| Diagnosis |
Lack of noninvasive diagnostic procedures to aid early confirmation of irAEs can delay recognition Early nonspecific symptoms (eg, fatigue and dyspnea) can make it difficult to distinguish irAEs Delayed patient reporting due to a variety of circumstances; for example, patients do not want treatment to be stopped, patients live in a rural area without immediate access to emergency care, patients’ lack of awareness of symptoms Difficult to distinguish irAEs in patients treated with ICI in combination with chemotherapy Late-onset adverse events may not be recognized as irAEs, especially when patients have moved on to subsequent alternative therapies, because practitioners tend to focus on current regimens and do not immediately consider delayed irAEs as a possibility
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| Monitoring |
• Oncologists do not intervene until moderate/severe symptoms are present
• Lack of resources to call patients in between treatment cycles to assess toxicities may lead to a delay in irAEs being recognized and treated
• Lack of evidence-based, cost-effective monitoring strategies for rare but life-threatening irAEs (eg, myocarditis) may delay diagnosis and treatment |
| Follow-up |
Time limitations of follow-up visits may preclude a detailed assessment to detect subacute symptoms, potentially delaying irAE recognition and treatment Inadequate period of follow-up for clinical trial patients may lead to an underreporting of late-onset irAEs
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