Telemedicine and territory: two areas that seem the opposite of each other but which, instead, must develop in parallel in order to respond effectively to the needs of the patient of the third millennium, including cancer. Above all, the development of remote assistance does not at all exclude the need to implement a local medicine that really works everywhere in Italy. The Covid-19 emergency has strongly brought out these aspects and now the game is to be able to strengthen these areas. The ‘Switch on’ project promoted by Sanofi and presented today in an online event with the participation of numerous clinicians and representatives of patient associations in the oncology and haematology field that make up the Scientific Committee goes precisely in this direction.
The positive aspects of technology
To test the needs that cancer and hematology patients will face in the near future, Havas Life conducted a survey of around 200 interlocutors including oncologists and hematologists, patients with multiple myeloma, caregivers of people with lung cancer and patient associations. The survey data showed that for 9 out of 10 doctors technology will play an increasingly predominant role in the development of the medical profession in the next 2-3 years.
Streamline procedures
Seven out of 10 doctors also believe that they will be able to improve the quality of their profession, thanks to the saving of time dedicated to bureaucratic procedures and thanks to the sharing of data and reports with other doctors for a multidisciplinary care of the patient. “The unbureaucratization for the patient must absolutely be pursued to overcome certain obstacles they are forced to today with a different organization that streamlines the procedures”, he declares Giordano Beretta, national president of Aiom, who adds: “We must bear in mind that in any case for a visit in telemedicine it takes the same time if not a little longer than what it takes for a face-to-face visit. The patient must be supported both on the technological front but also through territorial medicine which must be integrated with digitization because face-to-face visits will still have to be there but integrating them with telemedicine. The cancer patient – especially in some phases of the disease – must be visited and looked in the eye, while for the follow-up telemedicine can certainly be a formidable tool “.
From theory to practice
During the first lockdown and still today doctors and patients have had the opportunity to ‘train’ in telemedicine but what is missing is a control room that dictates the same rules for everyone. Some regions have activated and are further ahead as happens, for example, in Campania (but not only): “Our oncological network was born recently but an IT platform has developed itself through which there is an optimization of the various procedures . For example, patients can receive home care within 24 hours, there is a specialized team that provides nursing support, there is local integration and we carry out the online consultation of exams “, he says. Paolo Ascierto, National Cancer Institute Irccs Pascale Foundation – Naples. There are other virtuous examples but what is lacking is homogeneity in the various regions: “It is necessary to formalize teleconsulting, whether with Zoom or with other platforms for consulting medical documents”, underlines Paolo Corradini, Irccs Foundation National Institute of Tumors of Milan. “We need a unique technology for all regions and also a phase of education of patients and caregivers because the elderly are not very used to doing telemedicine. But you need input from the Ministry of Health to have a homogeneity that does not exist at the moment ”.
Develop local medicine
Despite the fact that during the Covid-19 emergency, the provision of therapies to patients did not slow down, both primary and secondary prevention of non-Covid patients declined. Precisely to meet this need, among the actions indicated as priorities for post-emergency, the one relating to the establishment of services capable of strengthening home care and territorial medicine stands out. “The national health system needs to be reprogrammed as well as our hospitals because we don’t have room for low-intensity patients,” he says. Mario Boccadoro, University of Turin. “Hematologists are fortunate to have a large number of patients who recover with chemotherapy and who then invade hospitals for checks but they should be removed from hospitals and treated in the area. Even in this case, however, for a truly functional integration between hospital and territory we need tools validated at national level so that it is possible to treat patients in a homogeneous way “.
The role of the patient
The survey also revealed that about 8 out of 10 doctors think that transversal support for patients, from psychological to nutritional and motor, represents one of the main needs that will need to be met in the near future. There is no doubt that remote communication will be increasingly central in the doctor-patient relationship, but it will have to be developed by gradually accompanying patients in the correct use: communication mediated by digital tools, for example, is considered suitable only in certain phases of the patient assistance and care pathways, such as checks and follow-ups, and not in the diagnostic-therapeutic phases. “We must take into account the socio-cultural implications because we are not used to the doctor-patient relationship through the web and our patients do not have a mental approach of this type, also for a matter of age”, he says. Silvia Novello, University of Turin. “And then there are technical implications because it would be good not to limit ourselves only to the telephone call but also to foresee the video call as much as possible but there are some patients and some geographical areas that have difficulty in doing this and this must be taken into account”. The presentation of the ‘Switch on’ project was also attended by some representatives of patient associations: Anna Costato, Salute Donna Onlus, Melania Quattrociocchi, Ail – Italian association against leukemia-lymphomas and myeloma, Giampiero Garuti, AIL – Italian association against leukemia -lymphomas and myeloma, Gabriella Masiello, AIMaMe – Italian Association of Melanoma and Skin Cancer Patients who have expressed their needs also in reference to the availability of scientifically valid information that protects them from the risk of running into fake news.
The Switch on project
The project presented today aims to create work tables and discussions between technicians, medical specialists, patient associations and reference stakeholders that can lead to the development of concrete project proposals. We start from the needs that emerged from the survey to move forward with the project. The next step will be the identification by the scientific committee of some of the needs that have emerged as priorities through the establishment of working groups to be able to implement projects to support and boost the oncology and hematology of tomorrow.
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