Yesterday’s chemotherapy on a mammary cancer kitty got me to thinking: I see so much cancer among my patient population yet I perform so few chemos—and it’s not just because I send all my cancer cases to the oncologist or internist (I try but owners don’t often choose to comply with this recommendation).
From my daily entries I’m sure you’ve already ascertained that cancer is no stranger to vets. Indeed, any pet lover lucky enough to have pets that live long enough will eventually experience cancer firsthand as well. It may seem odd, given that among humans cancer seems somehow strange and exotic—that is, unless you, a close friend or a family member have been afflicted.
How many new cancer patients do I see every week? Maybe four. Including rechecks, I see cancer almost every day of my working life.
Animal cancer and cancer treatment has exploded in the past decade. Oncology is one of the most rapidly growing fields in vet medicine. Mostly, it’s because pets are living longer—long enough for cancer to eventually affect older, dividing cells. But it’s also because we’re spending more on our pets. Now we have the luxury of identifying previously undiagnosed non-specific disease as cancer.
In years past, most pet owners would bring their old, sick pets to the vet with the expectation that their pet would have to be euthanized. Now they’re more likely to walk in the door looking for answers. But when the answer is cancer, chemo isn’t an option they’re happy to hear about.
Because specific cancer techniques and medicines have made cancer treatment more feasible, chemotherapy is a word that escapes my lips frequently. And it never fails to elicit a strong reaction from pet parents—usually a negative one. In fact, most owners recoil as if I’d just suggested we remove two limbs.
Truth be told, chemo is not so scary as it sounds and need not be so uncommonly employed. Many cancers, detected early enough, respond well to chemotherapy. Since the goal of chemo in pets is to restore or prolong a high quality of life, we seldom see the kind of crazy reactions that are the hallmark of chemo in human cancer patients.
In pets, chemo will not make hair fall out, will usually not cause nausea or vomiting, and very infrequently leads to medication-related death. If significant side effects are noted after the drug is administered, whether immediately or in days or weeks to follow, we usually recommend the chemo course be discontinued. Similarly, if the pet’s cancer does not respond to the chemo drugs in a measurable way (reduction is the size of tumors, for example), we stop using it altogether.
Most often, though, chemo does help for the cancers we know respond well to it. Because the goal is not a cure, and because our chemo approach is so mild by comparison to that of humans, the cancer inevitably rears its ugly head within months. It’s this inevitability, coupled with its fearsome reputation that makes all the difference to pet owners. Why put Fluffy through something so drastic if it’s just going to come back?
If that’s the case, why put her on antibiotics? Why perform surgery? Why administer steroids? We know she’s going to die. Why keep her alive at all?
Make no mistake, I’m not advocating the indiscriminate use of chemo, nor am I disrespectful of my clients’ choice to decline it. Rather, I’m suggesting that it should perhaps be considered in more realistic terms and not dismissed out of hand for personal emotional reasons.
Yes, it’s true. I’d like to see chemo used more frequently. The possibility of an increase in quality of life is too great. Furthermore, there’s no way that we’ll make strides in our treatment of cancer for all pets without making it a more commonplace alternative to immediate euthanasia. The more we know the more we can help. The more animals helped the better vets feel about recommending it enthusiastically.
The last ten years have seen more diagnostics and more cancer. I’m hoping the next ten will see more treatment. It starts with you and your pets. Just think about it.
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I can certainly second this. My thirteen and a half year old golden retriever was diagnosed with bone cancer last January. At our vet's recommendation, we had her front leg amputated, both for pain relief and to control the cancer. The vet told us that it was likely the cancer had "seeded" itself and would return, but that chemotherapy might give our dog a year or so. That seemed a generous time estimate, given her age, but we decided to go ahead with the chemo. There were about six treatments over six months. My vet was able to administer the chemo in his office (using UC Davis protocols and drugs). We did give anti nausea medications for a few days after each chemo treatment and an anti acid, but my dog tolerated the chemo very well. (We thought her hair did fall out more, but perhaps that was due to something else.)
She died just a couple of weeks ago, at 14 1/2. So we did get almost a year. I have ABSOLUTELY no regrets about any of the treatments. It was a good year for her. She adapted well to the loss of her front leg and was a real trouper throughout the chemo. Even on three legs, she continued to "chase" her red ball, her life's passion, and to respond lovingly to us (and all other people) up until a day or two before she died. She was sweet and gentle--and I think we underestimated her courage and ability to adapt, which she did so well. The chemo extended her life--and it was a good quality life. It was a year to be treasured.
Arlene December 20th, 2006 07:04:00 PM
Your post made me really think, especially about the choice I've made with my big guy.
He is a 10 year old GSDxRidgeback, weighing in at about 57 kgs. A year ago, he developed a lump on the one rear leg, and the vet recommended surgery and biposy. While he was sedated, she noticed a pea sized lump on the other rear leg, and removed that as well. The lab work showed that the big lump was a non-malignant growth, but the smaller one was mast cell cancer.
The options given to me were radical excision (not really possible because of the position of the tumour), amputation (vet said that this would be impossible for him because of his age and size), radiation (in a human hospital!, and guaranteed to affect his quality of life), or just monitoring for further outbreaks, with the knowledge that every surgery would increase the odds of a systemic malignancy, and treating symptomatically where needed.
I chose the latter, not because of cost, but because the oncologist said that the radiation treatment was definitely going to affect him adversely. If it were a question of money, I'd mortgage my house for him.
Touch wood, so far he is doing well. He's now developed two small growths on his nose, and I'm trying to mentally prepare us all for the possibility that when they are removed in the new year, they might be new mast cell tumours - and that once again we'll have to make the choice of treatment.
The option of chemo wasn't given - if it was available, and would have no impact on qualiity of life, I would take it immediately. Maybe it's because of the harshness of the human treatments, but Cancer is probably still the scariest illness I can think of.
jcat December 21st, 2006 06:54:00 AM
This is such a hard issue. We had a cat with cancer, and chemo wasn't mentioned as an option, but I'm not sure we'd have taken it if it had been. He was already fifteen, and he was so terrified of vets that he had to be sedated by having his carrying case gassed before he could even be taken out of it to be examined (when our vet euthanized him, she said, "He was so sick that he let me touch him without sedatives: that's how bad it was").
I've read -- I don't know if you have an opinion on this -- that fear's worse for animals even than pain is, not that pain's good. I've never had a cat who didn't fear and loathe going to the vet's office; I feel horribly guilty just bringing them in for routine shots and dental work. I'd think more than twice before subjecting them to IV chemo, although oral, administered at home, might be an acceptable option.
Susan December 21st, 2006 09:30:00 AM
Susan: I believe an animal's temperament must always be taken into consideration with any procedure that would require frequent or long stays in hospital. I believe it's cruel for some animals to have to come to the vet--and that's a must for chemo for obvious reasons (spills, reaction monitoring, not to mention OSHA requirements). But I always offer house calls on any patient that gets really freaked out for vet visits. Everyone's happier. People always forget to consider the fear-factor--and it's huge for some puts.
Dr. Patty Khuly December 21st, 2006 09:54:00 AM
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