Cancer Is Not a Death Sentence


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Being a cancer specialist means often delivering tough news. The cancer has spread. The cancer has relapsed. The cancer is no longer responding to treatment. Still, I believe the general practice veterinarian and team have the hardest job because they have to tell the client that the biopsy or aspirate of the mass was cancerous or that there is a high suspicion the patient has cancer.

“Cancer” is a scary word that is often equated with death. Cancer equals pain and suffering. Cancer treatment will make the patient sicker. With cancer, there is no hope.

I disagree. Cancer is not a death sentence. While we all want a cure for cancer, I encourage thinking about many cancers as chronic conditions that may require chronic therapy, such as kidney or heart disease. As an oncologist, I recommend treatment when the patient is likely to live longer with it than without. Thankfully, most patients feel good, if not great, during treatment.

My motto is “live longer, live well.” My patients need to do both—and they do. I think that is one of the reasons I love being an oncologist.

Most people think my job is sad and depressing. There are frustrating and heartbreaking moments when I lose a patient after sharing months or years together but, most of the time, treating cancer in animals is about providing quality of life, providing more quality time through treatment, and hope.

Most of my cancer patients are quite healthy despite the cancer, and treatment allows them to lead happy lives. Dogs and cats do not get sick like humans. I have watched human friends and family members get very sick after chemotherapy and hospitalized from side effects. I am grateful that is not how animals respond.

Chemotherapy

In my clinical experience, the majority of pets, approximately 80%, lead very normal lives with minimal, mild chemotherapy side effects that last only a few days. All my chemotherapy patients are discharged with maropitant citrate (Cerenia; zoetis.com), metronidazole, and a probiotic, so clients are prepared if the patient has GI side effects at home. I also provide detailed instruction sheets. Again, in my clinical experience, serious complications like severe inappetance, dehydration, vomiting, and/or diarrhea are rare and occur in less than 5% of chemotherapy patients.

Clients often tell me their pet has more energy during chemotherapy than 6 months or a year ago. In most cases, the cancer was not present then, but I think it is testament to how well most patients feel during and after treatment. I always tell clients considering chemotherapy to give their pet a dose or 2 and see how the pet reacts. Most clients are so pleased that they continue with treatment; if not, the treatment can be stopped. Cancer treatment and chemotherapy are not a binding contract.

The Language of Cancer

It is important to discuss with clients that cancer is one name for many different diseases. Lymphoma is different from hemangiosarcoma, oral melanoma, or osteosarcoma. Also, effects and treatments differ on an individual patient basis. Lymphoma in cats is different than in dogs, and cats generally tolerate chemotherapy better than dogs. The client may know someone whose dog did not tolerate doxorubicin, but that does not mean his or her newly diagnosed pet will also lack tolerance; the other patient may have had advanced-stage cancer and preexisting conditions that complicated treatment.

Patient Awareness

Another important aspect is that the patient does not “know” he or she has cancer. Of course, dogs and cats feel pain and do not enjoy feeling unwell, but they do not have to absorb all the cancer information, survival statistics, treatment options, and costs. Animals do not stress over whether the cancer or the treatment will make them feel sick, nor do they face the psychological aspect or worries like humans.

I advise my clients to try not to stress about their pet’s response and prognosis, because stressing and obsessing will not change the outcome. I tell them to let me worry about the disease, treatment, doses, and response. The client’s role is to give me feedback and the patient the prescribed medications.

Advances in Treatment

It is an exciting time to be an oncologist. We are more proactive in preventing and treating chemotherapy’s side effects and alleviating pain. Newer radiation therapy options such as stereotactic radiation can treat some tumors (eg, brain, nasal) in 1–3 treatments (instead of 15–20), with less anesthesia and fewer side effects and practice visits. We also have targeted chemotherapy drugs (eg, Palladia for mast cell tumors, a melanoma vaccine, monoclonal antibody immunotherapy for lymphoma; see Targeted Chemotherapy Drugs).

TARGETED CHEMOTHERAPY DRUGS
Following are some of the new targeted drugs and a link to more information:

Dogs with advanced metastatic cancer now have options. I was taught that patients with advanced metastatic disease would likely live 1–2 months and thus focused on palliative care and pain management. Today, we may not remove a patient’s tumor or get complete remission, but we can stabilize the tumors and maintain a good quality of life with metronomic chemotherapy (see Metronomic Chemotherapy), which uses well-tolerated, low-dose, oral chemotherapy. Instead of direct cancer cell-killing with high-dose chemotherapy, the goal is to target blood vessels that allow tumors to grow and metastasize. Now some patients with metastatic cancer are living for 6–12 months or more. Treatment may stabilize rather than cure the cancer, but patients tolerate treatment very well and experience a good quality of life.

METRONOMIC CHEMOTHERAPY refers to low-dose oral chemotherapy that is typically given daily, without breaks. Unlike conventional maximum tolerated dose (or high-dose) chemotherapy, metronomic chemotherapy targets the tumor blood vessel and the inhibition of tumor angiogenesis. These protocols typically have a low-toxicity profile and are very well-tolerated.

So, think “hope” and not “death sentence” when you hear “cancer.”


Editor’s note: Dr. Sue Ettinger is board-certified veterinary medical cancer specialist, book author, radio co-host, lecturer, and Certified Veterinary Journalist. A Cornell University graduate, she completed a general medicine and surgery internship and a medical oncology residency at The Animal Medical Center in New York City and is currently head of the Oncology Department at the Animal Specialty Center in Yonkers, New York. Also known as Dr Sue Cancer Vet, she is an advocate of early cancer detection and raising cancer awareness with her See Something, Do Something lumps and bumps detection program.

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