The impact of COVID-19 on oncology professionals-one year on: lessons learned from the ESMO Resilience Task Force survey series.

BACKGROUND: COVID-19 has had a significant impact on the well-being and job performance of oncology professionals globally. The European Society for Medical Oncology (ESMO) Resilience Task Force collaboration set out to investigate and monitor well-being since COVID-19 in relation to work, lifestyle and support factors in oncology professionals 1 year on since the start of the pandemic. METHODS: An online, anonymous survey was conducted in February/March 2021 (Survey III). Key outcome variables included risk of poor well-being or distress (expanded Well-Being Index), feeling burnout (single item from expanded Well-Being Index), and job performance since COVID-19. Longitudinal analysis of responses to the series of three surveys since COVID-19 was carried out, and responses to job demands and resources questions were interrogated. SPSS V.26.0/V.27.0 and GraphPad Prism V9.0 were used for statistical analyses. RESULTS: Responses from 1269 participants from 104 countries were analysed in Survey III: 55% (n = 699/1269) female, 54% (n = 686/1269) >40 years, and 69% (n = 852/1230) of white ethnicity. There continues to be an increased risk of poor well-being or distress (n = 464/1169, 40%) and feeling burnout (n = 660/1169, 57%) compared with Survey I (25% and 38% respectively, P < 0.0001), despite improved job performance. Compared with the initial period of the pandemic, more participants report feeling overwhelmed with workload (45% versus 29%, P < 0.0001). There remain concerns about the negative impact of the pandemic on career development/training (43%), job security (37%). and international fellowship opportunities (76%). Alarmingly, 25% (n = 266/1086) are considering changing their future career with 38% (n = 100/266) contemplating leaving the profession. CONCLUSION: Oncology professionals continue to face increased job demands. There is now significant concern regarding potential attrition in the oncology workforce. National and international stakeholders must act immediately and work closely with oncology professionals to draw up future-proof recovery plans.

The concerns of oncology professionals during the COVID-19 pandemic: results from the ESMO Resilience Task Force survey II.

BACKGROUND: The COVID-19 pandemic has resulted in significant changes to professional and personal lives of oncology professionals globally. The European Society for Medical Oncology (ESMO) Resilience Task Force collaboration aimed to provide contemporaneous reports on the impact of COVID-19 on the lived experiences and well-being in oncology. METHODS: This online anonymous survey (July-August 2020) is the second of a series of global surveys launched during the course of the pandemic. Longitudinal key outcome measures including well-being/distress (expanded Well-being Index-9 items), burnout (1 item from expanded Well-being Index), and job performance since COVID-19 were tracked. RESULTS: A total of 942 participants from 99 countries were included for final analysis: 58% (n = 544) from Europe, 52% (n = 485) female, 43% (n = 409) ≤40 years old, and 36% (n = 343) of non-white ethnicity. In July/August 2020, 60% (n = 525) continued to report a change in professional duties compared with the pre-COVID-19 era. The proportion of participants at risk of poor well-being (33%, n = 310) and who reported feeling burnout (49%, n = 460) had increased significantly compared with April/May 2020 (25% and 38%, respectively; P < 0.001), despite improved job performance since COVID-19 (34% versus 51%; P < 0.001). Of those who had been tested for COVID-19, 8% (n = 39/484) tested positive; 18% (n = 7/39) felt they had not been given adequate time to recover before return to work. Since the pandemic, 39% (n = 353/908) had expressed concerns that COVID-19 would have a negative impact on their career development or training and 40% (n = 366/917) felt that their job security had been compromised. More than two-thirds (n = 608/879) revealed that COVID-19 has changed their outlook on their work-personal life balance. CONCLUSION: The COVID-19 pandemic continues to impact the well-being of oncology professionals globally, with significantly more in distress and feeling burnout compared with the first wave. Collective efforts from both national and international communities addressing support and coping strategies will be crucial as we recover from the COVID-19 crisis. In particular, an action plan should also be devised to tackle concerns raised regarding the negative impact of COVID-19 on career development, training, and job security.

