Emotional health concerns of oncology physicians in the United States: Fallout during the COVID-19 pandemic

  1. Lauren Thomaier
  2. Deanna Teoh
  3. Patricia Jewett
  4. Heather Beckwith
  5. Helen Parsons
  6. Jianling Yuan
  7. Anne H. Blaes
  8. Emil Lou
  9. Jane Yuet Ching Hui
  10. Rachel I. Vogel

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Abstract

Cancer care is significantly impacted by the Coronavirus Disease 2019 (COVID-19) pandemic. Our objective was to evaluate the early effects of the pandemic on the emotional well-being of oncology providers across the United States and explore factors associated with anxiety and depression symptoms.

Materials and methods

A cross-sectional survey was administered to United States cancer-care physicians recruited over a two-week period (3/27/2020–4/10/2020) using snowball-convenience sampling through social media. Symptoms of anxiety and depression were measured using the Patient Health Questionnaire (PHQ-4).

Results

Of 486 participants, 374 (77.0%) completed the PHQ-4: median age was 43 years; 63.2% female; all oncologic specialties were represented. The rates of anxiety and depression symptoms were 62.0% and 23.5%, respectively. Demographic factors associated with anxiety included female sex, younger age, and less time in clinical practice. Perception of inadequate personal protective equipment (68.6% vs. 57.4%, p = 0.03) and practicing in a state with more COVID-19 cases (65.8% vs. 51.1%, p = 0.01) were associated with anxiety symptoms. Factors significantly associated with both anxiety and depression included the degree to which COVID-19 has interfered with the ability to provide treatment to cancer patients and concern that patients will not receive the level of care needed for non-COVID-19 illness (all p-values <0.01).

Conclusion

The perceived degree of interference with clinical practice along with personal concerns about COVID-19 were significantly associated with both anxiety and depression among oncology physicians in the United States during the COVID-19 pandemic. Our findings highlight factors associated with and sources of psychological distress to be addressed to protect the well-being of oncology physicians.

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  1. Version published to 10.1371/journal.pone.0242767
  2. ScreenIT

    SciScore for 10.1101/2020.06.11.20128702: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study was reviewed and approved by the University of Minnesota Institutional Review Board.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Survey items included demographics, measures of clinical practice, concerns about COVID-19, effects of the pandemic on treatment decision-making and practice, and emotional well-being, using REDCap for data collection and storage.
    REDCap
    suggested: (REDCap, RRID:SCR_003445)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations include its survey-based design, social media recruitment, and high proportions of surgeons and females; these respondents may not fully represent all oncologists practicing in the United States. We also chose to focus on physicians as they are heavily involved in treatment decision-making for oncology patients, however, we would expect similar results for advanced practice providers in oncology settings as well. These data may also under-report emotional symptoms due to social desirability bias. Finally, we do not know the rates of anxiety and depression among these oncologists prior to the pandemic and cannot infer these high rates were directly caused by the pandemic. The prevalence of anxiety-related symptoms we observed among oncology physicians in the United States is alarming. These findings support a recent call to action to address burnout, prior to the pandemic, to protect the mental health of all oncologists in order to preserve their ability to deliver high quality and efficient care to cancer patients at a time of unprecedented uncertainty16. Further studies are needed to identify the sources of psychological distress and assess the efficacy of interventions for physicians during and after the COVID-19 pandemic. We have made tremendous strides in cancer care over the past few decades and to lose oncologists to burnout and its sequelae will be an extra insult to the already tragic situation of cancer and COVID-19.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.06.11.20128702v1 on medRxiv