Decision-making when faced with a dog cancer diagnosis can be tough. Treatment outcome, age, cost, and side effects all can weigh heavily on the mind of a dog lover.
During the first decision-making period, so much has to be weighed. The difficult part in this process is that nothing seems to be for sure. Objective data may be hard to come by, and easy choices are elusive.
Many people can feel a bit overwhelmed.
One of the aspects of cancer medicine, whether in conventional oncology or “alternative” approaches, is the point at which we are over-treating. In other words, the treatment’s benefit is outweighed by its drawbacks. The Big Three (Surgery, Chemotherapy and Radiation) have drawbacks from many people’s perspectives.
To traditional oncology’s credit, there many patients do well, achieve longer lives, and are happier for a more prolonged period. However, there can be a difference between what is written in a veterinary textbook and what the real world demands.
Suppose a diagnosis of a nasal fibrosarcoma is made. The tumor is located quite close to the tip of the nose. Perhaps this dog is a year old 17 Shar Pei whose kidneys are a little diseased. If one were to widen back and look at the traditional recommended treatment (radiation with debulking surgery), it might not make a lot of sense.
Radiation requires multiple rounds of general anesthesia. The kidneys may not be able to tolerate its effects. The dog has already surpassed her life expectancy. The surgery will necessitate major pain management, and we cannot use anti-inflammatory pain meds due to the kidneys. Even with all of this, there is a significant possibility the tumor will regrow soon.
In this case, most aware vets and dog lovers would realize the traditional treatment should actually be called over-treatment. Most would agree that the direction the scale tips would not support textbook treatments.
A huge piece in this equation is the viewpoint of the person in charge: you! Your role is deciding the treatment plan is dictated by what type of philosophy you have in treating your dog.
If you would like more information on treatment decision-making for your dog, it can be found in The Dog Cancer Survival Guide.
It is really important to take just a few minutes and define where you stand, at this moment. A person who will accept most side effects (toxicities, pain, etc) in exchange for treatment benefits is not the same as one who will not. Note that you should be aware of what benefits you can expect from a given treatment, and the risks of side effects too.
Where do you stand? Are you willing to accept most side effects? Are you only willing to accept some in exchange for less treatment pay-off? Do you want to make sure that above all, nothing is done that will adversely affect your dog (palliative measures only)?
So we not only have to take into account age, life expectancy, concurrent disease, and financial feasibility. What determines over-treatment is really dependent on what your viewpoint is. Since we are all different people, what constitutes over-treatment can vary.
We realize that other options are needed in veterinary cancer care. We are furiously trying to develop strategies that will increase life quality for dogs in need. Stay tuned!
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.