Oncologists Facing Burnout Amid Seeing Patients Virtually

In response to the COVID-19 pandemic, United States oncologists have adjusted patient care by embracing telemedicine and switching more patients to oral therapies to limit office visits. However, more oncologists may be experiencing burnout due to the loss of face-to-face interactions with patients, according to a report released in late 2020 from Cardinal Health Specialty Solutions.

These findings, which were in the eighth edition of Oncology Insights, analyzed the views of more than 190 U.S. oncologists by surveys conducted in September through November 2020. It explored how oncologists are adapting their practices and caring for patients during the pandemic – and points to changes that may continue after COVID-19.

Some key findings in the report shared nearly all participating oncologists (97%) said they used telemedicine during a peak stage of the pandemic, and they are generally satisfied with the experience. Nearly six in 10 participating oncologists said their telemedicine experience has been “highly positive” (10%) or “better than expected” (49%). Lastly, about 80% of participating oncologists said they expect to continue using telemedicine with some patients after the pandemic.

Nevertheless, the amount of oncologists who've experienced more burnout since the pandemic began is significant.

According to Bruce Feinberg, DO, vice president and chief medical officer of Cardinal Health Specialty Solutions, the survey showed 49% experienced burnout at work since the pandemic began due to less in-person interaction.

However, three in five oncologists said the telemedicine experience has been either highly positive or better than expected, and 60% said they believe their patients had favorable or very favorable experiences.

Feinberg said the 49% experiencing burnout seems particularly high when less than a quarter said they frequently experienced stress at work or symptoms of burnout in a survey Cardinal Health conducted with a similar group of oncologists back in 2018.

"It’s interesting that the top-rated factor contributing to burnout was loss of face-to-face interaction with patients, followed by financial losses," he said. "While telemedicine has provided an invaluable touchpoint during the pandemic, our research suggests that it does not provide oncologists with the ability to personally connect with patients or deliver compassionate care in the same way that face-to-face office visits do. These findings also demonstrate that this personal interaction with patients is a key part of what drives oncologists’ professional satisfaction."

Heidi Hunter, president of Cardinal Health Specialty Solutions, said COVID-19 has posed enormous challenges for medical professionals across every discipline, but the impact on oncologists is particularly acute because of the number of patients who must continue treatment despite the circumstances.

“Our survey illustrates how oncologists have responded COVID-19 with resourcefulness and resiliency, while managing through higher levels of stress than ever before,” she added.

Also mentioned, while in-person cancer visits have changed, so have cancer treatments.

In the survey, most respondents (65%) said they have moved some patients from infused therapies to oral therapies to limit office visits.

Feinberg said although the transition from infused to oral therapies does not impact effectiveness, adherence is a critical component of effectiveness; and oral therapies come with an inherently higher risk of non-adherence than observed infusions in the cancer clinic, which is often a consideration when they are prescribed.

"The switching to, and initiation of, oral therapies as a result of COVID-19 has been the result of a complex decision process where oncologists have had to take into account the patient’s COVID-19 risk, the patient’s willingness to come to an infusion center and the logistics of managing infusion centers with depleted staff and required physical distancing," he said. "Oncologists tell us they expect the pandemic will lead to greater use of oral therapies in the future, but it’s not yet clear how significant of a shift will occur."

In addition to changes made in cancer care, some oncologists see certain things going back to normal after the pandemic wanes out.

The report shared about three-fourths of participants said they are “very confident” or “confident” their practices will return to pre-pandemic levels of success and profitability after COVID-19.

Oncologists are typically resilient in the face of adversity, and despite negative impacts to the financial performance in their practices, 69% said they see the COVID-19 challenges as short-term issues, Feinberg added.

"We expect the findings reflect their recognition that, unlike COVID-19, there isn’t a pan-cancer cure on the near horizon," he said. "In fact, some experts predict there will be a surge of new cancer diagnoses following the pandemic due to delays in routine screenings such a mammograms and colonoscopies."

The survey also suggests telemedicine will be used in a relatively limited way after the pandemic, with 67% of oncologists saying they expect to use it for 20% or fewer of patient visits. Reviewing laboratory/imaging results (81%) and routine monitoring of conditions (64%) were cited as the two areas where telemedicine is best utilized, Feinberg said.