Questions to Ask a Centre Before Starting Immunotherapy — And the Answers to Listen For

What Should You Ask a Centre About Toxicity Management?

Ask who identifies an immune side effect, who treats it, and how fast you can be seen. Giving the infusion is broadly standard practice. Managing an immune-related adverse event is not. A centre that can name the doctor on call, describe its steroid protocol and point to critical-care access is telling you something a brochure cannot.

Immunotherapy works by taking brakes off the immune system. That is also why its side effects look nothing like chemotherapy side effects. They appear as inflammation, and the inflammation can land almost anywhere — the gut, the lungs, the liver, the thyroid, the skin, the joints, occasionally the heart. They can start after the first dose or months after the last one.

NCCN, ASCO and ESMO all publish management protocols for immune-related adverse events. The protocols exist because timing and severity are unpredictable. So the question is never whether a centre has heard of them. It is whether the centre follows one, and who executes it at 11 p.m. on a Sunday. Take these six questions with you.

If diarrhoea, breathlessness, chest pain, severe fatigue or dizziness starts at any point during or after immunotherapy, treat it as a call-now situation rather than something to manage at home. Call your treating centre immediately, or reach CION on 1800 202 8726, and go to the nearest emergency department if the symptom is severe.

What Should You Ask About After-Hours Access?

Ask for the exact number you will dial at 2 a.m., and ask who picks it up. Not the reception line. Then ask whether that person can see your file, whether a doctor is reachable, and where you should go if they tell you to come in. A vague answer here is itself the answer.

Most immune side effects do not announce themselves during clinic hours. They start as something small and ordinary — loose motions, a dry cough, a day of unusual tiredness — on a Saturday night. What the family needs at that moment is not information. It is a person who already knows the case and can decide.

• “What is the exact number I call outside clinic hours?” Ask for it written on your file or treatment card, not read out. A number you have to search for at midnight is a number you will not use.
• “Who answers it — a nurse, a coordinator, or a doctor?” Any of these can work, provided the answer is specific and there is a doctor behind them who can be reached.
• “Can whoever answers see my treatment record?” Someone who can pull up your drug, your dates and your last blood results gives far better advice than someone taking a message.
• “If you tell me to come in, where do I actually go?” A day-care centre and an emergency department are different places. Get the night-time address before you need it.
• “I live two hours away. What is the plan for me?” Ask which nearby hospital can admit you tonight and who from the team will speak to them. Travel times quoted to you are indicative and change with traffic and time of day.
• “What should I carry?” The drug name, the dose dates, recent reports and a note that you are on immunotherapy. A doctor who has never met you needs to know that in the first minute.

Write the answers down during the appointment and keep them with your treatment card. The point of asking is not to test the centre — it is so that the person sitting with you at midnight already knows what to do.

What Should You Ask About Cost Transparency?

Ask for a written, itemised estimate for one cycle before the first dose — not a single total. Immunotherapy is priced by cycle, and the number of cycles depends on how the disease responds. A lump-sum figure quoted on day one is usually not an honest one. Ask what sits inside the number, and what does not.

Families are rarely told the cost is uncertain, so they plan around the first figure they hear and are then blindsided by additions. A centre that is comfortable itemising, and comfortable saying which parts it cannot predict, is easier to trust than one that produces a confident round number.

Any figure quoted by any centre, CION included, is indicative, as of August 2026. It depends on the molecule prescribed, the number of cycles, weight-based dosing where it applies, and what your scheme or insurer approves. Scheme ceilings and package rates are revised periodically, so confirm the current position rather than relying on a figure from a year ago.

What Should You Ask About What a Centre Cannot Do?

Ask what the centre refers out. Every honest cancer service has a boundary. CAR-T and cell therapy, complex transplant work and certain specialised imaging are referred onward by most Indian centres, CION included. A centre that appears able to do everything has usually answered a different question from the one you asked.

This is the question families skip, because it feels rude. It is also the one that predicts the next six months most accurately. Knowing in advance what happens elsewhere — and who arranges it — prevents the scramble that otherwise arrives mid-treatment.

• “Is my response scan done here or somewhere else?” At CION, immunotherapy is given as day care at our centres, and response-assessment PET-CT is coordinated at partner imaging centres rather than owned by us. Ask any centre to be equally specific about where you will physically go, and who books it.
• “Do you provide CAR-T or cell therapy?” CION does not. These treatments are delivered by a small number of specialised centres in India. We can explain whether CAR-T is relevant to your situation and refer you onward, but we do not administer or stock it.
• “Where is my biomarker testing sent, and how long does it take?” Ask for the laboratory and the expected turnaround in days, because the treatment decision waits on that report.
• “Which oncologist will actually see me at each cycle?” Continuity matters more on immunotherapy than on most treatments, because recognising a subtle change depends on someone knowing your baseline.
• “Is my case discussed by a tumour board?” A plan reviewed by medical, surgical and radiation oncologists together is a different thing from one doctor’s opinion. At CION every patient goes to a tumour board.
• “Can I take a second opinion without giving up my slot here?” The answer should be an unhesitating yes, along with an offer to release your reports and slides so the second opinion is a real one.

A centre naming its limits is not a weakness. It is the clearest available evidence that the rest of what it tells you is accurate.

How Do You Ask These Questions Without Sounding Difficult?

Take four written questions, not forty, and take one other person to write the answers down. Ask the same four at every centre you are considering. Then compare the answers rather than the atmosphere. A team that treats these questions as reasonable has already told you something useful about itself.

You are allowed to ask all of this. Nobody choosing where to spend months of treatment is being difficult by wanting the after-hours number in advance.

What Else Should You Check Before You Choose?

Three questions usually follow this one: whether a nearer, smaller centre is a safe choice, how government cover compares with private treatment in Telangana, and what paperwork you should be carrying from day one.

Ask Us the Same Four Questions

Toxicity cover, after-hours access, honest limits and costs in writing — ask us exactly what you would ask anyone else.