Clinical and Economic Impact of a Multidisciplinary Follow-Up Program in Lymphoma Patients
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design and Population
2.2. Description of the UMACOACH Lymphoma Program
2.2.1. Nurse Intervention
2.2.2. Pharmacist Interventions (PI)
2.3. Clinical and Economic Evaluation
2.3.1. Clinical Impact
2.3.2. Economic Impact
2.4. Quality of Life and Patient Satisfaction
2.5. Statistical Analyses
3. Results
3.1. ULP Description
3.2. Clinical Impact
3.3. Economic Impact
3.4. Quality of Life and Satisfaction
3.4.1. Satisfaction
3.4.2. Quality of Life
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | All | HL | NHL | NHL Subtypes | |||
---|---|---|---|---|---|---|---|
DLBCL | FL | MCL | Others | ||||
Total number of patients | 114 | 19 | 95 | 55 (58) | 17 (18) | 12 (13) | 11 (12) |
Age (years) Median [Min-Max] | 66 [22–92] | 34 [21–83] | 69 [36–92] | 70 [36–92] | 62 [45–86] | 70 [44–77] | 59 [39–82] |
Body surface area (m2) Median [Min-Max] | 1.8 [1.3–2.2] | 1.7 [1.36–2.2] | 1.8 [1.3–2.2] | 1.8 [1.3–2.2] | 1.8 [1.5–2] | 1.9 [1.6–2] | 1.8 [1.5–2] |
Gender n (%) | |||||||
Male | 64 (56) | 10 (53) | 54 (57) | 29 (53) | 10 (59) | 8 (67) | 7 (64) |
Female | 50 (44) | 9 (47) | 41 (43) | 26 (47) | 7 (41) | 4 (33) | 4 (36) |
Ann Arbor stage n (%) | |||||||
I–II | 25 (22) | 12 (63) | 13 (14) | 10 (18) | 1 (6) | 0 | 2 (18) |
III–IV | 89 (78) | 7 (37) | 82 (86) | 45 (82) | 16 (94) | 12 (100) | 9 (82) |
Performance status (ECOG) n (%) | |||||||
0–1 | 90 (80) | 16 (84) | 74 (79) | 41 (75) | 14 (88) | 11 (92) | 8 (73) |
2–4 | 23 (20) | 3 (16) | 20 (21) | 14 (25) | 2 (12) | 1 (8) | 3 (27) |
Age adjusted IPI n (%) | - | ||||||
0–1 | 32 (55) | - | 32 (55) | 30 (55) | - | - | 2 (67) |
2–3 | 26 (45) | 26 (45) | 25 (45) | - | - | 1 (33) | |
Occupational status n (%) | |||||||
Active | 6 (5) | 4 (21) | 2 (2) | 2 (4) | 0 | 0 | 0 |
Inactive/jobless | 34 (30) | 11 (58) | 23 (24) | 8 (15) | 6 (35) | 3 (25) | 6 (55) |
Retired | 74 (65) | 4 (21) | 70 (74) | 45 (82) | 11 (65) | 9 (75) | 5 (45) |
Treatment regimens n (%) | |||||||
R-CHOP | 59 (52) | 0 | 59 (62) | 36 (65) | 13 (76) | 8 (67) | 2 (18) |
R-miniCHOP | 13 (11) | 0 | 13 (14) | 10 (18) | 3 (18) | 0 | 0 |
R-ACVBP | 8 (7) | 0 | 8 (8) | 6 (11) | 0 | 0 | 2 (18) |
BEACOPP | 5 (4) | 5 (26) | 0 | 0 | 0 | 0 | 0 |
ABVD | 10 (9) | 10 (53) | 0 | 0 | 0 | 0 | 0 |
Others | 19 (17) | 4 (21) | 15 (16) | 3 (5) | 1 (6) | 4 (33) | 7 (64) |
Characteristics | Cases | Controls |
---|---|---|
Total number of patients | 78 | 78 |
Lymphoma type | ||
HL | 12 | 12 |
NHL | 66 | 66 |
DLBCL | 42 | 42 |
FL | 12 | 12 |
MCL | 10 | 10 |
Others | 2 | 2 |
Age (years) Median [Min-Max] | 65 [22–89] | 64 [22–96] |
Body surface area (m2) Median [Min-Max] | 1.83 [1.4–2.2] | [1.3–2.2] |
Gender n (%) | ||
Male | 44 (56) | 40 (51) |
Female | 34 (44) | 38 (49) |
Ann Arbor stage n (%) | ||
I–II | 28 (36) | 34 (44) |
III–IV | 50 (64) | 44 (56) |
Performance status (ECOG) n (%) | ||
0–1 | 65 (83) | 67 (86) |
2–4 | 13 (17) | 11 (14) |
Age adjusted IPI n (%) | ||
0–1 | 23 (55) | 23 (55) |
2–3 | 19 (45) | 19 (45) |
Occupational status n (%) | ||
Active | 23 (30) | 29 (37) |
Inactive/jobless | 5 (6) | 2 (3) |
Retired | 50 (64) | 47 (60) |
Treatment regimens n (%) | ||
R-CHOP | 47 (60) | 48 (62) |
R-miniCHOP | 7 (9) | 6 (8) |
R-ACVBP | 6 (8) | 6 (8) |
BEACOPP | 3 (4) | 3 (4) |
ABVD | 7 (9) | 7 (9) |
Others | 8 (10) | 8 (10) |
