Impact of the COVID-19 Epidemic on the Hospital Journey of Patients With Cancer of the Digestive System: Description of Typical Pathways and Simulation Model

The hospital care of patients with cancerous pathology is part of a multidisciplinary care path that includes many stages. The treatment conditions in this course vary depending on the reasons that led to suspect the existence of a cancerous pathology: accidental discovery, screening, warning signs (sometimes expressed in an acute form) or referral for treatment in charge after the diagnosis has already been made. As soon as the patient presents to the hospital, various expertises are mobilized to establish the diagnosis, carry out the extension assessment and assess the comorbidities and conditions that may have an impact on the choice of treatments. During this initial evaluation, each file is evaluated in a Multidisciplinary Consultation Meeting to define the optimal therapeutic strategy which will often include several stages involving surgery, radiotherapy, medical oncology (chemotherapy, immunotherapy, targeted therapy, etc. hormone therapy), interventional radiology, and / or supportive oncological care (nutrition, pain treatment, correction of metabolic abnormalities, palliative care, etc.). This treatment path is considered to be very complex and the fluidity of its organization determines the processing times.

The management of patients in a cancer department may vary depending on the organization specific to each hospital. Most often, this is secondary management after the patient has been taken care of by the emergency department - the diagnosis is then suspected but not yet established - or tertiary by a medical specialty service or surgical - the diagnosis is then established and part of the treatment, in particular surgical, has already been carried out. Primary care by addressing from correspondents outside the hospital directly to medical oncology is possible but rarer, particularly at Saint-Joseph Hospital. The first treatment by the oncology service is therefore carried out after a fairly complex preliminary hospital course, the duration of which is likely to vary depending on the number and complexity of each of the preliminary stages. The duration of the different stages of the care pathway is a very important element in the quality of the care because unjustified delays can impact on the therapeutic results.

The health crisis induced by the COVID-19 epidemic, associated with the containment measures put in place from March 19 to May 11, 2020, have limited the use of patients in hospitals, even for emergency activities. It has also led to a reorganization of scheduled activities within establishments, with a concentration of resources around unscheduled care, in particular COVID patients. In many establishments, the other activities were, for many, deprogrammed with postponed appointments. The impact of this epidemic on the hospital journey of patients with cancerous pathology is the subject of questions at the national level. The delays in diagnosis and treatment induced have possibly had an impact on the quality of the care and on the delays with, as a corollary, a possible loss of opportunity for the patient.

Within the Paris Saint-Joseph Hospital Group, which strongly participated in the management of the pandemic over the period from March 15 to June 15, 2020, observations were made compared to the same period in 2019:

• An 80% drop in day hospital stays for gastrology and proctology endoscopy
• A 60% drop in stays in digestive and proctological surgery (full hospitalization, week or day)
• A 40% decrease in emergency room consultations, as well as an activity focused on the care of COVID patients
• A decrease in consulting activities
• A reorganization of the healthcare offer: block restricted to emergencies, limitation of endoscopy activity and imaging activity.