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Review

Scoping Review of Peer-Reviewed Research Regarding Oncologist COVID-19 Redeployment to Emergency Care: The Emergency, Burnout, Patient Outcome, and Coping

by
Carol Nash
History of Medicine Program, Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
COVID 2025, 5(5), 61; https://doi.org/10.3390/covid5050061
Submission received: 15 March 2025 / Revised: 7 April 2025 / Accepted: 17 April 2025 / Published: 22 April 2025
(This article belongs to the Section COVID Clinical Manifestations and Management)
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Abstract

Introduction: A limited March 2024 Google Scholar search regarding COVID-19 redeployment to emergency care in fourteen medical specialties found no oncologist returns. Identifying oncologist redeployment through a scoping review of peer-reviewed research from several databases investigates this anomaly. Method: Searched are Web of Science, Scopus, PubMed, OVID, Google Scholar, and the Cochrane COVID-19 Study Register with the keywords “burnout AND COVID-19 AND emergencies AND oncologists” concerning the emergency experienced, their burnout response, and patient outcome. Results: Following the PRISMA scoping review process, the assessment is of eight reports from 17,848 results. The finding is that there was a redeployment of oncologists to emergency care. It was defined in various ways and caused oncologist burnout for several internally and externally directed reasons. These reasons negatively affected patient outcomes, contributing to the adoption of different coping techniques by oncologists. Oncologists, uniquely among medical specialists, experienced burnout regarding empathy for the increased mortality risk of their patients and the diminished doctor/patient bond. They also lacked symptom-directed coping. Conclusion: The results of this study may reinforce to oncologists the importance of their doctor/patient dyad and of initiating coping strategies that include symptom-directed health improvement techniques when the redeployment of oncologists is again to emergency care.

1. Introduction

In March 2024, this author investigated the response of medical specialties regarding redeployment from their usual appointment-based patient care to emergency care resulting from the 11 March 2020 [1]–5 May 2023 [2] COVID-19 pandemic to investigate their level of burnout and coping in an example of peer-reviewed publications. In this examination, oncologists were among those medical specialties searched by the author through Google Scholar on 31 March. The investigation period ran from 11 March 2020 to 5 May 2023 because the pandemic occurred between these dates. There was consideration of only the top four cited articles returned in the Google Scholar search for all specialties for that study. This limited search for examples produced no oncologists redeployed to emergency care. The result of the research was a June 2024 publication that did not include oncologists [3]—they were excluded because the limited Google Scholar for examples to only the top four results did not identify any. Consequently, the hypothesis is that oncologists redeployed to emergency care would be identified with a more extensive scoping review of peer-reviewed publications of relevant databases. The undertaking of this scoping review is to test this hypothesis.
That oncologists would be redeployed to emergency care during the pandemic and would experience burnout was thought likely as, pre-COVID-19, burnout in oncologists was recognized as a serious issue [4], something further reinforced by a systematic review and meta-analysis undertaken to investigate the extent of the problem pre-COVID-19 [5]. Since then, COVID-19 increased the burnout in all oncologists, apart from their redeployment to emergency care, as reported in several studies [6,7,8,9], with different approaches employed by oncologists to mitigate this burnout [10,11].
Additionally, it is reasonable to hypothesize that oncologists were redeployed to emergency care during COVID-19 because there have been systematic reviews of the redeployment of healthcare providers, in general, to emergency departments regarding intensive care that included cancer patients [12] and the effects of COVID-19 on cancer care [13]. Also, there is a scoping review on the impact of COVID-19 on cancer care [14], plus a study of the perceptions of oncology professionals about emergency preparedness during COVID-19 [15]. However, compared with these previous publications that generally assessed cancer patients seen in emergency departments and oncologist perceptions regarding emergency care during COVID-19, this is the first scoping review specifically on the redeployment of oncologists to emergency departments during COVID-19.
Such an investigation is timely because of the high and growing [16] volume of patients with advanced cancer who visit emergency departments annually, the complexity of their treatments required, plus their frailty and the acuteness of their illness, requiring the specialized knowledge of oncologists for adequate care management [17]. This need for oncologists is evident, although emergency medical professionals are receiving increasingly specialized training in this regard [16], as, significantly, cancer patients are often initially diagnosed from admittance to the emergency department [18]. What is also apparent is the awareness of oncologists that COVID-19 appreciably affected their cancer management [19].
This investigation aims to determine the redeployment of oncologists to emergency care during COVID-19. With a finding of redeployment, consideration is to the type of emergency they experienced, whether these oncologists had a burnout response [20,21,22,23], and the patient outcomes of combining the redeployment emergency and the burnout response. Also identified are the oncologist coping strategies [24], similar to the author's earlier publication regarding 14 medical specialists [3]. The consideration is that meeting the goal of determining if there was a redeployment of oncologists to emergency care and, if so, examining the results is best fulfilled by undertaking a scoping review [25].
This work is significant as there is no other scoping review of the redeployment of oncologists to emergency care during COVID-19 aiming to discover the type of emergency they encountered, their burnout experienced, the patient outcome, and the coping strategy used to mitigate the burnout. These results matter as the global cancer burden during the pandemic continued to increase [26,27], the perceived lack of pandemic emergency training led to oncologist trainees considering leaving the profession [28,29], and the likelihood of experiencing another future pandemic is perceived to be high [30] leading to their redeployment to emergency care again.

