The Hardest Weeks of My Life: A Qualitative Study of Experiences, Practice Changes, and Emotional Burden of New York City Oncology Physicians During the COVID-19 Surge in 2020

Abstract

PURPOSE: The COVID-19 pandemic surge in New York City in Spring 2020 resulted in an unprecedented constraint on health care resources. This study aimed to explore the experiences of doctors providing care to oncology patients during this time. METHODS: Hospitalists and medical oncologists from two large inpatient services at a dedicated cancer center participated in virtual in-depth interviews exploring how the pandemic affected their practice and to what extent it may have affected decisions for urgent evaluation or hospital admission, interventions, or goals-of-care discussions. Interviews also explored how the pandemic affected each individual physician's psychologic well-being. Transcripts were analyzed by three independent coders in Atlas.ti v. 7.5, using a thematic analysis approach. RESULTS: Eighteen physicians were interviewed (n = 6 GI medical oncologists, n = 6 gynecologic medical oncologists, and n = 6 hospitalists). Analysis identified five major themes related to fear and distress: (1) perceived patient fears of the hospital during COVID-19, leading to avoidance and delay of acute care needs before admission, (2) physicians' fear and distress delivering oncology care during COVID-19, (3) physician distress resulting from ambiguity in decision making, (4) distress and anxiety balancing the need for patient contact with the need to minimize infection risk, and (5) distress regarding impact of uncertainty and acuity of COVID-19 on goals-of-care discussions. CONCLUSION: Insight into the experiences of physicians providing cancer care during a COVID-19 surge underscores the need for strategies mitigate short-term distress and long-term psychologic impacts. Findings can also inform practitioner training and preparedness for future pandemics in the oncology setting.

Oncology Healthcare Professionals’ Mental Health during the COVID-19 Pandemic

“…All of the studies reviewed noted that there were rapid and sudden changes to the nature of oncology HCPs’ day-to-day work lives including a dramatic decrease in face-to-face interactions with patients [ 52 , 53 ], deployment to other area of the hospitals [ 54 ] (including working on the front-line), lack of access to resources including personal protective equipment (PPE) [ 50 , 55 ], cancellation of surgeries and other treatments critical to patient’s health resulting in delays of live-saving treatments for patients [ 50 ], a substantially increased workload [ 54 ], loss of autonomy [ 54 ], reduced job security [ 51 ], reduced income [ 56 ], and reduction in research activities [ 56 , 57 , 58 ]. Moreover, oncologists were forced to transition to modifications in workflow schedules and to rapidly turn to virtual and telemedicine technologies [ 50 ].…”

“…The majority of studies published noted a marked increase in psychological distress among oncology HCPs [ 50 , 54 , 56 , 58 , 63 , 64 ], particularly high levels of anxiety [ 50 , 52 , 58 , 62 , 64 , 65 , 66 ]. Similar to the statistics prior to the pandemic, being young (under the age of 40) and female were risk factors for higher levels of emotional distress [ 59 ].…”

“…Similar to the statistics prior to the pandemic, being young (under the age of 40) and female were risk factors for higher levels of emotional distress [ 59 ]. Oncology HCPs reported feeling anxiety about: their own health and contracting COVID-19 [ 50 , 52 , 55 , 56 , 66 ], about infecting their families with COVID-19 [ 50 , 53 , 55 , 56 , 65 ], about their lack of training and/or clear protocols about how to manage patients with COVID-19 [ 55 ], about their patient’s well-being, particularly those whose care was delayed as a result of the pandemic [ 53 , 66 , 67 ], and anxiety that the pandemic will go on for a long time [ 53 ]. One study that looked at 870 oncologists found that nearly 80% reported a delay in care for their patients as a result of the pandemic, and that this delay was correlated with high anxiety and burnout scores among physicians when compared to physicians whose patients did not experience treatment delays [ 67 ].…”

“…Oncology HCPs also experienced feelings of a lack of control and uncertainty [ 51 , 52 , 64 ], guilt about not looking after their families, or providing the best care for their patients, feelings of depression [ 50 , 53 , 58 , 64 , 65 , 66 ], irritability [ 50 ], anger [ 50 ], post-traumatic stress symptoms ([ 63 , 64 , 68 ], peritraumatic distress [ 63 ], and sleep disturbance [ 67 ]. As a result of this distress, they reported using substances more frequently and noted an increase in the use of antidepressants and anti-anxiety medications [ 58 ].…”

“…Finally, another qualitative study of 18 oncologists reported that regret and fear of failing patients were common feelings around the care provided during the pandemic. Oncologists worried that they did not do enough for their patients or did not do the ‘right thing’ for them [ 52 ].…”