Melanoma Tumor Board Meeting and ACF

I just returned from a Melanoma Tumor Board Meeting in Washington, DC and I do not remember being more excited by the outcome of a conference. There were close to 50 people in attendance ranging from medical oncologists to molecular biologists to geneticists to veterinary medical and radiation oncologists to pathologists-both veterinary and human. This group of people represented the “best of the best” in terms of melanoma researchers and clinicians.

This conference, supported by the Animal Cancer Foundation, will result in the publication of a “white paper” describing a consensus statement espousing the value of canine oral malignant melanomas as a model for certain types of melanomas in people. People from both sides of the “human and veterinary aisle” passionately and eloquently described the need for developing this model.

The organizers of this conference have done what no one has been able to do for 20 years—effectively guide such a diverse group of cancer researchers to reach a consensus statement.  They have truly allowed me to see a dream of mine move towards fruition. Since starting the Animal Cancer Foundation in 1999, I have hoped to galvanize the cancer community in this manner. It is such a wonderful feeling to

What I would change about the Veterinary Education System

I was at a conference recently with two colleagues of mine and we started talking about veterinary education. I am not sure how the topic came up, what we all started discussing the same point almost in unison. The topic was communication and how veterinarians discuss options with pet owners.

 

All three of us had graduated from different veterinary schools, gone through different internships and residencies –and yet we all agreed that veterinary students everywhere need to re-organize their communication priorities. 

 

What do I mean “communication priorities”—I mean medical/surgical options need to be prioritized above finances. Don’t get me wrong, finances are AN important consideration when discussing any medical therapy, but they should not be the primary one. Information about options- ALL the options available, should be THE most important consideration.  Once a veterinarian and pet owner both understand what options are available for the pet, then, and only then should finances-or whatever other constraints –time, emotional, finances, etc.--may be pertinent to that pet owner be discussed. 

 

By prioritizing information and options first and finances second, we can better insure that the pet will get the best care possible AND that everything will be done that the pet owner can afford. If the priorities are stay as they are, clients will continue to feel that optimal care was not recommended or given, veterinarians will feel they need to be accountants, bankers and financial managers first and medical professionals second.

 

We, the veterinary profession, need to trust pet owners. Trust that they can make the best decision for their family and their pet. This requires accurate and complete information. Veterinarians need to allow the owners to hear ALL of their options and then help them make choices, rather than only communicate those options the veterinarian THINKS the owner’s can afford.  Veterinarians need to be medical professionals not financial professionals. Pet owners come to us for medical information and guidance. 

 

Survey after survey over the past 25 years have shown that owners would have done more for their pet if their veterinarian had recommended it. The impetus to change the way we as veterinarians communicate needs to start at the veterinary schools throughout the country, this is where we learned the current communication prioritization.

 

Empowering the pet owners and informing them of all the options available—as a starting point for discussion –may not be easy, but it is the right thing to do for the pets that have been entrusted into our care.

Bladder Cancer in Dogs

From Petside.com

Did you know that both dogs and people get bladder cancer? Did you know that some breeds are almost 20 X more likely to get bladder cancer than other breeds? And did you know that there is a test that can help determine if your pet does NOT have bladder cancer?

Bladder cancer is not an uncommon cancer in either people or pets. In people somewhere between 1 in 28 to 1 in 84 will develop the disease. In dogs, 2% will develop the disease, but certain breeds—Scottish terriers, Shetland sheepdogs, beagles, and West Highland white terriers—have a much higher risk of developing bladder transitional cell carcinoma. Of these breeds, Scottish terriers have the highest risk, with an almost 20-fold increased risk compared with mixed-breed dogs. In addition to breed, another risk factor in dogs is the exposure to herbicides and / or pesticide s on the lawn. 

The signs of bladder cancer in dogs are straining to urinate, increased frequency of urination, and blood in the urine. These signs are very similar to the symptoms people report. Because our pets cannot talk to us, we often detect bladder cancer at a more advanced stage compared to people.  There is a test—the Bladder Tumor Antigen (BTA) test-that can be used. This test is very sensitive—meaning it is very good at detecting the disease if it exists, but it is not very specific—meaning it is NOT very good at telling us that a positive tests actually means that they have the disease. The BTA may, however, be very useful for screening young dogs of at risk breeds. If  Scottish terriers, Shetland sheepdogs, beagles, and West Highland white terriers were screened with the BTA,  a negative result would inform the owner with a high probability that the dog was free of bladder cancer at that time.

So the bottom line, and best advice for decreasing the risk of bladder cancer in your pets is to: 1) restrict their exposure to herbicides and pesticides and 2) if you have a breed that has a high risk (or you are a very concerned owner) you may want to start yearly screenings your dog with the BTA test at a young age.