2. Materials and Methods

The selection of a scoping review for this search is a consequence of the aim to find the range of research on this subject and to determine possible gaps in the literature on the topic [31] rather than to examine PICO (population, intervention, comparison, and outcome), requiring a systematic review and meta-analysis [32]. Therefore, following the expected process for a scoping review, a quantitative meta-analysis is excluded from this report. The general advice for scoping reviews in medicine is to include gray literature beyond peer-reviewed publications to improve the range and depth of the search [33]. However, the limiting practice of including peer-reviewed publications alone in a scoping review when practical and ethical considerations of educational value are involved [34] is the practice for this scoping review.
Scoping reviews have their most comprehensive examination in the 2018 seminal research by Tricco et al. [35], updated by Peters et al. in 2020 [31]. This study follows the 2020 PRISMA guidelines for scoping reviews [36] in the gathering of materials and the methods used [36,37]. Internationally standardized [31], the PRISMA process for scoping reviews is considered the best practice guidance for scoping reviews [38], providing the reason for following this process for this scoping review. The preregistration of this study as a scoping review is at https://doi.org/10.17605/OSF.IO/G9HZU (accessed on 15 March 2025).
The method includes searching relevant databases and a database register for the keywords, then removing each of the duplicates and those articles that are not peer-reviewed. This work was accomplished by hand by the author. As per the requirements of the PRISMA flow diagram [36], the databases searched are differentiated only regarding the location of the records. All records returned from each database are combined once the “Records removed before screening” is undertaken.
There is no requirement for the number of databases to search for a scoping review [38]. There is, however, a distinction between primary databases, which consistently return the same results, and those considered supplementary databases, where the search results depend on the particular search [39]. The primary databases used in this search are Web of Science, Scopus, PubMed, and OVID. Their search is conducted in that order. Their selection as the databases to search pertains to the topic and their high regard as databases [39]. Its relevance to COVID-19 [40] and reducing the manual screening workload needed for identifying COVID-19 research studies [41] are the reasons for including the Cochrane COVID-19 Study Register. A search of Google Scholar extended the reach of the returns.
Google Scholar is considered a supplementary database [39]. It was selected for the search as a 2019 study of twelve academic databases found it the most comprehensive search engine [42]—reconfirmed by 2023 research [43]. However, in 2020 [39], Google Scholar was evaluated as unsuitable for primary review searches; yet, in the same research, there is an acknowledgment that it is the most comprehensive database and the one used mainly by academics, regardless of its low precision and lack of support for many of the features of systematic searches. This database is recognized to outperform the coverage of either Scopus or Web of Science [42], providing the reason for including this database as part of the search process. As a scoping review, in which comprehensiveness is key, Google Scholar is significant to achieving the intended purpose of the undertaking.
Materials were obtained by following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews [36], providing the flow diagram for the conducted searches and checklist (submitted as unpublished material). The 8 February 2025 searches were of the keywords “burnout AND COVID-19 AND emergencies AND oncologists” for those articles published between 2020 and 2023 during the pandemic. The order of the searches was Web of Science, Scopus, PubMed, OVID, Google Scholar, and the Cochrane COVID-19 Study Register.
The inclusion criteria are peer-reviewed articles published during the COVID-19 pandemic (2020–2023), and all keywords are identifiable in the report. The exclusion criteria are duplicates, not peer-reviewed, published outside the pandemic period, keywords missing from the publication, and irrelevant information regarding the keywords.
The creation of a Word document followed each search, containing the information regarding the searched results. The combination of results of all the searches is in one document, Supplementary File S1: Search Results of Each Database Conducted on 8 February 2025 in Order of the Performed Search. The information for each search includes the keywords, additional limits, the number of returns, duplicates, and reports lacking oncologists, emergencies, and burnout.
The Web of Science search process included Keywords: burnout AND COVID-19 AND emergencies AND oncologists; Publication date: 12 March 2020–5 May 2023. There were three returns. All were duplicates of other database searches that followed—either to Google Scholar (in two instances) or to Scopus and PubMed (in one return). As there were only three—all duplicated with other databases—these articles are not those counted as included.
With the Scopus database search process, the inclusion was Keywords: burnout AND COVID-19 AND emergencies AND oncologists; Published from 2020 to 2023, and returned four articles. Two were duplicates—one in Web of Science and Pub Med, the other in Google Scholar. Another did not mention oncologists in the text, although it mentioned oncologists in the references. The last excluded (but first returned in the search) did not discuss emergencies. The outcome is that the count of the results from the Scopus search includes none.
The PubMed search process included Keywords: burnout AND COVID-19 AND emergencies AND oncologists; From 12 March 2020 to 05 May 2023. The result was that one counted as a duplicate of a return and was found in both the Web of Science and Scopus searches. This one represents the only relevant return of the five report results, as the other four did not concern emergencies.
With 32 returns, the OVID search was the first to return more than a handful of articles. There were several limits to the search process: Keywords: burnout AND COVID-19 AND emergencies AND oncologists; Databases searched: Embase Classic + Embase, APA PsycInfo, Ovid Healthstar, AMED (Allied and Complementary Medicine), JBI EBP Database, Journals@Ovid Full Text, Ovid MEDLINE(R) ALL; Publication years 2020–2023 However, only nine of the articles returned are included in the supplementary document because twenty-two were abstracts and one was a review—excluding them after screening. Three of the nine are duplicates of Google Scholar returns. Although two others are concerning oncology, they do not mention oncologists. Following the reports excluded, four reports remain included.
The Google Scholar search returned orders of magnitude more than the other searches, with 17,800 returns. The search limitations were Keywords: burnout AND COVID-19 AND emergencies AND oncologists—from 2020 to 2023. Since Google Scholar is a crawler-based search engine, returning the most relevant articles first [39], consideration was to the Google Scholar returns until a page listing ten returns did not include at least one relevant article. This process involved returns from eighteen pages, equaling 180 studies, excluding 17,620 records. Of these, it was clear that 128 of them did not concern oncologists from the title alone, and two were not in peer-reviewed journals. A manual investigation of the remaining 51 returns found that four were not regarding oncologists. Of the 41 that did not concern emergencies, two are the duplicates mentioned from Web of Science and Scopus. The Google Scholar search is the only search that returned reports lacking burnout, numbering three. Most returns were excluded, with only three included. The medically related primary databases did not return these three, which is notable—justifying the decision to search the Google Scholar database for this scoping review.
The Cochrane COVID-19 Study Register search was the Keywords: burnout AND COVID-19 AND emergencies AND oncologists; From 2020 to 2023. It produced no returns.
The recording of the databases and the search parameters is in Table 1.

