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Breast Cancer Treatment Journey Tracking Sheet

Personal Progress and Symptom Documentation Tool

Oncology

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Template Content

Last updated: Mar 24, 2025

Personal Information

  • Name: _________________
  • Date of Diagnosis: _________________
  • Medical Record Number: _________________
  • Oncologist: _________________
  • Nurse Navigator: _________________

Treatment Plan Summary

□ Surgery Date: _________________ □ Chemotherapy Start: _____________ End: _____________ □ Radiation Start: _____________ End: _____________ □ Hormone Therapy Start: _____________

Daily Symptom Tracker

Date: _________________

Physical Symptoms (Rate 0-10)

  • Pain Level: ___
  • Fatigue: ___
  • Nausea: ___
  • Appetite: ___

Emotional Well-being

  • Mood (Good/Fair/Poor): ___
  • Anxiety Level (0-10): ___
  • Sleep Quality (Good/Fair/Poor): ___

Medication Log

Medication Dose Time Taken Side Effects

Questions for Healthcare Team

Important Contacts

  • Emergency: 911
  • Oncology Office: _________________
  • After Hours Support: _________________
  • Pharmacy: _________________

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