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Lymphoma Treatment Progress Tracking Chart

Patient Self-Monitoring and Treatment Response Tool

Oncology

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Template Content

Last updated: Mar 24, 2025

Patient Information

Name: ________________________ Date of Diagnosis: ______________ Type of Lymphoma: ______________

Treatment Plan Summary

  • Primary Treatment: _________________
  • Start Date: ______________________
  • Expected Duration: ________________

Symptom Tracking

Rate symptoms on a scale of 0-5 (0 = none, 5 = severe)

Weekly Monitoring

Date Fatigue Night Sweats Fever Weight Changes Lymph Node Size

Blood Count Values

Complete Blood Count (CBC)

Date WBC RBC Platelets Hemoglobin

Treatment Response

  • Complete Response (CR)
  • Partial Response (PR)
  • Stable Disease (SD)
  • Progressive Disease (PD)

Side Effect Management

Side Effect Severity (1-5) Management Strategy Healthcare Provider Notes

Important Contacts

Oncologist: ____________________ Phone: _________________________ Emergency Contact: _____________

Notes

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