Cancer Treatment Plan
Summary of Cancer Treatment
Having detailed information about the cancer treatment you have received is important. Please fill out your diagnosis, multidisciplinary care team, medical treatment and current side effects. This information will be helpful for health & wellness professionals and others who may need to know your cancer history.

Only fill out the questions that you know. There are no mandatory questions.

Everyone’s cancer experience is different so some of the questions may not apply to you.

Personal Information

Cancer Diagnosis

Clinical Trials

Cancer research is an important part of cancer care and over the years has led to better treatments and outcomes for people diagnosed with cancer. A clinical trial is one type of cancer research and helps to show if a new approach to prevention, screening, diagnosis or treatment works better than current methods.

Are you currently in a clinical trial ?

Surgery and biopsy

Surgery and biopsies are performed to remove or repair a part of the body, or to find out whether disease is present. For many types of cancer, surgery may be used to remove the tumor as well as other tissue that is suspected of containing cancer cells.

Have had surgery or biopsy

Add all the surgery you had


Works by stopping or slowing the growth of cancer cells, which grow
and divide quickly. But it can also harm healthy cells that divide
quickly, such as red and white blood cells, cells that line the mouth
and intestines and cells related to the growth of hair.

Have had Chemotherapy


Radiation may come from a machine outside the body, or it may come from radioactive material placed in the body near cancer cells. Systemic radiation therapy uses a radioactive substance that travels in the blood to tissues throughout the body.

Have had Radiation

Hormone Therapy

Some hormones encourage the growth of some cancers, such as breast and prostate. But, they may kill, slow or stop cancer cells from growing. Hormone therapy usually involves taking medications that prevent cancer cells from getting the hormones they need to grow.

Have your or are you taking hormone therapy

Targeted Therapy

Targeted therapies are drugs or other substances that block the growth and spread of cancer by interfering with specific molecules. Targeted therapies differ from standard chemotherapy because they are designed to act on specific molecular targets and attack cancer cells without harming healthy cells. This is done by targeting some key differences between cancer cells and other cells. These targets may be genes, so the treatment aims to ‘switch off’ genes that tell cancer cells to grow or to ‘switch on’ genes that tell cancer cells to die. Other targeted therapies deliver substances directly to proteins in the cancer cell to destroy them or prevent growth.

Have you or are you taking targeted therapy

Treatment Side effects

Everyone’s cancer experience is different and so are their side effects. The following section details the common side effects that people can experience.

Fatigue is the most common side effect from cancer treatment. You can experience fatigue for months or even years after finishing treatment. Fatigue is a persistent feeling of physical, emotional, or mental tiredness or exhaustion. This type of fatigue is different from other types of fatigue because it interferes with your usual functioning, does not reflect your level of activity, and does not improve with rest.

Are you experiencing Fatigue

Pain is related to a state of lack of well-being and uneasiness that ranges from mild discomfort or dull distress to acute, often unbearable agony, it may be generalized or localized.

Are you experiencing Pain

Immune System is related to spleen, lymph nodes, bone marrow, leukocytes and neutrophils.

Are you experiencing problems with your Immune System

Cognitive problems are related to conscious intellectual activity such as thinking, reasoning, memory, attention to task, imagining, or learning.

Are you experiencing cognitive problems

Reproductive is related to prostate, testes, ovaries, ducts and glands

Are you experiencing reproductive problems

Gastrointestinal is related to mouth, oesophagus, stomach, small intestine, large intestine, rectum, anus, liver, pancreas, and gallbladder.

Are you experiencing gastrointestinal problems

Urinary is related to the renal system, urine, kidneys, ureters and bladder.

Are you experiencing urinary problems

Cardiovascular is related to the circulation of blood through the body including the heart, arteries and blood vessels.

Are you experiencing cardiovascular problems

Skeletal is related to bone and bone marrow

Are you experiencing skeletal problems

Musculoskeletal is related to the form, support, stability, and movement to the body including bones of the skeleton, muscles, cartilage, tendons, ligaments, joints, and other connective tissue that supports and binds tissues and organs together

Are you experiencing musculoskeletal problems

Integumentary is related to the skin, and skin derivatives such as hair, nails, glands and receptors.

Are you experiencing Integumentary problems

Pulmonary is related to inhalation of oxygen and the exhalation of carbon dioxide, including maintenance of body temperature and elimination of excess water from the body.

Are you experiencing pulmonary problems

Lymphatic is related to lymph fluid, white blood cells and lymph nodes including removal of lymph nodes

Are you experiencing lymphatic problems

Nervous System is related to the central and peripheral nervous system including the brain, spinal cord and nerves connected to the spinal cord.

Are you experiencing nervous system problems

Endocrine is related to the gland and other organs that are responsible for making hormones and producing eggs or sperm.

Are you experiencing endocrine problems