AMAFRICA, a patient-navigator program for accompanying lymphoma patients during chemotherapy in Ivory Coast: a prospective randomized study.

BACKGROUND: Previous studies have indicated that accompanying socially underserved cancer patients through Patient Navigator (PN) or PN-derived procedures improves therapy management and reassurance. At the Cancer Institute of Toulouse-Oncopole (France), we have implemented AMA (Ambulatory Medical Assistance), a PN-based procedure adapted for malignant lymphoma (ML) patients under therapy. We found that AMA improves adherence to chemotherapy and safety. In low-middle income countries (LMIC), refusal and abandonment were documented as major adverse factors for cancer therapy. We reasoned that AMA could improve clinical management of ML patients in LMIC. METHODS: This study was set up in the Abidjan University Medical Center (Ivory Coast) in collaboration with Toulouse. One hundred African patients were randomly assigned to either an AMA or control group. Main criteria of judgment were refusal and abandonment of CHOP or ABVD chemotherapy. RESULTS: We found that AMA was feasible and had significant impact on refusal and abandonment. However, only one third of patients completed their therapy in both groups. No differences were noted in terms of complete response rate (CR) (16% based on intent-to-treat) and median overall survival (OS) (6 months). The main reason for refusal and abandonment was limitation of financial resources. CONCLUSION: Altogether, this study showed that PN may reduce refusal and abandonment of treatment. However, due to insufficient health care coverage, its ultimate impact on OS remains limited.

The perturbation paradigm modulates error-based learning in a highly automated task: outcomes in swallowing kinematics.

Traditional motor learning studies focus on highly goal-oriented, volitional tasks that often do not readily generalize to real-world movements. The goal of this study was to investigate how different perturbation paradigms alter error-based learning outcomes in a highly automated task. Swallowing was perturbed with neck surface electrical stimulation that opposes hyo-laryngeal elevation in 25 healthy adults (30 swallows: 10 preperturbation, 10 perturbation, and 10 postperturbation). The four study conditions were gradual-masked, gradual-unmasked, abrupt-masked, and abrupt-unmasked. Gradual perturbations increasingly intensified overtime, while abrupt perturbations were sustained at the same high intensity. The masked conditions reduced cues about the presence/absence of the perturbation (pre- and postperturbation periods had low stimulation), but unmasked conditions did not (pre- and postperturbation periods had no stimulation). Only hyo-laryngeal range of motion measures had significant outcomes; no timing measure demonstrated learning. Systematic-error reduction occurred only during the abrupt-masked and abrupt-unmasked perturbations. Only the abrupt-masked perturbation caused aftereffects. In this highly automated task, gradual perturbations did not induce learning similarly to findings of some volitional, goal-oriented adaptation task studies. Furthermore, our subtle and brief adjustment of the stimulation paradigm (masked vs. unmasked) determined whether aftereffects were present. This suggests that, in the unmasked group, sensory predictions of a motor plan were quickly and efficiently modified to disengage error-based learning behaviors.