Acute Oncology Service
SACTCheck · treatment passport
Pembrolizumab + pemetrexed + carboplatin
A record of what you experience
One cycle per page. Each medicine has its own symptom table. Mark the worst symptoms since your last review, when they occurred and what they stopped you doing. Overlapping symptoms can be recorded under more than one medicine; you do not have to identify the cause.
These are patient-language severity prompts, not a validated questionnaire or a formal CTCAE grading tool. Your team assigns the clinical grade. Serious symptoms override the columns: call without waiting to decide a severity level.
Induction: all three medicines on Day 1 every 21 days for up to four cycles. Maintenance: carboplatin stops; pembrolizumab and pemetrexed may continue every 21 days while appropriate.
The four pages are reusable recording sheets, not a prescribed four-cycle course. Ask for additional sheets as needed.
Emergency: 112 / 999. Severe breathing difficulty, collapse, seizure or severe chest pain needs emergency help.
Contact oncology immediately for temperature ≥37.5°C or ≤36°C, shivering or suddenly feeling unwell, even with a normal temperature. Follow your own hospital’s instructions. If you cannot reach the team, seek urgent medical assessment.
Ask for medical oncology
Other hospitals: use the numbers your team provides.
Your own hospital / contact instructions:
https://sactcheck.com/patient/00568/
Full patient information, sources and visual timeline. No identifiers are encoded.
Source reconciled; independent clinical, pharmacy and patient/PPI review pending
NCCP 00568 v5 · one cycle, one page
Pembrolizumab + pemetrexed + carboplatin
Cycle number: __________ Start date: __________ Next review: __________
Induction cycle · carboplatin included · copy this sheet for another cycle of the same phase.
Pembrolizumab · Immunotherapy
| Symptom | None | Mild | Moderate / call | Severe / urgent | Emergency signs |
|---|---|---|---|---|---|
| Breathing / cough | □ Usual breathing | □ New cough or breathlessness: call promptly | □ Symptoms with usual activity: urgent review | □ Breathless at rest: urgent assessment | □ Severe breathing difficulty / collapse: 112/999 |
| Diarrhoea | □ Usual pattern | □ Up to 3 extra stools above normal | □ 4–6 extra stools/day or at night: call | □ 7+ extra stools/day or dehydration: urgent review | □ Collapse / severe dehydration: 112/999 |
| Skin / nail changes | □ None | □ Mild change: report | □ Pain or daily tasks affected: call | □ Spreading infection or blistering: urgent review | □ Severe illness / collapse: emergency help |
| Fatigue | □ Usual energy | □ Tiredness improves with rest | □ Rest does not help; usual tasks affected: call | □ Self-care difficult: urgent review | □ Collapse: 112/999 |
Pemetrexed · Chemotherapy
| Symptom | None | Mild | Moderate / call | Severe / urgent | Emergency signs |
|---|---|---|---|---|---|
| Fatigue | □ Usual energy | □ Tiredness improves with rest | □ Rest does not help; usual tasks affected: call | □ Self-care difficult: urgent review | □ Collapse: 112/999 |
| Mouth soreness / ulcers | □ None | □ Mild soreness; eating normally | □ Painful; soft food needed: call | □ Cannot eat / drink enough: urgent review | □ Major breathing difficulty: 112/999 |
| Skin / nail changes | □ None | □ Mild change: report | □ Pain or daily tasks affected: call | □ Spreading infection or blistering: urgent review | □ Severe illness / collapse: emergency help |
Carboplatin · Chemotherapy
| Symptom | None | Mild | Moderate / call | Severe / urgent | Emergency signs |
|---|---|---|---|---|---|
| Bleeding / bruising | □ None | □ New small bruise / brief bleed: report | □ Repeated bleeding: call today | □ Bleeding that will not stop: urgent help | □ Heavy bleeding / collapse: 112/999 |
| Fatigue | □ Usual energy | □ Tiredness improves with rest | □ Rest does not help; usual tasks affected: call | □ Self-care difficult: urgent review | □ Collapse: 112/999 |
| Numbness / tingling | □ None | □ Mild change; usual tasks unaffected | □ Limits buttons, writing or walking: call | □ Washing, dressing or walking difficult: urgent review | □ Sudden major weakness / paralysis: emergency help |
Dates / doses missed or changed / symptoms affecting daily life / questions:
Red flags override the table. Fever, shivers, suddenly unwell, chest symptoms or inability to drink: seek prompt advice. Severe breathing difficulty, collapse or severe chest pain: 112 / 999.
