To Chemo or Not To Chemo?
Dr. Demian Dressler is internationally recognized as “the dog cancer vet” because of his innovations in the field of dog cancer management, and the popularity of his blog here at Dog Cancer Blog. The owner of South Shore Veterinary Care, a full-service veterinary hospital in Maui, Hawaii, Dr. Dressler studied Animal Physiology and received a Bachelor of Science degree from the University of California at Davis before earning his Doctorate in Veterinary Medicine from Cornell University. After practicing at Killewald Animal Hospital in Amherst, New York, he returned to his home state, Hawaii, to practice at the East Honolulu Pet Hospital before heading home to Maui to open his own hospital. Dr. Dressler consults both dog lovers and veterinary professionals, and is sought after as a speaker on topics ranging from the links between lifestyle choices and disease, nutrition and cancer, and animal ethics. His television appearances include “Ask the Vet” segments on local news programs. He is the author of The Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog’s Life Quality and Longevity. He is a member of the American Veterinary Medical Association, the Hawaii Veterinary Medical Association, the American Association of Avian Veterinarians, the National Animal Supplement Council and CORE (Comparative Orthopedic Research Evaluation). He is also an advisory board member for Pacific Primate Sanctuary.
Updated: December 7th, 2018
One of the little known facts about veterinary medicine is that chemotherapy does not cure cancer in dogs, with few exceptions (except transmissible venereal tumor or the very rare lympho or something).
I believe that many people are unaware of this fact.
So we are left with a treatment modality that has a goal of improving two things:
- Longevity (or lifespan)
- Life quality
In order to make the choice about chemo, a life quality analysis has to be done (the technique to do this is in The Dog Cancer Survival Guide). Step one is for you to answer the question, “What kind of person am I?”
To learn more about your role as your dog’s guardian, get a copy of the Dog Cancer Survival Guide
This boils down to risk aversion. How important are avoiding any side effects for you?
Most people also don’t know that in conventional chemotherapy, often the more longevity one gets, the higher the risks of side effects. Usually these go hand in hand.
Speaking of side effects, there are some natural compounds (also discussed in the Guide) that can be used to help with these, like indole 3 carbinol.
At any rate, are you willing to accept some side effects for added life expectancy or is your number one goal life quality, for the remainder of the time your canine companion is with you?
Usually there is some risk of less life quality during treatment in exchange for added life expectancy.
By defining what kind of person you are, you create a platform that informs your decision making and gives you a clear idea of where you are headed.
Of course, you need to be aware of data, as step two. Get an oncologist on board if you want chemo, if at all possible. These folks live and breathe chemo and they are the ones you want. If you are able to get an oncologist who is integrative (familiar with diet, supplements, acupuncture etc) that is a bonus.
In getting data, simply ask questions like these:
“How many dogs respond to this treatment?” (This tells Doc that you are aware that not all dogs respond to chemo.)
Get a copy of this informative seminar to learn more on Chemotherapy Side Effects in Dogs
“What is your guess (and I won’t hold you to this), on the added life expectancy for my dog with this treatment, assuming we get a response to chemo?” (note this is different from median survival time…this question says, okay Doc, since you know my dog, give me a little info on what added time I am getting here.)
“In your experience, what are the side effects of this treatment? What are the severe side effects of this treatment that are less common? How often do they each occur? What would they look like if I were seeing my dog having them? What does my dog go through? How long will my dog be in the hospital during treatment? What happens during this time? How often will my dog be at the hospital??”
Questions like these allow you to get the data. Then you can take this info and see how it fits with the type of person you hare, and the priorities of this person given your dog’s age and circumstances.
Using a template like this, you can answer the question, “To Chemo or Not To Chemo.”
Best,
Dr D
Dr. Demian Dressler is internationally recognized as “the dog cancer vet” because of his innovations in the field of dog cancer management, and the popularity of his blog here at Dog Cancer Blog. The owner of South Shore Veterinary Care, a full-service veterinary hospital in Maui, Hawaii, Dr. Dressler studied Animal Physiology and received a Bachelor of Science degree from the University of California at Davis before earning his Doctorate in Veterinary Medicine from Cornell University. After practicing at Killewald Animal Hospital in Amherst, New York, he returned to his home state, Hawaii, to practice at the East Honolulu Pet Hospital before heading home to Maui to open his own hospital. Dr. Dressler consults both dog lovers and veterinary professionals, and is sought after as a speaker on topics ranging from the links between lifestyle choices and disease, nutrition and cancer, and animal ethics. His television appearances include “Ask the Vet” segments on local news programs. He is the author of The Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog’s Life Quality and Longevity. He is a member of the American Veterinary Medical Association, the Hawaii Veterinary Medical Association, the American Association of Avian Veterinarians, the National Animal Supplement Council and CORE (Comparative Orthopedic Research Evaluation). He is also an advisory board member for Pacific Primate Sanctuary.
