Expert Nurse
Avatar photoKrista Rubin

    Good question. In thinking about “survivorship issues: that would be specific to an I/O patient, I would include the following- this is just off the top of my head, and a start. I am sure I am missed many components. Would be great if others would add to this….

    Management of physical symptoms
    * Arthralgias/joint pains
    – need for chronic analgesia, safety mobility issues, need for PT
    * Neuropathy
    – need for chronic analgesia, safety/mobility issues, need for PT, is patient safe to drive?
    * Xerostomia-
    – oral hygiene, F/U with dental
    * Scar management
    * Lymphedema
    * Physical limitations impacting work
    * Other

    * Vitiligo, scar, [body image issues]
    * Anxiety
    – particularly around restaging scans- “scananxity”
    – do they identify with the term “survivor”
    * Depression
    * Impact on personal relationships
    * Impact on work-related relationships

    * If hypothyroid–> likely lifelong replacement
    * If hypophysitis–> likely lifelong replacement (possibly multiple hormones)
    * Adrenal insufficiency
    – temporary vs permanent will indicate need (or not) for lifelong replacement
    – plans for “sick day” steroid dosing, need for medical bracelet
    * Other

    If the patient was on long-term steroids for toxicity
    * Addressing bone health: calcium supplements, Dexa scan, etc.
    * Hyperglycemia/DM
    * Other

    Family Planning
    * Recommendations for pregnancy avoidance, and if so, guidance about how long to wait
    * Other