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Monitoring Ipilimumab + Nivolumab Treatment Diary
PLEASE USE THIS TREATMENT DIARY TO RECORD YOUR INFORMATION FOR EACH CYCLE
IMPORTANT: Please record and report even minor symptoms. All side effects must be reported to your cancer care team.
Cycle Date of ipilimumab + nivolumab infusion:
Day Date Comments
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
Date of my next appointment is:
Date of my next appointment for blood work is:
Date of next infusion is:
My next infusion is for: ipilimumab / nivolumab nivolumab only
Before my next appointment, I need to do: ___
___
My questions for my cancer care team are: __
__
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