The Red-Flag Symptom Card — Every Family Should Have

Every symptom that can appear during immunotherapy fits into one of three tiers: call today, call now (emergency), or note it for the next visit. Printing this table and keeping it where your family will see it is the single most useful thing a caretaker can do during treatment.

Call your oncology team the same day for any new or worsening symptom that is mild but persistent — loose motions that don't settle within a day, a new skin rash, unusual tiredness that doesn't improve with rest, joint aches, or a low-grade fever. None of these are emergencies on their own, but same-day reporting is what keeps a mild immune-related reaction from quietly turning into a severe one.

• New or increased loose motions that haven't settled within 24 hours
• A new rash, itching, or skin change that's spreading
• Fatigue that's clearly worse than your loved one's usual tiredness
• A low-grade fever, or joint and muscle aches that are new
• Any symptom your family isn't sure about — same-day reporting costs nothing; waiting can

Note the date it started and whether it's improving or worsening before you call — that detail helps the care team grade it correctly on the first conversation.

Call the CION helpline while heading to the nearest emergency room for chest pain, severe breathlessness, confusion, fainting, very high fever, severe abdominal pain, or signs of an adrenal crisis such as extreme weakness with low blood pressure. These can signal a severe immune reaction — myocarditis, pneumonitis, colitis, or adrenal insufficiency — where minutes matter and there is no safe home-management step.

These symptoms are explained in more clinical detail on our companion pages — Chest Pain on Immunotherapy: When It's an Emergency, Collapse or Confusion on Immunotherapy, and Recognising an Adrenal Crisis — worth reading once and bookmarking, not during an emergency itself.

Mild, stable symptoms that aren't getting worse — slight fatigue, a small dry patch of skin, occasional mild nausea, or one loose stool that resolves on its own — can usually be noted on the card and raised at the next scheduled visit. "Can wait" never means "ignore it": write the date and what happened, because a pattern your team can't see in one visit often becomes obvious across several notes on the card.

• Write the date, the symptom, and whether it's the same, better, or worse than yesterday
• Keep noting it even if it seems to go away — the pattern matters more than any single entry
• Bring the card itself to the appointment rather than trying to remember from memory

If a "can wait" symptom is still present at the next visit, or is joined by a new one, move it up a tier and call — the tiers are a starting point for judgement, not a rulebook that overrides your instincts.

A red-flag card only works if it's actually made and actually used — not just read once and forgotten. These five steps take under fifteen minutes and turn the three tiers above into something your family can act on under pressure.

1. 1

   List the three tiers

   Write three headings on one page — Call Today, Call Now (Emergency), Note for Next Visit — leaving space under each to jot symptoms as they appear.

2. 2

   Fill in your own baseline

   Record normal energy levels, normal stool pattern, and normal weight, so "worse than usual" has a clear starting point instead of being a guess.

3. 3

   Add the helpline and care-team details

   Write the CION helpline number in large print, plus the treating oncologist's name and centre, so the card works even when you're panicking.

4. 4

   Put it where it will actually be seen

   Keep the card on the fridge door, inside the hospital bag, and saved as a photo on every family member's phone — not filed away in a folder.

5. 5

   Review and update it every cycle

   Revisit the card after each infusion cycle — new side effects can appear even months into treatment, so the card should grow with the journey.

This card works best alongside a few habits that make every call to your care team more useful — these companion pages cover each one.

• Why Every Doctor Must Be Told "They Are on Immunotherapy" — the one sentence that changes how any doctor, not just your oncology team, treats a new symptom.
• Tracking Symptoms Between Cycles: What to Write Down — a deeper log to run alongside the red-flag card for anything that isn't a clear emergency.
• Counting and Reporting Loose Motions Accurately — the exact count your care team needs when a gut symptom lands in the Call Today tier.
• Immunotherapy at CION Cancer Clinics — how our team monitors and supports patients through immune-related side effects, from the first infusion onward.

Caretakers Are Part of the Care Team Too

Families who track and report symptoms early help their loved one stay on treatment safely.