CORE
Colorectal Cancer Resources & Education

Treatment Journal

Developed by Pfizer in partnership with the Colon Cancer Alliance

Introduction

Your Treatment Team

Appointments

Tracking Side Effects

Personal Journal

Introduction

This journal will help you keep track of your treatment and recovery. When you are dealing with cancer, it is very hard to remember questions you have for the doctor or even what the doctor says during a visit. Writing down your questions ahead of time, and what the doctor or nurse tells you, will help you a lot.

There is room for you to keep track of:

Your Treatment Team

Write down the names and phone numbers of all the people who provide your cancer care or other kinds of support.

Appointments

Keep track of each of your appointments for checkups, treatments, and tests. Jot down the questions you would like to ask your doctor and his or her answers. You can also write down your doctor’s or nurse’s suggestions and advice.

Side Effects

Use these pages to record any side effects you have. Bring this booklet with you to each of your appointments. This way, you won’t forget to inform your doctor or nurse.

Personal Journal

This is your section of this booklet. Keep track of your thoughts and feelings—or anything else you’d like.

Your Treatment Team

Use the spaces below to record contact information for members of your treatment team.

Your hospital

Name

Address

Phone number

Fax number

Anesthesiologist

Name

Phone number

Gastroenterologist

Name

Phone number

Home health nurse

Name

Phone number

Nutritionist or dietitian

Name

Phone number

Oncologist

Name

Phone number

Oncology nurse

Name

Phone number

Ostomy nurse

Name

Phone number

Pathologist

Name

Phone number

Pharmacist

Name

Phone number

Primary care physician

Name

Phone number

Radiation oncologist

Name

Phone number

Radiation therapist

Name

Phone number

Radiologist

Name

Phone number

Social worker

Name

Phone number

Surgeon

Name

Phone number

Your health insurance

Name

Address

Phone number

Fax number

Policy number

Others

Name

Phone number

Name

Phone number

Name

Phone number

Name

Phone number

Name

Phone number

Name

Phone number

Name

Phone number

Name

Phone number

Name

Phone number

Appointments

Date:

With:

Where:

Notes:

Questions to ask:

Answers to questions:

Comments from the doctor/nurse:

Things I should do next:

Things I should not do:

I should call the doctor if:

Appointments

Date:

With:

Where:

Notes:

Questions to ask:

Answers to questions:

Comments from the doctor/nurse:

Things I should do next:

Things I should not do:

I should call the doctor if:

Appointments

Date:

With:

Where:

Notes:

Questions to ask:

Answers to questions:

Comments from the doctor/nurse:

Things I should do next:

Things I should not do:

I should call the doctor if:

Appointments

Date:

With:

Where:

Notes:

Questions to ask:

Answers to questions:

Comments from the doctor/nurse:

Things I should do next:

Things I should not do:

I should call the doctor if:

Appointments

Date:

With:

Where:

Notes:

Questions to ask:

Answers to questions:

Comments from the doctor/nurse:

Things I should do next:

Things I should not do:

I should call the doctor if:

Appointments

Date:

With:

Where:

Notes:

Questions to ask:

Answers to questions:

Comments from the doctor/nurse:

Things I should do next:

Things I should not do:

I should call the doctor if:

Appointments

Date:

With:

Where:

Notes:

Questions to ask:

Answers to questions:

Comments from the doctor/nurse:

Things I should do next:

Things I should not do:

I should call the doctor if:

Appointments

Date:

With:

Where:

Notes:

Questions to ask:

Answers to questions:

Comments from the doctor/nurse:

Things I should do next:

Things I should not do:

I should call the doctor if:

Appointments

Date:

With:

Where:

Notes:

Questions to ask:

Answers to questions:

Comments from the doctor/nurse:

Things I should do next:

Things I should not do:

I should call the doctor if:

Appointments

Date:

With:

Where:

Notes:

Questions to ask:

Answers to questions:

Comments from the doctor/nurse:

Things I should do next:

Things I should not do:

I should call the doctor if:

Appointments

Date:

With:

Where:

Notes:

Questions to ask:

Answers to questions:

Comments from the doctor/nurse:

Things I should do next:

Things I should not do:

I should call the doctor if:

Appointments

Date:

With:

Where:

Notes:

Questions to ask:

Answers to questions:

Comments from the doctor/nurse:

Things I should do next:

Things I should not do:

I should call the doctor if:

Appointments

Date:

With:

Where:

Notes:

Questions to ask:

Answers to questions:

Comments from the doctor/nurse:

Things I should do next:

Things I should not do:

I should call the doctor if:

Appointments

Date:

With:

