Use this diary to track your symptoms daily or weekly. This helps your doctor understand how you are doing and adjust your care. Rate each symptom from 0 (none) to 10 (worst imaginable), or use the descriptors provided.
Weekly Symptom Tracker
Week of: _____________
| Symptom | Mon | Tue | Wed | Thu | Fri | Sat | Sun | Notes |
|---|---|---|---|---|---|---|---|---|
| Urinary | ||||||||
| Leakage (pads/day: 0,1,2,3+) | ||||||||
| Urgency (0–10) | ||||||||
| Frequency (times/night) | ||||||||
| Burning/pain (0–10) | ||||||||
| Blood in urine (Y/N) | ||||||||
| Bowel | ||||||||
| Urgency (0–10) | ||||||||
| Frequency (stools/day) | ||||||||
| Diarrhea (Y/N) | ||||||||
| Rectal bleeding (Y/N) | ||||||||
| Rectal pain (0–10) | ||||||||
| Sexual | ||||||||
| Erections (none / partial / full) | ||||||||
| Libido (0–10) | ||||||||
| Used medication or device (Y/N) | ||||||||
| General | ||||||||
| Fatigue (0–10) | ||||||||
| Pain — location: _______ (0–10) | ||||||||
| Hot flashes (number/day) | ||||||||
| Nausea (0–10) | ||||||||
| Appetite (good / fair / poor) | ||||||||
| Weight (lbs or kg) | ||||||||
| Emotional | ||||||||
| Mood (0–10) | ||||||||
| Anxiety (0–10) | ||||||||
| Sleep quality (0–10) | ||||||||
| Exercise | ||||||||
| Type: _________________ | ||||||||
| Duration (minutes) |
Monthly Summary
| Month | Biggest Concern | Improvement from Last Month? | New Symptoms? | Medications Changed? |
|---|---|---|---|---|
⚠️ When to Call Your Doctor — Red Flag Checklist
Call your doctor's office right away if you experience any of the following:
Urinary emergencies:
- Unable to urinate for more than 8 hours
- Large amount of blood in urine (bright red, with clots)
- Severe pain with urination that does not improve with medication
Bowel emergencies:
- Significant rectal bleeding (more than a few drops)
- Severe abdominal pain
- No bowel movement for more than 4 days with bloating and pain
Infection signs:
- Fever above 100.4°F (38°C)
- Chills or shaking
- Burning with urination plus fever
- Cloudy or foul-smelling urine with fever
Pain:
- New or worsening bone pain (especially back, hips, ribs)
- Pain that wakes you from sleep
- Pain not controlled by prescribed medications
Neurological (go to emergency room):
- New weakness or numbness in legs
- Loss of bladder or bowel control (new onset)
- Difficulty walking that is new
During chemotherapy:
- Fever above 100.4°F (38°C) — this is an emergency
- Severe nausea/vomiting not controlled by medications
- Unusual bleeding or bruising
- Severe mouth sores preventing eating or drinking
- Severe diarrhea (more than 6 episodes/day)
General:
- Sudden swelling in one or both legs
- Shortness of breath (new or worsening)
- Chest pain
- Confusion or sudden changes in mental status
- Unexplained weight loss of more than 10 pounds
My doctor's after-hours number: _____________________________________________
My cancer center's nurse line: _____________________________________________
Nearest emergency room: _____________________________________________