**3. Multidisciplinary approach in the treatment of COVID-19**

What seems most important, at the time of a pandemic, is that patients receive all the important information. The source of information must be professional, high quality, and reliable. A quality source of information is reflected in a multidisciplinary team. Multidisciplinary teams and the integration of a clinical/oncology pharmacist are necessary for optimal oncology care. By introducing consultation with a clinical/oncology pharmacist, who focuses on relevant issues, it significantly raises the quality of life, explaining the therapy itself, and emotionally preparing for what follows. Caring for patients during an epidemic/pandemic may impact negatively on the mental health of healthcare workers. The psychological responses of healthcare workers to the pandemic of infectious diseases are complicated. In a short time period, healthcare workers used a large part of their abilities in controlling how to spend their time, where to direct their attention, and how best to use scarce resources. The foundation of best care for cancer patients is without a doubt the well-being of oncology healthcare workers, where burnout has been most extensively studied. Burnout phenomenon and prevention among oncologists were known to be significant even before COVID-19 pandemic; however, it has gained strength since the global influence of coronavirus on healthcare system. The long-term nature and scope of this impact are still unknown. High level of anxiety has been noticed among oncology healthcare workers during the first period of COVID-19 pandemic in the United States

### *Impact of COVID-19 on Mental Health of Oncology Healthcare Workers and Interdisciplinary… DOI: http://dx.doi.org/10.5772/intechopen.110876*

and Singapore [7, 8]. Actually, physicians of various specializations suffer from the distress caused by COVID-19. In the study from Wuhan, China, the authors noticed that oncologists and nurses working directly with COVID-19 patients did not deal with such significant burnout like their colleagues who stayed in their familiar/previous settings. According to authors' opinion, the reason of this can be greater feeling of control due to direct involvement and mobilization connected with fighting with COVID-19. Thus, it can be concluded that the impact of COVID-19 on mental health and well-being is complex as well as it differs between regions and specializations [9]. Daily work with seriously ill patients had consequences for all members of the healthcare team. Nurses suffer physical and emotional stress every day, by caring patients and facing numerous ethical and moral challenges that this pandemic has brought with it. Due to insufficient healthcare workers, insufficient resources, and a large number of deaths, nurses are in a conflict of professional values every day. More and more nurses are sick with COVID-19, and some have died as a result of the disease which they received by performing their duty. Due to the large amount of stress and emotional suffering that passes, nurses need great courage, strength, and endurance when working and fighting with this virus, and during that time they are away from their families and loved ones. Patients who suffered from other severe chronic and incurable diseases were put on long waiting lists. The operating theaters were almost completely closed, and only emergency operations were performed. If someone got sick or had an accident, they should be hours in order to be able to come for an examination or to the clinic to dress a wound. Because of the increased costs for procuring protective equipment and all medicines necessary for the treatment of COVID-19, the "budgets" for other medicines and necessities have decreased, so often oncology patients were left without their expensive medicines, which they cannot afford on their own. Chemotherapy and radiation were postponed, so many were in uncertainty as to what would happen to their treatment. An oncology-palliative patient infected with the coronavirus is faced with numerous problems that they still have not managed to solve in the health system. So, it is not uncommon for them to undergo chemotherapy and radiation that are delayed due to lack of space or the impossibility of obtaining medicine. When they come to their own term of therapy, due to epidemiological measures, they mostly remain alone in the room, which is negative. It affects their psychological status because they feel lonely, sad, and rejected, and this can lead to the development of depression. Dissatisfaction was also observed among nurses who work in the oncology and palliative wards because due to the prescribed measures, their income has reduced interaction with the patient, so the psychological part of help and therapeutic communication are almost completely absent. Furthermore, the redistribution of staff due to the need for work in other departments in part of the pandemic leads to some nurses remaining to work with palliative care patients, so the nurses do not have enough time to dedicate themselves equally to each patient because of the scope of work. Similar problems are present in the oncology-palliative patient he visits and who is in home care [10]. Due to the lack of teams on the field and the increased number of palliative care users, the same problems develop as in many inpatients healthcare institutions. In addition to numerous organizational problems, lack of personnel, emotional stress caused by work, increased number of patients, ethical issues, and moral doubts making numerous decisions became another big burden during the implementation of palliative care for patients with COVID-19. Due to the increased volume of work and the number of patients due to the pandemic, stress is pronounced more than ever before. Great mental stress, seeing death every day, and great emotional stress pressure led to the psychological burnout of many healthcare

workers. Professional burnout has many negative effects on the body and mental health of the individual, which ultimately affects engagement and efficiency in work.

Psychological burnout can be defined as a continuous affective stress reaction that develops over a long period of time and consists of emotional exhaustion, feelings of inadequacy, success, and depersonalization. The most pronounced dimension of psychological burnout is most often emotional exhaustion. It arises due to intense emotional feelings that appear in interaction with patients and ultimately lead to irritability, fatigue, and decreased enthusiasm at work. Caring for the dying, looking death in the eye every day, dealing with dead bodies, and a large number of healthcare workers had an emotional breakdown. The long-term impact of the pandemic is still not fully known on the mental state of healthcare workers, but dealing with other people's suffering, pain, and death contributes to great psychological burnout. Watching how every day more and more young people were dying from this virus left a hard impression on the emotional consequences for health personnel. Shortness of breath, rapid breathing, coughing fits and coughing up large amounts of secretions caused great anxiety and fear in patients. Many nurses and doctors described how the fear of suffocation was present in all patients' lack of air and death and the impossibility of saying goodbye to the family. Due to major traumas and stressful situations experienced at work, healthcare workers are also at risk of developing PTSD (posttraumatic stress disorder). Faced with daily difficult decisions, they often struggle with feelings of guilt and they wonder if all the decisions were made well and if they could have done something better for such difficult patients. Every day they struggle with difficult decisions such as who to resuscitate and which one put the patient on a ventilator, and the biggest feeling of guilt is caused by the fact that due to the large scope work and lack of staff, many patients die alone and have no one to lend a hand to. Because of that harmonization of professional duties, which include making ethical decisions, has brought great pressure at work, and ethics meetings are very rare or almost nonexistent because for them it is simple, there is no time, or it is currently being neglected due to other important matters. Because of the immense courage and help they provide to the entire community, healthcare workers were often referred to by the public and the media as "heroes in white coats." The uncertainty of when humanity will return to normal has become an additional burden and pressure. An unprecedented rate of sadness and depression has been recorded, which can be devastating in the short and long term and affect individuals and society. This is why it is extremely important to take steps to solving long-term psychological stress, especially for health personnel. Self-care should be encouraged, and the support of family and colleagues is crucial and should always be available. In 2020, the medical academy issued a recommendation for the well-being of healthcare workers during the pandemic, including meeting basic human needs, respecting differences, and respect for human rights. The upheaval in the professional role of healthcare workers in dealing with the COVID-19 infection leads to new challenges and adjustments in the entire healthcare sector. Increased education, training, and preparation of health workers for work in crisis situations is one of the more effective measures to alleviate mental pressure for health workers. Therefore, in crisis situations, it is important to strengthen the enthusiasm, knowledge, and conscientiousness of healthcare workers. A closer monitoring of and active intervention for the mental health of healthcare workers should be continued. According to data from the literature, young health workers have more experienced stress levels and have higher anxiety than the elderly. One of the possible reasons why older workers show less symptoms and difficulties with mental health is that many older workers experienced this in their practice and
