title: Evaluation of the impact of a flowchart-type leaflet for cancer inpatients.
abstract: OBJECTIVE
  This study aimed to evaluate the benefits of an interactive and visual flowchart-type leaflet for head and neck cancer inpatients who received induction chemotherapy, docetaxel, cisplatin, and 5-fluorourasil (DCF), or docetaxel, cisplatin, and S-1 (DCS) from September 2009 to April 2012. The flowchart-type leaflet group used a flowchart-type leaflet during chemotherapy, while the non-flowchart-type leaflet group did not.
  
  
  METHODS
  A retrospective cohort study was performed using patient records. The endpoints of this study were to determine the following: the number of emergency hospital admissions/visits, incidence of Grade 2 or higher non-haematological adverse drug reactions, nonadherence to treatment, and the number of telephone calls from subjects.
  
  
  RESULTS
  A total of 109 subjects were identified as follows: 49 in the flowchart-type leaflet group (139 chemotherapy sessions) and 60 in the non-flowchart-type leaflet group (163 chemotherapy sessions). No significant differences were observed in age, performance status, or chemotherapy regimen. The incidence of emergency hospital admissions was significantly lower in the flowchart-type leaflet than in the non-flowchart-type leaflet group (1% vs 10%, p < 0.01). No difference was seen between groups (12% vs 19%, p = 0.1) in the nonadherence rate of supportive medication for adverse drug reactions. Telephone call rates were significantly higher in the flowchart-type leaflet (16%, 30 calls) than in the non-flowchart-type leaflet group (7%, 11 calls) in each chemotherapy regimen. Of the 30 calls from patients in the FCL group, 24 (80%) were made to the hospital, compared with only 5 (45%) of the 11 calls from patients in the non-flowchart-type leaflet group.
  
  
  CONCLUSIONS
  Our results suggest that the flowchart-type leaflet can reduce nonadherence and improve patient judgment during chemotherapy, leading to a decrease in emergency hospital admissions.
authors.affiliation: Pharmacy Division, National Cancer Center Hospital East, Chiba, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: Head and Neck Medical Oncology Division, National Cancer Center Hospital East, Chiba, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Enokida
authors.affiliation: Head and Neck Medical Oncology Division, National Cancer Center Hospital East, Chiba, Japan.
authors.forename: Takehiko
authors.initials: T
authors.lastname: Kobayashi
authors.affiliation: Head and Neck Medical Oncology Division, National Cancer Center Hospital East, Chiba, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Yajima
authors.affiliation: Head and Neck Medical Oncology Division, National Cancer Center Hospital East, Chiba, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Ishiki
authors.affiliation: Pharmacy Division, National Cancer Center Hospital East, Chiba, Japan.
authors.forename: Keishiro
authors.initials: K
authors.lastname: Izumi
authors.affiliation: Department of Drug Safety Management, Meiji Pharmaceutical University, Tokyo, Japan.
authors.forename: Kazushi
authors.initials: K
authors.lastname: Endo
authors.affiliation: Head and Neck Medical Oncology Division, National Cancer Center Hospital East, Chiba, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Tahara
keywords: Flowchart; adherence; leaflet; severe adverse events