3. Results

The search process following PRISMA guidelines [36] is represented in the PRISMA flowchart of Figure 1.
The titles of the eight included reports in order of their search on 8 February 2025 follow. The PubMed search returned one: “Burnout, coping and resilience of the cancer care workforce during the SARS-CoV-2: A multinational cross-sectional study” [44] published in 2023. The OVID search returned four reports, one from each of the four years associated with COVID-19. They included “Bio-ethical issues in oncology during the first wave of the COVID-19 epidemic: A qualitative study in a French hospital” [45], “The role of telehealth in oncology care: A qualitative exploration of patient and clinician perspectives” [46], “Victoria (Australia) radiotherapy response to working through the first and second wave of COVID-19: Strategies and staffing” [47], and “[Comment] Ethical and practical considerations on cancer recommendations during COVID-19 pandemic” [48]. The final group of returns is from the Google Scholar search: “Burnout among oncologists, nurses, and radiographers working in oncology patient care during the COVID-19 pandemic” [6] from 2023, “Oncology workload in a tertiary hospital during the COVID-19 pandemic” [49] published in 2022, and “Scientia potentia est: how the Italian world of oncology changes in the COVID-19 pandemic” [50]—an Italian publication from 2020 when COVID-19 was particularly severe in Italy [51] (see Table 2).
From Table 2 the following points are evident. The studies were either surveys [6,44,47,49,50] or interviews [45,46], except for the first publication during the pandemic, which was purely observational of colleagues [48]. Three studies had few participants [45,46,47], three had a mid-range number of subjects [6,44,49], and one study had a large number of oncologists participate [50]. In only the first published study was the number of participants unknown, the total representing the author’s colleagues [48]. Although there was a worldwide representation of the studies, the focus of all studies was developed countries. In the global investigation, only two of the 41 participants were from Africa [44], and there was no mention of their differences from oncologists in developed countries.
The eight reports confirm the hypothesis that there is a range of peer-reviewed publications regarding oncologist redeployment to emergency care during the years of the COVID-19 pandemic. Next, the examination of the text is with a qualitative assessment for three results: (1) the emergency experienced by the oncologists, (2) their burnout response to the emergency, and (3) the outcome for patients contending with the emergency and with the burnout of their oncologist.

3.1. Qualitative Assessment of Oncologist Redeployment Results

The results of oncologist redeployment are in Table 3. These results are obtained from a qualitative reading of each report in the tradition of narrative research [52] that (1) clarifies the study purpose(s), (2) defines the quality of the study, (3) situates the research in relevant contexts, (4) draws conclusions (5) and identifies limitations to the assessment [53].

3.1.1. Emergency Experienced

The emergency experienced by the oncologists, according to the records returned noted in Table 3, can be grouped by topic. Table 4 provides these groupings in order of their searched return, dividing them into whether the focus of the emergency concerns the oncologist or others. The first type of emergency experienced is oncologist-centered and regards a change in their work routine [44,48,50]. Modifications during COVID-19, producing an emergency, clarify that oncologists had not previously prepared for such emergencies, unlike nephrologists [54,55]. The second type of emergency is also oncologist-centered and concerns the increased workload experienced by the oncologists [6,44,49]. Similarly to the changes in the work schedules, this change was the first returned emergency from the search, also appearing twice later in the search process. The emergency following is other-centered regarding patients [45]. The emergency is an increase in their mortality and decreased patient survival time. Significantly, only one report considered the emergency to relate to a concern for the patient in this regard. The final topic covers the other-centered relationship between the oncologist and the patient [6,46,47]. This topic required the use of telehealth during COVID-19—also necessitated in several other medical specialties as a result of the pandemic, including cardiologists [56], dermatologists [57], gastroenterologists [58], and, most successfully, psychiatrists [59]. The use of telehealth was considered inappropriate for this relationship by both the oncologist and the patient when having to (1) relay bad news, (2) visually inspect the progress of the disease (similar to dermatologists [57]), or (3) show empathy.

3.1.2. Burnout Response

Similarly to the emergency experienced, burnout responses by oncologists found in Table 3 are groupable into two topics—oncologist-centered and other-centered—in Table 5. The concern of most oncologist burnout responses [6,44,47,48,49] was their increasing burnout regarding escalating personal symptoms associated with burnout [22]. These symptoms have been found in physicians in general [23]. The other-centered concerns leading to increased burnout in oncologists are of three different types. (1) Those regarding patients, (2) ethical dilemmas stemming from a decrease in quality care, and (3) worries about infecting family members. The evidence is that highly empathetic physicians are the ones who developed pronounced burnout during COVID-19, leading to abandoning the profession [45]. However, unlike oncology nurses [6], abandoning the profession was not an outcome displayed by oncologists concerning the burnout they experienced from empathy for patients during COVID-19. Burnout produced by ethical distress [46] is associated with oncologists, given their role in delivering serious news and end-of-life decision-making—the pandemic produced moral strain, distress, and injury in delivering serious news and end-of-life decision-making [9]. Telehealth decreased the ability of oncologists to provide empathetic care, presenting a form of burnout distinct to oncologists by producing compassion fatigue [60]. Concern for infecting family members [50] was not unique to oncologists and was found most evidently in those physicians specializing in internal medicine [61] and neurology [62]. Early in the pandemic, this worry was reported by all physicians in contact with COVID-19 patients internationally [63].

