Burnout in oncology: is the situation alarming or reassuring?

Eelen and her colleagues [1] recently conducted a study on burnout in Flemish oncology staves (FOS) and concluded that these professionals, especially oncologists, were problematically afflicted by burnout. We have a few concerns regarding these authors’ conclusions. First, the alarming conclusions of the authors regarding burnout in FOS seem to neglect the results obtained when combining the three dimensions of burnout—emotional exhaustion, depersonalization, and lack of personal accomplishment. In this configuration, only 12 (2.18%) of the 550 participants were identified by the authors as cases of burnout, including only 1 (2.22%) of the 45 oncologists enrolled in the study. Based on such findings, FOS may be viewed as relatively free of burnout rather than particularly afflicted by burnout. Second, although the levels of burnout symptoms in FOS are described as problematic by the authors, it is noteworthy that, in the study sample, emotional exhaustion was experienced on average once a month (mean score around 2/6 on the Maslach Burnout Inventory [MBI]); depersonalization, a few times a year (mean score around 1/6 on the MBI); and personal accomplishment, a few times a week (mean score close to 5/6 on the MBI). These results too offer a more nuanced perspective on the health status of FOS. Third, when confronting their findings with the available literature on oncology staves’ burnout, the authors overlook the fact that heterogeneous procedures have been used to identify burnout in past research (e.g., in terms of case-defining cut points or burnout’s dimensions combination). This heterogeneity makes between-study comparisons difficult, particularly in a context where there are no binding diagnostic criteria for burnout. The way cases of burnout are defined directly impacts the observed prevalence of burnout, all other things held constant. Finally, a statistical basis to the authors’ discussion of the between-study differences in burnout is lacking. Because the statistical significance of the discussed differences is unspecified, the validity of the conclusions drawn on them is unclear. This adds to the uncertainty surrounding the authors’ interpretations. While we salute the efforts of Eelen et al. to investigate the problem of burnout in FOS, we think that these authors’ findings should be further questioned before concluding that FOS—and especially oncologists—are specifically at risk of burnout. Fundamentally, binding diagnostic criteria for burnout are needed to allow for rigorous assessments and comparisons of burnout’s prevalence across occupations.