Effectiveness of telephone support during chemotherapy in patients with diffuse large B cell lymphoma: The Ambulatory Medical Assistance (AMA) experience

Background: During chemotherapy, patients experience disabling side effects or even sometimes life-threatening treatment-related complications, contributing to poor quality of life, reduced therapeutic compliance, decreased relative dose-intensity, and ultimately poorer outcomes. Objectives: The Ambulatory Medical Assistance (AMA) project, a monitoring procedure based on a standardized telephone intervention, was aimed to improve ambulatory care quality in aggressive B-cell lymphomas treated with standard front-line R-CHOP therapy. Design: Non-comparative prospective study. Setting and participants: Over a three-years period, one hundred diffuse large B cell lymphoma (DLBCL) patients were treated in a single hospital and monitored in an ambulatory setting through planned telephone interventions delivered by a single nurse under the supervision of an oncologist. Methods: In addition to biological monitoring, patients received a bi-weekly telephone call from an oncology-certified nurse. All events were recorded on a call form, which was forwarded to a supervisor oncologist. Nurse calls resulted in one of the following: no intervention, grade 1 intervention based on a pre-established protocol managed by the nurse under oncologist supervision, or grade 2 intervention related to more severe complications, managed directly by the oncologist, and mostly resulting in secondary hospitalization. Results: The AMA procedure consisted of 3592 phone calls (600 h) resulting in 989 interventions (27.5%). Grade 1 intervention represented 950 cases whereas grade 2 intervention was noted in only 39 cases (3.9%). AMA also appeared to improve medical management. Indeed, compared to the literature, we observed lower incidence in secondary hospitalization (6%), delayed treatment (6%), reduced relative dose-intensity (RDI) (no patient with RDI < 80%), toxic death (0%), and red blood cell transfusion (13%). Conclusions: AMA appears to improve R-CHOP therapy management. However, comparative studies are needed to demonstrate the advantage of the AMA over standard management, in terms of therapeutic compliance, progression-free survival, and medico-economics efficacy. (C) 2011 Elsevier Ltd. All rights reserved.