Where:

Notes:

Questions to ask:

Answers to questions:

Comments from the doctor/nurse:

Things I should do next:

Things I should not do:

I should call the doctor if:

Appointments

Date:

With:

Where:

Notes:

Questions to ask:

Answers to questions:

Comments from the doctor/nurse:

Things I should do next:

Things I should not do:

I should call the doctor if:

Appointments

Date:

With:

Where:

Notes:

Questions to ask:

Answers to questions:

Comments from the doctor/nurse:

Things I should do next:

Things I should not do:

I should call the doctor if:

Appointments

Date:

With:

Where:

Notes:

Questions to ask:

Answers to questions:

Comments from the doctor/nurse:

Things I should do next:

Things I should not do:

I should call the doctor if:

Appointments

Date:

With:

Where:

Notes:

Questions to ask:

Answers to questions:

Comments from the doctor/nurse:

Things I should do next:

Things I should not do:

I should call the doctor if:

Appointments

Date:

With:

Where:

Notes:

Questions to ask:

Answers to questions:

Comments from the doctor/nurse:

Things I should do next:

Things I should not do:

I should call the doctor if:

Appointments

Date:

With:

Where:

Notes:

Questions to ask:

Answers to questions:

Comments from the doctor/nurse:

Things I should do next:

Things I should not do:

I should call the doctor if:

Tracking Side Effects

Different treatments will have different side effects. In addition, some people may have different side effects even if they are on the same treatment. Attached is a list of possible side effects that may occur during treatment. (Please see list below.)

Some side effects can be very serious. Ones to watch for have stars (*) next to them. Tell your doctor or nurse right away if any of these occur. Don’t wait for your next appointment.

Use these pages to record the date of any side effects you have. You should bring this booklet with you to each of your appointments. This way, you will not forget to inform your doctor or nurse of any problems. It’s important that you track how mild or severe you feel the side effects are. Each week ask your doctor or nurse to write in those side effects that you should be looking out for. Space is provided on the bottom of each page.

POSSIBLE SIDE EFFECTS

Use the list as a guide throughout treatment to help record your side effects.

Stomach and Bowels
Diarrhea Diarrhea for more than 24 hours* Diarrhea with cramps or pain* Constipation Constipation for more than 2 days*	Blood in your stool* Black stool* Nausea Very severe nausea* Some vomiting Very severe vomiting*

Mouth, Gums, and Throat
Mouth sores* Sore throat* Dry mouth Jaw pain	Blisters on the lips* Bleeding gums* Dry lips

Lungs and Breathing
Wheezing* Severe cough*	Feeling short of breath*

Urination
Pain or burning when you urinate* A feeling that you must urinate right away (“urgency”)*	Urinating more often than usual* Not being able to urinate* Reddish or pinkish (bloody) urine*

Skin and Nails
Skin blisters* Sudden rash or hives* Swelling and redness of the skin* Small, red spots underneath your skin Changes in your fingernails or toenails Pale skin	Itching Strange bruise* Sudden or severe itching* Tingling feelings Redness, irritation

Hair
Hair seems thinner	Hair falling out in clumps

Other Side Effects
Body in General
Fever* Shaking chills* Severe night sweats* Always feeling cold Fatigue (tiredness)	Flu-like symptoms, such as body aches* Walking problems Shaking or trembling Loss of balance Clumsiness Weak, sore, tired, or achy muscles
Arms, Legs, Hands
Warm or hot feelings in your arm or leg* Finding it hard to pick up objects and button clothing* Weakness or numbness in your hands or feet* Lower leg (calf) pain
Head, Eyes, Ears, Nose
Dizziness Nosebleed* Problems hearing	Headaches* Changes in your vision*
Other
Feeling confused* Feeling depressed* Soreness at the site of your injection*	Unusual discharge from the vagina* Vaginal bleeding that is new or lasts longer than your normal period*

*These side effects can be very serious. Tell your doctor or nurse right away if any of these occur.

Tracking Side Effects

EXAMPLE:

Month: ______________ Year: ______________

DATE	SUN	MON	TUE	WED	THU	FRI	SAT
POSSIBLE SIDE EFFECTS	6/20	6/21	6/22	6/23	6/24	6/25	6/26
Stomach and Bowels
Diarrhea	X					X	X
Cramps							X

Mouth, Gums, and Throat



Lungs and Breathing



Skin and Nails



Hair



Other
Tired	X	X	X	X	X	X	X
Numbness/Tingling	X	X	X

Lab Results

DOCTOR/NURSE NOTES

Call the doctor immediately if you have the following:

Diarrhea with cramping for more than 24 hours