Any major toxicity and hospitalization resulting from treatment complications such as febrile neutropenia;
Response to treatment (based on radiographic, biochemical, or clinical criteria, or combinations of these criteria;
The reason treatment was discontinued;
Planned next steps (e.g. hospice care, an alternative regimen, expectant management, posttreatment surveillance etc.);
Who is responsible for performing follow-up and any other special monitoring.
When cancer patients transition from active treatment to surveillance, and then from close surveillance to long-term survivorship, it is important to generate both a summary document that specifies any ongoing problems for that patient and schedules for follow-up evaluations and procedures.
Figure D.1-1 illustrates a draft ASCO treatment summary for a patient with stage III colon cancer. It was completed at the end of adjuvant therapy. This document is synoptic; that is, it does not include all details about the care provided. Although it is intended to be shared with patients, it includes enough detail for other treating health practitioners. These documents are not meant to replicate the medical record. The treatment plan/summary should include no more detail than two sides of a sheet of paper. This is consistent with most operative reports, hospital discharge summaries, pathology reports, pediatric records of growth and immunization, and other key synopses that are well-accepted in health care. The goal of the ASCO treatment summary initiative is to obtain consensus among oncology professionals about key elements. For now, it focuses on care coordination and traditional medical issues rather than on psychological well-being or secondary prevention such as tobacco use, nutrition, or exercise, though these are nonetheless recognized as very important.
Changing the professional culture of medical oncology to include preparation of treatment plans and treatment summaries will be extremely challenging. Previous pilot work conducted by ASCO with volunteer physician practices indicates that although physicians think that treatment plans and summaries are important and worthwhile, the main obstacle to preparing them is limited time given their busy and demanding practices. Demonstrating that this mode of documentation can ultimately save rather than add time—particularly with development of electronic versions that are easy to