training could be beneficial early in a clinician's career—possibly as early as medical school. 

This has been introduced by NMC by including Yoga in the MBBS curriculum. Calm, clean, quiet spaces could be provided for relaxation, sleep, and work without distractions. Opportunities for the provision of refreshments and healthy meal choices, as well as group activities such as yoga, aerobics, and gym classes should be there.

A holistic and multilevel approach is required to implement relaxation strategies, as well as promote positive and motivational messages, psychological and emotional support, access to counselling, mindfulness programs, self-care strategies, and online support groups.

To promote beneficial change, such as limiting working hours, international organisations should interact with national organisations to encourage local conversations with institutions and policymakers, protected time for breaks during day shifts, and longer parental leave

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Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Bipinesh Sansar, DM Medical Oncology, is an Associate Professor of Medical Oncology at MPMMCC and HBCH, Varanasi.