Episode 39: In the Clinic - ESMO Resilience Task Force & Oncology Burnout with Professor Susana Banerjee

Burnout in oncology and throughout healthcare is a major issue.

An ESMO survey conducted in young Oncologists in 2013-2014 revealed 70% of young oncologists in Europe were impacted by burnout. 

25% of oncologists surveyed were thinking of a change of career and 38% of leaving the profession. All this at a time of needing more oncologists! 

Join us in this 2 part episode where we join the superb Professor Susana Banerjee.

She discusses the issue of burnout and the excellent work done by the ESMO Resilience Task Force  on this critical issue.

Professor Banerjee is an internationally renowned medical oncologist at The Royal Marsden Hospital treating and researching gynaecological cancers.

She has been heavily involved in the ESMO Resilience project and looking for strategies for dealing with the huge problem that is burnout in oncology.

We hope you find this as useful as we have!

https://www.esmoopen.com/article/S2059-7029(24)01403-0/fulltext

Transcript

Simply Oncology_ Burnout recording-20250116_160813-Meeting Recording

 Hello. I'm Doctor John McGrane. And I'm doctor Michael Rowe. And in this podcast today, we are going to be looking at the really important topic of burnout in oncology. Now burnout is a is a thing that's happens in medicine in lots of professions, but in medicine in particular due to the stresses that.
 Staff are under to deliver the services and in oncology, that's.
 Even possibly more of a more of a problem, John. And today we've got Professor Susie Banerjee from the Royal Marsden Hospital. Anybody who is used to hearing Susie talk will know that she is a world expert in gynae cancer. But alongside that today, we're not talking about gynae cancer. We're talking about her work with ESMO looking into burnout. Susie, how are you?