Cancer is NOT a death sentence

Recent advances in human and veterinary medicine are increasing survival rates for both people and animals with cancer. Both human and veterinary oncologists treat cancer traditionally using methods including surgery, chemotherapy, radiation therapy and immunotherapy. Over the past 20 years in oncology practice, I have seen some wondrous advances in treatment options. These newer modalities include cancer vaccines and targeted chemotherapy, which will be explored in future columns.
Today, veterinary surgeons are using innovative techniques such as limb sparing surgeries that can help pets with bone cancer avoid amputation. When surgery is combined with chemotherapy, veterinary oncologists achieve significant improvement in extending the lives of our pets. In addition, the pet’s quality of life is maintained with new chemotherapy dosing regimens and advanced methods to mitigate the side effects of chemotherapy. Veterinary oncologists anticipate and prevent side effects such as vomiting, diarrhea, anorexia (loss of appetite) and lethargy (loss of energy level), rather than address them as they occur. New Information from European cancer centers that certain antibiotics can be used to help alleviate many of the side effects of chemotherapy is being used in veterinary hospitals as well.
The melanoma vaccine, produced by Merial, is another example of how much progress researchers and clinicians are making in cancer treatment. This vaccine helps pets with the most aggressive form of melanoma—those that arise in the mouth or on a digit—to live much longer than previous treatments. I experienced this first hand in 2003 when my own dog, Smokey, a miniature schnauzer, developed a digital melanoma at age 12. Not only did Smokey have a tumor on his toe, but the cancer had spread to his lungs as well. I knew that the prognosis was grave—3 months. Smokey was given the melanoma vaccine, which was in experimental phase at that time. With this therapy, he enjoyed wonderful quality of life and lived 2 ½ more years. You can read more about Smokey’s experience at http://www.acfoundation.org/dedications/smokey.php.
I just completed filming an informational video for the Riedel and Cody Fund that provides more evidence that pet cancer is not a death sentence; you can find it online at http://www.ustream.tv/riedelcody.
Pets with cancer are enjoying longer and better lives than ever before; there is a plethora of treatment options available to insure that every dog and cat with cancer gets a chance at therapy.

Gerald Post, DVM, DACVIM (Oncology)

Chemo--for my pet????

Chemotherapy is one of the four major therapies for cancer--the three others being surgery, radiation, and immunotherapy. During most of the consults that we do, chemotherapy is discussed. The looks I get when I recommend chemotherapy for people's pets can range from unbelief to fright.

The first thing that I do is immediately tell owners that chemotherapy is handled much better by dogs and cats than it is by people. Although cancers are similar among dogs, cats, and people, the therapies affect them differently. The reason why our dogs and cats handle chemotherapy differently is because we as veterinary oncologists and you as pet owners have decided that we don't want to put our pets through what people go through. Because of this mindset, veterinary oncologists have changed the way chemotherapy is given. We use lower doses as compared to the doses used to treat people with cancer. In addition, we give the chemotherapy for a longer time period, sometimes as long as a year, whereas most chemotherapy protocols used to for people take only a few weeks to months to complete.

Additionally, over the past 5 years, there have been significant advances in strategies to mitigate the toxicity of chemotherapy. New medications such as Cerenia (an anti-vomiting medication) along with anti-diarrhea medications and certain classes of antibiotics are used to decrease and in some cases eliminate the most common side effects--vomiting, diarrhea, lethargy (loss of energy) and anorexia (loss of appetite). We have also found that it is easier to prevent these side effects, rather than wait for them to occur and then treat. We do this because the veterinary oncologists at VOHC are not only concerned with quantity of life but also with quality of life. We try very hard to insure that all the pets we treat have the highest quality of life and the longest quantity of life.

Are ALL breeds at risk for cancer?

This is a question I am often asked by family and friends who are looking for a dog. The answer is both simple and complex. The simple answer is yes--ALL breeds, ALL dogs, ALL cats have a risk for getting cancer in their lifetime. Just as all people have a chance of getting this awful disease. As it turns out, the overall risk is about 30% overall, whether you are a dog, cat, human or even a blue whale (as Carl Zimmer pointed out in a recent blog post (http://blogs.discovermagazine.com/loom/2011/02/28/the-mere-existence-of-whales/).

Golden Retrievers, Boxers, Rottweilers, Bernese Mountain dogs- these are some of the breeds we often think of when talking about cancer. Lymphoma is common in Goldens, Boxers and many other breeds. Osteosarcoma is all too familiar for owners of Rottweilers, Greyhounds, and giant breeds in general. The Scottish Terrier has an 18 fold higher chance of developing bladder cancer (transitional cell carcinoma) than the average dog.

In a recent landmark study, researchers determined the breed-specific causes of death (Journal of Veterinary Internal Medicine, 2011; 25 (2): 187 ). As it turns out, cancer is one of, if not the leading cause of death in larger dogs.

The unfortunate truth--any dog or cat can develop cancer. I have seen mutts, mixed breeds, dogs of all shapes and sizes develop cancer. There is no breed that is immune from this disease. So the best advice I can give you if you are looking for a pet--find a dog or cat that you love, whether that be through a rescue organization or a breeder. Take care of the pet with routine health check ups, a complete and balanced diet, and as the pet gets older, talk to your veterinarian about screening tests for cancer--catching this diseaese early is still helpful whether you are a dog, cat or person.

I Can't Afford Treatment

We hear this a lot, especially over the last 3 years during the economic downturn. While it is true that treating your dog or cat with cancer can be very costly, it does not have to be. While the traditional therapies of surgery, chemotherapy and radiation therapy remain the standards and they are usually (but not always) the most effective therapy for a particular type of cancer they are not the only options any more. Over the past few years the number of options to treat cancer in pets have mushroomed. There are more protocols and types of therapy now than there ever was.

We now utilize anti-angiogenic therapy and metronomic therapy. These two types of treatment typically utilize oral medications. They are also less costly than many other protocols--and in some cases equally as effective.

A great example is "Penny" a 14 year old mix breed who was diagnosed with a low grade sarcoma 2 years ago. The owners opted for anti-angiogenic therapy as they could not afford traditional radiation therapy or chemotherapy. It has been 2 years and "Penny" is still doing well and her owners are thrilled that they were able to do something for their pet.

At our practice in Norwalk, we also participate in many clinical trials. One of the advantages of clinical trials is that they are either partially or fully funded. This means direct and in some cases, substantial savings to the pet owner. This is just one of the advantages of clinical trials--I will discuss the other advantages in a later post.

So, the next time you think "I can't afford to treat my pet with cancer," you may need to think again.