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You can print out this form to help you answer the questions
Members of my family and others close to me who have the same kind of cancer I have.:
_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________
That person's experience with lung cancer and how it affected me or how I felt about it:
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The symptoms I have:
_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________
The type of lung cancer I have:
(If you don't know, ask your doctor or nurse and have them write it down
for you).
_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________
The following are the tests I have had and the results of those tests:
_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________
The results of my biopsy:
_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________
The result of my sputum cytology:
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