ASCO — Insufficient time is a major source of stress and burnout in the practice of oncology, but oncologists can use a variety of strategies to increase their efficiency and get more satisfaction from their work and from life in general, according to an education session that took place at the 42nd Annual Meeting of the American Society of Clinical Oncology (education session 68).

Session chair Laurie J. Lyckholm, MD, of Virginia Commonwealth University, noted that four sources of stress and burnout in oncology come up repeatedly in the literature: not enough time for family and leisure activities, inability to keep up with current literature, not enough time to see patients the way one wants to, and dealing with telling bad news and with bad patient outcomes. Her informal straw poll of attendees suggested that more than half viewed "not enough time for family and leisure" as the most stressful aspect of their profession.

62% Report Burnout

In a recent survey of more than 1,700 US oncologists, 62% said they felt burned out. Moreover, 77% said that their burnout had been getting worse in recent years, said Tait D. Shanafelt, MD, of the Mayo Clinic College of Medicine.

Dr. Shanafelt noted that people drawn to medicine may be inherently at higher risk for burnout. One theory holds that physicians have a set of characteristics termed the "triad of compulsiveness," made up of doubt, guilt, and an exaggerated sense of responsibility. These traits are at the same time adaptive (eg, driving thoroughness and commitment to patients) and maladaptive (eg, making it difficult to relax and not feel responsible for things beyond one's control). In other words, he said, "Some of the traits that may make us good clinicians and devoted oncologists may be the very things that place us at risk of burnout."

Leading Stressors

Superimposed on these personality traits and characteristics are a number of work-related stressors, Dr. Shanafelt pointed out. In a survey of 241 oncologists in the North Central Cancer Treatment Group (NCCTG), the five leading stressors cited were patient load, balancing personal and professional life, keeping current with the literature, dealing with patient death and suffering, and delivering bad news to patients. "I think we can all look at these and identify that most of these things are fundamental tasks for us as oncologists," he commented.

When oncologists were asked which period of their career was most stressful, internship/residency was the leading response (35%), but current position was second (26%), suggesting that the perception that things will get better after training is not necessarily true, he noted. Lending further support to a concept of "life on hold" was the finding that 37% of oncologists said that looking forward to retirement was an essential wellness promotion strategy—a strategy equally common among respondents younger than and older than age 40.

Strategies for Relief

The good news, according to Dr. Shanafelt, is "increasing evidence that there are things that we can do to recover from burnout and to promote our own satisfaction with our career and our personal life." In the survey of NCCTG oncologists, common wellness promotion strategies reported by survey respondents overall included finding meaning in work (71%), having an approach/philosophy to dealing with death/end-of-life care (69%), protecting time away from work with spouse/family (66%), discussion with family or significant others (65%), and recreation/hobbies/exercise (59%). Most of these strategies were significantly more prevalent among oncologists reporting high overall quality of life than among those not.

Personal Perspectives