DR QUINN: Hyperlipidemia is an issue. It’s usually mixed — that is to say, the cholesterol and the triglycerides are elevated. And we treat these patients usually in concert with their internist. We used to be a little more laissez faire. We’d say, “The patient’s got cancer. We don’t need to treat their lipids. They come off their statin drug.” Now if the cholesterol goes above 200, we’re certainly making sure that we optimize their statin therapy.
And triglycerides, we have an absolute threshold of 400 for triglycerides, at which point we put them on a fibric acid derivative, and fenofibric is one that we use in our practice. But it varies. There are different agents throughout the world. And we’re normally able to get control and we don’t generally have to stop the therapy. The biggest issue here is actually working out how often you need to measure the lipids. And we normally do it at about a month, and then we do it at the time they get their CT scan. And we try not to do it more often than that.
DR LOVE: Tom?
DR HUTSON: In the community setting, it’s not as easy to call up a phone and get an endocrinologist to see your patient. I mean, they usually have a month to two wait. You almost have to plead with them to get them in early. And remember, these are patients that are developing the diabetes problem while they’re on therapy. They — generally, it’s an exposure. So these people have been probably on therapy for a couple of months, at least, before it’s becoming an issue.
And your options are either you’re going to handle the diabetes management by starting a sulfonylurea urea or if you’re going to get into insulin, using that, or you’re going to have them hold their medication and get them — try to get them to an endocrinologist. It’s a challenge for them to do. It’s a challenge for me even at a kind of middle-of-the-road kind of academic community hybrid practice. So I know — Bob has told me before, he has a nice setup at his place where he has all the subspecialists there, and he just writes the thing and they go. But that’s probably less common than common.