Burnout in psychosocial oncology clinicians: A systematic review

OBJECTIVE: Few studies have examined burnout in psychosocial oncology clinicians. The aim of this systematic review was to summarize what is known about the prevalence and severity of burnout in psychosocial clinicians who work in oncology settings and the factors that are believed to contribute or protect against it. METHOD: Articles on burnout (including compassion fatigue and secondary trauma) in psychosocial oncology clinicians were identified by searching PubMed/MEDLINE, EMBASE, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, and the Web of Science Core Collection. RESULTS: Thirty-eight articles were reviewed at the full-text level, and of those, nine met study inclusion criteria. All were published between 2004 and 2018 and included data from 678 psychosocial clinicians. Quality assessment revealed relatively low risk of bias and high methodological quality. Study composition and sample size varied greatly, and the majority of clinicians were aged between 40 and 59 years. Across studies, 10 different measures were used to assess burnout, secondary traumatic stress, and compassion fatigue, in addition to factors that might impact burnout, including work engagement, meaning, and moral distress. When compared with other medical professionals, psychosocial oncology clinicians endorsed lower levels of burnout. SIGNIFICANCE OF RESULTS: This systematic review suggests that psychosocial clinicians are not at increased risk of burnout compared with other health care professionals working in oncology or in mental health. Although the data are quite limited, several factors appear to be associated with less burnout in psychosocial clinicians, including exposure to patient recovery, discussing traumas, less moral distress, and finding meaning in their work. More research using standardized measures of burnout with larger samples of clinicians is needed to examine both prevalence rates and how the experience of burnout changes over time. By virtue of their training, psychosocial clinicians are well placed to support each other and their nursing and medical colleagues

Distress, the 6(th) vital sign in cancer care Caring for patients’ emotional needs: what does this mean and what helps?

Distress has been endorsed as the 6(th) Vital Sign by the International Psycho-Oncology Society (IPOS) in 2009 with Screening for Distress as a proposed IPOS strategy in 2010. The need for skilled psychological care is well-recognized as a necessary, integral part of oncology care. There has been significant development of this field over the last two decades in the area now commonly labelled “psycho-oncology”. Given the advances in psycho-oncology, it is helpful to overview the approaches to provision of psychological care, so we can better understand how to care for the emotional needs of cancer patients, their partners and families. The focus here is on patients with high and enduring levels of need in terms of emotional functioning and the formal therapies that are available to help patients and their families manage these needs

Emotional distress in cancer: screening policy, clinical limitations and educational needs

Several studies have shown that 30–40% of cancer patients present psychosocial disorders according to the DSM-IV and WHO ICD-10 disease classification systems and a further 20-25% suffer from psychosocial conditions deserving medical attention (e.g., health anxiety, demoralisation). In order to increase the likelihood that cancer patients with psychosocial distress can be detected and offered opportunity to be helped, guidelines and psychological instruments such as the NCCN Clinical Practice Guidelines in Oncology on Distress Management and the Distress Thermometer (DT) have been developed and applied in cancer settings. A cutoff score of 4–5 on the DT has been repeatedly shown to optimise sensitivity and specificity in identifying “cases” both among cancer patients and their family members. However, clinical limitations have been raised regarding the DT. The tool can benefit from changes increasing its capacity to capture different psychological dimensions, Furthermore, the policy of screening for emotional distress in cancer patients is only the first step, and it may prove to no avail if not followed by more specific psychosocial oncology programmes aimed at improving referral and adherence to referral of cancer patients with high levels of emotional distress

The biology of depression in cancer and the relationship between depression and cancer progression

The prevalence of depressive symptoms in patients with cancer exceeds that observed in the general population and depression is associated with a poorer prognosis in cancer patients. The increased prevalence is not solely explained by the psychosocial stress associated with the diagnosis. Pro-inflammatory cytokines, which induce sickness behaviour with symptoms overlapping those of clinical depression, are validated biomarkers of increased inflammation in patients with cancer. A growing literature reveals that chronic inflammatory processes associated with stress may also underlie depression symptoms in general, and in patients with cancer in particular. Therapeutic modalities, which are frequently poorly tolerated, are used in the treatment of cancer. These interventions are associated with inflammatory reactions, which may help to explain their toxicity. There is evidence that antidepressants can effectively treat symptoms of depression in cancer patients though the database is meager. Novel agents with anti-inflammatory properties may be effective alternatives for patients with treatment-resistant depression who exhibit evidence of increased inflammation