NCCP 00568 v5 · one cycle, one page
Pembrolizumab + pemetrexed + carboplatin
Cycle number: __________ Start date: __________ Next review: __________
Induction cycle · copy for the next induction cycle · copy this sheet for another cycle of the same phase.
Pembrolizumab · Immunotherapy
| Symptom | None | Mild | Moderate / call | Severe / urgent | Emergency signs |
|---|---|---|---|---|---|
| Breathing / cough | □ Usual breathing | □ New cough or breathlessness: call promptly | □ Symptoms with usual activity: urgent review | □ Breathless at rest: urgent assessment | □ Severe breathing difficulty / collapse: 112/999 |
| Diarrhoea | □ Usual pattern | □ Up to 3 extra stools above normal | □ 4–6 extra stools/day or at night: call | □ 7+ extra stools/day or dehydration: urgent review | □ Collapse / severe dehydration: 112/999 |
| Skin / nail changes | □ None | □ Mild change: report | □ Pain or daily tasks affected: call | □ Spreading infection or blistering: urgent review | □ Severe illness / collapse: emergency help |
| Fatigue | □ Usual energy | □ Tiredness improves with rest | □ Rest does not help; usual tasks affected: call | □ Self-care difficult: urgent review | □ Collapse: 112/999 |
Pemetrexed · Chemotherapy
| Symptom | None | Mild | Moderate / call | Severe / urgent | Emergency signs |
|---|---|---|---|---|---|
| Fatigue | □ Usual energy | □ Tiredness improves with rest | □ Rest does not help; usual tasks affected: call | □ Self-care difficult: urgent review | □ Collapse: 112/999 |
| Mouth soreness / ulcers | □ None | □ Mild soreness; eating normally | □ Painful; soft food needed: call | □ Cannot eat / drink enough: urgent review | □ Major breathing difficulty: 112/999 |
| Skin / nail changes | □ None | □ Mild change: report | □ Pain or daily tasks affected: call | □ Spreading infection or blistering: urgent review | □ Severe illness / collapse: emergency help |
Carboplatin · Chemotherapy
| Symptom | None | Mild | Moderate / call | Severe / urgent | Emergency signs |
|---|---|---|---|---|---|
| Bleeding / bruising | □ None | □ New small bruise / brief bleed: report | □ Repeated bleeding: call today | □ Bleeding that will not stop: urgent help | □ Heavy bleeding / collapse: 112/999 |
| Fatigue | □ Usual energy | □ Tiredness improves with rest | □ Rest does not help; usual tasks affected: call | □ Self-care difficult: urgent review | □ Collapse: 112/999 |
| Numbness / tingling | □ None | □ Mild change; usual tasks unaffected | □ Limits buttons, writing or walking: call | □ Washing, dressing or walking difficult: urgent review | □ Sudden major weakness / paralysis: emergency help |
Dates / doses missed or changed / symptoms affecting daily life / questions:
Red flags override the table. Fever, shivers, suddenly unwell, chest symptoms or inability to drink: seek prompt advice. Severe breathing difficulty, collapse or severe chest pain: 112 / 999.
NCCP 00568 v5 · one cycle, one page
Pembrolizumab + pemetrexed + carboplatin
Cycle number: __________ Start date: __________ Next review: __________
Maintenance cycle · carboplatin stopped · copy this sheet for another cycle of the same phase.
