We should order a FISH and consider giving him RICE.”
If you are thinking about a delicious meal, you’re wrong! That discussion was from my first malignant hematology tumor board. Learning a new language of medicine—that’s how hematology-oncology fellowship appeared to me initially.
Indeed, everything was new: new city, new hospital, new business card that proudly displayed the word “Fellow,” and of course, new people.
There’s a lot to take in when you transition from residency to fellowship. “Just try to keep your head above the water,” a senior fellow advised me. It was not easy. I had barely moved into my new apartment, with less than a week between my residency and fellowship. I was about to take the internal medicine boards in a month. Time was flying.
The emotional aspect of my new role was challenging as well. In a stark contrast to any of my prior medical training, I lost several patients under my care in the first few months of fellowship. During those difficult months on the wards, I couldn’t help but identify with the words of another Dr. Mukherjee, the author of The Emperor of All Maladies: “I felt I was slowly becoming inured to the deaths and the desolation—vaccinated against the constant emotional burnout.”
Apparently, most oncology fellows feel that way during the initial months of their fellowship.
Burnout is prevalent among cancer care providers and can manifest itself in three different ways: emotional exhaustion, depersonalization, and low personal accomplishment.1 A recent survey conducted among U.S. oncology fellows showed that burnout seems to peak in the first year of fellowship and decreases subsequently in the second and third years, with incremental improvements in fatigue, quality of life, and work-life balance.2
Several studies have been conducted to identify factors that reduce stress among oncology fellows. Peer support groups have emerged as an important step. At our institution, each first-year fellow is paired with a senior fellow to discuss issues related to patient care, professionalism, and personal development.
Training in palliative care and end-of life discussion has also been shown to reduce emotional burnout in fellows by empowering them with essential communication and self-care skills. This training is increasingly being adopted by fellowship programs.
Furthermore, a study conducted among Brazilian medical oncologists suggested that engaging in hobbies and physical activities, having adequate vacation time, and religious affiliation also help prevent burnout.3 At our last Trainee Council meeting held at ASCO Headquarters in Alexandria, VA, medical oncology fellows spent a significant amount of time discussing burnout and potential strategies to overcome it.
The first and most important step towards solving this problem, as with any other problem, is to acknowledge that it exists. While all oncology professionals may suffer from some degree of burnout, this is a particularly serious issue among fellows since they face unique challenges at the beginning of their oncology career. Early burnout may also adversely influence fellows’ career development.
Potential strategies to overcome it include both personal efforts by fellows for self-care as well as organizational endeavors to identify burnout among fellows. Oncology fellowship programs should consider instigating peer support groups and integrating palliative care training in fellowship. Most importantly, fellowship programs should work to foster a supportive culture and encourage fellows to report issues related to burnout.
1. Trufelli DC, Bensi CG, Garcia JB, et al. Eur J Cancer Care (Engl). 2008:17:524-31.
2. Shanafelt TD, Raymond M, Horn L, et al. J Clin Oncol. 2014;32:2991-7.
3. Glasberg J, Horiuti L, Novais MD, et al. Rev Assoc Med Bras. 2007;53:85-9
Published February 23, 2016 online issue of ASCO Connection.org.