It has been a long, hard winter, hasn’t it? My kids were out of school for eleven days, usually for 1 or 2 inches of snow or a “wintry mix.” Any snow at all in Richmond is disastrous. In Goochland, one of the suburbs of Richmond, the kids missed eighteen days of school. We’ve had a few teaser days of nice weather, but it is the last week of March and we have been wearing sweaters all week. I passionately despise all of my winter clothes. I’m so sick of wearing them!
Spring brings with it so much promise and hope. I love seeing little shoots of green here and there and buds on the trees. Baby goats, lambs and bunnies are scampering around at Maymont, our local petting zoo. People are trying to wear their spring outfits, even though it is still cold outside. Here at the FETCH office, we are gearing up for a very busy spring. We have several events in April, our big golf tournament in May, and our Gala in June. We are feeling a little overwhelmed by everything we have to do, but we are super excited to be able to participate in such great community events with our wonderful supporters. Check out our calendar of upcoming events at www.fetchacure.org. We hope to see you out and about! Look for me – I’ll be the one wearing flip-flops and a cardigan.
FETCH a Cure relies very heavily on its volunteers and supporters. We have a very small staff and would not be able to accomplish all that we do without our volunteers. Some of events require staffing over 100 volunteers! April is actually National Volunteers Month, but we would like to show our love to our volunteers a little bit early in honor of Valentine’s Day.
Our Companions in Crisis program provides funding to families who could not otherwise afford cancer treatments for their dogs or cats. If approved, we generally pay about 20 to 40 percent of the total treatment cost to the treating veterinarian. We do not ask recipients to pay us back, but we do ask them to pay it forward by volunteering for us for ten hours a month for one year from the time that funds are awarded. We offer a lot of different ways for people to volunteer. Some are very happy doing some office work. Others would rather be out and about in the community – pouring beer at a street festival, doing check-in at our annual Gala, driving people around in a golf cart at our annual golf tournament, or handing out brochures about FETCH a Cure to pet-friendly businesses.
We welcome volunteers of all ages and abilities. We have had kids as young as five come in and help us do some office work. We have a group of adults with intellectual disabilities who take great pride in stuffing snack bags with dog treats for our Holiday Bone Trees every year. Some middle school-aged and high-school aged children volunteer because they need community service hours for their schools. Others show up just because they love animals.
We enjoy meeting so many different people from all different walks of life. Some of our volunteers are amazing and show up year after year whenever needed, or will be there in an emergency situation, like driving out to one of the correctional centers to take a Pen Pals dog to the veterinarian. We at FETCH a Cure are very grateful to all of our volunteers and are constantly inspired by their dedication and hard work. We could not do it without you!
Beyond Chemotherapy: How Veterinary Oncologists Can Improve Outcomes and Extend Quality of Life
By: Angharad Waite VMD, DACVIM (Oncology)
The Oncology Service
As a veterinary oncologist, my primary objective is to provide information to my clients about the benefits and risks associated with a cancer treatment. A principal component of this effort is to bring hope to families and to provide prolonged high quality of life to my patients who have been stricken by cancer. The primary means to deliver the best care is through a personalized review of the available clinical information for a specific patient and a discussion about the cancer, its prognosis, and the spectrum of available treatment options. It is increasingly the case that this discussion does not focus on the use of chemotherapy alone.
A diagnosis of cancer is often obtained from a tissue section that has been submitted to a pathologist. The information provided on the pathology report can offer a wealth of information to the oncologist regarding the biologic behavior of that tumor type and what other diagnostic tests may be indicated to provide more prognostics information. Additionally, it is important to remember that the conclusions generated on the pathology report may not always be consistent with an oncologist’s experience or inclusive of the newest information available to an oncologist. With the development of advanced cellular and molecular tools, we are now able to extend the value of a pathology report and to provide additional information that is helpful and often essential to completely describe the prognosis for a given patient. This information can often provide insight into the necessity for and types of additional therapy that may be offered.
Once a diagnosis of cancer has been obtained, there are many treatment options. We are aware that chemotherapy is a term that carries many negative connotations for pet owners. The good news is that our ability to effectively manage the risks of chemotherapy have dramatically improved. Indeed, we can now be confident in a high level of quality of life for our patients. Nonetheless we understand that chemotherapy may not be in the interest of a family or may not be relevant to the treatment of a given cancer. Therefore, a concern about chemotherapy should not be the only basis to decide on the input of a cancer specialist. For example, if a primary bone tumor is diagnosed in the limb of a dog, surgery and chemotherapy would be one treatment option. However, if surgery and chemotherapy are not elected, many options remain.
Intravenous infusions of pamidronate, lidocaine and ketamine, and/or palliative radiation can markedly improve comfort and the ability to walk. Pamidronate is a bisphosphonate inhibitor which minimizes bone turnover (and therefore pain from the tumor destroying the bone) and is well tolerated. Palliative radiation is a short course of radiation treatment with reduced incidence of side effects and with the intent of improving comfort for the short term. In my experience, 60% of patients will respond to pamidronate and the improved comfort can be maintained for 2-6 weeks with treatments repeated as needed (often every other week). The reported response rate with pamidronate in the literature is 28-40% with pain control lasting for greater than 4 months. I have also routinely used lidocaine/ketamine infusions with pamidronate and have seen most patients show signs of improved comfort, typically within 24 hours, and this has lasted for several weeks before a repeat treatment is pursued. As such my role in improving outcomes, even in this single example, extend well beyond a focus on conventional chemotherapy.
