HOPA Annual Conference 2019

Compassion Fatigue, Burnout and Self-Care: Why Self-Care is Not Selfish

Given that pediatric oncologists experience first-hand chronic mortality of young patients, this subset of physicians are especially vulnerable to developing compassion fatigue, which can lead to burnout. As such, these physicians need to take steps ensure they preserve their own physical and mental health, according to a presentation by Justin Baker, MD, an oncologist with St Jude Children’s Research Hospital,

Compassion fatigue, also known as vicarious traumatization or secondary traumatic stress, consists of the psychological consequences that medical professionals undergo working with people in the wake of traumatic events. Compassion disorder was first studied with respect to professions who were treating persons suffering from post-traumatic stress disorder (PTSD). Figley, who initially described compassion fatigue in 1995, stated that the term, “reflects the inevitable experience of the emotional exhaustion that comes from continuous compassion directed toward those in crisis.”

Potential factors that contribute to compassion fatigue include feelings and responses caused by empathy, concern, as well as prolonged exposure to suffering patients and families. The condition follows a stepwise trajectory comprised of four phases:

  • Zealot Phase – Characterized by an initial feeling of high enthusiasm and commitment, and the desire to make a difference while going the “extra mile.” Physicians in this phase often volunteer without being asked.


  • Irritability Phase – Practitioners may begin cutting corners and avoiding contact with patients/families. Physicians in this phase are susceptible to making mistakes and losing concentration.


  • Withdrawal Phase – Marked by diminished enthusiasm, increased exhaustion, and a tendency to view patients as irritants.


  • Zombie Phase –Irritability turns to disdain, and hopelessness to anger.


Perpetual compassion fatigue may lead to the onset of burnout, which refers to the long-term effects of emotional exhaustion and/or a decreased sense of personal accomplishment and purpose. Baker cited one author describing burnout as “the (end) result of a gradual process of wearing down, whereas compassion fatigue is a more immediate specific reaction.”

To avoid burnout, Baker outlined several strategies oncologists can implement for enhanced self-care. On an individual level, he said it’s pivotal to develop coping strategies.


  • Cognitive coping – Involves oncologists coming to terms with patient mortality and focusing more on the positives, both as it relates to their patients and field of oncology in general.


  • Behavioral coping – Oncologists are urged to take up hobbies, play sports, or take vacations as a means of clearing their minds.


  • Professional coping – Includes compartmentalizing work responsibilities, and possibly withdrawing from patients as end-of-life draws near.


  • Spiritual coping – Faith-based relaxation.


Baker J. Compassion Fatigue, Burnout and Self-Care: Self-Care is not Selfish. Presented at the Hematology/Oncology Pharmacy Association Annual Conference; April 3-6, 2019; Fort Worth, TX.

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