The COVID-19 pandemic has placed the entire healthcare workforce under severe strain. The incredibly steep rise of COVID-19 cases during the spring of 2020, combined with pre-existing workforce shortages, left no time to train additional doctors and nurses for the specificities of Intensive Care Unit (ICU) care. Thus, cancer staff members already used to working with sedation and ventilation (e.g. surgery anesthesiologists and nurses), were urgently repurposed to support COVID-19 infection control. Hospital pharmacists and pharmacy technicians were also mobilised to prepare and deliver ready-to-administer drugs. Their workload was multiplied severalfold within one week in many hospitals, thereby undermining their availability to perform other tasks, notably pertaining to cancer care, such as dispensing of drugs for clinical trials, or chemotherapy compounding. Additionally, hospital staff had to repurpose regular infrastructure, such as postsurgical recovery units or the operating rooms themselves, into ICU stations or isolation rooms, often within days. Inevitably, this often brought regular surgery programmes, including oncology surgery, to a halt and led many hospitals to close some or all of their regular wards.
Collectively, these elements created a significantly increased workload for the oncology workforce, extensively affecting cancer care providers’ job performance and wellbeing, and leading to psychological distress, exhaustion and burnout36,37. Additionally, cases of COVID-19 infection among these frontline workers increased (even when PPE availability was adequate), further exacerbating their distress and the pressures on workforce availability.
The cancer workforce has been significantly affected by the above-indicated disruptions during the COVID-19 pandemic. Pre-existing shortages in the cancer workforce, in areas such as pathology, cancer nursing and hospital pharmacy technicians, have been widened. This has exacerbated pressure imposed on frontline hospital workers, as reflected, for instance, in the many known examples of COVID-19+ nurses having to continue working, despite risks for themselves and the community.
Furthermore, the ‘brain drain’ experienced by Central and Eastern Europe (CEE), as talented specialists educated and trained in CEE countries have sought better working conditions, higher salaries and opportunities to deliver advanced health technology in other countries, is further reducing the sustainability of these countries’ health systems and their capacity to respond to a crisis such as the COVID-19 pandemic.
In the immediate period, health system managers in all countries must give the most urgent consideration to the welfare and wellbeing of healthcare professionals who have conducted their daily work under enormous pressure and strain for more than 7 months, with little sign of immediate easing. In the context of an ongoing second wave of the pandemic, the EU should encourage sharing and uptake of best practices in this respect, such as the reduction of unnecessary bureaucratic workload, the addition of psychologists to healthcare teams working in the frontline and the establishment of ‘peer support systems’.
Any redeployment of staff to meet COVID-19 needs must be accompanied by an appropriate assessment of impact on the delivery of cancer care, with immediate actions following such an assessment to address newly created gaps.
Opportunities to ease and better organise cross-border redistribution of the workforce in specifically relevant situations (e.g. border areas), such as through leveraging mutual professional recognition instruments, should also be closely considered.
While the EU RescEU mechanism has demonstrated an important coordinating role by the European Commission in addressing product shortages, COVID-19 has also highlighted lack of resilience in the cancer professional workforce. There is an urgent need to better understand the cancer workforce landscape, and how its distribution can be improved. A RescEU mechanism for workforce shortage (in both the short and long term) should be considered.
In the context of Building Back Better and of the Europe’s Beating Cancer Plan, the role of the EU in assisting pan-European cancer workforce planning should be reemphasised and expanded. This must notably include mapping availability of cancer workforce across the EU and addressing persistent and critical shortages in disciplines such as pathology, hospital pharmacy and cancer nursing.
Furthermore, the readiness of European cancer workforce systems to respond to future crises through redistribution of relevant staff must be elevated. This could be achieved by re-emphasising and refreshing the mandate for EU action to promote harmonisation and mutual recognition of healthcare professional qualifications.