Contribution of the telemedicine applied to digestive cancerology.

Aim of the study - Telemedicine offers new possibilities far multidisciplin ary care of cancer patients, allowing direct communications between differe nt, complementary and geographically distant specialists. Thus, it is possi ble to form oncology committees in small hospitals where all specialties ar e not represented The purpose of this study was to evaluate the medical and economic impact of visioconferences in the therapeutic management of cance r patients without access to oncology centers. Materials - A telemedicine network was created in Paris between the General Surgery and Gastroenterology services of Rothschild Hospital and the servi ces of Oncology at Saint-Antoine Hospital and Radiotherapy at Tenon Hospita l. The three hospitals were connected simultaneously (multipoint) by visioc onference and thus constituted a pluridisciplinary oncology committee of ra diotherapy, chemotherapy and surgery. Eighty seven cases were evaluated in 27 staff conferences. In 48 cases, this consisted of re-evaluating therapeu tic decisions made in surgery or gastroenterology, and in 39 cases opinions were requested by surgery (18), gastroenterology (14) or oncology departme nts (7). Results - In only 34/87 cases therapeutic agreement was reached directly. T he 53 other cases (60,9%) were debated. In fact, all 39 requests for opinio n in difficult therapeutic decisions resulted in consensus. Among the 48 re -evaluations disagreement persisted in one case between the surgeon in char ge of the patient and the chemotherapist. Importantly, in 13 of 48 cases (2 7%), the discussion modified the therapeutic protocol initially proposed. T he average cost was 118 French Francs per case and per center Total initial investment was 334,762 French Francs, but the price of some equipment has already dropped from 30 to 60%. Conclusion - In our study, the visioconference improved management of cance r patients for a weak working cost.