Drug Related Problem (According to FSCP) | n (%) | PI (According to FSCP) | n (%) | ||
---|---|---|---|---|---|
PI category n = 300 | PI with prescribers (PIpr) n = 115 (38%) | Contra-indication/non-conformity to guidelines Drug or medical device not received by the patient Dosage problem (under or over dosage) Unjustified drug prescription Drug interaction Adverse drug reaction Improper prescription Drug omission Monitoring Therapeutic redundancy Pharmacodependence | 15 (13) 41 (36) 19 (17) 10 (9) 4 (3) 1 (1) 15 (13) 4 (3) 6 (5) 0 0 | Addition of a new drug Discontinuation or refusal to deliver Drug switch Choice of administration route Drug monitoring Optimisation of the dispensing/administration mode Dose adjustment | 45 (39) 30 (26) 01 (1) 4 (3) 8 (7) 27 (23) |
PI with patients (PIpa) n = 185 (62%) | Improper prescription | 185 (100) | Optimisation of the dispensing/administration mode | 185 (100) | |
Clinical Impact of PI n = 300 | Clinical impact of PI (according to CLEO) n (%) | ||||
Harmful Null Minor Moderate Major Lethal Non determined | 0 2 (1) 219 (73) 63 (21) 16 (5) 0 0 |
Cases (n = 78) | Controls (n = 78) | p Value | |||||
---|---|---|---|---|---|---|---|
Adverse Events | All | Grade 1–2 | Grade 3–4 | All | Grade 1–2 | Grade 3–4 | |
Anaemia | 77 (99) | 65 (83) | 12 (15) | 76 (97) | 62 (79) | 14 (18) | 0.672 |
Thrombocytopenia | 59 (76) | 45 (58) | 14 (18) | 48 (61) | 32 (41) | 16 (21) | 0.288 |
Neutropenia | 77 (99) | 2 (3) | 75 (96) | 78 (100) | 1 (1) | 77 (99) | 0.620 |
Febrile neutropenia | 10 (13) | 0 | 10 (13) | 11 (14) | 1 (1) | 10 (13) | 0.524 |
Infection without neutropenia | 27 (35) | 22 (28) | 5 (6) | 25 (32) | 13 (17) | 12 (15) | 0.038 |
Diarrhea | 18 (23) | 17 (22) | 1 (1) | 9 (12) | 9 (12) | 0 | 0.667 |
Constipation | 34 (44) | 33 (42) | 1 (1) | 21 (27) | 21 (27) | 0 | 0.618 |
Haemorrhoids | 16 (21) | 16 (21) | 0 | 7 (9) | 7 (9) | 0 | - |
Mucositis | 22 (28) | 19 (24) | 3 (4) | 17 (22) | 14 (18) | 3 (4) | 0.535 |
Neuropathy | 31 (40) | 31 (40) | 0 | 18 (23) | 18 (23) | 0 | - |
Pruritus/eruption | 13 (17) | 13 (17) | 0 | 8 (10) | 8 (10) | 0 | - |
Pulmonary disorders (cough/dyspnea) | 18 (23) | 18 (23) | 0 | 4 (5) | 4 (5) | 0 | - |
Cases (n = 78) | Controls (n = 78) | p Value | |
---|---|---|---|
Number of GCSF injection (total) | 1007 | 949 | |
Patient receiving GCSF, n (%) | 74 (95) | 72 (92) | 0.746 |
Patient receiving ASE, n (%) | 31 (40) | 11 (14) | 0.001 |
Transfusions (total) | 140 | 157 | |
Transfused patient, n (%) | 31 (40) | 34 (44) | 0.745 |
Re-hospitalised patients | 35 (45) | 37 (47) | 0.872 |
Re-hospitalisation (total) | 76 | 88 | |
Outpatient department, n (%) | 54 (71) | 53 (60) | 0.217 |
Hospitalisation, n (%) | 22 (29) | 34 (39) | |
Intensive care unit, n (%) | 0 | 1 (1) | |
Re-hospitalisation cause | |||
Febrile neutropenia/Infection, n (%) | 17 (22) | 29 (33) | 0.179 |
Blood transfusions, n (%) | 51 (67) | 42 (48) | |
ARDI | |||
<85%, n (%) | 6 (8) | 13 (18) | 0.138 |
>85%, n (%) | 67 (92) | 60 (82) | |
Delayed treatment (>7 days), n (%) | 23 (32) | 24 (33) | 1 |
Questions n (%) | I Fully Agree | Moderately Agree | Disagree at All | Not Answered |
---|---|---|---|---|
Have regular phone calls reassured you, put you at ease? | 80 (99) | 1 (1) | 0 | 0 |
Did the rhythm of the calls match to the difficulties related to the side effect you experienced? | 72 (89) | 8 (10) | 0 | 1 (1) |
Much better than expected | As much as expected | A little less than expected | Not answered | |
