Optional discussion worksheet
Your survivorship passport
Keep a verified treatment summary, an individual follow-up plan and the responsibilities of each team together after treatment.
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1. Your verified treatment summary
Ask the oncology team to check this summary. Attach official reports or the existing caregiver-toolkit treatment-history record. You do not need to copy every result here.
Patient identifier chosen by you / plan date / team that checked this summary
Confirmed diagnosis, site, pathology and stage; key report dates and location
Surgery and dates; radiotherapy site, dates and dose from official summary
Cancer medicines and dates; important doses or cumulative exposure from the team
Major treatment complications, allergies, devices or alert cards
2. Ongoing treatment and possible late effects
Do not stop ongoing treatment because a main course has ended. Risks depend on the particular treatment and person; there is no universal scan or blood-test schedule.
Current medicines, purpose and planned review; current prescription location
Ongoing symptoms and rehabilitation or symptom-support needs
Late effects the team says are relevant; what to watch for and who manages them
Fertility, sexual health, menopause, bone or heart health questions, where relevant
Questions about vaccinations, dental care or other medical treatment
3. Your individual follow-up plan
Record only the tests and intervals agreed by your team. Clarify who orders each test, reviews the result and contacts you. New concerning symptoms should not wait for a routine visit.
Oncology review: purpose / timing / responsible team / contact
Tests specifically recommended: which / why / when / who reviews results
Primary-care and other condition reviews; routine screening appropriate for you
Symptoms that need an earlier call / emergency route confirmed by the team
Who to contact if an appointment or result is missing; next plan-review date
4. Life after treatment and sharing the plan
Recovery is not a deadline. Ask for help with physical, emotional, social or financial effects. Agree whom the patient wants to receive a copy of the plan.
Personal recovery goals: activity, fatigue, work, sleep, food or confidence
Practical and emotional support; who can help and when
Oncology, primary-care and specialist contacts; backup route
Who has the latest copy / date shared / records or alert cards to carry
Questions for the next review; changes since the last plan
Before sharing or printing
Print completed PDF answers from your PDF reader; “Open printable PDF” opens the blank layout designed for handwriting. Downloaded files are not encrypted. Keep completed copies securely and take care on shared devices and printers.
These are discussion prompts, not prescriptions, emergency instructions or formal medical or legal documents. Use the current verified plan from your care team.
Read with this tool
- When cancer returns or treatment stops working: a guide for patients and families
- Cancer treatment in later life: a guide for older adults and families
Sources and further reading
These prompts accompany the source-checked guides linked above. Their Sources and further reading sections contain the original references.