Harmeet Singh Narula, MD, FACP
Harmeet Singh Narula, MD, FACP, works in endocrinology at Banner Arizona Medical Clinic in Sun City West, AZ. He is also a member of the American Association of Clinical Endocrinologists.

Many patients with cancer also have diabetes and other hormonal disorders. Multiple elements of cancer care can impact comorbid endocrine conditions.

Chemotherapy can affect a patient’s pituitary, adrenal, or thyroid function, and it may suppress appetites, which can predispose a patient with diabetes to hypoglycemia. High-dose steroids can drastically impact blood sugar levels in patients with or without diabetes and can significantly increase the insulin requirement in many diabetics. Endocrinologists are continually working to address these issues in patients with cancer. Often, because of treatment changes, side effects, and suppressed appetites, glycemic levels can become a “moving target” that require constant adjustment of treatment protocols.

Although some patients are treated for hyperglycemia later in their
care, endocrinologists can be vital at any stage of the cancer continuum.

Oncology nurses are in the unique position of being able to work with the endocrinologist to identify and address changes in patient care. By informing the endocrinology team of a change in care, they can then identify and adjust the levels of insulin and other diabetes medications that are required to maintain a healthy blood sugar level for a patient. This can lead to fewer suboptimal outcomes and unnecessary trips to the hospital. By working together to manage and coordinate patient care, endocrinologists and oncology nurses can eliminate emergency situations where a patient’s blood sugar levels rise or fall to unsafe levels.

Through close monitoring and open communication with teams, oncology nurses and endocrinologists can actively manage patients with comorbid endocrine conditions and address problems before they arise.

In many institutions, endocrinologists aren’t involved as part of the initial care team, but oncology nurses should advocate for their inclusion in care of patients with comorbidities that include diabetes or hyperglycemia. By sharing electronic medical records (EMRs), the endocrinology team can be alerted to any alterations in a patient’s care plan, they can adjust their treatment approach, and they can administer medications accordingly when trying to hit the “moving target” that’s best for that patient. If EMRs can’t be shared, a fax or phone call is often enough to keep each team in the loop of patient changes.

Through close monitoring and open communication with teams, oncology nurses and endocrinologists can actively manage patients with comorbid endocrine conditions and address problems before they arise. Including the endocrinology team early in the process of patient care allows them to offer their expertise and incorporate any necessary adjustments to their care plan. Ultimately, strengthening communication between endocrinology and oncology nurses can improve outcomes and limit potentially hazardous events for patients with cancer.