My dog Scully is a 13-year old Aussie who loves life. She always used to bark at the grandkids and wrestle my other dog Fox to the ground. You wouldn’t know she was 13! She has been diagnosed with cancer and has had two surgeries to remove several tumors. My question to you is: Are there any treatments available (Chemo or Holistic) that will help bring back the dog I once knew.
Thanks,
Sue F.
Sue,
It depends on the type of cancer and whether it has spread. One cannot mkae treatment recommendations without that important info.
All my best, Dr Sue
Thanks, Jane. I’ll check into that.
Debbie … why don’t you try CV 247 – look it up on the internet … my 12 year old cocker spaniel had mammary tumours and I didn’t want to put her through chemo … she is currently on that and I am very hopeful and very happy … it’s worth a try, as well as the Budwig Protocol for dogs – you just mix up cottage cheese and flaxseed every day – look these things up and look at the success stories .. give your little dog every chance. Much hope xxxx
Our thirteen year old long-hair Chihuahua has bladder cancer. The tumor is not operable and is very large. Mia is tiny. She weighs 3 1/2 pounds. She is currently taking Piroxicam and is doing well on it. We have seen an oncologist and have the option of chemotherapy. However, there is only a 30% chance that it will do any good. We don’t know if she’ll have side effects, but the doctor said that when there are side effects, they usually happen with small dogs. We are trying to decide what to do. My husband doesn’t want to put her through any it. I’m leaning that way, but I’m not sure. She has a good chance to live about six months with the Piroxicam only. The chemo (if it does work) could possibly extend her life another six months. There is NO chance for a cure. I’d hate to make her sick and lessen the quality of life she has now, but I feel a little guilty if I don’t give her a chance at more life. It’s truly a difficult decision to make.
Debbie,
It is a hard decision, but I think it is important to put the survival times in perspective with the overall life span, meaning dogs sadly live much shorter than people. For bladder TCC, the addition of chemo doubles the survival times and that is significant and most dogs tolerate chemo well. Still you are making an educated decision and that is all your dogs could ask from you. Some of my clients try a dose or 2 of chemo and see how the dogs handles it (the majority are happy and continue). Good luck!
All my best, Dr Sue
Dr. Dressler,
My 4 yr old female lab was diagnosed with MCT in Nov of 2011. It was high grade II with MI of 82 #10hpf; Ki-67 High; c-Kit IHC II 20%; kit mutation exon 11.. We had tumor originally on her left [thigh. ] removed and did 7 sessions of vinblastine with prednisone. She has been great until a few days ago, we found a golf ball size hard lump on her abdomen aprox 2 inches before her genetalia and central between her legs. My vet is on 2 week vacation. We are assuming at this point that the cancer is back and we have decided to not go through the chemo with her again..it was rough for her. We want to keep her comfortable by giving her Benadryl and Tagamet. I have done everything in your book except getting the appocaps. What should we do now? Do you think the lump could be something else? At this point, she is doing fine, although she has lost weight since her chemo treatment, about 8 lbs, she is not over weight at all. We just want her to be as happy and comfortable as possible.
Thanks too for this great sight and the very helpful book.
Dayna
Hello, My Boby has limphoma that was diagnos in June 2010 …. we made a tratment and two months after i came back. Now he is going once every 3 to 4 weeks for an injection with Doxorubicin and Dexrazoxane …. it is helping him very good ….. and if you see him he runs burks and play …. some dadys he is a little down ……
My question doc. is I know this drug also in the long run probably cause adverse effect …. and indeed is very costly at the point that Iam about to go bankrupt ….
before the vet gave him vincristine ….Is there oher treatment or some way to get financial aid .
My Boby is a Beagle 12 years old ….. his sister died one year ago
I lived in Los Angeles California in the San Fernabdo Valley Northridge
Thank you
Dear Alejandro-
the doxorubicin is one of the central drugs in the stronger chemo protocols and is used in the ones that seem to give the best survival time. The best person to speak with about changing the chemo is your oncologist! You must share your thoughts openly. Also please see these blog posts:
https://www.dogcancerblog.com/blog/the-cost-of-my-dogs-life-part-1/
https://www.dogcancerblog.com/blog/the-cost-of-my-dogs-life-part-2/
I hope you also are paying attention to diet and supplements and increasing life quality and the other steps in the Guide too!
