Addressing Endocrine Issues in Cancer Survivors

Dr. Nicole Barnes’ clinic tackles the many endocrine-related challenges cancer survivors can face.

When pediatric endocrinologist Nicole Barnes, M.D., started at Children’s of Alabama in December 2021, it made sense for her to begin a clinic designed specifically for childhood cancer survivors, who often experience endocrine issues from their cancer or treatment. Barnes came to Children’s from St. Jude Children’s Research Hospital in Memphis, where she specialized in survivorship care.

“About 50% of children who are cancer survivors have at least one endocrine disorder,” she said. These endocrinopathies include growth hormone deficiency, disorders of puberty, thyroid abnormalities, poor bone mineral density and metabolic disorders. Some survivors are also at risk for infertility. Barnes started the Endocrine Care for Children with Cancer Clinic to address all these issues.

“Primary care physicians may not be accustomed to identifying endocrinopathies associated with survivors’ treatment exposures,” Barnes said. Even general pediatric endocrinologists may not be familiar with the clinical guidelines published by the Children’s Oncology Group for monitoring childhood cancer survivors. “We’re taught in training about cancer-related endocrine disorders, but until you’ve treated multiple children with cancer you may not fully appreciate the impact endocrine disorders can have,” she said.

One reason is the subtlety of the signs and symptoms. “For instance, a premenarchal 13-year-old female may not be concerning in the general population,” Barnes said. “However, a premenarchal 13-year-old female childhood cancer survivor exposed to total body irradiation and alkylating chemotherapy agents is at high risk for ovarian failure and should be monitored and treated accordingly.” 

Barnes’ clinic currently meets twice monthly. So far, she has seen several patients during and after treatments. She hopes to coordinate more closely with oncology and the Children’s of Alabama Taking on Life after Cancer (TLC) Clinic—which provides a varied and multidisciplinary approach to managing the special needs of pediatric cancer survivors—in order to catch endocrine issues early.

She hopes to bring more attention to endocrine disorders in pediatric cancer survivors while educating clinicians and families that remission is not the end of a child’s cancer-related health journey. “Ongoing monitoring for growth, puberty, bone health and metabolism remains essential,” she said

“I enjoy treating these children and adolescents. They’re survivors,” Barnes said. “Although cancer may rob them of some of their potential, I have the opportunity to optimize their growth and development.”

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