Burnout is a syndrome of emotional exhaustion and depersonalization that may affect the quality of oncologist?s work. Available evidence suggests that younger doctors are at higher risk for burnout. Data presented at the 35th Congress of the European Society for Medical Oncology (ESMO) in Milan, Italy, suggests that this is a common phenomenon but that it is often underestimated.
Speakers at the special symposium for young medical oncologists called for further research to be done across Europe and for the development of screening strategies and intervention programs.
?Burnout is not an individual problem as it not only affects physicians? quality of life, but also their work and relationship to patients. It probably also discourages vocations for oncology? said Dr. Laurence Albiges, from the Institut Gustave Roussy, France who presented the results of a comprehensive nationwide cross-sectional study which took place in 2009. Results of the study conducted by three national associations of oncology residents together with the French College of Oncology Professors, were recently published in the European Journal of Cancer (P. Blanchard, EJC, April 2010). ?According to our study, 44% of residents experience burnout. This is a high number but not unlike previous data coming from other parts of the world, such as the US. What is particularly worrying is that 18% of interns showed severely abnormal levels of both emotional exhaustion and depersonalization and around 20% were taking anxiolitic/hypnotic medications in order to cope. There was no significant difference reported between the different specialties (radiation oncology, medical oncology and hematology)?.
The chair of the ESMO Young Oncologist Committee, Dr Michael Karamouzis from Greece, who also moderated the special symposium, says that more data is needed across Europe: ?Europe is a highly heterogeneous community from cultural, social and scientific points of view and this problem has never been handled globally, only country by country. Obtaining these statistics for all countries is a challenge we must meet and evaluate because the problem affects the quality of care European cancer patients get?.
A combination of factors contributes to medical oncologists? burnout. Doctors Marina Garassino from the ESMO Young Committee and Massimo di Maio, head of the Italian Young Oncologist Committee who co-chaired the special symposium at the ESMO Congress, point to some of the issues: ?The main factors seem to be, firstly, the emotional load involved in dealing with frequent and repeated losses, which give rise to existential questioning and a feeling of inadequacy. Secondly, factors related to the intern status such as anxiety about their future position, the quality of medical training and tensions with senior physicians due to differing therapeutic choices. Another fundamental cause is the total workload: young physicians are often under pressure from working long hours dedicated to treating patients, doing research and studying, which leaves little time for rest and personal endeavors ?. Dr. Albiges adds that in the French study, burnout levels were higher among residents who did not feel adequately recognized or rewarded for their work.
Burnout levels are usually measured using the Maslach Burnout Inventory, a 22 item questionnaire covering 3 dimensions: Emotional Exhaustion, Depersonalisation, and Personal Acccomplishment.
Burnout does not only affect young medical oncologists. Dr Fortunato Ciardello, Professor of Medical Oncology, Second University, Naples, Italy and a member of the ESMO Educational Committee, believes that burnout is experienced in different degrees, sooner or later, by every health professional working in oncology. ?We live in a precarious equilibrium. It is hard to see a patient go. This is true even if you are 70 years old! Maybe young medical oncologist?s burnout stems from the contrast between their initial enthusiasm with the career, they tend to be over optimistic and believe they can cure more patients than is really possible and this can lead to disillusionment. It is also difficult for a younger professional to deal with the patients and families? expectations. Illness is tough on everyone involved. Communication skills training can have a real impact on the reduction of burnout. If you can communicate with patients and also with your team, a lot of stressful situations can be avoided?.
Dr Albiges confirms: ?Communication is a key element and one of the aspects that intervention programs should focus on. Medical instruction should include training in breaking bad news; managing patients and families reactions; interaction with other colleagues; daring to talk about ones difficulties to senior oncologists, to other interns and to hospital psychologists should the need arise. Burnout should cease to be a taboo. The creation of groups where interns can share their concerns is also an element that should be integrated into medical oncologists education.? Dr. Garassino agrees: ?One of my personal strategies is to share difficult cases with my colleagues. This reduces the sense of global responsibility for the management of patients. Daring to ask for help without shame when I feel stressed or pushed?. For Dr. Ciardello the ?true multidisciplinary approach that exists in modern hospitals today is a big factor which helps in the management of difficult cases, reducing the pressure on the individual physician?.
Dr. Alexander Kiss, Medical Director, Division of Psychosomatic Medicine, University Hospital, Basle, Switzerland, who chaired the Communications Skill Training (CST) Special Session at the 35th ESMO Congress explains: ?In Anglo-Saxon medical schools, students have to go to compulsory communication modules. This is not the case in other parts of Europe and should be generalized. In Switzerland, interns also go through modules in Communication Skills Training. One of the modules in our CST deals with burnout and how to avoid it. Creating awareness for the need to include communication as an obligatory subject in medical oncologists education is also very important. ESMO can help by promoting this in their guidelines and lobbying for mandatory training across Europe. Oncologists are in constant danger of burnout. Communication can help prevent this problem but it requires specific skills that can be taught and improved by training.?
So what should a medical student consider before embarking in the field of oncology? Dr. Francesco Atzori, Cagliari, Italy, who introduced the subject of ?presenting bad news to the patient? during the Young Medical Oncologist Symposium at the ESMO Congress, believes students aiming to go into oncology need to be ?highly motivated and committed to patients, as this is a particularly tough field. Moreover, before making the final decision, interns should be able to have a trial period of at least six months in an Oncology Department?. Dr. Albiges believes that interns considering oncology should be clear about the considerable investment this specialty requires. At the same time, they should be able to establish limits to their personal involvement. ?They are individuals attracted by the intense human situations encountered which can also become very dramatic. Dealing with patients and families who are facing extreme situations over long periods can be trying. Oncology research is very rich: therapies are constantly evolving. Future physicians should be keen to keep up with the rapid changes.?
?The high rate of burnout among young oncologists should be a cause for concern?, concludes Dr. Albiges. ?Burnout is reversible, so it is urgent to start by developing a simple screening instrument that can be used by senior physicians to detect interns at risk. Secondly, intervention programs need to be encouraged to improve the well being of interns in medical oncology. These should include the establishment of support groups, more i
ntense coaching by senior physicians and training programs on communications and stress management. The positive news is that recovery from burnout is possible?.