Did the listening and the time spent meet to your needs and expectations? | 52 (64) | 29 (36) | 0 | 0 |
Were the given answers adapted to your needs? | 47 (58) | 33 (41) | 1 (1) | 0 |
Very important | Quite important | Little important | Not answered | |
Was it important for you to be assisted by a health professional in your care pathway (contact, telephone, advice, etc)? | 70 (86) | 11 (14) | 0 | 0 |
Very satisfied | Satisfied | Unsatisfied | Not answered | |
Are you satisfied with the explanations given by the pharmacist about treatment and their adverse drug effect? | 53 (65) | 24 (30) | 2 (2) | 2 (2) |
Are you satisfied with the answers given by the pharmacist to your questions? | 53 (65) | 25 (31) | 2 (2) | 1 (1) |
Are you satisfied with the written information you received (personalised pharmaceutical plan)? | 46 (57) | 32 (40) | 2 (2) | 1 (1) |
Yes | No | Not answered | ||
Has all the support provided by the various people involved (doctor, nurse, pharmacist) helped you to better understand your treatment? | 79 (98) | 2 (2) | 0 | |
Would you recommend this type of phone follow-up to one of your relative? | 79 (98) | 2 (2) | 0 | |
In the meantime, between phone appointments, have you encountered any difficulties in contacting the nurse? | 7 (9) | 74 (91) | 0 |
Score | ||||
---|---|---|---|---|
Items | Visit | Mean | Evolution | p Value |
Global health status | Before | 64.0 | 3.3 | 0.298 |
After | 67.3 | |||
Physical functioning | Before | 74.7 | 3.3 | 0.514 |
After | 78.0 | |||
Role functioning | Before | 69.5 | 12.1 | 0.077 |
After | 81.6 | |||
Emotional functioning | Before | 63.1 | 4.2 | 0.241 |
After | 67.3 | |||
Cognitive functioning | Before | 81.6 | 2.3 | 0.271 |
After | 83.9 | |||
Social functioning | Before | 71.0 | 0.6 | 0.975 |
After | 71.6 | |||
Fatigue | Before | 48.3 | −8.8 | 0.161 |
After | 39.5 | |||
Nausea and Vomiting | Before | 7.5 | −1.7 | 0.590 |
After | 5.7 | |||
Pain | Before | 29.9 | −9.2 | 0.182 |
After | 20.7 | |||
Dyspnea | Before | 20.7 | 6.9 | 0.277 |
After | 27.6 | |||
Insomnia | Before | 43.7 | −5.7 | 0.537 |
After | 37.9 | |||
Appetite Loss | Before | 25.3 | −8.0 | 0.300 |
After | 17.2 | |||
Constipation | Before | 29.9 | −3.4 | 0.912 |
After | 26.4 | |||
Diarrhoea | Before | 20.7 | −8.0 | 0.137 |
After | 12.6 | |||
Financial Difficulties | Before | 11.1 | −3.7 | 0.416 |
After | 7.4 | |||
QLQ-C30 Summary Score | Before | 72.2 | 5.1 | 0.199 |
After | 77.3 |
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Devaux, M.; Boulin, M.; Mounier, M.; Caillot, D.; Ahwij, N.; Herbin, A.; Bastie, J.N.; Favennec, C.; Robert, P.; Pistre, P.; et al. Clinical and Economic Impact of a Multidisciplinary Follow-Up Program in Lymphoma Patients. Cancers 2022, 14, 2532. https://doi.org/10.3390/cancers14102532
Devaux M, Boulin M, Mounier M, Caillot D, Ahwij N, Herbin A, Bastie JN, Favennec C, Robert P, Pistre P, et al. Clinical and Economic Impact of a Multidisciplinary Follow-Up Program in Lymphoma Patients. Cancers. 2022; 14(10):2532. https://doi.org/10.3390/cancers14102532
Chicago/Turabian StyleDevaux, Madeline, Mathieu Boulin, Morgane Mounier, Denis Caillot, Nuri Ahwij, Adélie Herbin, Jean Noël Bastie, Camille Favennec, Philippine Robert, Pauline Pistre, and et al. 2022. "Clinical and Economic Impact of a Multidisciplinary Follow-Up Program in Lymphoma Patients" Cancers 14, no. 10: 2532. https://doi.org/10.3390/cancers14102532