3.1.3. Patient Outcome

Grouping the patient outcomes by oncologist-centered and other-centered from Table 3 by topic in Table 6, the detrimental change to the patient’s relationship with their oncologist that was the most significant outcome was a decrease in their level of care [6,44,48,49] to the extent that patients felt the emergency experienced by oncologists and their burnout response put their own life in danger [45]. In a study of oncology patient perceptions of their care during COVID-19, concerns regarding dying from COVID-19 gained one of the most “agreed” and “strongly agreed” responses to questions [64]. The loss of intimate contact with the oncologist [6,46,47] was primarily a result of necessitating telehealth and what patients witnessed as institutional decisions coming between them and their oncologist [50]. During COVID-19, there was an association between feelings of social isolation of oncology patients and a higher incidence of death [64]. Of these concerns, the most numerous regarded what patients saw as the decreased level of care provided, producing oncology patient mistrust in the healthcare system during COVID-19, recognized in a qualitative analysis of patient experiences [65]. This result indicates that medical resource allocation is among the other potential factors affecting patient outcomes. Although most patients did not equate this decrease in care to the possibility of their increased mortality, and, in a qualitative study, oncology patients did not see COVID-19 as a barrier to continuing their in-person care [66], noting the decrease in care as the outcome means this decrease might lead to that result. Oncologists anticipated this concern by patients early in the pandemic regarding the possibility of increased litigation resulting from the COVID-19 imposed changes [67,68]. A significant and persistent impact on oncologic patient care results from the pandemic, irrespective of geographical areas [69]. The prevalence of these patients experiencing long COVID [70] is noticeably higher than in other patients, possibly due to immune system compromise and weakened physiology [71]. However, a 2025 publication in a volume has noted that delays in surgery for one type of cancer did not affect long-term patient outcomes, demonstrating that there can be positive results in these difficult situations [72]. The long-term effects on breast cancer patients remain unknown [73].

3.2. Oncologist Coping

The eight articles describe the coping of oncologists. They presented various ways oncologists dealt with their burnout and the effect of COVID-19 on their relationship with their patients. The coping style changed over the years of the pandemic (See Table 7). “[Comment] Ethical and practical considerations on cancer recommendations during COVID-19 pandemic” [48] and “Scientia potentia est: how the Italian world of oncology changes in the COVID-19 pandemic” [50] were both published in 2020. In this first year of the pandemic, oncologists used avoidance as a coping technique by transferring patient emotional support to psychological support provided by experienced volunteers. At the same time, they turned to preparedness methods as a coping strategy to reduce their burnout. The publication of “Victoria (Australia) radiotherapy response to working through the first and second wave of COVID-19: Strategies and staffing” [47] was in 2021, and during this second year of the pandemic, oncologists were coping with their burnout through detachment because thinking about COVID-19 made them fearful. “The role of telehealth in oncology care: A qualitative exploration of patient and clinician perspectives” [46] and “Oncology workload in a tertiary hospital during the COVID-19 pandemic” [49] were published in volumes in 2022. This year saw some oncologists still using detachment to cope, as losing their direct contact with patients was too upsetting to consider. However, this detachment resulted in oncologists lashing out at others, even producing thoughts about leaving the profession. Each of “Burnout, coping and resilience of the cancer care workforce during the SARS-CoV-2: A multinational cross-sectional study” [44], “Bio-ethical issues in oncology during the first wave of the COVID-19 epidemic: A qualitative study in a French hospital” [45], and “Burnout among oncologists, nurses, and radiographers working in oncology patient care during the COVID-19 pandemic” [6] were reports from 2023. Oncologists used three coping techniques at that time. The first was continued reaction because of their diminished coping and reduced resilience. The second was attacking the problem by a call for the creation of multidisciplinary team meetings for emergencies like COVID-19. Thirdly, the emotional exhaustion that oncologists experienced led to the type of detachment causing depersonalization. This emotional exhaustion and detachment were the primary means of coping for healthcare workers generally during the pandemic period [74]. Although it might have [7], the results of these eight reports indicate that the introduction of vaccines did not have a noticeable effect on reducing the burnout of oncologists.
In process-related coping theory [75,76], coping is a relationship between the objective environment and the focus of an individual regarding that environment. The basis of these descriptions of the coping techniques and their relationships is the 1985 presentation of the process by Lazarus [77], with added refinement from the 1993 publication by the same author [76]. From the point of view adopted, the individual then makes a cognitive appraisal of the sensed environment. Once the oncologist appraised the COVID-19 pandemic as a negative, the selection was between emotion and problem-focused coping responses, although these foci are not exclusive since a physician may use several coping strategies simultaneously [78]. The emotion-focused coping that oncologists experienced was a detachment from the pandemic. This strategy began to be employed once the pandemic endured. It was not one used at the beginning of COVID-19. Problem-focused coping was the first form of coping. Throughout the pandemic, it took three forms: avoid, prepare, and attack, in that order, with attack coming later in the pandemic. Together, the coping techniques by oncologists reported in the eight studies during their redeployment to emergency care were insufficiently effective in reducing their burnout, causing a decrease in patient care.