Best,
Dr D
Dear Dr. Dressler,
My letter is relevant to the subject of this post — to chemo or not to chemo — but also seeks your take on my dog Silas’s cancer paradox.
Silas’s cancer presents a puzzle to every vet who has looked at him and/or his relevant records. I’ve searched and searched online and cannot find any reference anywhere to a similar situation, or how to approach it. I don’t know where to turn.
Here’s the deal: Eight months ago, in July 2010, a small hard growth was noticed on his gums. It was biopsied in early September and identified by the lab as osteosarcoma. Then (it’s a long, upsetting story) the vet dropped the ball in a huge way; I never learned of this identification until two weeks ago (end of March 2011). Since then, a CT scan has revealed the following: (1) the growth in his mouth, a somewhat uncomfortable but so-far manageable-sized pink blob on his lower rear gums, seems mostly confined to the soft tissues with minimal invasion of the underlying jaw bone. (2) There are two small nodules in his lungs (one ~.5cm, one ~1.5 cm). (3) He has a prominent lymph node near his airway.
Because of (1), above, the oncologist’s dx is soft-tissue osteosarcoma, though she acknowledges being “surprised” at its behavior; if that’s what it is, nobody can understand why it has, so far anyway, been so slow-growing — with the bump first discovered nine months ago, I get the impression that with soft-tissue osteosarcoma (especially untreated) he should have been dead long since. Instead, except for some discomfort in his mouth, he seems to feel fine — quite his normal, frisky, leapy/springy (he’s a standard poodle) self. Normal appetite, etc.
Nonetheless, they’re going ahead on the assumption that it is indeed soft-tissue osteosarcoma and that the nodules in his lungs are metastases. The option of performing an ultrasound-plus-needle biopsy on the larger lung nodule to confirm diagnosis was briefly raised but quickly passed over with no comment, and I was too overwhelmed with the news and ignorant to pursue the idea (I’m not much less so now). Given what they found with the CT scan, they’re offering a poor prognosis, and nothing more than low-dose Palladia with the hope of buying him a little more time. I purchased two weeks’ worth of it but then had second thoughts; I’ve yet to start him on it because I wanted to understand Silas’s situation better and learn more about Palladia.
While he clearly has cancer — the growth in his mouth is in exactly the same spot that the small bump was removed from last summer — I can’t get the thought out of my mind that there’s something wrong with this picture, and nobody is paying attention to it. Again, in all my obsessive researching, I can find absolutely nothing online that relates at all to Silas’s osteosarcoma paradox, no similar experiences, nothing. (It almost makes me wonder whether, rather than shrugging it off, somebody might be interested in studying him! But that’s not why I’m writing.)
The docs scratch their heads, and then they shrug and dismiss it. (I’ve received a second opinion from an oncologist who examined him in person; two other vets who’ve seen only his first oncologists’ report and other records, while agreeing with both oncologists that his cancer manifestation is odd, have made nothing of it, either). What if the nodules in his lungs are just granulomas or something? My dog is a very fit standard poodle, but he did just turn 11, and he has always had small benign bumps and cysts and growths here and there on his body. With the exception of slightly elevated lymphocytes, all of his blood work is normal. His kidney & liver function are also just fine.
When I bring up the idiosyncratic nature of his cancer with yet another vet, I keep hearing something along the lines of, “Yes, this is surprising. Whatever is happening with this osteosarcoma, it’s not typical. But we know how osteosarcomas procede. There’s no point in going further to establish for certain that the nodules are malignant. Just assume they are.” One told me, “When you hear hoofbeats behind you, you can safely assume it’s a horse and not a zebra.”
And perhaps they’re right, and I should stop focusing on the puzzle and use the probabilities as a starting point from which to move ahead.
As I mentioned, I have some Palladia but have hesitated for several days to start him on it. Still, my anxiety is growing that my hesitation is doing nothing for him and even as I dither, the cells are multiplying. (For what it’s worth, I do have him on K9 Immunity, and a cancer-inhibiting diet with lots of fish oil, and am researching more supplements, including from your book.) At the same time, my oncologist assumes Silas to be a dead-dog-walking, so the Palladia isn’t intended to accomplish much (and little else has been suggested in the way of options). But something is better than nothing, and I’m making myself crazy with doubts and unknowns, and the fervent desire to do the best I can for my boy without making him sick, or sicker.
My first question: Have you ever in your career heard of a case resembling Silas’s?
Also, I know that you cannot examine him personally, nor have you seen his records, but can you offer any insight or inferences or ideas at all? Might I be making more out of his cancer’s inconsistency than I should be?
