Alexithymia, Empathy and Burn-out Amongst Radiation Oncologists. the Pro Bono Survey

Abstract

Burn-out syndrome (BOS) is a frequent stress-related syndrome amongst oncology professionals. It affects performance in the working environment, physical and mental well-being. Certain personality traits may predispose to BOS. Alexithymia is a psychological construct describing deficits in emotion processing and awareness. Empathy is the ability to share and understand another’s ‘state of mind’ or emotion. The PROject on Burn-Out in RadiatioN Oncology (PRO BONO study) was developed to explore BOS in the field of radiation oncology and to investigate whether and how alexithymia and empathy may affect the likelihood to develop BOS. An anonymous survey was conducted online using the platform SurveyMonkey, targeting all European Society for Radiotherapy and Oncology (ESTRO) members. All professionals within ESTRO were involved, providing specific demographic and professional information, and requested to complete 3 validated questionnaires to evaluate alexithymia, empathy and BOS: the Toronto Alexithymia Scale (TAS-20), the Interpersonal Reactivity Index (IRI) and the Professional Quality of Life Scale (ProQoL), respectively. The present analysis was focused on the population of radiation oncologists. Compassion satisfaction (CS), secondary traumatic stress (STS) and BOS (the 3 ProQoL subscales) were evaluated and correlation with alexithymia and empathy (empathic concern, perspective taking and personal distress) was investigated usinggeneralized linear modeling. Covariates found to be significant on univariate linear regression analysis were included in the multivariate linear regression model. R2 and adjusted R2 were used to assess model fit. A total of 825 radiation oncologists, 56% male and 44% female, completed all requested questionnaires. Mean age was 41.8 years (SD:10.6). A higher level of alexithymia was associated to significantly decreased CS (β:-0.292;SE:0.019;p<0.001), increased STS (β:0.417;SE:0.018;p<0.001) and BOS (β:0.417;SE:0.018;p<0.001). A higher empathic concern was significantly associated to increased CS (β:0.121;SE:0.335;p=0.001), STS (β:0.120;SE :0.309;p<0.001), with no significant effect on BOS (β:0.059;SE:0.298;p=0.070). Personal distress was significantly associated to decreased CS (β:-0.179;SE:0.302;p<0.001), increased STS (β:0.227;SE:0.278;p<0.001) and BOS (β:0.178;SE:0.268;p<0.001). Perspective taking had no significant influence on CS, STS nor BOS. The PRO BONO study provided an overview on BOS, alexithymia and empathy among radiation oncologists. Alexithymic personality trait increased the likelihood to have BOS, with less professional satisfaction. Empathic concern was associated to increased level of stress (STS), but did not lead to BOS, resulting in higher professional fulfillment. Conversely, personal distress was associated to increased STS and BOS.