Clinical outcomes of patients with cancer who tested positive for COVID-19 hospitalised in a UK district general hospital

Background: Individuals diagnosed with cancer have been particularly affected by the COVID-19 pandemic. Most of the relevant information so far has come from tertiary cancer centres and less is known of the outcomes of patients in District General Hospitals (DGH). In this audit, we aimed to investigate the clinical outcomes of patients with cancer who tested positive for COVID-19 and were admitted in a DGH. Methods: Electronic records of patients admitted at Tameside General Hospital (TGH) (>500 beds) between March 2020–March 2021 were reviewed retrospectively. Clinical outcomes of those who tested positive for COVID-19 and factors relating to death were analysed. Cox regression and Kaplan-Meier survival analyses were performed (SPSS v26.0). Results: Within the 12-month study period, there were 2417 inpatients who tested positive for COVID-19 at TGH. Of 235 individual patients with cancer admitted during this period, 14% (n=33) tested positive. Median age was 75 (68;81) years;majority female (67%). The most prevalent primary site of cancer were lung (21%) and breast (12%). Most were ECOG PS 1 (39%) or PS 2 (36%), and had high Charlson Comorbidity Index (median 5 (3;6), range 0-10). 24% of patients were on curative treatment, 39% palliative treatment, 18% best supportive care and 18% not on treatment. Types of treatment included chemotherapy (37%), hormonal treatment (26%), radiotherapy (21%) and immunotherapy (5%). On average, patients were admitted at least once (range 0-4) prior to positive test for COVID-19. At last follow-up, there were n=664/2417 (27%) and n=22/33 (67%) deaths in the non-cancer and cancer patient subgroups, respectively. The median time from diagnosis of COVID-19 to death/censor date was 44 (4;85) days. In univariate Cox regression analysis, only ECOG PS was significantly correlated with death, HR 1.523 (95% CI 1.064-2.181, p=0.022). Conclusions: The outcomes of our cohort of patients with cancer who tested positive for COVID-19 and hospitalised were poor. The high comorbidity burden and poor ECOG PS could potentially account for this rather than the recent oncological treatment. Acute oncology input to general medical teams treating cancer patients with COVID-19 is pivotal for best possible outcomes for patients. Legal entity responsible for the study: Konstantinos Kamposioras. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

The future of the oncology workforce since COVID-19: Results of the ESMO Resilience Task Force survey series

