Brain Tumor Treatment Progress Tracking Chart

Patient Information

Name: ___________________ Date of Birth: //___ Diagnosis: ________________ Date of Diagnosis: //___

Daily Symptom Tracker

Rate severity: 0 (none) to 5 (severe)

Medication Log

• Medication Name: ________________
• Dosage: _______________________
• Time Taken: ____________________
• Side Effects: __________________

Treatment Sessions

Radiation Therapy

• Session Date: //___
• Radiation Site: ______________
• Dose: _____________________
• Side Effects: ______________

Chemotherapy

• Cycle Number: ______________
• Date: //___
• Medication: _______________
• Response: ________________

Cognitive Function Notes

• Memory Changes: □ Yes □ No
• Speech Difficulties: □ Yes □ No
• Concentration Issues: □ Yes □ No

Important Contacts

• Neurologist: _________________ Phone: ____________
• Oncologist: __________________ Phone: ____________
• Emergency Contact: ___________ Phone: ____________

Follow-up Appointments

Monthly Progress Summary

Physical Changes

• Weight: ________
• Activity Level: □ Improved □ Same □ Decreased
• Sleep Quality: □ Good □ Fair □ Poor

Quality of Life Assessment

• Pain Level (0-10): ___
• Mood (1-5): ___
• Daily Activities: □ Independent □ Need Some Help □ Need Significant Help