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
– need for chronic analgesia, safety/mobility issues, need for PT, is patient safe to drive?
– oral hygiene, F/U with dental
* Scar management
* Physical limitations impacting work
* Vitiligo, scar, [body image issues]
– particularly around restaging scans- “scananxity”
– do they identify with the term “survivor”
* 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
If the patient was on long-term steroids for toxicity
* Addressing bone health: calcium supplements, Dexa scan, etc.
* Recommendations for pregnancy avoidance, and if so, guidance about how long to wait