4. Discussion

Compared with other medical specialties [3] that had developed emergency care procedures before the pandemic, such as nephrologists [54,55], oncologists were less effective in managing their burnout. Furthermore, unlike psychiatrists [59], they had not found a way to successfully incorporate telehealth into their emergency care to improve patient care. In contrast, in viewing this type of contact with patients as producing ineffective care, there was a similarity between the telehealth experience of oncologists and dermatologists [57]. Although, early in the pandemic, oncologists had focused on the increased possibility of augmented litigation resulting from COVID-19 [67], these worries did not appear [79]—as they did for physicians in gastroenterology [80] and physicians specializing in internal medicine [81]. It may be because the litigious environment did not evolve as it did for these other specialties that oncology did not observe mass resignations [8] resulting from the COVID-19 redeployment of these specialists to emergency care.
Oncology has a well-established focus on empathy as patients with cancer experience significant emotional distress to the extent that oncologists aim to reduce patient emotional distress after a consultation [82]. This specialty focus on empathy provides the foundation for identifying a concern for the compromised health of the patient and the reduced intimacy in the doctor/patient relationship as a cause of oncologist burnout [45,46]. Burnout in other specialties did not result from this remarkable patient and relationship empathy [3]. What was similar among oncologists [50] and other specialties [57,62,80,83,84] was their concern about infecting their families due to redeployment to emergency care during COVID-19.
The cherished relationship between patient and oncologist supports why the patient outcome was generally negative regarding the redeployment of oncologists to emergency care, exacerbating their burnout because of a compromised relationship. Patients were unhappy about the effect of oncology burnout on their health [6,44,48,49] and its increasing risk of mortality [45], as well as the breakdown in the patient/oncologist relationship [6,46,47]. This relationship focus for patient outcomes regarding oncologists was not evident for other specialties [3]. What was similar among oncologists [50], gastroenterologists [80], nephrologists [85], obstetricians [86], and plastic surgeons [87] is that patients deemed the administrative changes instituted at hospitals competed with their best interests.
There is extensive research on the techniques of burnout reduction in oncologists in [10,11]. Also, in the publication that prompted this scoping review [3], the author conducted a substantial analysis of coping strategies for physicians redeployed to emergency care. Similarly to other medical specialties [3], one type of emotion-focused coping technique that was unmentioned in the eight returned articles of this scoping review as utilized by oncologists was symptom-directed. Such symptom-directed, emotion-focused coping techniques take both positive and negative forms regarding physician health. Relaxation techniques, such as meditation, physical exercise, yoga, or other mindfulness techniques, were available to the oncologists regarding their burnout from redeployment [88,89]. The identification is that yoga is particularly effective in reducing the stress leading to burnout of healthcare workers in general [90]. However, regarding these eight articles, none of the oncologists studied used these relaxation techniques. These positive coping techniques may have been effective for oncologists had they been used. Significantly, there was no report in these eight studies of oncologists turning to substance use to mitigate their burnout—the negative form of symptom-directed emotion-focused coping techniques. However, not all oncologists were able to avoid the use of substances for their burnout during the pandemic [91].

Strengths, Limitations, and Future Research Directions

The strengths of this analysis are that (1) evidence has been provided from the most likely databases to contain reports from peer-reviewed sources that redeployment of oncologists to emergency care during COVID-19 was evident, and (2) the analysis following the PRISMA requirements for scoping reviews was of the type to answer the emergency experienced, the burnout result, and the patient outcome. Additionally presented are the coping strategies employed by oncologists from the returned results of the scoping review.
There are several limitations regarding the method selected for the review. In choosing a scoping review, the author did not select to follow a PRISMA systematic review with a meta-analysis. Such systematic reviews answer narrow clinical questions in the PICO (population, intervention, comparison, and outcome) format [32]. As the intent of this examination is not direct guidance of clinical decision-making, the delivery of care, or policy development [25], a systematic review and meta-analysis is inappropriate. The aim instead corresponds with a PRISMA scoping review [25,92]. Ensuring the quality of the included studies with the performance of a risk of bias assessment is, therefore, not recommended [93]. What this study does as a scoping review is identify and highlight research gaps suggesting further investigation [38]. However, in conducting this scoping review, the decision was made to limit the review to peer-reviewed articles as this corresponded to the scoping reviews related to practical and ethical considerations of educational value [34]. Had this scoping review extended to gray literature and works in languages other than English, the likelihood is that additional results regarding the redeployment of oncologists to emergency care might have been apparent. Future research directions should include a scoping review with gray literature and other languages. These suggestions would extend to a future systematic review and meta-analysis.
That one researcher accomplished the work undertaken is another method limitation. As the interpretation of the results might have been affected by misreading the results [94] or an unrecognized cognitive bias [95], documenting all processes is the most effective way to eliminate bias in such circumstances. By providing extensive detail regarding the PRISMA scoping review process undertaken—more than required by [36]—and submitting the results as Supplementary File S1, other researchers may examine the method and results for veracity. Future research would involve a research team conducting additional scoping reviews of this matter.
The paucity of relevant results for several database searches, especially the Cochrane COVID-19 Study Register yielding no results, is an additional limitation. This lack of returns questions the chosen keywords for inclusion, as studies with added depth or contrast to the results might be missing. However, limiting the keywords in this manner eliminated many irrelevant articles [96]. Another limitation regarding the small number of returns is a reduction in the generalizability of the findings [97]. Finally, by including Google Scholar—a supplementary database—as one of the searched databases, the importance of its search results overshadowed those of some of the primary databases (Scopus and Web of Science). The Google Scholar search results were successful because this database is the most comprehensive, explaining it as the primary search engine academics use [39]. Consequently, it is reasonable to select it for this search and that it would provide more returns than some primary databases. Continuing investigation into the effectiveness of Google Scholar for scoping review in the medical sciences is necessary.
The returns from this scoping review found no oncologists who could decrease their burnout with the coping strategies they employed. This result does not mean that there were no oncologists who were able to reduce their burnout during the pandemic. Oncologists judged as hardy or resilient [11] had a significant possibility of lessening their burnout during the pandemic as these traits have been found protective in the healthcare provider population in general [98]. Young oncologists with a good work–life balance are those likely to mitigate burnout [10]. Research concentrating on investigating the efficacy of various relaxation techniques used by oncologists to lessen their burnout from redeployment to emergency care during COVID-19 would be valuable.
Finally, the results were from developed countries. There is no information provided in this scoping review of the effect of emergency deployment of oncologists in developing countries on their burnout and patient outcomes. Future research on this topic would be to gather the results regarding oncologists in developing countries.

