The stress of a being cancer patient is something most people can understand and many of our readers will be only too familiar with this. (For some tips on coping with stress, read more here.)
However, we seldom hear about the stress experienced by the medical professionals who treat cancer. Professor Dame Lesley Fallowfield from the University of Sussex UK spoke on the topic of burn-out and self-care to a large audience of oncologists and other cancer health care professionals at Breast Cancer Trials’ recent conference in Hobart.
A recent survey of cancer doctors and nurses in the UK showed that only 54% look forward to going to work; this can result in patients experiencing poor communication and even lack of compassion. Professor Fallowfield explained that the reasons for clinician burn-out are multifactorial, some of them institutional, including high numbers of patients, the faster pace of information exchange (the tyranny of emails), and a toxic culture in medicine which dictates that physicians must not show weakness and must stoically ‘soldier on’.
Signs of burn-out include feeling overwhelmed, mentally distressed and emotionally exhausted. This can lead to ‘de-personalisation' with clinicians becoming callous with their patients and their colleagues. When mental distress was measured using a General Health Questionnaire, 36% of cancer patients and 27% of oncologists scored highly enough to need intervention.
Professor Fallowfield also described moral distress and moral injury which are different from but related to burn-out. Physicians can feel moral distress when institutional and resource constraints prevent them from doing their jobs as well as they believe they should. This can lead to a profound sense of guilt and shame and result in serious mental health problems.
Compassion fatigue, which can result from the frequent witnessing of pain and suffering, was also reported by 55% of surveyed nurses.
If these issues are not recognised, physicians can resort to dangerous behaviours. Professor Fallowfield reported research revealing that one fifth of healthcare professionals have dangerous drinking habits: 44% of doctors are binge drinkers and 44% use drugs (mostly non-illicit prescription drugs) to ease mental distress. Rates of suicide are significantly higher in healthcare professionals than in the general population, particularly among female doctors and nurses.
Professor Fallowfield noted that not all the contributing factors to physician burn-out can be modified, and to change any of them would require energy, but she suggested the following interventions and mitigations: a supportive work environment, good teamwork, management and communication training, mentoring, Cognitive Behavioural Therapy, relaxation techniques, Mindfulness-Based Stress Reduction, and optimising workloads.
When attempting personal stress mitigation, Professor Fallowfield warned against blurring professional boundaries; it is important that physicians are not too cold, but also not too emotionally involved with patients. Treating one’s family or friends, making Facebook friends with patients, giving out personal phone numbers and hugging patients were all risky behaviours. ‘It is hard to be truthful about a prognosis if you like the patient, and you may not be able to make objective decisions about their care’ she warned.
Professor Fallowfield’s advice for clinicians was to review boundaries: the hours you work, the committees you sit on, learn how to say ‘no’ and not feel guilty, and re-evaluate what you love about your job and what you hate about it – can you increase the former and decrease the latter? Being a healthcare professional should be what you do, not define who you are.
She concluded by noting advice to doctors from Sir William Osler who in the 1880s emphasized the importance of having an avocation (a hobby or pastime) alongside their vocation in medicine.
8 August 2025
