September 20, 2017

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Here at the SIOP blog  this month, we wanted to continue to focus on the mental health of care providers.  In doing so we hope to ultimately provide resources to both recognize emotional distress in our colleagues and ourselves, as well as provide coping techniques.

Below is an excerpt from from an anonymous medical professional who graciously shared their own story regarding emotional distress within the confines of their work environment.  Following that, please read an article written by child psychologist Nicole Schneider, specializing in hematology/oncology  who emphasizes the known challenges of health care providers within this field and discusses coping methods for those working in pediatric oncology:

“I have a perfect life: my work is amazing; I have an incredibly supportive partner; we have no significant health or money worries.

I have depression.  I love my job and it is the one thing that drags me out of bed in the mornings. It is what forces me to ask for help; to take the medication; and to disclose to my supervisors that I am struggling.

There are good days and bad days. The bad days stretch into weeks and months until I forget what it’s like to have good days. I forget that this does not have to be my normal.

I will battle as hard as I can to stop my depression affecting how I act at work. It takes all of my spare energy. Because I love my job.  My colleagues think I am tired, that I need to rest.  But you cannot pretend with children: they see and understand. They do not heed the polite excuses; they don’t care when I say “I’m fine thank you. Just a bit tired!” with the bright tone in my voice and the upward-turned mouth.

“Why doesn’t she smile anymore?” says one of my patients, and I turn and show her that I am smiling, look my face is making the right shape. She is not fooled – she is 7 years old, partially sighted, and dying from the tumour that has taken her sight. But she walks over to give me a hug. I realise that she doesn’t care what labels my diagnoses place on me.

I am still her doctor. And she still hugs me”



Nicole Schneider, Psy.D. is a licensed psychologist at Texas Children’s Hospital, where she specializes in working with children, teenagers, and young adults with cancer.  She will be completing two posts on mental health in the pediatric oncology workplace.

As one might expect, taking care of chronically and critically ill patients can be extremely emotionally difficult. We are not surprised when we see parents struggle to cope with their child’s cancer diagnosis or when a spouse experiences stress while his or her loved one undergoes treatment. However, as providers, we often overlook our own emotional burden that stems from working with patients with cancer. As most of us have experienced, caring for patients and families affected by cancer can be particularly stressful because of the difficult conversations that often need to be had with families, the arduous and often unpredictable nature of cancer treatments, the bleak prognoses that some patients may have, and the increased demands in patient volume.

Literature suggests that working in oncology is further challenging because of clinicians’ perceptions that work demands are high while control is low, though the ratio of these factors have been found to vary depending on health care discipline [1]. This emotional stress has a number of adverse consequences which, when experienced for a prolonged period, can result in burnout. Burnout—which is characterized as exhaustion, decreased motivation, and hopelessness—is associated with diminished job satisfaction and performance [2]. Burnout also has significant behavioral, psychological, and physical health-related consequences. Studies show between one-third and one-half of oncologists suffer from emotional exhaustion, a major component of burnout; oncology nurses tend to evidence even greater emotional exhaustion [3, 4, 5].

Despite that oncology work is emotionally taxing for providers, there are numerous ways that we can protect ourselves from experiencing symptoms of burnout. Be sure to look for next week’s blog post to learn some practical coping strategies for managing job-related stress.


  1. Jones MC, Wells M, Gao C, Cassidy B, Davie J. Work stress and well-being in oncology settings: a multidisciplinary study of health care professionals. Psychooncology 2013;22:46-53.
  2. Freudenberger HJ. The issues of staff burnout in therapeutic communities. J Psychoactive Drugs 1986;18(3):247-251.
  3. Eelen S, Bauwens S, Baillon C, Distelmans W, Jacobs E, Verzelen A. The prevalence of burnout among oncology professionals: oncologists are at risk of developing burnout. Psychooncology 2014;23:1415-1422.
  4. Shanafelt TD, Gradishar WJ, Kosty M, et al. Burnout and career satisfaction among US oncologists. J Clin Oncol 2014;32(7):678-686.
  5. Alacacioglu A, Yavusen T, Dirioz M, Oztop I, Yilmaz U. Burnout in nurses and physicians working at an oncology department. Psychooncology 2009;18:543-48.

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