5. Conclusions

Based on previous research on the redeployment of medical specialties to emergency care during the pandemic, the results were unknown whether there was such redeployment of oncologists from their usual appointment-based care. This scoping review determined there was a redeployment of oncologists to emergency care. Additionally, there was an identification of the emergency they encountered, their burnout, and the effect on patient outcomes, with the results divided between oncologist-centered and those centering on others, leading to various coping means that changed over the years of the pandemic.
Initially, the emergency that oncologists faced was a decrease in the treatments offered to patients, requiring a reorganization of patient management. Although remote working strategies saw a quick adoption, this change resulted from an inability to meet with patients in person, not from choice. Unable to meet with their oncologist in person, the number of visits of oncology patients to the emergency department increased, with critical surgeries delayed and a reduction or suspension of chemotherapy. Patient mortality increased, and their chance of survival decreased, brought on in part by the restricted methods of contact between oncologists and their patients demanded by hospital administrations resulting from COVID-19-related limitations.
The burnout of oncologists changed over the years of the pandemic in response to the emergencies they encountered. The stress level increased, as did fatigue, leading to the possibility of accidents. Concomitantly, oncologists were concerned about the high risk of infecting their families with COVID-19. Feeling exhausted by the end of the day, oncologists experienced significant distress regarding telling patients dire news on telehealth. The increased fatigue led to poor personal health, including increased levels of post-traumatic stress, anxiety, and depression. Part of this burnout was additional concern for the increased mortality of their patients and decrease in effective contact with them, leading to feelings of depersonalization.
Cancer patients were distressed by the redeployment of their oncologists to emergency care and the burnout experienced by oncologists, feeling neglected. These feelings produced a clash between patients and hospital administration, as 90% of patient contact was now by telehealth, resulting in decreased intimacy in the patient/oncologist dyad. Postponement of elective admissions and non-critical appointments meant most oncologists reported that they could not attend to patients effectively. Mortality of patients increased partially resulting from an inability of family members to visit, leading to the mishandling of patient emotions by oncologists.
The coping of oncologists with their redeployment, burnout, and patient outcomes took two forms: emotion-focused and problem-focused. At the pandemic's start, oncologists were apt to be problem-focused—either through avoidance or preparedness. However, as the pandemic persisted, the coping strategies shifted primarily to emotion-focused, with oncologists either detaching from the situation or reacting to it with intense, negative outbursts or by wanting to leave the profession. The result of these strong negative emotions was that the problem-focused coping to which oncologists returned late in the pandemic was attacking the problem by wanting change in how emergencies, like the COVID-19 pandemic, were handled administratively. One unreported type of coping strategy in this scoping review was symptom-directed, both positively through relaxation techniques and negatively with substance use.
How the redeployment of oncologists to emergency care affected oncologists was in some ways similar to other medical specialties, but because of the intimate relationship developed between the oncologist and patient, the empathy of oncologists towards their patients affected and increased their burnout and the forced changes to the relationship—usually the result of institutional requirements—diminishing patient outcomes.
These research results are a valuable reinforcement to oncologists and their patients regarding the importance of their doctor/patient bond. Hearty and resilient oncologists will cope best with pandemics in this regard. For those lacking these qualities, the advice to oncologists is to initiate coping strategies during future pandemics that improve their health through relaxation techniques rather than those assumed during the COVID-19 that did not reduce their burnout. When oncologists are again redeployed to emergency care, relying on these positive symptom-directed coping techniques has the best chance of effectiveness in reducing burnout and improving patient outcomes.

Supplementary Materials

The following supporting information is downloadable: https://www.mdpi.com/article/10.3390/covid5050061/s1, Supplementary File S1: Search Results of Each Database Conducted on 8 February 2025 in Order of the Performed Search.

Funding

This research received no external funding.

Data Availability Statement

No new data were created.

Conflicts of Interest

The author declares no conflicts of interest.