Background: The ESMO Resilience Task Force has investigated wellbeing since COVID-19 in relation to work, lifestyle and support factors in oncology professionals globally. We reported on the significant impact of the initial surge of the pandemic on wellbeing and job performance (Banerjee et al. 2021). As the pandemic continues, it is imperative to understand experiences and concerns to better inform support measures for the oncology workforce. Methods: Three anonymous online surveys were conducted during the COVID-19 pandemic (S1, Apr/May 2020;S2, Jul/Aug 2020;S3, Feb/Mar 2021). Longitudinal analysis of responses at these timepoints were conducted. Here, we present responses to questions on job demands and resources, and perceived job performance since COVID-19 (JP-CV). Results: We analysed 3894 individual responses (S1, n=1520;S2, n=942;S3, n=1432): 53% (n=1961/3731) female, 45% (n=1679/3731) =/<40 years, 31% (n=1132/3692) non-white ethnicity, >100 countries. There has been significant increases from S1 to S3 (p<0.001) in feeling overwhelmed with workload (29% vs 45%);COVID-19-related clinical (14% vs 58%) and research (16% vs 64%) work;out-of-hours work (16% vs 41%), shift work (12% vs 26%) and overall working hours (17% vs 47%);and inadequate time for personal/family life (35% vs 45%). 59% (n=1156/1946) were unable to take allocated annual leave. While JP-CV has improved (34% vs 49%, p<0.001), there remained concerns about the negative impact of the pandemic on career development/training (43%), job security (37%) and international fellowship opportunities (76%). Overall, less than half had felt supported by their work management, professional societies or government, and/or had access to wellbeing support services. 25% (n=266/1086) were considering changing their future career with 38% (n=100/266) contemplating leaving the profession. Conclusions: Since COVID-19, oncology professionals have reported increased job demands, concerns over career development/training and job security, and inadequate time for personal life. There is a real threat of potential attrition in the current workforce. National and international stakeholders must act together to ensure robust recovery plans as we emerge from the COVID-19 crisis. Legal entity responsible for the study: The authors. Funding: ESMO. Disclosure: K.H.J. Lim: Financial Interests, Personal, Invited Speaker, Speaker honorarium: Janssen;Non-Financial Interests, Officer, Trainees committee representative for the North West deanery: Royal College of Physicians (UK);Non-Financial Interests, Officer, Trainees representative at the RCP Patient Safety Committee: Royal College of Physicians (UK);Non-Financial Interests, Officer, ACP representative at the RCP Student and Foundation Doctor Network (SFDN): Royal College of Physicians (UK);Non-Financial Interests, Officer, Trainees committee member: Association of Cancer Physicians (ACP) UK;Non-Financial Interests, Officer, Young Oncologists Committee (YOC): ESMO;Non-Financial Interests, Officer, Resilience Task Force (RTF): ESMO;Other, Currently funded by Wellcome-Imperial 4i Clinical Research Fellowship: Wellcome Trust. K. Punie: Other, Institutional, Other, institution received speaker fees or honoraria for consultancy/advisory roles: AstraZeneca, Eli Lilly, Gilead Sciences, Medscape, MSD, Novartis, Pfizer, Pierre Fabre, Hoffmann La Roche, Mundi Pharma, PharmaMar, Teva, Vifor Pharma;Other, Institutional, Research Grant: Sanofi;Other, Personal, Other, Travel support: AstraZeneca, Novartis, Pfizer, PharmaMar and Roche. C. Oing: Other, Personal, Other, research funding and honoraria: Roche;Other, Personal, Other, travel grant and honoraria: Medac Pharma and Ipsen Pharma;Other, Personal, Other, travel grant: PharmaMar. E. Elez: Other, Personal, Other, personal fees: Hoffman La - Roche, Bristol Myers Squibb, Servier, Amgen, Merck Serono, ArrayBiopharma, Sanof. T.M.S. Amaral: Other, Personal, Other, personal fees: Pierre Fabre and CeCaVa;Other, Personal, Other, personal fees and travel grants: BMS;Other, Perso al, Other, grants, personal fees and travel grants: Novartis;Other, Personal, Other, grants: Neracare, Sanofi and SkylineDx. P. Garrido Lopez: Other, Personal, Other, personal fees: Roche, MSD, BMS, Boerhinger-Ingelheim, Pfizer, AbbVie, Novartis, Lilly, AstraZeneca, Janssen, Blueprint Medicines, Takeda, Gilead, and ROVI. M. Lambertini: Other, Personal, Other, Consultant: Roche, AstraZeneca, Lilly and Novartis;Other, Personal, Other, Honoraria: Theramex, Roche, Novartis, Takeda, Pfizer, Sandoz, and Lilly. C.B. Westphalen: Other, Personal, Other, honoraria, travel support and advisory board: Bayer, BMS, Celgene, Roche, Servier, Shire/Baxalta, RedHil, and Taiho;Other, Personal, Other, speaker honoraria: Ipsen;Other, Personal, Advisory Board: GSK, Sirtex, and Rafael. J.B.A.G. Haanen: Other, Personal, Advisory Role, personal fees for advisory role: Neogene Tx;Other, Institutional, Other, grants and fees paid to institution: BMS, MSD, Novartis, BioNTech, Amgen;Other, Institutional, Other, fees paid to institution: Achilles Tx, GSK, Immunocore, Ipsen, Merck Serono, Molecular Partners, Pfizer, Roche/Genentech, Sanofi, Seattle Genetics, Third Rock Ventures, Vaximm. C. Hardy: Other, Personal, Other, Director of a private company Hardy People Ltd.: Hardy People Ltd. S. Banerjee: Other, Institutional, Research Grant: AstraZeneca, Tesaro and GSK;Other, Personal, Other, Honoraria: Amgen, AstraZeneca, MSD, GSK, Clovis, Genmab, Merck Serono, Mersana, Pfizer, Seattle Genetics, and Tesaro. All other authors have declared no conflicts of interest.

