Nonsmall Cell Lung Cancer Form

You can print out this form to help you answer the questions

The TNM of the cancer I have:

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The stage of the cancer that I have:

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Information about the operation I am going to have:

Day of surgery

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Time of surgery

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Time when I need to be at the hospital

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Location (hospital)

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My surgeon

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The person who will take me to the hospital

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The person who will bring me home after my operation

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My instructions for my care at home after the operation:

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Exercises I can do:

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Medications I will need to take:

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Arrangements for help while I recover:
(May include family and friends, Meals on Wheels, housekeeping services, home health services, etc.)

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Other:

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My schedule for radiation therapy:

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Side effects I am having from my radiation treatments:

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Special instructions from my doctor and/or nurse while I am getting radiation treatments:

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The kinds of chemotherapy I will receive:

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My chemotherapy treatment schedule:

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Side effects to expect from my chemotherapy:

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Special instructions from my doctor and/or nurse about my chemotherapy treatments:

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