The pediatric oncology workforce has faced a host of financial, physical, and psychological obstacles during the COVID-19 pandemic, according to a study that surveyed workers from more than 200 institutions in 79 countries.
A snapshot of the extensive findings reveals that half of participating institutions experienced staffing shortages that had a “major impact” on pediatric cancer care. On the financial front, many respondents pointed to instances of unpaid leave and diminished salary, and others highlighted the psychological toll of providing care, including high rates of burnout and stress. The challenges were evident across high- and low-income countries.
Despite these barriers, pediatric oncology clinicians demonstrated incredible perseverance.
Healthcare professionals “caring for children with cancer across the world were shown to be incredibly resilient, coming together to continue to provide care even in the direst circumstances,” Elizabeth R. Sniderman, MSN, APRN, of St. Jude Children’s Research Hospital, Memphis, Tennessee and colleagues conclude.
The findings, published online January 24 in the journal Cancerhighlight the global impact of COVID-19 on pediatric oncology clinicians early in the pandemic.
The survey, conducted in summer 2020, included responses from 311 pediatric oncology clinicians who completed a 60-item questionnaire about their experiences of clinical care, resources, and support. The investigators also convened 19 multidisciplinary focus groups who answered questions related to teamwork, communication, and changes to care. Respondents practiced in low- to high-income countries, and included pediatric hematologists and oncologists, nurses, and infectious disease physicians.
Overall, the investigators found that just over half of institutions experienced “major” shortages of clinical staff (108 of 213), and two thirds experienced reductions in staffing availability (141 of 213). Notably, national income was not associated with this reduction; rather, staffing shortages were more likely to occur in countries with greater COVID-19 incidence and mortality rates.
Respondents reported experiencing threats to their physical health, with half pointing to a lack of necessary personal protective equipment. The financial and psychological toll of the pandemic represented another major stressor, with the effects described across all income levels.
One respondent from Belarus commented on financial concerns, noting that “people do not really want to admit that they do not feel well… they know, that if infected, unpaid self-isolation is waiting for them. Either you do not go to work for 2 weeks, unpaid, or you go to work for two weeks, paid, and endanger all of your colleagues with your infection. “
A respondent from Mexico described the psychological stress: “Honestly, I think that sometimes we put aside the mental health of all of us involved, myself included. I think we were all on the verge of collapse… practically all the residents who were rotating here told us that they had anxiety attacks, panic attacks, they could not sleep, [and] many of them needed psychiatric medicine. “
Others highlighted feelings of guilt about their ability to provide the highest level of care. An oncologist in the US noted, “This was a major stress for many providers because [we are] feeling unable to provide the same level of care which we used to provide. And this is what eventually takes a toll. “
And despite these pandemic-related challenges, the study authors found that only 46% of institutions (99 of 213) made psychological support available to staff.
Rays of Hope
But it was not all bad news.
Participants also described a greater sense of teamwork, communication, and collegiality throughout the pandemic – “stabilizing elements,” which helped mitigate the many physical, psychological, and financial stressors.
An infection-control physician in Belarus highlighted the importance of receiving “support and encouragement” from colleagues: “When a person gets tired and they have no more enthusiasm, it’s easy to give up and say, ‘I can not do this anymore. ‘ But when you see a colleague who tries to share the work, and help each other, then you get extra strength. “
An oncologist in South Africa agreed, noting that “everyone has got their sleeves rolled up and are doing the work… and that’s a testament to everyone that we work with. There was no one that shied away from work or used this as an excuse to do less work. “
An oncologist in Spain described practicing during the pandemic being “one of the best experiences I have had,” explaining that “I have been working in this hospital for… 25 years, [and] I have never had the feeling of being so informed at all levels. “
Overall, the findings paint a picture of a resilient workforce, and offer lessons on preparedness for future crises, the investigators conclude.
“To protect pediatric oncology providers and their patients, organizations must pay attention to interventions that increase physical, psychological, and financial safety,” the authors stress. For instance, providing adequate personal protective equipment and vaccines, allowing for time off and rest, and setting up professional psychology services as well as access to peer-support programs can help protect staff.
Although this survey took place relatively early in the pandemic, organizations should take heed of the findings, according to Lorena V. Baroni, MD, of Hospital JP Garrahan, Buenos Aires, Argentina, and Eric Bouffet, MD, of The Hospital for Sick Children , Toronto, Canada, in an accompanying editorial.
“The results presented in this study should not be taken lightly,” Baroni and Bouffet write. “The most concerning findings are the physical and psychological impact experienced by pediatric oncology providers.” And perhaps most surprisingly, “the survey did not identify any difference based on country income groups. Participants in both low- and high-income countries described similar oncologic care limitations.”
Overall, these findings “reflect a serious risk that can ultimately affect the care of children and compromise the success of their treatment,” Baroni and Bouffet write.
This study was supported by the American Lebanese Syrian Associated Charities. The study authors and editorialists have disclosed no relevant financial relationships.
Sharon Worcester is an award-winning medical journalist at MDedge News, part of the Medscape Professional Network.