The impact of changes in servicedelivery in patients with colorectalcancer during the first peak of theCOVID-19 pandemic

Background: Increased levels of anxiety and distress in both patients and physicians have been reported in response to the significant impact COVID-19 has on cancer service delivery globally. We aimed to investigate how these changes have been perceived by patients diagnosed with colorectal cancer and identify determinants of increased anxiety. Methods: Survey (32-item) of consecutive patients diagnosed with colorectal cancer attending a large tertiary comprehensive cancer centre in the United Kingdom (18 May to 1 July 2020). Self-reported GAD-7 (both paper/electronic forms) was used as a screening tool for anxiety. Statistical analyses of associations:Chi-square, Fisher's exact, and uni- and multi-variable analyses were performed using SPSS v19 and R. Results: A total of 143 patients (response rate 67%), 82% male, and median age of 61-70 years were included. Majority of patients had telephone consultation (78%), including 40% who had scan results discussed over the phone;with favourable feedback received with both respectively. Twenty-three patients (18%) were considered to have anxiety, with 7 (6%) scoring for moderate or severe anxiety. Three items asked patients if they had concerns about getting COVID-19, were worried that COVID-19 would have effect on mental health, and affect their experience of cancer care. Patients answering positively to any of these items were most likely to have anxiety;multivariate analysis - OR 2.361 (95% CI 1.187-4.694, p=0.014), 3.219 (95% CI 1.401-7.395, p=0.006) and 3.206 (95% CI 1.036-9.920, p=0.043), respectively. Majority of the patients did not feel that they needed support during the pandemic period and hence the available well-being services were not used. Patients felt that friends and family had been very supportive but less so the primary care services (p<0.05). However, they felt they were supported by the clinical team. Conclusions: At our centre, during the first-peak of COVID-19 pandemic in the UK, patients with colorectal cancer did not display increased rates of significant anxiety. The findings of this survey suggests that some service changes implemented, including increased telephone follow-up, may have already improved the overall experience of cancer care. Importantly, patients were much more concerned about their cancer treatment than COVID-19, emphasising the need to continue to provide comprehensive cancer care even if we get a ?2nd wave? of COVID-19.

The impact of COVID-19 on oncology professionals: results of the ESMO Resilience Task Force survey collaboration.

BACKGROUND: The impact of the coronavirus disease 2019 (COVID-19) pandemic on well-being has the potential for serious negative consequences on work, home life, and patient care. The European Society for Medical Oncology (ESMO) Resilience Task Force collaboration set out to investigate well-being in oncology over time since COVID-19. METHODS: Two online anonymous surveys were conducted (survey I: April/May 2020; survey II: July/August 2020). Statistical analyses were performed to examine group differences, associations, and predictors of key outcomes: (i) well-being/distress [expanded Well-being Index (eWBI; 9 items)]; (ii) burnout (1 item from eWBI); (iii) job performance since COVID-19 (JP-CV; 2 items). RESULTS: Responses from survey I (1520 participants from 101 countries) indicate that COVID-19 is impacting oncology professionals; in particular, 25% of participants indicated being at risk of distress (poor well-being, eWBI ≥ 4), 38% reported feeling burnout, and 66% reported not being able to perform their job compared with the pre-COVID-19 period. Higher JP-CV was associated with better well-being and not feeling burnout (P < 0.01). Differences were seen in well-being and JP-CV between countries (P < 0.001) and were related to country COVID-19 crude mortality rate (P < 0.05). Consistent predictors of well-being, burnout, and JP-CV were psychological resilience and changes to work hours. In survey II, among 272 participants who completed both surveys, while JP-CV improved (38% versus 54%, P < 0.001), eWBI scores ≥4 and burnout rates were significantly higher compared with survey I (22% versus 31%, P = 0.01; and 35% versus 49%, P = 0.001, respectively), suggesting well-being and burnout have worsened over a 3-month period during the COVID-19 pandemic. CONCLUSION: In the first and largest global survey series, COVID-19 is impacting well-being and job performance of oncology professionals. JP-CV has improved but risk of distress and burnout has increased over time. Urgent measures to address well-being and improve resilience are essential.