Finally: When I’ve expressed concerns about Palladia’s side effects, I’ve been told that I can always try the Palladia and see how he tolerates it and then simply discontinue it if he has a poor reaction. Is it true that trying and then stopping Palladia (or other chemo drugs) can result in a more aggressive, faster growing cancer?
Unfortunately, I haven’t yet been able to find a veterinarian who falls between the very intelligent but blinkered (and rushed/impatient) conventional oncologist who neither knows nor cares about complementary approaches, and the kind but non-confidence-inspiring (and nearly as expensive) homeopath-types, whose proposed remedies, when I research them, seem to have nothing but flower power supporting them; in some cases it seems they might even be dangerous.
And I fear I’m running out of time.
Sincerest thanks for all you do,
Katherine & Silas
p.s. I have purchased your e-book, and it’s very helpful. Will you be coming out with updates that include Palladia and its more recent, non-mast-cell uses?
I’m sorry this is long. If I’m asking too many questions, please just focus on those relating to Silas’s cancer and ignore the rest! 🙂
Hi Katherine,
I have indeed had a weird oral cancer like this once. This dog presented for a second opinion on a bx of an oral mass. Undifferentiated sarcoma as I recall, on the gumline like your dog’s. So I discussed the usual things I talk about, and that was the last I saw of the guardians and the dog for about a year. Then I run into the guy at a hardware store where he is working, and he has the dog behind the counter. Runs over to me to show me his doggie. I recall the dog and take a look at his gums. You would not believe it. The thing was gone. This dog previously had teeth falling out of his mouth and blood on my exam room floor. So these folks had decided to put a purple metal board under this dog for sleeping called a soma board. Supposedly this board keeps veggies fresh and fruit and whatnot. Anyway, I could not believe it. (For all of you out there, no, I am not saying this board cures cancer or anything. I am saying that it was very weird though).
So, at any rate, there you go. I would get the thing re biopsied perhaps to make sure you are on the right track with the chemo selection as one option to consider. Might get a soma board, certainly can’t hurt, and let the dog sleep on it. No, I have no proof it does anything. As to the question of chemo resistance, yes, there is truth there. You might consider masitinib. In my experience it seems to have a bit of higher safety margin, although we don’t have studies to support this impression. Make sure you are considering your medicinal mushrooms and your artemisinin and apocaps and diet if this comes back osteosarc again.
Hope this helps
D
My 5 year old lab Sophie was diagnosed with mast cell cancer in 2008. We did not do chemo, but chose Benadryl and Prednisone as her treatment, as well as grain free, high protein home cooked foods and supliments. She has been cancer free now for over 2 years. My other lab, Star, now 12 and a half, was just diagnosed with stage 3 Lymphoma. We will not do chemo and are making her comfortable. I will do the same treatment, high omega 3, low omega 6, pro biotics, grain free and high protein. We never give our dogs sugar and wheat, I don’t use chemiclas in my home or yard. Our dogs are well cared for and so loved, they have daily outings with us and are like our children. They were both raised and trained by me to be seeing eye dogs and did not make the program. They were working dogs turned pets. This is a complete devistation and we know we will lose our girl Star to this cancer. We will just keep loving her as much as humanly possible until we have to say goodbye.
My husband and I found out our 4-year-old boxer had gastrointestinal lymphoma (small, t cell) back in October. We knew chemo could result in remission, but we were clear in the fact that her cancer would probably come back. We made the decision to try and give her some more time. After even just her first treatment, we saw some great results. Her weight gain was particularly remarkable. We worked with some fantastic vets to monitor her quality of life throughout the process and ended up ending chemo early because her liver was being adversely affected.
Now, we’re doing our best to keep her keep her cancer symptoms under control. By the end of March, it seemed clear the cancer was coming back. (We can mostly tell because of her diarrhea.) However, she remains happy and wiggly. We cherish the moments we have with her.
Dear Allyson,
thinking of you in this hard time.
Best,
dr D
Dr. Dressler:
My Boone was diagnosed with bone marrow cancer about 9 weeks ago. He has been on prednisone since and has had 2 chemo treatments of vincristine about 2 weeks apart and and just received a doxorubicin injection, which has left him throwing up a dark brown smelly liquid and drooling nonstop for almost 24 hours – despite an injection of cerenia. How can I make him comfortable? Do I continue with this chemo treatment, or let the cancer run its course? I would appreciate any advice you might have.
Thank you–
Donna Wilkens
Dear Donna
you really should have your oncologist involved in chemo choices. Doses and drugs can be changed, anti-emetics can be rotated, and so on. For these particular questions, it is important to have a history and a relationship with the patient and I believe your oncologist is the best person for this.
Hang in there
Dr D