Pembrolizumab · Immunotherapy
| Symptom | None | Mild | Moderate / call | Severe / urgent | Emergency signs |
|---|---|---|---|---|---|
| Breathing / cough | □ Usual breathing | □ New cough or breathlessness: call promptly | □ Symptoms with usual activity: urgent review | □ Breathless at rest: urgent assessment | □ Severe breathing difficulty / collapse: 112/999 |
| Diarrhoea | □ Usual pattern | □ Up to 3 extra stools above normal | □ 4–6 extra stools/day or at night: call | □ 7+ extra stools/day or dehydration: urgent review | □ Collapse / severe dehydration: 112/999 |
| Skin / nail changes | □ None | □ Mild change: report | □ Pain or daily tasks affected: call | □ Spreading infection or blistering: urgent review | □ Severe illness / collapse: emergency help |
| Fatigue | □ Usual energy | □ Tiredness improves with rest | □ Rest does not help; usual tasks affected: call | □ Self-care difficult: urgent review | □ Collapse: 112/999 |
Pemetrexed · Chemotherapy
| Symptom | None | Mild | Moderate / call | Severe / urgent | Emergency signs |
|---|---|---|---|---|---|
| Fatigue | □ Usual energy | □ Tiredness improves with rest | □ Rest does not help; usual tasks affected: call | □ Self-care difficult: urgent review | □ Collapse: 112/999 |
| Mouth soreness / ulcers | □ None | □ Mild soreness; eating normally | □ Painful; soft food needed: call | □ Cannot eat / drink enough: urgent review | □ Major breathing difficulty: 112/999 |
| Skin / nail changes | □ None | □ Mild change: report | □ Pain or daily tasks affected: call | □ Spreading infection or blistering: urgent review | □ Severe illness / collapse: emergency help |
Dates / doses missed or changed / symptoms affecting daily life / questions:
Red flags override the table. Fever, shivers, suddenly unwell, chest symptoms or inability to drink: seek prompt advice. Severe breathing difficulty, collapse or severe chest pain: 112 / 999.
NCCP 00568 v5 · one cycle, one page
Pembrolizumab + pemetrexed + carboplatin
Cycle number: __________ Start date: __________ Next review: __________
Maintenance cycle · copy for the next maintenance cycle · copy this sheet for another cycle of the same phase.
Pembrolizumab · Immunotherapy
| Symptom | None | Mild | Moderate / call | Severe / urgent | Emergency signs |
|---|---|---|---|---|---|
| Breathing / cough | □ Usual breathing | □ New cough or breathlessness: call promptly | □ Symptoms with usual activity: urgent review | □ Breathless at rest: urgent assessment | □ Severe breathing difficulty / collapse: 112/999 |
| Diarrhoea | □ Usual pattern | □ Up to 3 extra stools above normal | □ 4–6 extra stools/day or at night: call | □ 7+ extra stools/day or dehydration: urgent review | □ Collapse / severe dehydration: 112/999 |
| Skin / nail changes | □ None | □ Mild change: report | □ Pain or daily tasks affected: call | □ Spreading infection or blistering: urgent review | □ Severe illness / collapse: emergency help |
| Fatigue | □ Usual energy | □ Tiredness improves with rest | □ Rest does not help; usual tasks affected: call | □ Self-care difficult: urgent review | □ Collapse: 112/999 |
Pemetrexed · Chemotherapy
| Symptom | None | Mild | Moderate / call | Severe / urgent | Emergency signs |
|---|---|---|---|---|---|
| Fatigue | □ Usual energy | □ Tiredness improves with rest | □ Rest does not help; usual tasks affected: call | □ Self-care difficult: urgent review | □ Collapse: 112/999 |
| Mouth soreness / ulcers | □ None | □ Mild soreness; eating normally | □ Painful; soft food needed: call | □ Cannot eat / drink enough: urgent review | □ Major breathing difficulty: 112/999 |
| Skin / nail changes | □ None | □ Mild change: report | □ Pain or daily tasks affected: call | □ Spreading infection or blistering: urgent review | □ Severe illness / collapse: emergency help |
Dates / doses missed or changed / symptoms affecting daily life / questions:
Red flags override the table. Fever, shivers, suddenly unwell, chest symptoms or inability to drink: seek prompt advice. Severe breathing difficulty, collapse or severe chest pain: 112 / 999.