Important updates on veterinary oncology and discussing options with clients - An interview with Dr. Maureen Cooper, Veterinary Oncologist
Dr. Maureen Cooper obtained her veterinary degree at the Western College of Veterinary Medicine in Saskatoon, Saskatchewan, Canada, completed her residency in Veterinary Oncology and then became a Fellow in the Australian College of Veterinary Scientists in Oncology in 2010.
Before we get stuck into the interview, here are some interesting updates from Maureen.
Cancer treatments and advice are always changing, that is one of the great things about our profession - you are always learning new things! Immunotherapy is a new and exciting field in terms of fighting cancer. There are now vaccines available for melanoma and studies have shown significant improvements in outcomes to be made when combining immunotherapy with other standard treatments. There is also a lymphoma vaccine and osteosarcoma vaccine undergoing clinical trials. Whilst these latter two are not available in Australia, if they show favourable results, hopefully we will have access to these soon. More cutting edge immunotherapy involves using CAR-T cells (chimeric antigen receptor). In brief summary this involves harvesting the patients own lymphocytes, training them to fight the specific cancer and placing them back in the body to do the ‘dirty work’. Whilst this is quite expensive and requires skilled administrators, with time should this be a successful treatment hopefully there will be less costly veterinary applications.
What are the top 5 referred oncology conditions you see in dogs?
1. Lymphoma is by far the most common cancer we see. In dogs; diffuse, large, B cell (DLBCL) peripheral lymphoma is the most common type; however we see a broad range of lymphoid cancers in dogs.
2. Mast cell tumours
3. Anal sac adenocarcinoma
What are the top referred oncology conditions you see in cats?
1. Lymphoma is by far the most common cancer we see in cats. This is really a broad term for a large group of lymphoid cancers. In cats we most commonly see EATL type 1 and type 2 which are different types of intestinal lymphoma. Other types of lymphoid cancers we treat in cats include leukaemia’s and other lymphoma’s.
2. Squamous cell carcinoma is also frequently seen, in particular given the UV exposure in Australia.
3. Other general visceral carcinomas
4. Mammary carcinomas
Are there any conditions that are on the rise?
We are seeing more histiocytic cancers and more indolent lymphomas. In regards to histiocytic cancers, this may be due to better diagnostics and classifications from our general practitioners and pathologists. In the past histiocytic cancer may have been misclassified as other cancers such as splenic sarcomas or synovial cell sarcomas.
Likewise, indolent lymphoma seems to be on the rise. These forms of lymphoid cancer comprise 5-30% of all canine lymphoma. I’m not sure whether these are becoming more prevalent or whether the oncology and pathology communities are becoming better at separating this subtype of cancer from the intermediate and higher grade forms.
In what cancer conditions can veterinarians make a real difference in life expectancy and quality of life?
There are really very few, if any cancers, where we can not make a difference in terms of improvement in quality of life or outcome. Even with cancers that have poor prognosis there are often palliative care options which can be implemented.
What do you think we can do as an industry to improve cancer awareness and prevention?
'Stop giving up on cancer so quickly!’ Often in our industry a diagnosis of cancer is inferred to be an end point, we feel this needs to change. Cancer is the only chronic disease you can cure and often pets can have a great quality of life whilst living with this disease. Many of our clients are well educated in terms of diagnostics and treatments for cancer thanks to our great general practitioners and to the media. Often clients will want to discuss new and potential cancer treatments; it is up to the veterinary industry to offer options for clients to gain more information so that they can make an educated decision regarding their pets cancer. This is where oncologists can partner with general practitioners to help these pet owners.
What are the top 3 causes for client confusion when it comes to cancer therapy?
- Animals will become as sick as people do with chemotherapy - The dogma behind maximum tolerated dose chemotherapy is that the harder you push the drug the better the success you will have at obliterating the cancer. This comes at the expense of some of the bodies ‘good cells’. With humans often this is an acceptable situation, in particular as informed consent and explanation can be given to people. The situation is different with animals and quality of life is extremely important. For this reason, most oncologists will reduce the dose in order to maintain a good quality of life while still treating the cancer. The trade off is that we may not get as good of control as we can get when treating cancer in people. Often the goal is to have an almost normal quality of life during treatment.
- Cancer treatments are extremely expensive - Some cancer treatments can be expensive, in particular as tests and treatments are not subsidised as they can be for humans. It is important to always discuss all expected costs of treatments with clients and remember that advice and treatments may need to be altered depending upon the pet owner’s budget. We also advocate having a thorough oncology discussion before undertaking a lot of tests as the owner may not wish to treat the cancer, as such it may have been less important to spend funds on further diagnostics.
- You can’t cuddle your pet when they are receiving anti-cancer treatment - There are some cancer treatments, such as radioactive iodine, where their waste products can be radioactive. In this situation contact must be limited. This is not true with chemotherapy, we encourage our clients to have regular contact with their pets during treatment. We tend to follow the advice given at human cancer clinics in terms of handling waste products from patients receiving chemotherapy. Chemotherapy is not contagious however sometimes precautions still need to be undertaken. The main issue we come across is ensuring that owners take precautions when handling oral chemotherapy.
When briefing clients on what to expect with cancer, what would be your top 3 tips?
- Whilst often cancer is terminal in our pets often they can have a great quality of life and live with the disease for some time. Cancer does not equate to an imminent death.
- It is important that the client considers their goals in terms of outcomes, whilst we all want our pets to be ‘cured’, this may not be a reasonable expectation. This is where an oncologist can help by providing accurate and up to date information regarding treatments and survival times. It is important to also consider what the pet owner can commit to both physically, emotionally and financially. This highlights the importance of 'individualised medicine’.
- You don’t have to treat the cancer. Just because your pet has been diagnosed with cancer it does not mean you need to embark on active treatment, there are many less active and palliative options available for pets.
What are your tips on getting clients to follow your recommendations?
Communication is key. During their initial consultation we will discuss the cancer diagnosis in detail but also present various other options. Once the client has indicated how they would like to proceed we then give more detailed advice tailored to the individual pet. No patient is exactly the same and it is important that we adjust our advice and treatment for each pet. We provide detailed handouts regarding the patient’s cancer, the treatment recommended and estimates for potential tests and treatment. Finally, should they undergo treatment they are given a detailed discharge sheet.
Top VetCheck Oncology Templates
We've put together the top 10 oncology resources from the VetCheck library to help you educate your customers on treatment options, prognoses and more.