Expert Nurse
Krista 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