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Dr Luc Garcette is an ENT surgeon. He practices at the Parc de Saint-Saulve polyclinic, an ELSAN establishment near Valenciennes, in which he contributed to the implementation of a coordinated care pathway for faster care of patients with ENT cancer. He agreed to talk to us regarding it.
You have set up a care pathway for patients with ENT cancer. Why this initiative?
We wanted to meet both patient needs and strategic health issues. We still see very advanced cases of ENT cancers, from the first consultation. However, an ENT tumor can change stage in 30 days. We have therefore tried to make treatment as quick as possible, in particular with easier access to imaging.
We therefore initially consulted with the radiologists who agreed to reserve a dedicated slot each week so that our patients with ENT cancer might benefit from a faster scan and MRI. This benefits an average of 1-2 patients per week.
The idea of day hospitalization then came naturally, in the form of a morning during which the entire assessment would be carried out. This is how the course of care was set up.
The patient is hospitalized in the morning, he has a biological check-up, a cardiological consultation, a consultation with the anesthesiologist in anticipation of the endoscopy, he sees a dental surgeon, a dietician and has a scanner and MRI examination if necessary. The various appointments are made by the coordinating nurse.
Our goal is that there are less than 30 days between the first consultation and the intervention.
After the intervention, an appointment is also obtained quickly with the radiotherapist, as soon as the healing is complete.
By whom are the patients referred to you?
Mainly by general practitioners. The setting up of this course has been a little slowed down by the Covid, but it is starting to be known by city doctors and it is very much appreciated.
Nutrition is very important in the management of ENT cancers. How is the care done?
The patient sees the dietician on the first morning of day hospitalization. He is then seen once more, during his hospitalization following the operation. She implements nutrition and provides post-discharge follow-up. If parenteral nutrition is needed at home, she takes care of that too.
Have you provided psychological support?
After the announcement of the diagnosis by the doctor, an announcement consultation is organized by the coordinating nurse. She explains the treatment process to the patient. During this consultation, he sees the psychologist if he wishes. Social assistance is also contacted at this time if necessary.
Tobacco and alcohol are the main risk factors for ENT cancer. How is addiction treatment going?
It is systematically proposed by the coordinating nurse. It can only take place if the patient agrees.
We have also set up a signposted fitness course where, during their hospitalization, the patient can perform physical exercises, practice the elliptical trainer and the rowing machine. After their intervention, patients spend an average of 15 days at the clinic. They can benefit from the fitness journey around the 6th and 7th day, and they appreciate it.
ENT cancer treatment may require a tracheostomy. Have you planned therapeutic education to learn how to manage it?
Indeed, I start from the principle that the patient must be autonomous at the time of his discharge and must know how to manage his cannula. The nurses are specifically trained and around the 7th or 8th day following the intervention, they begin to initiate the patient so that he takes care of his cannula himself. Thus, when he goes out, he is autonomous. I do not call on service providers, which considerably improves the patient’s autonomy.
Your region is particularly affected by ENT cancers. Can you tell us how epidemiology is changing?
The incidence of ENT cancers is decreasing in the region. I have seen up to 80 patients a year with ENT cancer. Now this is the number we see between the 3 ENT practitioners at the clinic.
On the other hand, what is not decreasing is the number of serious cases at the time of the first consultation. Social difficulties still mean that a certain number of people do not receive treatment.
Our workhorse is to improve the precocity of diagnosis. We run campaigns and
formations regularly, with general practitioners, to make them aware of screening. We encourage them to refer patients to us immediately, without making an assessment beforehand, since our course is organized for this.
Treatments have improved lifespan, but it’s all regarding early diagnosis.
ENT cancer management at ELSAN
• 27 ELSAN facilities treat ENT cancer, ie 20% of the group’s facilities.
• In 2021, ELSAN covered 6.5% of ENT cancer surgery stays nationwide and 1 in 4 patients in the private hospitalization sector.
Day hospital check-ups at ELSAN
• 50,000 HDJ assessments carried out, including approximately 4,000 in oncology
Interview by Dr Roseline Péluchon