 Susana Banerjee   1:34
 Thank you very much. Thanks. A really kind introduction. It's a real pleasure to be on this programme with you.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   1:41
 Can you tell us how you got into your work with ESMO looking at Bernard, anybody, by the way, whoever sees Susie at ESMO will see that she has going for the competition of the most little tags that sit at the bottom of your lanyard. I think it goes down to your knees.
Susana Banerjee   1:59
 They're rather short.
 Thank you. Thank you very much. So well actually all started when I was a member of the Young Oncologists Committee. And as you probably can tell now, I'm not as young as I was then. So you need to be under 40 and it was a really, really nice committee to be to get into and we really wanted to see well, what can we do.
 To help younger oncologists and at that time, so really around.
 20/13/2014.
 There wasn't much publicised or talked about recognition about burnouts. Now, ASCO actually has a great history over the years of actually really focusing on this as well.
 So I put forward this proposal as a survey.
 Of young oncologists across Europe and.
 I was flabbergasted by the number.
 Responses worldwide, and I must say the UK, had the highest number of respondents. So, thank you to the UK oncology community and Association of Cancer Physicians.
 Because it really, you know, helped us also understand that country levels what the differences were. So, I presented our survey gosh back in ESMO 2014 and highlighted frankly that burnout's common. It's a universal problem facing under 40 year old oncologists at the time.
 And what we showed was that 71% of young oncologists had evidence of burnout and that these burnout rates basically varied across Europe.
 Within this, we also looked at, you know, potential factors and things that came out in multivariate analysis was no access to support services.
 No adequate vocation, no good work. Life balance.
 And actually interestingly, at the time living alone.
 So these are just.
 Factors that came out and it was really, really.
 Surprising and overwhelming, I won't forget to this day that the Scientific Committee chair of ESMO at that time.
 Said, you know, this abstract doesn't actually fit into any category.
 You know, but people voted for that and really wanted it as an oral presentation. So, and the coverage.
 Was overwhelming in the newspapers globally, so it really, really showed the actual empathy from the public because my concern would be people would be worried that, oh gosh, what's wrong with oncologists? Why are they feeling this way? This is negative, but it was more of a positive that this came out.
 And what can we do about it? So that's where this all kicked off.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   5:07
 I suppose that was in in young oncologists, but the problem is not is not is not limited to the under forties in the oncology community.
Susana Banerjee   5:14
 Exactly.
 So what happened subsequent to that, that really led to a bit of a snowball effect. You know, in in individual countries wanting to look at the problem.
 Other societies and what was great.
 For, for, for me and the team, was that ESMO, recognised the importance of this? And then I put in a proposal along with colleagues who were interested.
 Across different countries in.
 How to tackle this for growing the ESMO developing the ESMO Resilience Task Force?
 And basically that was approved and that's how we formed. And so we basically formed.
 Back in 2019.
 With a mission as a task force to help address burnout.
 Help raise awareness, but actually find out what can be done and find solutions.
 But you know, as I'm sure you can understand that you know there isn't A1 size fits all solution to such.
 A significant problem that has multiple factors leading to it, and everyone's an individual so, so, and of course the timing. I just told you.
 Ended up coinciding when we started in 2020 with the COVID-19 pandemic.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   6:51
 Which was the mother load of all of all stressors.
Susana Banerjee   6:56
 Exactly. So we, we thought well what you know as you remember, you know all too well there was loads going on and what we thought of that time was, is it even possible to actually.
 Survey oncology healthcare professionals globally.
 At this unique challenge that's been thrown at everyone but including the medical profession and specifically oncology.
 So during COVID and also one year after the so-called end of the pandemic.
 From the start of the pandemic.
 We basically did a series of surveys.
 And again, overwhelmed, despite the pressures that everyone faced globally, that people took the time to fill in the online surveys. And we learned many more lessons thanks to that, thanks to the huge number of participants that took part in those three surveys at those challenging times we're experiencing.
 But basically what we found, and I think what the significance of it is, it's not just about COVID, because sadly, as we know an experience, things haven't miraculously got better post the pandemic. In fact, you could argue in many ways that things are worse.
 As it's you know, there isn't an end insight as it were. So, the learnings from our surveys I think.
 Will be very important.
 Establishing retaining a workforce in oncology now and going forward and the main predictors of well-being burnout, but we also looked at job performance.
 And resilience and also change of working hours. And what was interesting is that also there was concerns regarding negative impacts on career development and training.
 So that goes alongside in our profession, with obviously our main vocation, which is treating patients.
 And interestingly, in those series risk of poor well-being feeling burnt out continued despite an improvement in job performance. So, we're getting better at coping with the cancer care during COVID and a year after the start of the pandemic.
 But to what extent, expense really. And it was poor well-being and feeling burnt out. So young oncologists under 40 and female colleagues appeared in these surveys at higher risk of poor well-being distress and feeling burnouts.
 There are alarming concerns actually raised regarding.
 Sort of perception of the lack of job control, job security.
 And actually access to.
 Personal and work related support.
 One of the main things that I found quite frightening was that there was concerns, major concerns regarding workforce attrition in the future.
 25% were thinking of a change of career.
 38% actually leaving the profession.
 And that's a real issue.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   10:26
 Can I just? Can I just come? Can I just come in on that? So, I'm just doing some very quick maths, but that is that 63% of people surveyed either thinking of leaving or leaving the profession.
Susana Banerjee   10:43
 Well, will the individual the individual?
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   10:43
 25 and 38%.
Susana Banerjee   10:48
 Responses you could vote. You know you could vote basically more than once so, but either way, you know, at the at the very least it's more than 1/4, yes, so.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   10:50
 Yeah.
 Those are shocking numbers.
 In a time in in time in oncology, when we desperately need more oncologists, so we cannot afford any loss at all.
Susana Banerjee   11:06
 Exactly. And you mentioned earlier that it's not just about young oncologists and you know in this service of course these weren't age.
