Background

In 2006, at the University Hospital (CHU) of Toulouse, the AMA project was born (Assistance Médicale Ambulatoire, or outpatient medical support). Objectives: to assess the effectiveness of telephone follow-up in improving onco-haematology patients’ compliance with dose intensity. Seven years later, the project has show very positive results, with an average dose reduction of 8%, compared to 20% without follow-up – all due to a simple and inexpensive procedure.

In 2015, Prof. Laurent, encouraged by these achievements, suggested duplicating the study in Ivory Coast, where nearly 20,000 new cancer cases are reported annually, with a 60% treatment refusal and dropout rate, and a 20% survival rate at five years. The project, financed by Fondation Pierre Fabre, took the new name AMAFRICA. A simple, monocentric, randomised study will be conducted in collaboration with the onco-haematology department at the Abidjan University Hospital, headed by Professor Koffi. The central hypothesis is that consistent telephone contact with the patient by a coordinating nurse could reduce the dropout rate (primary objective), but also help identify and prioritise the causes of treatment dropout (secondary objective).

The AMA procedure seems well-suited to the challenge of monitoring Ivorian patients, as 60% of the local population has a mobile phone. Working with a group of 100 adults and children with lymphoma, AMAFRICA will make it possible to track patients in the active phases of their treatment, and compare treatment adherence and toxicity in regard with patients not receiving phone follow-up during treatment.

*Total dose administered and administration rate.

Institut Universitaire du Cancer de Toulouse Oncopole (IUCT)

Centre Hospitalier Universitaire de Youpougon à Abidjan

Association-Assistance des Malades Ambulatoires (AAMA)

The AMA procedure has tremendous potential in emerging countries suffering from an extreme shortage of specialised medical personnel. This is particularly true in Côte d'Ivoire, where there are only four oncologists for 25 million inhabitants. So this country was a natural choice for duplicating this procedure. What’s more, it is a French territory, and the University Hospital of Toulouse has trained three generations of academic haematologists in Abidjan. Nevertheless, the Amafrica objectives differ from those of the French project. Improving treatment adherence is certainly a challenge, but this is also about understanding the mechanisms of treatment dropout, whether the reasons are economic, logistical, cultural, etc. The extremely diverse sociological parameters in Abidjan will inevitably come into play. And this means that Amafrica will serve as an excellent information resource regarding health inequalities and could be very instructive for our own practices in the North.”

Prof. Guy Laurent Coordinator of the CAPTOR project (Cancer Pharmacology of Toulouse-Oncopole and Region), haematologist at the University Hospital of Toulouse (Institut Universitaire du Cancer de Toulouse-Oncopole) and President of the AAMA.

Future initiatives

This project, based on regular phone contact between the patient and the coordinating nurse, could ultimately lessen the burden on healthcare facilities and could be used for other pathologies, including chronic ailments.

Partners

  • Association Amafrica
  • Haematology Department at University Hospital of Yopougon, Abidjan