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Lymphoid 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: Lymphoid Summary of Treatment and relevant dates: (delete as necessary) Intensive Non-intensive Other Organ/Staging IPI Stating Performance Status (ECOG) Local/Distant Treatment Aim: (delete as necessary) Curative Non-curative Include remission date Name drugs Radiotherapy intervention Possible treatment toxicities and / or late effects: Impaired fertility/Early menopause – List symptoms Cardiac failure – List symptoms Thyroid abnormalities – List symptoms Secondary cancers especially skin – List symptoms Psychological morbidity – List symptoms Additional regime specific side effects/consequences – List symptoms These may be managed within primary care or trigger a referral to a specialist team when necessary Advise entry onto primary care palliative or supportive care register (delete as necessary) Yes/No Added to CMC Yes / No DS 1500 application completed (delete as necessary) Yes/No Prescription Charge exemption arranged Yes/No Alert Symptoms that require referral back to specialist team: Contacts for re referrals or queries: Recurrence of B-symptoms (fevers/ drenching night sweats and unexplained weight loss more than 10% of body weight) New pruritis New neurological signs New Lymphadenopathy/ hepato-splenomegaly. Falling blood counts Rising ESR/LDH. In Hours: CNS Out of hours: Other service referrals made: (delete as nec) District Nurse Secondary Care Ongoing Management Plan: (tests, appointments etc) As per clinical guidelines for each diagnosis- follow up and monitoring. AHP Social Worker Dietitian Clinical Nurse Specialist Psychologist Benefits/Advice Service Palliative Care Other Required GP actions in addition to GP Cancer Care Review (e.g. ongoing medication, osteoporosis and cardiac screening) Annual flu vaccine Pneumovacc as per national guidelines Good management of hypertension, diabetes, smoking, exercise etc Breast screening if radiotherapy given for Hodgkin with mantle radiotherapy Summary of information given to the patient about their cancer and future progress: Treatment response Planned follow up Additional information including issues relating to lifestyle and support needs: Works/Education Travel Exercise/Diet Dental Care for people on bisphosphonates MSCC alert card and information No live vaccinations, unless in remission for curable disease Completing Doctor: Signature: Date: Supporting Documents that may help – Please delete this section before giving to the patient Fatigue Prompt Tool (http://www.londoncanceralliance.nhs.uk/media/122127/lca-hna-fatigue-prompt-sheet-january-2016.pdf) Pain Prompt Tool (http://www.londoncanceralliance.nhs.uk/media/122133/lca-hna-pain-prompt-sheetjanuary-2016.pdf) 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