At Duke Cancer Institute, the implementation of electronic-consults for patients experiencing endocrine irAEs improved patient access and reduced healthcare utilization.
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Between 4% to 15% of patients with cancer who are treated with a class of medications called immune checkpoint inhibitors experience immune-related adverse events (irAEs), including hypothyroidism, hyperthyroidism, and insulin-deficient diabetes. Delayed access, diagnosis, and management of irAEs are often causes of preventable hospital admissions in cancer patients.
At Duke Cancer Institute, the implementation of electronic-consults for patients experiencing endocrine irAEs improved patient access and reduced healthcare utilization. Time to appointment and hospitalizations were reduced from 61 days to 39 days and from 11% to 2%, respectively. To propel integration and scalability, the next step is to ensure adequate reimbursement from payers for these types of e-consults.
Afreen Shariff, MD, MBBS
Director, Duke Endo Oncology Program
Associate Director, Cancer Therapy Toxicity Program, Center for Cancer Immunotherapy
Duke Cancer Institute
Durham, North Carolina
“I’ve been a strong advocate to fix the effort and reimbursement mismatch because these are very different from traditional e-consultative services…the acuity of patients is different. The level of expertise that is needed to triage and give recommendations to patients is different…the reimbursement we get through third party-payers is what I call the ‘coffee and bagel’ consult because it really doesn’t do justice to the kind of service we provide.”
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The views and opinions expressed herein are those of the author(s)/faculty member(s) and do not reflect the official policy or position of their employer(s) or the Association of Cancer Care Centers.
July 8, 2026
June 30, 2026
At the 2026 ASCO Annual Meeting, the Louisiana Oncology Society received the ASCO Jeffrey C Ward Affiliate Advocacy Award for advancing critical advocacy priorities that have translated into meaningful legislative victories. The Iowa Oncology Society and Washington State Medical Oncology Society were also recognized for their advocacy efforts in 2025 at the meeting, receiving second place awards.