The impact of COVID-19 on oncology professionals: Initial results of the ESMO resilience task force survey collaboration

Background: The impact of the COVID-19 (CV-19) pandemic on wellbeing has the potential for serious negative consequences on work, home life and patient care. The ESMO Resilience Task Force collaboration set out to investigate wellbeing in oncology over time since CV-19. Methods: 2 online surveys were conducted (survey I April/May;survey II July/August 2020). Statistical analyses were used to examine group differences, associations and to explore predictors of key outcomes: 1) wellbeing/distress (Wellbeing Index (WBI-9)), 2) burnout (1 item);and 3) CV-19 job performance (2 item CJP;standard of care and job delivery compared to pre-CV 19). Results: Survey I had 1520 participants from 101 countries. Responses indicate that CV-19 is impacting the oncology workforce resulting in a number of changes to work and personal lives. 25% were at risk of distress (poor wellbeing, WBI ≥4);38% reported feeling burnout and 66% were not able to perform their job compared to pre-CV-19. Higher CJP was significantly associated with better wellbeing and not feeling burnout (p<0.01). Differences were seen in wellbeing and CJP between countries (p<0.001) and related to CV-19 country mortality rate (p<0.05). The main predictors of wellbeing, burnout and CJP were resilience and changes to work hours. Others frequently identified were coping strategies, ethnicity, concern about training/career, worried about current wellbeing, and working conditions. In Survey II, results from 942 participants are undergoing analysis. Overall, comparisons between surveys show overall wellbeing and burnout rates have worsened overtime but CJP has improved. Among 272 participants who completed both surveys, WBI scores ≥4 (indicating higher risk of distress) and burnout rates were higher in survey II compared to survey I (22% vs 31% p=0.01;35% vs 49% p=0.001 respectively) suggesting wellbeing and burnout may be worsening overtime. CJP improved (38% vs 54% p<0.001). Conclusions: In the largest global survey series, COVID-19 is impacting on the wellbeing and job performance of oncology professionals. Risk of distress and burnout has increased over time. Urgent measures to address wellbeing and improve resilience are essential. Legal entity responsible for the study: ESMO. Funding: ESMO. Disclosure: S. Banerjee: Research grant/Funding (institution): AstraZeneca;Research grant/Funding (self): GSK;Honoraria (self): Amgen;Honoraria (self): AstraZeneca;Honoraria (self): MSD;Honoraria (self): GSK;Honoraria (self): Clovis;Honoraria (self): Genmab;Honoraria (self): Merck Serono;Honoraria (self): Mersana;Honoraria (self): Pfizer;Honoraria (self): Seattle Genetics;Honoraria (self): Tesaro. C. Oing: Research grant/Funding (institution): PharmaMar;Travel/Accommodation/Expenses: Ipsen;Travel/Accommodation/Expenses: PharmaMar;Travel/Accommodation/Expenses: Medac. K. Punie: Honoraria (self): AstraZeneca;Honoraria (self): Eli Lilly;Honoraria (self): Novartis;Honoraria (self): Pfizer;Honoraria (self): Pierre Fabre;Honoraria (self): Hoffmann La Roche;Honoraria (self): Vifor Pharma;Speaker Bureau/Expert testimony: Eli Lilly;Speaker Bureau/Expert testimony: Mundi Pharma;Speaker Bureau/Expert testimony: Novartis;Speaker Bureau/Expert testimony: Pfizer;Speaker Bureau/Expert testimony: Hoffmann La Roche;Honoraria (self): Teva;Research grant/Funding (institution): Sanofi;Travel/Accommodation/Expenses: