title: Effectiveness of telephone support during chemotherapy in patients with diffuse large B cell lymphoma: the Ambulatory Medical Assistance (AMA) experience.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  Non-comparative prospective study.
  
  
  METHODS
  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.
authors.affiliation: Service d'hématologie clinique, CHU Purpan, 1 place du Dr. Baylac, F-31300 Toulouse, France.
authors.forename: Gisèle
authors.initials: G
authors.lastname: Compaci
authors.forename: Loic
authors.initials: L
authors.lastname: Ysebaert
authors.forename: Lucie
authors.initials: L
authors.lastname: Obéric
authors.forename: Hélène
authors.initials: H
authors.lastname: Derumeaux
authors.forename: Guy
authors.initials: G
authors.lastname: Laurent
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D013689:Telephone