Counting and Reporting Loose Motions — Accurately

What Counts as the Patient's Baseline?

The baseline is simply how many times a day the patient passed stool before immunotherapy started — commonly once a day to once every two days, but it is personal to this patient, not a fixed number that applies to everyone. Every threshold on this page is an increase measured against that number, so write it down before treatment begins, or ask the oncology team to note it in the file.

If you're reading this after treatment has already started and no one recorded a baseline, don't guess backwards — use the patient's own honest description of "normal for me" and move forward from today. An imperfect baseline started now is still far more useful than no baseline at all.

How Do You Actually Count Loose Motions Each Day?

Count in a fixed 24-hour window — for example, morning to morning — and mark every episode the moment it happens, using a phone note or a paper tally rather than trying to remember the total at the end of the day. Keep the count separate from notes on anything unusual, and compare the day's total to baseline before deciding what it means.

What Number of Loose Motions Means You Should Call?

An increase of 4 to 6 stools a day above baseline needs a same-day call to the oncology team, even if the patient otherwise feels well. An increase of 7 or more above baseline, or any blood, black stools, fever above 38°C, severe abdominal pain, dizziness, or an inability to keep fluids down, needs a call right now — any one of these on its own is enough, they don't all need to be present together. This reflects the CTCAE-based framework referenced in NCCN and ASCO guidance on immune-related adverse events.

This table is for orientation, not self-diagnosis — the oncology team's own assessment always takes priority. All clinical decisions, including any change to medicines or the treatment schedule, are made by the treating team, never at home.

What Should You Write Down Every Time You Report?

Have five facts ready before you call, in this order — it lets the oncology team judge urgency in the first minute instead of asking follow-up questions first.

• The exact count above baseline for the current 24-hour window — not "a lot," a number.
• Blood or mucus — even a small amount, even once.
• Fever or abdominal pain — a temperature reading if you have one.
• How much fluid the patient is keeping down — normal, reduced, or none.
• Any medicine already taken, including over-the-counter tablets bought without asking first.

The only home step generally advised while you arrange to be seen is drinking oral rehydration solution or clear fluids to prevent dehydration. Anti-diarrhoeal medicines, dose changes, and whether steroids are needed are decisions for the treating team, never something to start on your own.

What Mistakes Delay a Call the Most?

The most common one is waiting for the next scheduled appointment instead of calling the day a threshold is crossed — immune-mediated diarrhoea can move from manageable to severe within 24 to 48 hours, and a delayed call is the single biggest reason a reportable symptom becomes an emergency. A close second is accepting the patient's own downplayed account instead of the number on your tally; it is common for a patient to minimise symptoms because they don't want treatment paused, which is exactly the situation covered in When the Patient Wants to Stop and the Family Does Not.

A third mistake is only counting on days the patient feels unwell and skipping the count on days they seem fine — steady monitoring matters even between symptoms, which is the same principle behind Helping a Patient Who Feels Fine but Needs Monitoring. And a fourth is mentioning "a bit of blood" as an afterthought rather than leading the call with it — any blood should be the first thing you say, not the last.

Related Reading for Caretakers and Families

• When the Patient Wants to Stop and the Family Does Not — what to do when the patient's own account of symptoms and the family's isn't lining up.
• Helping a Patient Who Feels Fine but Needs Monitoring — why counting matters even between symptomatic days.
• Supporting Someone Through a Long Steroid Course — what happens after a reaction like this is treated.
• Immunotherapy at CION Cancer Clinics — our full guide to immunotherapy, how it's monitored, and what to expect at every stage.

Don't Wait to Ask — Even If You're Not Sure

Every patient at CION is reviewed by a tumor board, not one doctor's opinion. Free first consultation, no commitment to start treatment.

This page is general health information for caretakers about counting and reporting stool frequency during immunotherapy. It is not a diagnosis and cannot replace urgent assessment of the patient's own symptoms, medical history and test results. If you notice any of the emergency signs described above, treat them as an emergency now — call our helpline or go to the nearest emergency department. All clinical decisions, including any change to medicines or the treatment schedule, are made by the treating oncology team, not at home.