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Increasing Access and Quality Care for Immune Checkpoint Inhibitor-Related Thyroid Dysfunction
Anne K Brinkman1, Amori Y Salami-Henry1, Lori A Aaron-Brija2
1Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX.
JCO Oncology Practice
|December 19, 2025
Summary
A new immuno-oncology toxicity (IOTOX) clinic significantly reduced wait times for patients with immunotherapy-related thyroid dysfunction (irTD). This specialized clinic expedited thyroid function test normalization, improving patient care for immune-related adverse events.
Area of Science:
- Endocrinology
- Oncology
- Quality Improvement
Background:
- Cancer immunotherapy is increasing, leading to more immune-related adverse events (irAEs).
- Immunotherapy-related thyroid dysfunction (irTD) is common, causing endocrine consultation delays.
- Timely management of irTD is crucial for patient outcomes.
Purpose of the Study:
- To decrease consultation wait times for patients with irTD.
- To reduce the time for thyroid function test (TFT) normalization in irTD patients.
- To implement a quality improvement project using the Plan-Do-Study-Act framework.
Main Methods:
- Established a dedicated immuno-oncology toxicity (IOTOX) clinic.
- Staffed the clinic with advanced practice providers (APPs) and physician support.
- Utilized standardized algorithms for irTD evaluation and treatment.
Main Results:
- Median consultation wait time decreased from 21 to 9 days (P = .01).
- Median time to follow-up improved from 180 to 58 days (P < .001).
- Median time to thyroid-stimulating hormone normalization reduced from 102 to 38 days (P < .001).
Conclusions:
- The IOTOX clinic model effectively improved patient access and expedited TFT normalization.
- APP-led clinics with standardized protocols enhance care for irAEs.
- This model can be adapted by other institutions to manage irAEs.
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