ABSTRACT
Background Coronavirus disease 2019 (COVID-19) has changed the practice of all health-care professionals. Determining the impact could prevent repercussions in future crisis. Objectives The objectives of the study were to assess the impact of the COVID-19 pandemic on dermatology residents' professional practice, working conditions, academic training and mental health. Methods An online questionnaire was sent to all French dermatology residents. We compared the activity of residents working in areas heavily impacted by COVID-19 to others. Logistic multivariate regressions were done, using as outcome variables the negative impact of the COVID crisis on residents' possibility to practice dermatology during the crisis, supervision, academic training and working more than 50 h/week. The last part of the questionnaire was the burnout questionnaire of Maslach. Results A total of 246 residents filled the questionnaire. Residents working in highly impacted COVID areas (odds ratio, OR 0.34 confidence interval, CI [0.18, 0.61], P ≤ 0.001), first-year postgraduate (PGY-1) residents (OR 0.46 CI [0.23, 0.91], P = 0.023) and those in private practice (OR 0.10 CI [0.01, 0.57], P = 0.032) were significantly less able to maintain dermatology activities. Worse supervision was significantly more frequent with non-PGY-1 residents (OR 3.24 CI [1.65, 6.65], P < 0.001). One hundred and eighty one residents claimed the pandemic to have a negative effect on their dermatology curriculum with no difference according to their regions' affection by COVID-19. This was mostly attributed to the cancelation of courses and congresses. PGY-1 residents (OR 2.09 CI [1.09, 4.04], P = 0.029) and residents in highly affected areas (OR 1.79 CI [1.01, 3.18], P = 0.049) were more at risk of working above the maximal legal working time. None of the residents was free of burnout symptoms. Conclusion Dermatology residents have been highly affected by COVID-19. It might be important to have a more integrated healthcare system to fight times of crisis with the least repercussions on residents.
Subject(s)
COVID-19 , Dermatology , Internship and Residency , COVID-19/epidemiology , Dermatology/education , Humans , Pandemics , SARS-CoV-2 , Surveys and QuestionnairesABSTRACT
Treatment of melanoma with immune checkpoints inhibitors .Immunotherapy with checkpoints inhibitors stimulates the anti-tumor response. It has dramatically changed the prognosis of advanced melanoma and other cancers. Anti-PD1, alone or in combination with anti-CTLA4, has demonstrated significantly better response and overall survival rates than chemotherapy. The immuno-mediated toxicity is more frequent and more serious with the combination of anti-PD1 and anti-CTLA4, which also appears as the most effective treatment for metastatic melanoma. Adjuvant anti-PD1 therapy is also effective in preventing recurrence in patients with resected stage III or IV melanoma. Studies are underway to evaluate this treatment in a neo-adjuvant situation and in localized melanomas with high risk of recurrence (stage II) with promising results.
Traitement du mélanome par les inhibiteurs du contrôle immunitaire .L'immunothérapie, en inhibant les points de contrôle (« checkpoints ¼) immunitaire, stimule la réponse antitumorale. Elle a considérablement modifié la prise en charge du mélanome et d'autres cancers. Les anticorps monoclonaux anti-PD-1, seuls ou en association aux anti-CTLA4, ont permis d'obtenir des taux de réponse et de survie globale largement supérieurs à la chimiothérapie. La toxicité, immunomédiée, est plus fréquente et plus grave avec l'association anti-PD-1 et anti-CTLA4, qui semble aussi être le traitement le plus efficace actuellement dans le mélanome métastatique. L'immunothérapie adjuvante par anti-PD-1 a également démontré son efficacité en prévention d'une récidive dans les mélanomes de stade III ou IV opérés. Des études sont en cours pour évaluer ce traitement en situation néo-adjuvante et dans les mélanomes localisés à haut risque de récidive (stades II) avec des résultats prometteurs.