Progress in the field has also taken us beyond chemotherapy alone. Advances in immunotherapy and targeted cancer therapy continue to be made in human and veterinary oncology. The two immunotherapies I most commonly use are inhaled IL-2 for lung metastases and the melanoma vaccine. IL-2 has a 30% response rate in patients with pulmonary metastatic osteosarcoma. This therapy has been well-tolerated in my patients and can result in stabilization and even regression of the metastatic lesions. The melanoma vaccine has shown significant improvements in survival time in dogs with malignant melanoma. Recently, a paper published looking at canine patients with oral malignant melanoma including dogs that had spread to local lymph nodes had long survival times when surgery and the vaccine were pursued. The median disease free interval was not reached at two years in these patients. In the future, additional novel immunotherapeutic drugs will become available and will be safely integrated into the care of our patients. In the setting of targeted therapy we are now in the era of targeted small molecule inhibitors for veterinary cancer patients. Two approved agents (Palladia and Masitinib) are available and more are expected for several cancers.
In summary my role as a veterinary oncologist extends well beyond that of chemotherapy. Changes in our field have increasingly required me to carefully review a pathological report and to consider what additional cellular and molecular tests are needed to fully define a diagnosis and prognosis. From there, my goal is to provide families with information on the specific cancer in their pet and discuss the diversity of options that can be used to treat cancer. This includes the use of chemotherapy combined with medications that successfully limit the side-effects previously seen with chemotherapy, and to include the vast numbers of new treatments from targeted radiation to immunotherapy and small molecule inhibitors into a treatment plan that meets the goals of each patient family.
My Dog has Cancer. Now what?
by Dr. Alison Rhoades, DVM
Midlothian Animal Clinic
Frequently, a cancer diagnosis makes everyone in the family feel helpless. After deciding on a treatment plan, owners often want to know what they can do to help keep their pet comfortable during treatment.
First, let’s talk about nutrition. A nutritious diet will help your pet’s body have the energy it needs to fight cancer. There are prescription diets available designed for cancer patients. They are high in protein to help prevent muscle loss, and supplemented with fatty acids to help reduce chemotherapy side effects. These diets are also designed to be pretty tasty for animals who may have a poor appetite. Many animals are also able to stay on their current food, as long as it is of good quality. If there is a day when your pet’s appetite is not good, sometimes tempting them with chicken and rice or scrambled eggs will get them eating and still be bland enough for a sensitive tummy. There are also medications available to control nausea in cancer patients.
Second, we encourage regular but not strenuous exercise. Many pets are able to continue their current level of exercise, but bear in mind they may tire faster.
Third, they may continue to be around other dogs that you know are vaccinated and not ill. We discourage visits to dog parks and other places where large numbers of dogs congregate since our pet’s immune systems are not as able to fight off infections while they have cancer.
Lastly and most importantly, enjoy them and love them. Some cancers are curable, but many are not. While your pet is being treated hug them a little longer, bring them their favorite treat, let them get on the bed. The time we have with them is precious.
Common Misperceptions for Cancer Therapy in our Companion Animals
By Dr. Monika Jankowski, DVM, DACVIM, Veterinary Emergency Specialty Center
Cancer. It’s a word that sets off a variety of emotions in all of us. We may see characters in movies portraying severe sickness from chemotherapy treatment or know of acquaintances undergoing treatment with chemotherapy. The majority of us have perceptions regarding chemotherapy treatment in people. And naturally, this gets carried over to our companion animals. One of the most common misperceptions of cancer treatment in our pets is that chemotherapy will make them sick as it does with people. They will have extreme nausea, vomiting and diarrhea, and no appetite. Another common misperception may be that all therapy takes several hours to administer. Another common misperception is that our pet’s fur will all fall out and they will become bald. Probably the biggest concern that most people have is that chemotherapy will give all pets a very poor quality of life.
The reality is that our companion animals handle chemotherapy and chemotherapy administration very well with a very low percentage of animals becoming sick. We can see 95-97% of all cases having a completely normal lifestyle with almost no vomiting, diarrhea, or decreased appetite. In those cases where we do see some side effects, the majority of those can be symptomatically treated at home with anti-nausea or anti-diarrheal medication. There are few cases that require hospitalization.
The majority of our treatments are delivered in a very short time span. The overall time from when these pets walk in the door, to the time they leave the facility, is generally 30 minutes or less. We use a temporary catheter to deliver these drugs into the veins, and the amount given is very small. There are some drugs that may take a little longer to give, but the overall time is still less than 30-60 minutes.
Dogs and cats also hardly ever lose their fur. They can lose their undercoat and they can lose their whiskers, but they grow back once chemotherapy is discontinued. There are some breeds that do have hair coats similar to people. This means they have a continuous hair growth cycle. Those dogs will generally lose their hair, but it will grow back. Some breeds with continuous hair growth cycles can include Old English Sheepdogs, Poodles, and Bishons.
The bottom line is that quality of life is the most important. We want our patients feeling well, going on hikes, playing ball, or simply being the couch potato they love to be. Our goal is to keep our pets at home with their owners and not to hospitalize them for chemotherapy side effects. We tend to achieve this goal in the majority of our cancer patients.
