ABSTRACT
L'épidémie de Covid-19, au-delà de mettre en évidence l'obésité comme facteur pronostique important, modifie grandement la prise en charge de cette maladie chronique. L'expérimentation article 51 Espace médical nutrition et obésité (EMNO) a dû intégrer des outils numériques pour maintenir les parcours de soins. Cette démarche a également été enrichie par l'apport d'un outil d'éducation thérapeutique digital. L'ensemble du processus de prise en charge a ainsi été réalisé malgré la situation, avec un retour très positif des patients inclus dans l'expérimentation. En contexte épidémique, le maintien des parcours de soins d'une maladie chronique comme l'obésité peut ainsi être assuré avec l'apport du numérique tout en dépassant le simple cadre de la téléconsultation et du suivi en y associant une approche pédagogique digitale.Alternate :The Covid-19 outbreak has not only brought evidence for obesity as an important prognostic factor, it also modifies this chronic disease management. The Article 51 Espace Médical Nutrition et Obésité (EMNO) experiment has had to include digital tools to ensure care pathway maintenance. The response of patients included in the experiment is, in this context, very positive. The procedure has also been enriched with the contribution of a digital therapeutic education tool. The care process has been maintained, despite the situation, with a positive response from patients. In the epidemic context, the maintenance of care pathways for a chronic disease such as obesity can be done with the contribution of digital tools, going beyond teleconsultations or tracking, by adding a digital education approach.
ABSTRACT
Background: We aimed to assess the impact of the COVID-19 crisis on 1) perceived changes in cancer treatment and follow-up care;and 2) cancer patients’ wellbeing in comparison with a norm population. Methods: Patients participating in the PROFILES (Patient Reported Outcomes Following Initial treatment and Long-term Evaluation of Survivorship) registry and a norm population were invited to complete a questionnaire mid-April 2020. Analyses included cohorts of colon, rectal, breast, melanoma, gynecological, prostate, hematological, pancreas, and esophagogastric cancer patients diagnosed between 1/2006 and 3/2020. Logistic regression analysis assessed factors associated with changes in cancer care. General Linear Models were computed to assess differences in QoL, anxiety/depression and loneliness between patients and age- and sex matched norm participants. Results: Of 3,960 cancer patients, 213/768 (28%) in treatment and 448/2575 (17%) in follow-up reported that their treatment or appointment was cancelled or replaced by a telephone consult (TC) in the COVID-19 crisis. Older age, type of cancer, higher BMI, more comorbidities, metastasized cancer and being worried about getting infected with SARS-CoV-2 were independently associated with these changes. Twelve percent of cancer patients had their consultation replaced by a TC, and although most patients preferred a face-to-face consultation, 39% said that they would like to use a TC again. Cancer patients were a bit more worried about getting infected with SARS-CoV-2 (22%) compared to the 900 norm participants (17%). Remarkably, norm participants had worse QoL scores than measured before the crisis, and we did not see clinically relevant differences with the QoL scores of cancer patients in the current comparison. Norm participants more often reported depression (13% vs. 10%) and loneliness (11% vs. 7%) than cancer patients (p<0.05). Conclusions: Up to one in four cancer patients reported changes in cancer care in the first weeks of the COVID-19 crisis, associated with vulnerability factors. Follow-up will show its impact on outcomes. The crisis seems to have more impact on QoL and mental wellbeing in the norm population than in cancer patients. Legal entity responsible for the study: The authors. Funding: Dutch Research Council. Disclosure: G. Vink: Research grant/Funding (institution), Travel/Accommodation/Expenses: Servier;Research grant/Funding (institution): Bayer;Research grant/Funding (institution): Merck. M. Koopman: Honoraria (institution), Research grant/Funding (institution): BMS;Nordic Pharma;Servier;Honoraria (institution): Amgen;Research grant/Funding (institution): Bayer;Merck-Serono;Roche;Sirtex;Sanofi-Aventis;NVMO. H.W.M. van Laarhoven: Research grant/Funding (institution): Bayer;Advisory/Consultancy, Research grant/Funding (institution): BMS;Nordic Pharma;Servier;Research grant/Funding (institution): Celgene;Janssen;Lilly;Philips;Roche;Advisory/Consultancy: MSD;Novartis. All other authors have declared no conflicts of interest.