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Data Supplement - ASCO Templates for Use in Practice

Non Small Cell Lung Cancer Treatment Plan and Summary Resources

Several types of non small cell lung cancer treatment plan and summary templates are provided below. These forms include a plan component, to be completed prior to chemotherapy treatment, and a summary to be completed following chemotherapy.

1. Adjuvant Non Small Cell Lung Cancer Treatment Plan and Summary templates – choose any of the following formats:

2. Advanced Non Small Cell Lung Cancer Treatment Plan and Summary templates- choose any of the following formats:

Lung Development Work Group Roster

Small Cell Lung Cancer Treatment Plan and Summary Resources

Several types of small cell lung cancer treatment plan and summary templates are provided below. These forms include a plan component, to be completed prior to chemotherapy treatment, and a summary to be completed following chemotherapy.

1. Limited Stage Small Cell Lung Cancer Treatment Plan and Summary templates – choose any of the following formats:

2. Extensive Stage Small Cell Lung Cancer Treatment Plan and Summary templates – choose any of the following formats:

Lung Development Work Group Roster

Information About Use of Treatment Plans and Summaries

The treatment summary is not intended to be, and should not be considered, a substitute for written or verbal communication, physical examination and history, or review of the complete medical record. Because the treatment summary will summarize parts of your patient’s medical record and treatment plan, it should be treated as confidential and used or disclosed only in accordance with federal and state privacy laws.

No single treatment plan or summary can be appropriate for all patients. Treating oncologists assume responsibility for tailoring the treatment summary to meet individual patient’s needs.

Use of the treatment summary is entirely voluntary. Use of this tool does not imply ASCO’s endorsement of any specific treatment or any product. ASCO is not responsible for any inaccurate or inappropriate use of the treatment summary.



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