New clinic helps streamline care for cancer patients with endocrine complications

Immune checkpoint inhibitors, a type of immunotherapy drug that helps the immune system fight against cancer, have boomed in popularity in recent years — and with this, the number of people experiencing side effects affecting their endocrine system has also risen.  

Responsible for creating and distributing the body’s hormones, the endocrine system is essential to many bodily functions including maintaining a healthy heart rate and blood pressure levels. To help cancer patients who are experiencing endocrine complications, health care providers in the University of Colorado Anschutz Department of Medicine and the CU Cancer Center have collaborated to establish a new endocrine-oncology clinic to provide efficient, multidisciplinary care.

“The endocrine system impacts the whole body, and many of the newer cancer therapies impact the endocrine system,” says Jennifer Morrison, MD, PhD, an associate professor of clinical practice in the endocrinology, metabolism, and diabetes division who helped form the clinic. “It’s becoming increasingly important to streamline our care with a multidisciplinary approach — and that includes endocrinologists so that we can take the best care of our cancer patients.” 

Streamlining care

As a physician-scientist who specializes in thyroid-related cancer care, when Morrison learned from Whitney Goldner, MD, head of the division, about the effort to create this clinic, Morrison says it felt like “the stars aligned.”

“This clinic was such a novel idea, and the opportunity to combine my interests in oncology and endocrinology was a perfect fit, which is why I applied for this position,” says Morrison, who completed her fellowship training at CU Anschutz and re-joined the institution this year.

Under the new clinic, Morrison spends two mornings a week in the CU Cancer Center to provide care to cancer patients who are experiencing endocrinology-related complications and need specialized care. As part of this partnership, Morrison, Goldner, and other health care providers created a new endocrine-oncology referral process.

“Historically, when oncologists placed a referral for specialized care like endocrinology, the request would have to work its way through the system and it may not be the most direct approach of getting someone seen quickly,” Morrison says. “With this partnership, we will get patients seen in a timely fashion so we can provide the best care to support their health.”

‘An underserved need’

This new clinic helps address “an underserved need,” explains Heather Brooks, MD, an assistant professor of endocrinology, metabolism, and diabetes who also helped form the new clinic and provides care to cancer patients with endocrinology-related conditions. In her years practicing as a general endocrinologist — providing care to patients with conditions like thyroid dysfunction, diabetes, and osteoporosis — Brooks has seen a rise in patients experiencing endocrine complications from their cancer treatment.

When Brooks, who previously completed her residency and fellowship training at CU Anschutz, joined the division in 2024, she became involved in a collaborative research project with endocrinologist Virginia Sarapura, MD, oncologist Theresa Medina, MD, and autoimmune researcher Mia Smith, DVM, PhD, on immune checkpoint inhibitor-related thyroiditis.

“We were studying how these immune checkpoint inhibitors, which were treatments that were becoming especially common among patients with melanoma, could lead to thyroid disease,” Brooks says. “And now, immune checkpoint inhibitors have been approved for multiple cancer types, and their use is becoming more popular — hence there are more patients experiencing complications.”

Immune checkpoint inhibitors are designed to activate the immune system to help fight the cancer, she explains, but it can cause the immune system to sometimes attack normal tissues, potentially causing autoimmune diseases and negative effects to the endocrine system, such as the thyroid, adrenal glands, pituitary gland, or pancreas. 

“It’s estimated that 20% to 30% of patients on an immune checkpoint inhibitor will have an endocrine immune-related adverse event, such as thyroid issues, inflammation of the pituitary gland, adrenal insufficiency, or even type 1 diabetes,” she says. “The risk of developing a complication depends on which inhibitor a patient takes, their dosage, and if they’re using multiple inhibitors.”

Another way that immune checkpoint inhibitors can affect the body is by causing issues like colon or lung inflammation, and to address that, patients may start taking high dose steroids. Additionally, some patients who are receiving traditional chemotherapy will also get high dose steroids to prevent vomiting and other complications.

“Those high dose steroids can end up causing endocrine issues such as adrenal insufficiency, diabetes, or osteoporosis. That’s another way that patients can get an endocrine complication from their treatment,” Brooks says.

Morrison has seen a similar rise in endocrine complications from cancer therapies, saying, “These drugs have the potential to impact the endocrine system at so many levels, and oftentimes, these drugs are used in combination with one another — so we see more and more of these complications.”

When it comes to treating endocrinology complications, the treatment approach depends on the patient and their specific needs. 

“We help tailor their endocrinology treatment to their cancer treatment,” Morrison says. “For example, a person undergoing chemotherapy and steroid infusions will have variations in their blood sugar on a day-to-day basis, so we must customize their treatment program.”

Continuing a pattern of collaboration

Before joining CU Anschutz in 2024, Goldner established a similar multidisciplinary endocrine-oncology clinic at her previous workplace at the University of Nebraska in conjunction with the Fred and Pamela Buffett Cancer Center. Creating this clinic at CU Anschutz is one of the latest steps in a longstanding effort to partner with oncologists to advance care for cancer patients, explains Brooks.

For example, endocrinologist Christie Turin More, MD, previously worked with oncologists to develop an educational protocol that provides guidance to oncologists on how to monitor for endocrine complications of immune checkpoint inhibitors. Beth Tupta, NP, MSN, developed a protocol that helps educate oncologists about diabetes in cancer patients. Emily Harvey, RN, CDCES, works as a certified diabetes care and education specialist with the oncology team in the CU Cancer Center.

“Prior to this clinic, we had those two protocols in place, Emily Harvey was working with oncologists as a diabetic educator, and I also became a resource to oncologists,” Brooks says. “Now, by establishing this clinic and the new referral process, we can provide even better care to patients. Also, we can collect data to assess the needs of our patients, which potentially lays a foundation for future research opportunities.”

By spending two mornings in the CU Cancer Center each week, Morrison hopes to establish face-to-face connections with the oncology team and with patients.

“I’m a learner and a teacher, and just as I will learn more about oncology, the oncologists will learn more about endocrinology,” she says. “Ultimately, we want to take good care of our patients, and multidisciplinary care is so important and critical to get the best possible outcomes for them.”