 Restricted and so you know what's really clear is that.
 This is, you know, people aren't immune to burnout. It's not just the young people. It can. People who have been working for many years and coming towards the so-called end of their career.
 It can affect any gender.
 At any level of training, you know whether you're you know, registrar or a senior head of department so. So this is something that in a way unites all because we're all at risk.
 So you know, we need to work together.
 Across the disciplines across ages across stage to try and you know effectively prevent people leaving the medical profession.
 So that we can do what we set out to do, which was, you know, help patients.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   12:15
 And when we're talking about helping patients, Suzie, do you think there's something in the nature of treating cancer? Because we're not alone in being stressed. But is there something in the nature of treating cancer? Yes, we have made huge strides forward. Immunotherapy, better radiotherapy, better surgical techniques. But within the core, there still is a considerable element of patients who progress with cancer at some stage. And we deal with death quite a lot.
 Is that a particular part of? Does that play a part in the in the survey? Do you get that feedback that that has a role to play or is it just this other concept that we have of the load that we're bearing? We did an episode with the psychologist called Doctor Mike Osborne before, which was great.
 And he talked a lot about the load that we were carrying, the micro stressors every day, everyday stresses that keep creeping up, and we've all seen it, you know, more and more patients that were able to treat. Then there's the more and more treatment options, the more. And it's just, the more keeps coming into every conversation.
Susana Banerjee   13:18
 Yeah.
 So there's been, there's been work predating these surveys as well, you know, across different, you know beyond oncology in other.
 Specialities, but as you pointed out and we're focusing on oncology, I think the constantly facing.
 Patient effectively, life death decisions or seen as life death decisions delivering bad news.
 And then the therapies, it's, it's wonderful that we've got so many new therapies.
 Seeing therapies with new side effects, toxic side effects.
 Has added pressures as well and.
 You know, despite the improvements in treatments for a lot of cases of different types of cancers, different stages of the pathway, there can be limited ability to actually prolong life substantially for far too many patients. So alongside that, we need to keep at the forefront rapid scientific and treatment advances.
 And as you've pointed out in a background of working actually probably at the foreground increased workload, the administrative requirements. So, it's not just making the specialist decisions, it's actually executing. You know how we order this test; how do we document these things are changing also the medical legal pressures in an environment where we have.
 Reduced resources so and this is not. You know this is this is.
 You know from our discussions from what we can see in the surveys, but also from talking to people across the world, this is not unique to one specific country or type of hospital. This is something we are all facing.
 And you know, somehow we need to, you know, address.
 This before it gets completely out of hand, but I'm positive about that.
 And I think there has been.
 Improvements and you know, I hope we get a chance to talk about some of those.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   15:31
 Move straight on to those actually so.
 You've talked about, we've talked about sort of the different stressors and there are there are some macro stresses that an individual or an individual department will find very difficult to address. For example, workforce pressures, you know, the change in oncology landscapes. So, I suppose one of the one of the areas where the responsibility sits for improving sits at sort of national international level with.
 Organisation such as MO so.
 What improvements have been driven forward at that level?
Susana Banerjee   16:08
 Right. So, I think.
 The first thing, and I know it sounds simple but really important in oncology, where many people would think actually admitting to.
 To burnout or feeling stressed is seen as a taboo area. You know, it's not something you want to admit. We're meant to be the strong people basically for our patients. So I think the first thing which we're much better at globally, nationally, institutionally.
 Is actually raising awareness and we've come a long way with that.
 And I do see if I was to divide things and what we tried to do.
 With the ESMO Resilience Task Force recommendations was thinking about what an individual can do, what an institution can do, and what.
 Societies can do like ESMO as you've highlighted, and there's going to be overlap there. But I think there needs to be duties and responsibilities in all those areas and then they combine together in order to improve our working environments and risk of distress.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   17:15
 OK.
Susana Banerjee   17:23
 And so in terms of ESMO for example.
 By running these surveys at the actual ESMO congresses, you may have seen that we have sessions and forums dedicated to resilience, and these are not lecture based. These are actually.
 Round table discussions and people talking about their experiences, but more importantly as well.
 And in hand about what they've seen could work for them individually, but also at their institutions, and also talking about the barriers. Now. What I'm really excited about because a lot of the feedback, you know, understandably you've got is like we know there's a problem. It's really difficult to tackle this. What can we actually do? That's where the recommendations came in. Because when you when many have gone to institutions or gone to workplaces.
 It's like, well, OK, yeah, we know there's a problem. But actually, as you pointed out.
 You know, we've got lots of pressures here. What can we do about it? So by in a way, having a tool kit, having a recommendation plan.
 I think individuals, institutions, societies can look at this in more detail. I think what little changes we can do that may have a bigger impact in time?
 And I don't mean a long time. Some people can be quite immediate, and some, you know, we'll take more infrastructure or a change in mindset.
 Institutionally or in different countries, so. So that's where this came about. And actually, it was evidence based because often some criticism may be well, it's just an idea. Where's the evidence for that? So, this was based on over 3700 participants, and this was 11 action plan.
 And we feel that those recommendations are actually.
 You know, actionable basically.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   19:23
 If we can look at those actions, if we could look at those actions, what would be the headline actions from that?
Susana Banerjee   19:23
 You know it's a set.
 Yeah. So, we ended up dividing it into themes actually, because we thought it was easier that way. And I just want to say it was, you know, we had such incredible support working with psychologists here because, you know, as you know, you've pointed out I'm a specialist in gynaecological cancers. So, you know, I know what the problem is. I can see what people are suffering with. But in terms of the expertise, you know, we really needed, and we had.
