Date:
Patient:
MRN:
Clinician: (Hematologist, Oncologist)
Reason for Visit:
Follow-up for follicular lymphoma
Evaluation of symptoms and disease status
Review of imaging and laboratory results
Treatment plan discussion
History of Present Illness:
Briefly describe the patient’s current status:
Time since diagnosis of FL
Presence and severity of any symptoms (fatigue, night sweats, weight loss, lymphadenopathy – swollen lymph nodes)
Current treatment regimen (watch and wait, chemotherapy, immunotherapy) and response to therapy
Past Medical History:
Prior treatments for FL (chemotherapy, radiation therapy)
Other medical conditions (important for treatment considerations)
Family History:
Family history of lymphoma or other cancers
Social History:
Occupation and potential exposures (not typically relevant for FL)
Physical Exam:
Vital Signs: (may be normal)
Lymphadenopathy: Palpation for enlarged lymph nodes (axillary, inguinal, cervical)
Spleen: Palpation for splenomegaly (enlarged spleen)
Labs:
Complete Blood Count (CBC): Monitor for anemia, neutropenia (low white blood cell count) due to bone marrow involvement.
Liver function tests (LFTs): Assess for potential liver toxicity from chemotherapy.
LDH (lactate dehydrogenase): Elevated levels may indicate more aggressive lymphoma.
Consider mentioning other labs ordered as needed:
Serum protein electrophoresis (protein electrophoresis) – to monitor for monoclonal protein production
Imaging:
Previous imaging studies: Briefly describe the findings of imaging studies used for diagnosis and staging (CT scan, PET scan) at the time of diagnosis or on previous follow-up visits.
Current imaging studies: Describe the findings of any recent imaging studies used to monitor disease progression (CT scan, PET scan).
Assessment:
Summarize the current disease status based on symptoms, physical exam, labs, and imaging:
Stage of FL (I-IV) based on the Lugano classification system.
Response to treatment using response criteria (complete response, partial response, stable disease, progressive disease).
Consideration of disease activity (active vs. indolent) based on symptoms and rate of progression.
Plan:
Outline the treatment plan based on the assessment:
Watch and wait: For patients with asymptomatic, indolent FL.
Chemotherapy: Induction or maintenance chemotherapy regimens for active disease.
Immunotherapy: Monoclonal antibodies like rituximab used alone or in combination with chemotherapy.
Radiation therapy: May be used in specific situations.
Clinical trial participation: Discuss potential benefits and risks of participation.
Prognosis:
Briefly discuss the prognosis. FL is a slow-growing lymphoma, but it is incurable. Survival rates vary depending on the stage and response to treatment.
Emphasize the importance of regular follow-up to monitor for disease progression.
Education:
Document any education provided to the patient regarding:
The nature of FL, its stages, and treatment options
The importance of adhering to the treatment plan and managing side effects
The importance of regular follow-up and monitoring for disease progression
The emotional impact of a cancer diagnosis and available support resources
Notes:
Include any additional relevant information not covered above, such as the patient’s understanding of the disease and treatment plan, and any concerns they may have.
Consider mentioning the importance of maintaining a healthy lifestyle (diet, exercise) to support overall well-being during treatment.
Disclaimer: This is a template and should be adapted to the specific needs of each patient. It is important to consult with a hematologist or oncologist for diagnosis, treatment recommendations, and prognosis.