Date:
Patient:
MRN:
Clincian: (Neuro-oncologist, Neurosurgeon)
Reason for Visit:
Follow-up for glioblastoma
Evaluation of symptoms (headaches, seizures, cognitive decline, weakness)
Review of imaging studies
Discussion of treatment plan and potential complications
History of Present Illness:
Briefly describe the patient’s current status:
Time since initial diagnosis and previous treatment modalities (surgery, radiation, chemotherapy)
Current symptoms and their impact on daily function
Response to previous treatment approaches
Past Medical History:
Underlying medical conditions relevant to treatment considerations
Social History:
Not typically relevant unless impacting overall health or treatment adherence.
Neurological Exam:
Assess mental status, cranial nerves, motor function, sensory function, and coordination.
Document any new or worsening neurological deficits.
Labs:
Routine blood tests (CBC, electrolytes) may be ordered pre-operatively or to monitor for treatment side effects.
Consider mentioning other labs ordered as needed (tumor markers may be helpful in some cases to monitor for recurrence).
Imaging:
MRI scan: Brain MRI with contrast is essential to assess tumor size, location, and any signs of recurrence or progression.
Assessment:
Summarize the diagnosis and current disease state:
Confirmation of glioblastoma diagnosis based on pathology results (if available).
Evidence of recurrence or progression based on imaging studies and clinical presentation.
Plan:
Outline the treatment plan based on the assessment:
Surgery: May be considered for recurrent tumors or to relieve symptoms caused by mass effect.
Re-irradiation: May be an option in some cases, depending on prior radiation dose and time elapsed since initial treatment.
Systemic chemotherapy: Temozolomide is the mainstay chemotherapeutic agent used for glioblastoma.
Clinical trials: Discuss the possibility of participation in clinical trials for new treatment approaches.
Palliative care: Important for symptom management and improving quality of life.
Prognosis:
Briefly discuss the prognosis. Glioblastoma is an aggressive brain tumor with a poor prognosis. However, treatment can help improve symptoms and quality of life, and some patients may experience extended survival.
Emphasize the importance of ongoing supportive care and honest communication about prognosis.
Education:
Document any education provided to the patient regarding:
The nature of glioblastoma, its progression, and treatment options
The potential side effects of treatment and supportive care measures
Palliative care options and the importance of focusing on quality of life
The availability of support groups and resources for patients and caregivers
Notes:
Include any additional relevant information not covered above, such as the patient’s understanding of the diagnosis and treatment plan, and any concerns they may have about treatment side effects, prognosis, or emotional impact of the disease.
Consider the emotional well-being of the patient and family and offer support or referral for mental health services if needed.
Disclaimer: This is a template and should be adapted to the specific needs of each patient. It is important to consult with a neuro-oncologist or neurosurgeon for diagnosis, treatment recommendations, and prognosis.