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Figure 1. The PRISMA Flow of Information Chart for scoping reviews [36] of a search of the keywords “burnout AND COVID-19 AND emergencies AND oncologists” on 8 February 2025, of Web of Science, Scopus, PubMed, OVID, Google Scholar databases, and the Cochrane COVID-19 Study Register listed in order of the most results to the fewest.
Figure 1. The PRISMA Flow of Information Chart for scoping reviews [36] of a search of the keywords “burnout AND COVID-19 AND emergencies AND oncologists” on 8 February 2025, of Web of Science, Scopus, PubMed, OVID, Google Scholar databases, and the Cochrane COVID-19 Study Register listed in order of the most results to the fewest.
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Table 1. Databases searched on 8 February 2025, the search parameters and the number of returns regarding searches of the keywords “burnout AND COVID-19 AND emergencies AND oncologists” listed in the order searched.
Table 1. Databases searched on 8 February 2025, the search parameters and the number of returns regarding searches of the keywords “burnout AND COVID-19 AND emergencies AND oncologists” listed in the order searched.
DatabaseSearch Parameters#
Web of ScienceKeywords: burnout AND COVID-19 AND emergencies AND oncologists
Publication date: 12 March 2020–5 May 2023		3
ScopusKeywords: burnout AND COVID-19 AND emergencies AND oncologists
Published from 2020–2023		4
PubMedKeywords: burnout AND COVID-19 AND emergencies AND oncologists
From 12 March 2020 to 05 May 2023		5
OVIDKeywords: burnout AND COVID-19 AND emergencies AND oncologists
Databases searched: Embase Classic+Embase, APA PsycInfo, Ovid Healthstar, AMED (Allied and Complementary Medicine), JBI EBP Database, Journals@Ovid Full Text, Ovid MEDLINE(R) ALL
Publication years 2020–2023		32
Google Scholar Keywords: burnout AND COVID-19 AND emergencies AND oncologists
From 2020 to 2023		17,800
Cochrane COVID-19 Study RegisterKeywords: burnout AND COVID-19 AND emergencies AND oncologists
From 2020 to 2023		0
Table 2. Citation number, report title, year of publication, study type, number of oncologist subjects, and research country of included articles returned on 8 February 2025 regarding searches of the keywords “burnout AND COVID-19 AND emergencies AND oncologists” for three databases: PubMed, OVID, and Google Scholar listed in order of their return.
Table 2. Citation number, report title, year of publication, study type, number of oncologist subjects, and research country of included articles returned on 8 February 2025 regarding searches of the keywords “burnout AND COVID-19 AND emergencies AND oncologists” for three databases: PubMed, OVID, and Google Scholar listed in order of their return.
Citation #Report TitleDatabaseYearStudy
Type		Oncologist
Subjects		Country
[44]Burnout, coping and resilience of the cancer care workforce during the SARS-CoV-2: A multinational cross-sectional studyPubMed2023Cross-
sectional survey		41Global
[45]Bio-ethical issues in oncology during the first wave of the COVID-19 epidemic: A qualitative study in a French hospitalOVID2023Interviews3France
[46]The role of telehealth in oncology care: A qualitative exploration of patient and clinician perspectivesOVID2022Semi-
structured
interviews		7Australia
[47]Victoria (Australia) radiotherapy response to working through the first and second wave of COVID-19: Strategies and staffingOVID2021Cross-
sectional survey		6Australia
[48][Comment] Ethical and practical considerations on cancer recommendations during COVID-19 pandemicOVID2020ObservationalunclearBelgium France
[6]Burnout among oncologists, nurses, and radiographers working in oncology patient care during the COVID-19 pandemic. RadiographyGoogle Scholar2023Cross-
sectional survey		75Hungary
[49]Oncology workload in a tertiary hospital during the COVID-19 pandemicGoogle Scholar2022Retrospective survey Entire
department		Singapore
[50]Scientia potentia est: how the Italian world of oncology changes in the COVID-19 pandemicGoogle Scholar2020Electronic survey250Italy
Table 3. Emergency experienced, the burnout response, and the patient outcome of included articles returned on 8 February 2025 regarding searches of the keywords “burnout AND COVID-19 AND emergencies AND oncologists” for three databases: PubMed, OVID, and Google Scholar listed in order of their return.
Table 3. Emergency experienced, the burnout response, and the patient outcome of included articles returned on 8 February 2025 regarding searches of the keywords “burnout AND COVID-19 AND emergencies AND oncologists” for three databases: PubMed, OVID, and Google Scholar listed in order of their return.
Citation #Emergency ExperiencedBurnout ResponsePatient Outcome
[44]Delay of critical surgeries, suspension or reduction in chemotherapy treatments and change in chemotherapy regimens, increased workloadThere were increased levels of burnout, posttraumatic stress, anxiety, and depression, 35% of oncologists raising to 49% at follow up66% of oncologists reported an inability to perform their job effectively for patients in comparison with pre-COVID-19
[45]Patients have high COVID-19-associated mortality rates and decreased survivalIncreased concern for patients is viewed as part of the increase in burnoutProhibition of infected patient family visits implicated in increasing patient mortality
[46]Inability to meet with patients in person, telehealth required for meetingsExperienced ethical distress over their poor performances in breaking bad news on telehealthFaced decreased intimacy and familiarity previously formed from care pre-COVID-19
[47]Remote working strategies expanded, and additional telehealth supports were quickly adoptedOver half of the respondents indicated that they often or always felt worn out at the end of the working dayContact of 90% of new and returning patient clinic reviews was by Internet video or telephone
[48]Reduced number of treatment sessions than initially presented to patients with distinctions based on age criteria and level of emergencyMore stressful working conditions than usual, resulting in augmented fatigue and less patience—additional accidents a possibilityDistressed cancer patients feel they are being put aside and neglected by their oncologist despite an increased mortality risk