AstraZeneca;Travel/Accommodation/Expenses: Novartis;Travel/Accommodation/Expenses: Pfizer;Travel/Accommodation/Expenses: PharmaMar;Travel/Accommodation/Expenses: Hoffmann La Roche. M. Lambertini: Advisory/Consultancy: Roche;Advisory/Consultancy: Novartis;Honoraria (institution): Theramex;Honoraria (institution): Takeda;Honoraria (institution): Roche;Honoraria (institution): Lilly;Honoraria (institution): Pfizer;Honoraria (institution): Novartis. C. Benedikt Westphalen: Honoraria (institution), Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Bayer;Honoraria (self), Honoraria (institution), Travel/Accommodation/Expenses: Celge e;Honoraria (self), Honoraria (institution), Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Ipsen;Honoraria (self), Honoraria (institution), Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: MedScape;Honoraria (self), Honoraria (institution), Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Rafael Pharmaceuticals;Honoraria (self), Honoraria (institution), Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: RedHIll;Honoraria (self), Honoraria (institution), Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Roche;Honoraria (self), Honoraria (institution), Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Servier;Honoraria (self), Honoraria (institution), Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Shire;Honoraria (self), Honoraria (institution), Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Taiho;Research grant/Funding (institution): Roche. P. Garrido Lopez: Advisory/Consultancy: AbbVie;Speaker Bureau/Expert testimony: AstraZeneca;Advisory/Consultancy: BluePrint Medicine;Advisory/Consultancy, Speaker Bureau/Expert testimony: Boerhinger Ingelheim;Advisory/Consultancy, Speaker Bureau/Expert testimony: BMS;Advisory/Consultancy: Gilead;Advisory/Consultancy: Guardant Health;Advisory/Consultancy: Janssen;Advisory/Consultancy: Lilly;Advisory/Consultancy, Speaker Bureau/Expert testimony: MSD;Advisory/Consultancy, Speaker Bureau/Expert testimony: Novartis;Advisory/Consultancy, Speaker Bureau/Expert testimony: Pfizer;Advisory/Consultancy, Speaker Bureau/Expert testimony: Roche;Advisory/Consultancy, Speaker Bureau/Expert testimony: Takeda;Speaker Bureau/Expert testimony: Rovi;Speaker Bureau/Expert testimony: Sysmex. T.M.S. Amaral: Honoraria (self), Travel/Accommodation/Expenses: BMS;Honoraria (self), Travel/Accommodation/Expenses: Novartis;Honoraria (self): PIerre Fabre;Honoraria (institution): Neracare;Honoraria (institution): Sanofi. J.B.A.G. Haanen: Advisory/Consultancy: AIMM THerapeutics;Advisory/Consultancy: Amgen;Advisory/Consultancy: AZ;Advisory/Consultancy: Bayer;Advisory/Consultancy: BioNtech;Advisory/Consultancy: BMS;Advisory/Consultancy: GSK;Advisory/Consultancy: Gateta;Advisory/Consultancy: Immunocore;Advisory/Consultancy: Ipsen;Advisory/Consultancy: Merck Serono;Advisory/Consultancy: MSD;Advisory/Consultancy: Molecular Partners;Advisory/Consultancy: Roche;Advisory/Consultancy: Sanofi;Advisory/Consultancy: Seattle Genetics;Advisory/Consultancy: Third Rock Venture;Advisory/Consultancy: Vaximm;Research grant/Funding (institution): Neogene;Research grant/Funding (institution): Amgen;Research grant/Funding (institution): BMS;Research grant/Funding (institution): BIoNthech;Research grant/Funding (institution): MSD;Research grant/Funding (institution): Novartis;Advisory/Consultancy: Genentech. All other authors have declared no conflicts of interest.