Clinical and Economic Impact of a Multidisciplinary Follow-Up Program in Lymphoma Patients

Simple Summary The treatment of Hodgkin and non-Hodgkin lymphoma is mainly based on highly haematotoxic chemoimmunotherapy regimens that can cause serious adverse events (AEs). We hypothesised that scheduled phone calls by a nurse combined with the intervention of the pharmaceutical team can reduce the frequency of AEs and their consequences. Thus, the UMACOACH Lymphoma Program (ULP) was created in 2019 in our institution. The primary objective of our study was to evaluate the clinical and economic impact of the ULP compared to a matched cohort of patients managed before the start of ULP. The secondary objective was to assess patient satisfaction and quality of life (QoL). Our study highlights the positive impact of a triple nurse-pharmacist-hematologist collaboration in reducing AEs and re-hospitalisations through earlier detection of symptoms and better management of patients' supportive care at home, as well as patient satisfaction and improved quality of life. Objectives: The UMACOACH Lymphoma is a multidisciplinary monitoring program for patients initiating a first highly haematotoxic treatment for Hodgkin or non-Hodgkin lymphoma. Patient follow-up is based on consultation with a pharmacist and planed phone calls by nurses supervised by a clinical haematologist. Our objective was to assess effectiveness and cost of the UMACOACH Lymphoma Program (ULP) and to investigate patient satisfaction and quality of life (QoL). Methods: This French monocentric case-control study included all patients enrolled in the ULP over a one-year period (cases) matched with retrospective patients receiving usual care (controls). Numbers of adverse events (AEs), re-hospitalisations, average relative dose intensity (ARDI), treatment response and survival were compared between the two groups. Among cases, patient satisfaction and QoL using the EORTC-QLQC30 questionnaire before and after treatment were evaluated. Results: Seventy-eight cases were matched to 78 controls. Twenty-six percent grade 3-4 AEs were observed in cases versus 38% in controls (p = 0.001). There were 76 and 88 re-hospitalisations in the case and control groups, respectively (p = 0.217). ARDI > 85% was observed in 92% and 82% of cases and controls, respectively (p = 0.138). No differences were observed in terms of treatment responses and survival. Estimated cost savings were of EUR 81,782 in favour of the case group. An improvement of 5.1 points was observed in the total QoL score before and after treatment in cases. Conclusions: A nurse-pharmacist-haematologist collaboration seems to be promising to reduce grade 3-4 AEs in HL and NHL patients receiving highly haematotoxic chemotherapy regimens. Cost savings from hospitalisation being avoided were also shown.

Automated summary

This study demonstrates that a collaboration between nurses, pharmacists, and hematologists can reduce adverse events in patients with Hodgkin and non-Hodgkin lymphoma receiving highly haematotoxic chemotherapy regimens. The earlier detection of symptoms and better management of supportive care at home resulted in reduced re-hospitalizations and improved patient satisfaction and quality of life.