[6]Contending with COVID-19 in association with on-call duties and inappropriate communication techniquesIncreased depersonalization and emotional exhaustion, particularly for males and those working more than 50 h per weekMishandling of patient emotions by their oncologists became overwhelming for patients during the pandemic’s progression
[49]The proportion of emergency department admissions to medical oncology increasedThe risk of fatigue resulting from the increased workload, leading to poor personal healthA decrease in elective admissions, postponement of non-essential clinic appointments
[50]Required to redefine clinical organization and patient managementVery high perception of risk and concern of infectious danger for their family membersClash between treatment for patients with cancer and COVID-19 management requirements
Table 4. Citation number, topic, and topic details of included articles returned on 8 February 2025 regarding keyword searches of “burnout AND COVID-19 AND emergencies AND oncologists” for three databases: PubMed, OVID, and Google Scholar regarding the emergency experienced.
Table 4. Citation number, topic, and topic details of included articles returned on 8 February 2025 regarding keyword searches of “burnout AND COVID-19 AND emergencies AND oncologists” for three databases: PubMed, OVID, and Google Scholar regarding the emergency experienced.
Citation #TopicTopic Details
[44,48,50]Oncologist-centeredDelay of critical surgeries, suspension or reduction in chemotherapy treatments, and change in chemotherapy regimens
[6,44,49]Oncologist-centeredIncreased workload
[45]Other-centeredPatients have high COVID-19-associated mortality rates, decreased survival
[6,46,47]Other-centeredInability to meet with patients in person, telehealth required for meetings
Table 5. Citation number, topic, and topic details of included articles returned on 8 February 2025 regarding searches of the keywords “burnout AND COVID-19 AND emergencies AND oncologists” for three databases: PubMed, OVID, and Google Scholar regarding the burnout response of oncologists.
Table 5. Citation number, topic, and topic details of included articles returned on 8 February 2025 regarding searches of the keywords “burnout AND COVID-19 AND emergencies AND oncologists” for three databases: PubMed, OVID, and Google Scholar regarding the burnout response of oncologists.
Citation #TopicTopic Details
[6,44,47,48,49]Oncologist-centeredPosttraumatic stress, anxiety, depression, and fatigue
[45]Other-centeredIncreased concern for patients’ health
[46]Other-centeredEthical distress for requiring telehealth
[50]Other-centeredConcern for family members
Table 6. Citation number, topic, and topic details of included articles returned on 8 February 2025 regarding searches of the keywords “burnout AND COVID-19 AND emergencies AND oncologists” for three databases: PubMed, OVID, and Google Scholar regarding patient outcomes of oncologist burnout as a result of redeployment to emergency care during the COVID-19 pandemic.
Table 6. Citation number, topic, and topic details of included articles returned on 8 February 2025 regarding searches of the keywords “burnout AND COVID-19 AND emergencies AND oncologists” for three databases: PubMed, OVID, and Google Scholar regarding patient outcomes of oncologist burnout as a result of redeployment to emergency care during the COVID-19 pandemic.
Citation #TopicTopic Details
[6,44,48,49]Oncologist-centeredPoor care from the oncologist
[45]Oncologist-centeredIncreased risk of mortality from oncologist burnout
[6,46,47]Oncologist-centeredLoss of intimate contact with oncologist
[50]Other-centeredPatient concerns contrasted with institutional decisions
Table 7. Citation number, year of publication, coping type, and type of coping details of included articles returned on 8 February 2025 regarding searches of the keywords “burnout AND COVID-19 AND emergencies AND oncologists” for three databases: PubMed, OVID, and Google Scholar regarding patient outcomes of oncologist burnout as a result of redeployment to emergency care during the COVID-19 pandemic.
Table 7. Citation number, year of publication, coping type, and type of coping details of included articles returned on 8 February 2025 regarding searches of the keywords “burnout AND COVID-19 AND emergencies AND oncologists” for three databases: PubMed, OVID, and Google Scholar regarding patient outcomes of oncologist burnout as a result of redeployment to emergency care during the COVID-19 pandemic.
Cit. #YearCoping TypeCoping Details
[48]2020AvoidTransferring patient emotional support to psychological support
[50]2020PrepareOncologic department reorganization of routine clinical activity
[47]2021DetachThinking about COVID-19 makes oncologists fearful
[46]2022DetachLoss of personal contact with patients is upsetting
[49]2022ReactLashing out and thoughts about leaving the profession
[44]2023ReactDiminished coping abilities, exhaustion, and reduced resilience
[45]2023AttackCalls for the creation of multidisciplinary team meetings
[6]2023DetachExperienced depersonalization and emotional exhaustion
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Nash, C. Scoping Review of Peer-Reviewed Research Regarding Oncologist COVID-19 Redeployment to Emergency Care: The Emergency, Burnout, Patient Outcome, and Coping. COVID 2025, 5, 61. https://doi.org/10.3390/covid5050061

AMA Style

Nash C. Scoping Review of Peer-Reviewed Research Regarding Oncologist COVID-19 Redeployment to Emergency Care: The Emergency, Burnout, Patient Outcome, and Coping. COVID. 2025; 5(5):61. https://doi.org/10.3390/covid5050061

Chicago/Turabian Style

Nash, Carol. 2025. "Scoping Review of Peer-Reviewed Research Regarding Oncologist COVID-19 Redeployment to Emergency Care: The Emergency, Burnout, Patient Outcome, and Coping" COVID 5, no. 5: 61. https://doi.org/10.3390/covid5050061

APA Style

Nash, C. (2025). Scoping Review of Peer-Reviewed Research Regarding Oncologist COVID-19 Redeployment to Emergency Care: The Emergency, Burnout, Patient Outcome, and Coping. COVID, 5(5), 61. https://doi.org/10.3390/covid5050061

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