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Brain CNS Radiotherapy Patient Name Dear Patient Name TREATMENT SUMMARY You have now completed your initial treatment for cancer. This Treatment Summary provides a summary of your diagnosis, treatment and on-going management plan. It includes information on the symptoms you should be aware of, and who to contact. Your GP will also receive a copy of this summary. Diagnosis: Date of Diagnosis: PS ECOG MoCA Summary of Treatment and relevant dates: Treatment Aim: Current Neurological Deficits Current medication Possible treatment toxicities and / or late effects: Advise entry onto primary care palliative or supportive care register Yes / No DS 1500 application completed Yes/No Prescription Charge exemption arranged Yes/No Alert Symptoms that require referral back to specialist team: Contacts for queries: Other service referrals made: (delete as nec) District Nurse AHP Secondary Care Ongoing Management Plan: (tests, appointments etc) Social Worker Dietician . Clinical Nurse Specialist Psychologist Benefits/Advice Service Community Palliative Care Team Other Required GP actions in addition to GP Cancer Care Review (e.g. ongoing medication, onward referrals, GSF register) Summary of information given to the patient and/or their carer: Additional information including issues relating to lifestyle and support needs (delete as necessary): Smoking cessation advice given Diet and weight management Physical activity Alcohol intake Sunscreen advice Health and Well Being Event Date: Psychological status Completing Doctor: Signature: Date: GP READ CODES FOR COMMON CANCERS (For GP Use only). Other codes available if required. (Note: System codes are case sensitive so always ensure codes are transcribed exactly as below) System 1 Diagnosis: Lung Malignant Tumour Carcinoma of Prostate Malignant tumour of rectum Bowel Intestine Large Bowel Female Malignant Neoplasia Male Malignant Neoplasia Histology/Staging/Grade: Histology Abnormal Tumour grade Dukes/Gleason tumour stage Recurrent tumour Local Tumour Spread Mets from 1° Treatment Palliative Radiotherapy Curative Radiotherapy Chemotherapy Radiotherapy Treatment Aim: Curative procedure Palliative procedure Treatment toxicities/late effects: Osteoporotic # Osteoporosis Infection Ongoing Management Plan Follow up arranged (<1yr) Follow up arranged (>1yr) No FU Referral PRN Referrals made to other services: District Nurse Social Worker Nurse Specialist SALT Actions required by the GP Tumour marker monitoring PSA Osteoporosis monitoring Referral for specialist opinion Advised to apply for free prescriptions Cancer Care Review Palliative Care Review Medication: New medication started by specialist Medication changed by specialist Advice to GP to start medication Advice to GP to stop medication Information to patient: DS1500 form claim Benefits counselling Cancer information offered Cancer diagnosis discussed Aware of diagnosis Unaware of prognosis Carer aware of diagnosis Miscellaneous: On GSF palliative care framework GP OOH service notified Carers details National Cancer Survivorship Initiative (5 digit codes) XaOKG X78Y6 XE1vW X78gK X78gN B34.. B35.. 4K14. X7A6m XaOLF XaOR3 X7818 XaFr. 5149. XalpH x71bL Xa851 Xallm XaiL3 Xa1TO XaELC Xa9ua 8H8.. XaL.. 8HA1. 8HAZ. XaBsn XaBsr XaAgq XaBT6 Xalqg Xalqh XalSd Xalst 9D05 Xalyc XalG1 XEOhn 8B316 XaKbF XaJC2 All other systems Version 3 five byte codes (October 2010 release) Diagnosis Malignant neoplasm of bronchus or lung Malignant neoplasm of prostate Malignant neoplasm of Rectum Malignant neoplasm of Colon Malignant neoplasm of female breast Malignant neoplasm of male breast B22z. B46.. B141. B13.. B34.. B35.. Histology/Staging/Grade: Histology Abnormal Tumour staging Gleason grading of prostate Ca Recurrence of tumour 4K14. 4M… 4M0.. 4M6.. Metastatic NOS Treatment Radiotherapy tumour palliation Radiotherapy Chemotherapy BB13. 5149. 7M371 8BAD. Treatment Aim: Curative treatment Palliative treatment 8BJ0. 8BJ1. At risk of osteoporosis Osteoporosis 1409. N330. Ongoing Management Plan Follow up arranged 8H8.. No follow up arranged 8HA.. Referrals made to other services: Refer to District Nurse Refer to Social Worker 8H72. 8H75. Actions required by the GP Tumour marker monitoring PSA Osteoporosis monitoring 8A9.. 43Z2. 66a.. Entitled to free prescription Cancer Care Review Palliative Care Plan Review Medication: Medication given Medication changed 6616. 8BAV. 8CM3. 8BC2. 8B316 Information to patient: DS1500 completed Benefits counselling Cancer information offered Cancer diagnosis discussed 9EB5. 6743. 677H. 8CL0. XaJv2 Xaltp Miscellaneous: On GSF Palliative Care Framework GP OOH service notified 8CM1. 9e0.. 9180. Carer details 9180. XaCDx 6743. XalmL XalpL XaQly XaVzE XaVzA