Hearing that your dog may have cancer is overwhelming. It often triggers a sense of panic accompanied by many different "what if" scenarios racing through the mind. The endless scenarios and questions about your dog's future play over and over again in your head...
Will he need surgery? How long will he live? Can he be cured? Does he really have cancer? Is he is pain? How much will this cost? Is it too late to get insurance? Do I even want to treat him? Is it fair to treat a dog that has cancer? Will he need chemotherapy - does that even work? Can I cure him with diet or supplements? Should I change his diet? Does my vet know what he's talking about? Should I get a second opinion? Could I have caused this? Could I have found this sooner? Should my vet have caught this sooner?
Often these thoughts begin racing as soon as you hear the word "cancer" and then you may realize that you just missed the last 10 or 20 minutes of your vet or oncologist explaining the diagnosis or next steps to take because you've been lost in your head.
Have you experienced this?
If the answer is 'yes', it's completely normal. I see it every day in the clinic.
So how can you get the information you need and make the most out of an oncology consultation? If you don't have an oncologist, how can you find out more about your dog's cancer?
Suggestion #1: Ask your oncologist or veterinarian if they mind if you make an audio recording of the visit. This way, you can replay it when you are more relaxed and make certain you (1) heard what you think you heard and (2) have an excellent understanding of your dog's cancer. The recording can also be used to formulate a list of questions to ask the doctor at a follow-up visit.
**Ask permission before you begin recording. I don't know any vet that would say 'no' to being recorded, and it feels like a violation to find out that you've been recorded without your consent (this is obvious common courtesy).
Suggestion #2: Ask the oncologist or veterinarian if they mind typing up a summary of what was discussed. Most oncologists will automatically give you a summary of the cancer and treatment options that were discussed at your visit. It's common that clients forget they've received this because the visit is emotionally draining - just call and ask if something was sent home, and if not, then ask if a summary letter can be prepared.
Suggestion #3: Bring a level-headed friend or family member (preferably with medical knowledge) to your consultation for support and so they might be able to ask questions you forget. My recommendation is to choose this person carefully. Too often the guest sabotages the visit by being extremely negative and closed-minded. This can make it difficult to even get through all of the treatment options. The guest has the best of intentions - they are trying to protect their friend (and their friend's pocketbook) and ensure they make good decisions. They forget that the oncologist's goal is to present all reasonable options and help their client make a decision they feel comfortable proceeding with.
Try not to bring a guest that would talk you out of making a decision that YOU feel is best just because they wouldn't choose it.
Suggestion #4: Bring a list of questions to your oncology consultation.
These should be basic questions such as:
(1) What is the diagnosis? If we don't have a diagnosis, what tests are needed to obtain a diagnosis? How much do the tests cost and when can they be done?
***Note, if your goal is to just "keep your dog comfortable" and not treat his cancer specifically or pursue advanced cancer treatments, it may not make sense to pursue additional tests to establish a specific diagnosis. Discuss the pros and cons of this with your care provider and be clear on your goals from the start.
(2) Has cancer metastasized (spread)? What organs are affected? What tests are needed to determine if cancer has spread/metastasized? How does this change the prognosis (how long he will live, on average)? How does this change the treatment options that are available?
(3) Do you think my dog has a good quality of life? Is he in pain? What signs should I look for to help determine that his quality of life is changing? If he is in pain or doesn't have an adequate quality of life, do you have any suggestions for helping him feel better? Do you think his quality of life can be improved?
(4) What would you do if you were in my situation? This refers to specific treatment decisions for your dog based on his disease, age, and any other health conditions he may have. It also could refer to your financial situation, as that does influence what the "best" treatment is for someone that doesn't have pet insurance.
***Note: This is a good question to ask an oncologist. When asking a family veterinarian this question, I would keep in mind that many family vets do not have a lot of experience with cancer treatments, do not have accurate prognostic information (cannot tell you how long a dog will live with certain cancers and with certain cancer treatments), and do not know how much cancer treatments cost. Therefore, many family vets are biased against treating cancer even for cancers that can have a good prognosis with treatment.
Suggestion #5: Communicate your goals and your budget very clearly with your care provider. To get the most out of your time with an oncologist and to get the most appropriate information from your family practitioner, tell them what your goals are. If your family practitioner knows that you want to do everything possible for your dog, they will be more likely to offer referral to an oncologist. If your dog is referred to an oncologist and has the benefit of the standard of care treatments, he is likely to live longer than if he did not receive specialty treatment. When talking to your oncologist, tell them if you want to do everything possible. You might be offered different options if you make it clear that you want the best outcome and are willing to do whatever it takes.
On the other hand, if you have $500-1000 to spend for all of the treatment that your dog will ever need, communicate this to the oncologist and to your family vet. If the oncologist knows your budget, they will focus on what can be done palliatively (keep your dog feeling well for as long as possible) and not on a cure. This means that they will forego certain diagnostic tests like x-rays and ultrasound and do the best they can with medications and blood work.
Suggestion #6: It is always best to see an oncologist for a cancer diagnosis, even if it's just to sit down with them for an hour and make sure that you are hearing all of the current treatment options as well as an accurate prognosis for your dog's cancer.
If you don't have an oncologist locally, you can either (1) see if an oncologist would be available for a phone consultation (this isn't ideal, as it is really important for the oncologist to perform a physical exam, but it's better than nothing), (2) ask your vet if she can call an oncologist so the two of them can discuss your dog's cancer over the phone. In this case, the oncologist will not have your dog's records or all of the details, but they will be able to give your vet a general picture of what treatment options and prognosis might look like.
This list should serve as a good guide to ensure that you are able to find out everything you need to know about your dog's cancer.
Please remember that if you don't understand something from your consult or have additional questions, call your oncologist (if that's who you met with). We want clients to have an excellent understanding of their dog's cancer and the options that were discussed - otherwise, we know that you won't be able to make a good decision. So don't hesitate to reach out if you're confused or uncertain!
Dr. Lori Cesario
Board Certified Veterinary Oncologist
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