SARS-CoV-2 was first detected in China as a respiratory disease in December 2019. It has spread around the world and become a global public health emergency. This disease was declared the first pandemic of the 21st century on March 11, 2020. The pandemic has duly affected oncology practitioners and has radically transformed health care delivery around the globe. It has created a sudden pool of patients with COVID-19 and has shifted focus, resources, and workforce to their management. Also, oncologists have been forced to bring changes in inpatient treatment schedules and workflows. In oncology, the pandemic has brought about changes in work schedules and roles and has facilitated the adoption of one telehealth. Also, it has caused a delay in patient presentation, delays of procedures and treatments, and suspension of clinical trials. Triage decisions about prioritizing essential versus nonessential have become fundamental in oncology care as well.
It is also becoming apparent that the events and the stress of the past several months have presumably affected the oncologists themselves in several ways, including physical, mental, social, and economic implications. This survey was conducted to assess the impact of COVID on current daily practice, oncologists' well-being, and understanding the extent of support available to them.
On April 25, 2021, the principal investigator designed an in-house survey form in consultation with department colleagues and was sent by e-mail/WhatsApp to 205 radiation oncologists working in the radiation oncology department of government and private hospitals across India. The survey had 17 questions and google form software was used for the final analysis. The form had several components covering a broad spectrum of issues. These included the clinical behavior of oncologists towards patients in COVID times, personal and financial matters related to the oncologist, the overall mental state of oncologists, and questions pertaining to COVID infections in oncologists and their vaccination status. The form was sent to medical, surgical, and radiation oncologists across the country. By April 27, 106 responses were received and were analyzed for the outcomes related to this study.
In all, there were 106 respondents. In total, 49.1% of these were radiation oncologists, while surgical oncologists and medical oncologists constituted 27.4 and 23.6%, respectively.
Approximately, 35% of respondents reported feelings of depression during the ongoing pandemic situation. In total, 41% of the oncologists reported a drop in their monthly salaries/emoluments. Compared to 62% of U.S. doctors said their income had dropped during COVID-19 compared to 31% of doctors in Spain, 41% of doctors in France, and 63% of doctors in Brazil.
In total, 20.8% of the responder oncologists had themselves suffered from COVID infection. Typically, 85.8% of oncologists had taken both vaccination doses, while 11.3% had received only a single dose so far.
In total, 49.5% of oncologists had reduced the extent of clinical examination of their patients, and 46.2% of oncologists felt that oncology care had been compromised in the present pandemic [Figure 1].
Some facets of changes in clinical practice have also been evident in oncologists. Our study was exciting but concerning to note that nearly 50% of the oncologists have reduced the extent of physical examination of their patients. This appears a direct consequence of the fear of getting closer to a potential COVID patient. Although we did not specifically ask the question, it is also likely that clinicians are more freely advising investigations, including computed tomography, magnetic resonance imaging, and positron emission tomography-computed tomography. In the same context, nearly 45% of the oncologists agreed that oncology care has become compromised and less evidence based. Over the last year, various oncology organizations have proposed modifying their treatment given the COVID situation. European Society for Medical Oncology Resilience Task Force collaboration evaluated how oncologists and other oncology professionals are affected by COVID challenges by assessing the impact on current daily practice, well-being, burnout, job performance, and understanding what support is available. The survey covered relevant issues as the COVID-19 pandemic evolves with a longer-term impact across countries.
In our study, nearly 35% of the respondents reported some feeling of depression. In the reported studies in literature, demographic factors associated with anxiety included female sex, younger age, and less time in clinical practice. Perception of inadequate personal protective equipment (68.6% versus 57.4%, P = 0.03) and practicing in a state with more COVID-19 cases (65.8% versus 51.1%, P = 0.01) have also been associated with anxiety symptoms.
The vaccination drive in our country was launched in January 2021. It is fulfilling to note that 85% of the oncologists have received both doses of vaccination, and 11% have received at least one dose of vaccination. To the best of our knowledge, there is no comparative figure for this parameter from the oncology community across the world.
We have to accept the limitations of this study. Being a questionnaire, it remains subject to several biases. Among our respondents, the majority came from Tier 1 cities. We have not presented any complex statistical analysis of our data since we just aimed to report simple figures and percentages of various aspects. On the positive side, this is the first study from our country to analyze the clinical issues and personal attributes related to oncologists in the present pandemic. While simplistic in design, it sheds valuable light on critical aspects of oncologists, their stress levels, and the pandemic implications for managing patients with cancer. While medical, surgical, and radiation oncologists are not exactly equal, there is a fair representation of each specialty in the responders.
In summary, our simple survey has shown that there are several ways in which the Indian oncology community has been affected by the pandemic. This seems to have affected not only patient care but the oncologists themselves as well. Managing patients with cancer with evidence-based guidelines can be challenging in present times.
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Conflicts of interest
There are no conflicts of interest.
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