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Featuring Demian Dressler, DVM and Susan Ettinger, DVM, Dip. ACVIM (Oncology), authors of The Dog Cancer Survival Guide

The chemotherapy appointment, demystified

Updated: November 16th, 2018

Ever wonder what happens at your dog chemotherapy appointment?

The idea of chemo may conjure up an image of a bunch of people sitting around in chairs hooked up to their IV chemo lines, but how do we do that in dogs? Let’s break a typical chemo appointment down, with Charlie as my example. Charlie was diagnosed last May with lymphoma. His first course of treatment was the UW CHOP protocol, which is a 19 week course of treatment that I often find very helpful for lymphoma. It involves several different chemotherapy agents. Charlie finished this protocol in September, four months after diagnosis.

Then in May, a year after his original diagnosis, Charlie’s lymphoma relapsed, which means it came back. We started a second protocol, called a “rescue protocol,” to try to put him back into remission.  His guardians chose to restart the same protocol, since it worked last time. At last week’s appointment he had the chemo agent called Elspar, and at today’s appointment Charlie was doing well, back in remission and due for vincristine (another chemotherapy agent).

(We typically give one chemo agent at a time, depending upon what I see when a dog comes in on a particular day.)

You may remember Charlie, a happy Golden Retriever, from a previous post on chemotherapy side effects (The Oncologist’s Perspective on Chemotherapy and Gastrointestinal (GI) side effects: Part Two). Although he was hospitalized after his first vincristine treatment during his UW CHOP protocol last year, we decreased the dose in later vincristine treatments and were able to give it to him seven more times between last May and September. Even so, I wanted to be careful about today’s dose, because I don’t want him to get sick on vincristine.

He’s older than he was last time he got this drug, but he’s also stronger than he was, because he’s been well for the last few months. To figure out today’s dose, I rely on a thorough intake that tells me just how strong and healthy Charlie is today, at this moment.

At my practice at the Animal Specialty Center, my wonderfully trained chemo nurses check my patients in for me. I want them to find out how the dog handled the last treatment. Any changes in appetite or energy? Any vomiting or diarrhea? How many days did this occur after chemo treatment? And did you give any nausea or diarrhea medications? I ask them to get as much information as possible, because I want to minimize side effects. I will use this info to adjust or tweak the next time that chemo drug was given.

Then Charlie comes into the back of the office, with us alone, so we can get his CBC (complete blood count) blood sample drawn and running in our in-house lab. We need to check the blood cells, specifically the white blood cells (the neutrophils), and to make sure the counts are adequate for chemo. These tests need to be run the day of treatment, because blood counts can change from day to day. A CBC from a few days ago or last week does not tell us what Charlie is like today — but a CBC from yesterday is acceptable for treatment.

Charlie also gets weighed, so we can make sure he is not having any consistent weight loss issues (he was stable today). He also has his temperature taken to make sure he does not have a fever (he did not). We give chemotherapy drugs based on weight, so it’s really important to know what his current weight is, so I can calculate today’s chemo dose. While his tests are running in the lab, I give Charlie a physical examination and check the tumor. I’m glad to note that all of Charlie’s lymph nodes have returned to normal size. 

Once the CBC results are done, I calculate his chemotherapy dose based on today’s weight, and my notes about how well he has tolerated vincristine in the past. Then I write up an order for the drugs — the recipe for today’s treatment. I get one of my chemo nurses to doublecheck my math and dose. It’s always good to have someone else doublecheck your work!

The nurses “draw up” or assemble the chemo treatment under a ventilation hood, a large stainless steel unit that I joke looks like a large oven. When on, this ventilation system eliminates toxic fumes from our work space. (Safety is a big concern for the staff regularly handling chemo.) In addition to using the hood to draw up fumes, the nurses and handlers wear chemo safety gowns, special gloves, and masks. We also use special attachments on the syringes and catheter lines to minimize any chemo getting into the air.

The chemo treatment is also given in a separate room in or hospital. The room is locked during treatments so there are no interruptions and the pets can relax as much as possible. Charlie sits on the floor, which is padded with blankets for long treatments, and the nurse sits next to him to administer the chemo using a catheter. (We have a table for cats and small dogs, but 70 pound dogs like Charlie are happier on the ground.) There aren’t any chairs in a row hooked up to chemo, like people. We are next to the pet the entire treatment, and only one pet is treated at a time, so everyone can remain calm and as stress-free as possible.

You should know that some chemotherapy drugs can cause mild to severe irritation to the tissues if the catheter is not perfectly placed in the vein. Perfect placement is often referred to as a “clean stick” catheter, and getting a clean stick is a big reason you want an experienced chemo nurse administering your dog’s chemo. I may be biased, but I think my nurses are the best.

I note in Charlie’s chart that he has had stomach issues after previous vincristine doses, so today, he also gets a subcutaneous injection of Cerenia, an anti-nausea and vomiting medication. While Charlie is in the treatment room with his nurse, I type up a thorough summary of our treatment for his parents. We also refill medications, to make sure he has everything he needs. When it’s time to say goodbye, we all give Charlie a ridiculous number of kisses, and some treats, and then out the door he goes with mom.

I try to make sure that all appointments are complete within one to two hours, depending on the drug being given. We’ll see Charlie next week for the next round of UW CHOP treatment. The agent next week will be cyclophosphamide.

I hope this takes away some of the mystery around chemotherapy treatments for dogs, and be sure to check the Guide for more info on chemotherapy appointments, individual drugs, and tips to minimize side effects. There’s a lot of ground to cover. 

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