Mental Health Impact of COVID-19 in Radiation Oncology Health Care Workers of Asian Countries


A pandemic of epic proportions, COVID-19, caused by the new virus SARS-CoV-2, has taken the Asian medical fraternity by storm, not to undermine its impact on the rest of the world. The number of affected patients deluging hospitals has devastated the existing protocols of treatment and medical administration. Hospitals have been constrained to abandon traditional areas of medical attention and concentrate on the new epidemic. The sudden surge in the number of COVID-19 cases, coupled with national lockdowns, has exacerbated the pressure on health care systems across the globe.

The highly infectious nature of the virus and the lack of a medical repertoire to effectively combat it have put health care workers (HCWs) across Asia under the burden of mental and physical fatigue. Hospitals are working around the clock, over the accepted and permissible limits of infrastructure and manpower. The pressure on HCWs, both physical and psychological, with the added dimension of social ostracism, has made them susceptible to a variety of health consequences. This calls for ameliorative steps to be taken to keep the medical system from collapsing while facing an aggressive virus that has claimed over two million lives across the globe.

The COVID-19 pandemic created a detrimental impact on oncology centres worldwide. In cancer care, especially radiation oncology, the course of treatment extends to several weeks. The physicians and health care personnel involved – medical physicists, nurses, radiation therapy technologists, trainees and social workers – are at risk of constant exposure due to the fractionated nature of the radiation course. Psychological effects, such as anxiety, depression, stress, etc., significantly affect the medical workforce in the pandemic setting. The ‘morale and mental health’ of the HCWs are vital at such critical times. The indefatigable effort of the HCWs in the oncology community has made it possible to extend services to vulnerable cancer patients impacted by the pandemic.

An analysis of HCWs brings out a collective fear among them, largely sequestered in the domain of psychological pressure, infrastructural inadequacies, personnel administration and socioeconomic constraints. There is a high risk of infecting family members, especially in an Asian joint family environment with low/middle income and a high density of family members; inadequacy of personal protective equipment and raw exposure to infected patients; long working hours, shifts, etc. The long period of mandatory quarantine for HCWs has also had a deleterious effect on their mental health.

In this backdrop, the psychological impact of COVID-19 among radiation oncology HCWs catering to patients from various tertiary cancer care centres in Asia was analysed. The approval of the Institutional Ethics Committee (IEC) and registration under the Clinical Trial Registry of India (CTRI) was taken before the start of the study. With informed consent, 758 HCWs from 29 cancer centres with radiation oncology facilities in Bangladesh, India, Indonesia and Nepal participated in the study.

The analysis covered a period of 3 months from May to July 2020, when the pandemic was at its peak. A basic demographic profile and answers to three questionnaires to evaluate mental health status, the seven-item Generalised Anxiety Disorder (GAD-7), the nine-item Patient Health Questionnaire (PHQ-9) and the 22-item Impact of Events Scale-revised (IES-R), were collected, with the help of responses documented on Google sheets. The severity of anxiety, depression and post-traumatic stress disorder was examined from the GAD-7, PHQ-9 and IES-R scores, respectively, with higher scores representing increased severity.

European Journal of Clinical Oncology Cancer poses a major challenge to development; it undermines socio-economic advances throughout the world. It is estimated that the number of patients with cancer would increase from 12.7 million in the year 2008 to 22.2 million by 2030. It is universally agreed that the condition is reaching epidemic proportions. At this time, the European Journal of Clinical Oncology is conveniently placed in the scholarly communication milieu to help counter the menace of cancer by aiding the development of novel treatment strategies, by providing novel insights into the mechanisms underlying this complex disease.

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John Robert

Managing Editor
European Journal of Clinical Oncology
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