 Psychological.
 Experts, but also public policy experts as well, because that's where we are.
 I'm going to try and make and hopefully make a more sustainable difference. OK, so our themes were sounds simple, but you know our key to spell out, you know, high quality information and training can help support the practise and development of oncologists and cancer care. The other theme was dedicated strategies and resources should be developed to safeguard the psychological and physical health of staff. And then finally.
 That activism and advocacy.
 You know, for our discipline, discipline of oncology.
 And the well-being of the workforce and then within that we had aspects of for example.
 Something that is very close to my heart in terms of.
 Providing individualised career supervision, mentorship, you know support throughout not only training but career development, job security, mentorship, thinking about ways of learning. You know, our work has changed.
 You know, there's a lot more online activity.
 So actually combining those virtual strategies but also you know more innovative solutions as well to try and access flexible work arrangements and which I know is, is, is not going to happen overnight. But I actually feel, and I hope.
 That.
 These recommendations are basically laid out for institutions, societies and individuals. You know, I hope they'll just shift attitudes and priorities.
 Within the oncology.
 Sector and by making those shifts in the way people think about when they're planning their workforce.
 I think we could and we will reduce burnout in professionals.
 And really ultimately improve the efficiency. You know if we can show well actually if you've got people taking time off be because they're sick from a stress perspective or they might be having physical illness because of burnout.
 Or indeed leaving the profession.
 Retiring far too early? Then, that's going to have an effect on the efficiency of our care for patients, so.
 And the quality, the quality of our care for patients. So, you know, I'm sure every hospital, every oncologist you know will want to maintain excellent patient care. So, if we think about it that way, well, how do we do that? We always think that's via drugs via this. I think this needs to be seen hand in hand actually.
 Protecting the workforce and when I say when I'm talking about oncologists, but as you know in the surveys and also we did do the COVID now survey in the UK during COVID that was across oncology healthcare professionals. So you know we looked at nursing, we looked at pharmacies, support services.
 We work in a multidisciplinary team so I think that's my main aim and what I'd really like to highlight because you said what could ESMO do.
 Well, we've got a really exciting for the first time we've actually got a resilience Task Force workshop. You may have heard of the preceptor ships and individual cancers, which is learning, so you know, it's not a preceptorship per SE, because I guess it's not a tumour type.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   23:23
 Yes, indeed. Yeah, I did one.
Susana Banerjee   23:31
 But effectively the model is the same, so this is basically happening in the next few weeks end of January. Early February is the first of its kind and it's a workshop.
 It's not lectures and we and you'll know from the preceptorship programmes that people apply to attend and what we had was we'd like to have some slides, a proposal of either a burnout initiative to try and address this locally or institutionally or individually.
 And then the task force member of us helped select.
 Some of what the candidates to attend the workshop, but also to present.
 What they feel has worked or could work, or what evidence they've seen, or what their experiences are, and in the beginning we thought and assumed this would be in Europe. Of course, as I said before, it's global burnouts as an issue. But we were overwhelmed by also the interest beyond Europe, and we have people attending.
 From Asia, as well as Europe.
 At this event.
 Where we also have training on resilience skills, and this is not focused entirely on an individual. What we want is for effectively leaders, supervisors, people in charges of departments and programmes to think well, how can I support my team and the oncology workforce. So by attending this, I hope we cannot only.
 Implement some tools and give it give a toolkit of what to do, but equally it's about networking so.
 And actually establish connections with other oncology leaders across Europe to create this supportive sort of peer network for promoting this transformation and well-being internationally. So, I know it's ambitious. I'm really delighted about the interest in in the workshop. As I said, it's the first of its kind, we're already planning.
 Forums and an ability to discuss resilience and burnouts at the ESMO Congress.
 Later on this year.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   25:53
 And I think that is definitely needed. As you pointed out, you've got interest from around the world. I would suggest that in this year of 2025, almost every oncology department will have one individual at least, if not more, who are off work at some point this year due to burnout. This affects everybody up and down the UK all the way through Europe.
 All the way across the globe, it is a recurring problem that we're seeing over and over again.
 And as you rightly point out, we need people. We need people for consistency. Our patients need it, our teams need it. So, we need it so that we can stay efficient and deliver care for patients. So, I'm not surprised that there's been overwhelming.
 Kind of desire for people to go to these workshops and they sound excellent and I'm certainly jealous as well. I think. I think I seem to have missed that. I didn't see that coming through, but that would have been really great to go to and I'll obviously look out for other things I suppose.
Susana Banerjee   26:45
 Thank you.
 And it's in Barcelona, Michael.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   26:56
 Oh Barcelona, if only if only.

Susie, that's been a brilliant introduction into this scale of this problem and the work that's kind of foundation work that was done with a lot of the surveys through ESMO. Could you give us 3 takeaway points from that?

 Susana Banerjee   42:51
 And the main point is that burnout is common.
 It can affect any of us, any age, gender, part of our training and career development. Second main point is that.
 There are real concerns about the lack or I was going to say the lack of support or the need for more support work related support.
 A Third Point I'd like to reiterate the concerns about.
 The oncology profession, and far too many people considering a change of career or even leaving the profession. And so, I think this is what's really important and that will hopefully Dr improvements in workforce planning knowing this.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   43:41
 Thank you so much. And I think that last point is particularly telling because we talk about resilience, but by definition, people who have gone through medicine, nursing, their basic training, their specialist training and then gone into working in oncology have proven their resilience. So, these are a resilient group of people. And if we are pushing them too hard.
 Then we need to reflect that back on ourselves as a society as to what's happening. So, thank you so much for that.
Susana Banerjee   44:12
 Thank you.