Ambulatory Medical Assistance--After Cancer (AMA-AC): A model for an early trajectory survivorship survey of lymphoma patients treated with anthracycline-based chemotherapy.
BACKGROUND
Cancer survivorship has emerged as an important aspect of oncology due to the possibility of physical and psychosocial complications. The purpose of this study was to assess the feasibility of the Ambulatory Medical Assistance for After Cancer (AMA-AC) procedure for monitoring lymphoma survivorship during the first year after chemotherapy.


METHODS
AMA-AC is based on systematic general practitioner (GP) consultations and telephone interventions conducted by a nurse coordinator (NC) affiliated to the oncology unit, while an oncologist acts only on demand. Patients are regularly monitored for physical, psychological and social events, as well as their health-related quality of life (HRQoL). Inclusion criteria were patients newly diagnosed with non-Hodgkin or Hodgkin lymphomas, who had been treated with anthracycline-based chemotherapy and were in complete remission after treatment.


RESULTS
All 115 patients and 113 collaborating GPs agreed to participate in the study. For patients who achieved one year of disease-free survival (n = 104) their assessments (438 in total) were fully completed. Eleven were excluded from analysis (9 relapses and 2 deaths). The most frequent complications when taking into account all grades were arthralgia (64.3%) and infections (41.7%). About one third of patients developed new diseases with cardiovascular complications as the most common. Psychological disorders such as anxiety, depression and post-traumatic stress disorder were diagnosed in 42.6% of patients. The data collected showed that Hodgkin lymphoma patients, females, and patients with lower HRQoL (mental component) at study entry were at greater risk for developing at least one psychological disorder.


CONCLUSIONS
This study showed that AMA-AC is a feasible and efficient procedure for monitoring lymphoma survivorship in terms of GP and patient participation rates and adherence, and provides a high quality of operable data. Hence, the AMA-AC procedure may be transferable into clinical daily practice as an alternative to standard oncologist-based follow-up.
Department of Hematology - Internal Medicine, Toulouse University Hospital, Cancer University Institute of Toulouse Oncopole, Toulouse, France. compaci.gisele@iuct-oncopole.fr.
Gisèle
G
Compaci
INSERM Unit 1027 (The French National Institute of Health and Medical Research), Faculty of Medicine, Toulouse, France. rueter.m@chu-toulouse.fr.|Service of Medical and Clinical Pharmacology, Center of Pharmacovigilance, Pharmaco-epidemiology and Information on Drugs, Toulouse University Hospital, 37 Allées Jules Guesde, 31000, Toulouse, France. rueter.m@chu-toulouse.fr.
Manuela
M
Rueter
INSERM Unit 1027 (The French National Institute of Health and Medical Research), Faculty of Medicine, Toulouse, France. sebastien.lamy@univ-tlse3.fr.|Service of Medical and Clinical Pharmacology, Center of Pharmacovigilance, Pharmaco-epidemiology and Information on Drugs, Toulouse University Hospital, 37 Allées Jules Guesde, 31000, Toulouse, France. sebastien.lamy@univ-tlse3.fr.|Department of Epidemiology, Health Economics and Public Health, Faculty of Medicine, University of Toulouse III Paul Sabatier, Toulouse, France. sebastien.lamy@univ-tlse3.fr.
Sébastien
S
Lamy
Department of Hematology - Internal Medicine, Toulouse University Hospital, Cancer University Institute of Toulouse Oncopole, Toulouse, France. oberic.lucie@iuct-oncopole.fr.
Lucie
L
Oberic
Department of Hematology - Internal Medicine, Toulouse University Hospital, Cancer University Institute of Toulouse Oncopole, Toulouse, France. recher.christian@iuct-oncopole.fr.|INSERM Unit 1037 (The French National Institute of Health and Medical Research), Center of Cancer Research, Toulouse, France. recher.christian@iuct-oncopole.fr.
Christian
C
Recher
INSERM Unit 1027 (The French National Institute of Health and Medical Research), Faculty of Medicine, Toulouse, France. maryse.lapeyre-mestre@univ-tlse3.fr.|Service of Medical and Clinical Pharmacology, Center of Pharmacovigilance, Pharmaco-epidemiology and Information on Drugs, Toulouse University Hospital, 37 Allées Jules Guesde, 31000, Toulouse, France. maryse.lapeyre-mestre@univ-tlse3.fr.|Laboratory of Medical and Clinical Pharmacology Faculty of Medicine, University III Paul Sabatier, Toulouse, France. maryse.lapeyre-mestre@univ-tlse3.fr.
Maryse
M
Lapeyre-Mestre
Department of Hematology - Internal Medicine, Toulouse University Hospital, Cancer University Institute of Toulouse Oncopole, Toulouse, France. laurent.guy@iuct-oncopole.fr.|INSERM Unit 1027 (The French National Institute of Health and Medical Research), Faculty of Medicine, Toulouse, France. laurent.guy@iuct-oncopole.fr.
Guy
G
Laurent
INSERM Unit 1027 (The French National Institute of Health and Medical Research), Faculty of Medicine, Toulouse, France. fabien.despas@univ-tlse3.fr.|Service of Medical and Clinical Pharmacology, Center of Pharmacovigilance, Pharmaco-epidemiology and Information on Drugs, Toulouse University Hospital, 37 Allées Jules Guesde, 31000, Toulouse, France. fabien.despas@univ-tlse3.fr.|Laboratory of Medical and Clinical Pharmacology Faculty of Medicine, University III Paul Sabatier, Toulouse, France. fabien.despas@univ-tlse3.fr.
Fabien
F
Despas
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000458:organization & administration*; D018943:Anthracyclines / Q000627:therapeutic use*; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use*; D015897:Comorbidity; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D006689:Hodgkin Disease / Q000150:complications / Q000188:drug therapy / Q000523:psychology; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000150:complications / Q000188:drug therapy / Q000523:psychology; D008297:Male; D001523:Mental Disorders / Q000209:etiology; D008875:Middle Aged; D010174:Pamphlets; D010353:Patient Education as Topic / Q000379:methods; D011446:Prospective Studies; D011788:Quality of Life; D017741:Survivors; D013689:Telephone; D055815:Young Adult
D018943:Anthracyclines; D000903:Antibiotics, Antineoplastic