Download Treatment Record Summary Template

Bladder Cancer
Date
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:
Organ/Staging
Bladder Cancer
Local/Distant
Summary of Treatment and relevant dates:
Treatment Aim:
You have been treated with the intention of
curing your bladder cancer
Transurethral resection of bladder tumour for low-risk non-muscle-invasive
bladder cancer
Possible treatment toxicities and / or late effects:



Blood in the urine – this is common (in more than one in 10 people) and
you may experience a mild burning sensation when passing urine for a
couple of days/week after your operation.
 Drink plenty of water (2-2.5 ltrs per day) to keep hydrated and flush
your system.
Urine infection – this happens occasionally (in between one in 10 and one
in 50 people).
 If you have symptoms like a high temperature, painful urination, or
frequency or urgency of urination you should ask your GP to test your
urine for infection. You will be given antibiotics to treat the infection if
this is confirmed.
Deep vein thrombosis (a blood clot, usually in the large leg veins)
 Wear the anti-embolism stockings you are given until you are fully
mobile after the procedure to prevent this. It will also help if you get
mobile as quickly as possible after the procedure.
Advise entry onto primary care palliative or
supportive care register
Yes / No
DS 1500 application completed
Yes/No
Prescription Charge exemption arranged
Yes/No
Urinary symptoms

Blood in your urine (haematuria)

Pain on passing urine (urine infection/cystitis)

Urinary symptoms (frequency and urgency)
 Unless otherwise advised you should be drinking 2 litres of
water/cordials throughout the day and avoid caffeine drinks
(tea/coffee/carbonated/fizzy) to help relieve your urinary symptoms.
Other symptoms

Pain when you ejaculate, less forceful ejaculation or a reduced amount of
ejaculate.

Erectile dysfunction

Feeling tired

Psychological issues
Alert Symptoms that require referral back to specialist team:
Potential post TURBT complications:

If your stream of urine slows down or divides, stops and starts (stricture) –
URGENT – Call your specialist nurse

Unable to pass urine – URGENT – Get to your local A&E department
Contacts for re referrals or queries:
In Hours:
Out of hours:




Passing large blood clots
Pulsating chest/calf pain (DVT/PE) - URGENT
Pain on passing urine (urine infection/cystitis)
Bladder or kidney pain (usually severe lower back pain)
Other symptoms to seek advice about:

Unintended weight loss (more than 3kg)

Loss of appetite
Secondary Care Ongoing Management Plan: (tests, appointments etc)

Other service referrals made: (delete as nec)
District Nurse
AHP
Social Worker
Dietitian
Clinical Nurse Specialist
Psychologist
Benefits/Advice Service
Other
The results of your TURBT will be available within 2 weeks of your
operation. An appointment will be made for you before you leave the
ward.
.
Required GP actions in addition to GP Cancer Care Review (e.g. ongoing medication, osteoporosis and cardiac screening)
Summary of information given to the patient about their cancer and future progress:
Additional information including issues relating to lifestyle and support needs:

Contact your GP or practice nurse
Completing Doctor:
Signature:
Date:
PRIVATE AND CONFIDENTIAL
cc.
Patient GP Name
Patient GP Address
Patient GP Post Code
Supporting Documents that may help – Please delete this section before giving to the patient




Sexual Consequences for Men Prompt Tool
(http://www.londoncanceralliance.nhs.uk/media/118596/lca-hna-male-sexual-consequences-january-2016.pdf)
Sexual Consequences for Women Prompt Tool
(http://www.londoncanceralliance.nhs.uk/media/118602/lca-hna-sex-consequences-women-prompt-sheet-january-2016.pdf)
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-sheet-january-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
December 2010
(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