Cancer Survivor Care PlanWhat146s Next Life After Cancer Treatment - PDF document

Cancer Survivor Care PlanWhat’s Next? Life After Cancer Treatment A project of: The Minnesota Cancer Alliance is pleased to provide this survivorship care plan: What’s Next? Life After Cancer Treatment. This booklet is a road map of sorts, a way to help you record where you’ve been and provide inf

ormation to help you plan the next part of your cancer journey.• crNatN a concisN historQ of Qour cancNr trNatmNnt NxpNriNncN• providN a platform for dialog Pith Qour carN providNrs• managN Qour folloP-up mNdical carN• gain an aParNnNss of sidN NffNcts in both thN short and long-tNrm • providN tools and

dirNction for sNlf-carN involving phQsical, emotional and practical issues Karen Karls is a cancer survivor from Grand Rapids, Minnesota. She has some thoughts to share on cancer and the use of this booklet.It’s cancer.The words set your world spinning and ll you with fear. Soon your life is centere

d on doctors, tests, and treatments. You learn what comes Then comes your last big treatment, and you are left wondering, What next? A survivor care plan would have helped me with this question. A care plan is a history of your cancer journey. It is a place to note the stages of your treatment, long-term side eff

ects and what to expect from your follow-up care. It’s been 11 years for me, and the exact treatment dates have faded from my memory. With a care plan, I can nd these details without A survivor care plan is for the future – an empowering reminder that you s�ll have control of your life.C

ancer happened to you, but it does not have to de�ne who you are.– Karen Karls TABLE OF CONTENTSSummary of Cancer TreatmentMedical Care TeamClinical Trial InformationOther TreatmentsAfter Treatment CareLong Term IssuesFolloP-Up TNsts NNNdNdAdvice from Your Care TeamOther ConcernsCommunity Resource

s This publication was supported by CDC Cooperative Agreement Number 5U58DP000802-03. Its contents are solely the responsibility of the authors and ofcial views of the CDC. SUMMARY OF CANCER TREATMENT Having detailed information about the cancer treatment you receive UsN this sNction to PritN notNs about Qou

r diagnosis, trNatmNnt, and care team. This will be useful to future doctors and others who may need to know your cancer history.Please update this section as you learn more details about your cancer journey.Every person’s cancer experience is different, so parts of the booklet 5 PERSONAL INFORMATION: Addr

essPeople who supported me through my diagnosis and treatment: “release of information” form?this form needs to be renewed every year.I have completed a Health Care Directive: Yes Where my Health Care Directive is located A Health Care Directive (also known as a Living W

ill or Durable Power of Attorney document in which a person may name someone to make decisions for them and/or 6 PEOPLE IN MY FAMILY WITH CANCER TQpN of cancNr AgN at diagnosis Mother’s mother Mother’s father Father’s mother Father’s father GENETIC COUNSELIN

GGenetic testing will tell you if cancer runs in your family. Most cancers do not run in the family. Only a small number of people will Did my care team suggest genetic counseling? Yes I received genetic counseling. Yes 2. Type of genetic test I had MEDICAL CARE TEAMGeneral Care Address Cancer SurgeryAdd

ress Cancer CareAddress MEDICAL CARE TEAMRadia�onAddress Other Specialist Address Hospital or Clinic Address 9 MEDICAL CARE TEAMHospital or Clinic Address Other Care Providers Contact Informa�on Alternative Medicine care providers (chirop

ractor, CANCER DIAGNOSISType of cancerDate I learned I had cancer I have a copy of my pathology report: Yes Where my pathology report is locatedCANCER TREATMENT SUMMARYSome of the treatments may not apply to you.1st SurgeryType of surgeryWhere surgery was doneDescribe any problems you had after surgeryI ha

ve a copy of my surgery record: Yes CANCER TREATMENT SUMMARY2nd SurgeryType of surgeryWhere surgery was doneDescribe any problems you had after surgeryI have a copy of my surgery record: Yes 3rd SurgeryType of surgeryWhere surgery was doneDescribe any problems you had after surgeryI have a copy of my surgery

record: Yes CANCER TREATMENT SUMMARY1stCourseRadia�onWhere I received treatmentsDates: from Area of body treatedNumbNr of trNatmNnts Total dosN CourseRadia�onWhere I received treatmentsDates: from Area of body treatedNumbNr of trNatmNnts: Total dosNYes CANCER T

REATMENT SUMMARYPortInforma�onHospital where port was placedArea of bodyType of port (brand and company)Yes ClinicalTrialInforma�onYou may join a clinical trial at any point in your cancer journey.Hospital or clinic where trial was doneI have a copy of the details from my clinical trial: Y

es 14 CANCER TREATMENT SUMMARYChemotherapy, Biotherapy, Hormone Therapy (and other drugs received as part of my cancer treatment)Where I received therapy CANCER TREATMENT SUMMARYChemotherapy, Biotherapy, Hormone Therapy I have a copy of my therapy records: Yes Bone Marrow or Cord Blood TransplantType of tra

nsplant: Autologous (you received cells that you donated) Allogeneic (you received cells that someone else donated)Other Procedures and Treatments (red cells or platelets) AFTER TREATMENT CAREThis section explains the care you will need after you nish your cancer treatment. It lists questions you may

want to ask your a cancer survivor.After your treatment ends, you will still see your doctor for regular care. You should know:• WhNrN to go for tNsts and Nxamsyears. During clinic visits, your care team will check your health and 17 AFTER TREATMENT CARELong-term IssuesAsk your doctor what side effects you mig

ht have after your treatment has stopped:Breathing problems Dental concerns children (fertility) problems changes changes patterns (lymphedema) UrinarQ problNmsWorry hands or feet Other (list) AFTER TREATMENT CAREQues�onstoHow long ca

n side effects last after treatment has stopped?Who should I call if I have any of these side effects?How can I manage these side effects? 19 AFTER TREATMENT CARE Purpose of visit CommentsNowthatmycancertreatment:When should I call other doctors or care providers involved in my care? AFTER TREATMENT CAREScans

and X-rays (MRIs, PET Scans, CT Scans, etc.)Who will order the tests?How will I get my test results?Lab tests & blood drawsWho will order the tests?How will I get my test results?A�er-TreatmentTestsWho will order the tests?How will I get my test results? AFTER TREATMENT CAREAdvice from Your Care TeamSc

reening tests (to check for cancer):Exercise – what kind should I do?Healthy weight programs:Sunscreen:Support groups:Complementary and alternative medicinePreventing osteoporosis (weak bones): 22 AFTER TREATMENT CAREBelow is a list of topics to think about after you nish treatment. Topic

My concern My relationships Money problems Long-tNrm carN Fear of cancer return (recurrence) RESOURCESwww.cancer.orgwww.acscsn.orgPPP.cancNr.gov Life After Cancer TreatmentPPP.cancNr.gov/cancNrtopics/lifN-aftNr-trNatmNntNotes P.O.Box 64882http://www.mncanceralliance.org A