Caring for patients with incurable cancer: What stresses us

Stress and burnout are common phenomenon among clinicians managing patients with incurable cancer. Among oncologists various studies have demonstrated prevalence rates fo 25-56%. Burnout results from overwhelming stress that creates an imbalance between the professional's needs and the rewards derived from the job itself. Opinions are divided regarding the major sources of stress for oncology clinicians:1) time pressure: the major reasons for stress and burnout are related to the issue of time pressures. This relates to more time to spend with patients, excessive paperwork, and inadequate time to spend away from work with family and friends. 2) Mortality stress: This school of thought holds that the primary source of stress in oncology derives mostly from the emotional strain of dealing with patients facing mortality issues and their soon to be bereaved families. Oncologists must deal daily with stressed patients and families, disproportionate hopes and expectations, emotionally laden dialogues with patients and families, and the limitations of treatments that are unable to deliver cures. The ESMO survey of medical oncologist's attitudes to and involvement with the management of advanced and incurable cancer (1) shed some further light on the issue. In this survey of almost 900 oncologists, just over a third of respondents reported that they feel emotionally burned out by having to deal with too many deaths. This predilection to burnout was associated closely with negative attitudes to involvement in supportive and palliative care and low levels of actual involvement or referral to specialist colleagues. Burnout, therefore, was not so much associated to over-exposure rather to poor attitudinal preparedness and aberrant role definition. On the other hand, physicians with positive attitude toward end-of-life care and their role in it, expresses much lower tendency to burnout with dying patients. These finding suggest that positive attitudes and involvement in palliative care are all resilience factors that helps prevent burnout caused by exposure to advanced cancer.