Cancer Treatment and Survivorship Care Plans
ASCO developed two forms to help providers offer patients a straightforward record of their treatment plan and recommended follow-up care. These forms are intended to be filled out by a member of the cancer care team in partnership with the patient, and to be easily shared with other health care providers once the patient has transitioned to primary care.
The ASCO Cancer Treatment Plan organizes basic information about a patient’s cancer care history. This includes treatments, medication doses, surgeries, and any additional treatment that was given.
The ASCO Survivorship Care Plan organizes information about a patient’s recommended follow-up care plan. This includes how often the patient should have checkups, the types of tests needed, and the potential long-term and late effects of cancer treatments received. It also provides suggestions for healthy living.
These forms are available in English and Spanish.
These forms are not intended to provide a complete medical record. No single treatment or survivorship care plan is appropriate for all patients due to the complexity of cancer care. Talk with your doctor for more information about your individual treatment and follow-up care. Use the ASCO Cancer Treatment Plan and Survivorship Care Plan with the guidance of your doctor.
Links below are to downloadable Microsoft Word (.docx) files.
Any Cancer
Disease-Specific
- Breast Cancer Survivorship Care Plan (Spanish)
- Cervical Cancer Survivorship Care Plan (Spanish)
- Colorectal Cancer Survivorship Care Plan (Spanish)
- Lung Cancer (Non-Small Cell) Survivorship Care Plan (Spanish)
- Lung Cancer (Small Cell) Survivorship Care Plan (Spanish)
- Diffuse Large B-Cell Lymphoma Survivorship Care Plan (Spanish)
- Ovarian Cancer Survivorship Care Plan (Spanish)
- Prostate Cancer Survivorship Care Plan (Spanish)
- Uterine Cancer Survivorship Care Plan (Spanish)
Permission to Use ASCO Treatment and Survivorship Care Plan Templates
Patients and other consumers may use ASCO’s Treatment and Survivorship Care Plan Templates without seeking permission from ASCO.
Practitioners may incorporate the Templates into their workflow and/or into their electronic medical records system without seeking permission from ASCO. If the templates will be altered in any way, including the addition of institutional branding, ASCO requires that all ASCO identifiers be removed.
For permission to use the Templates in a commercial manner or in any manner not described above, please contact permissions@asco.org.