Can an oncologist really save you money when your dog is diagnosed with cancer? It seems counterintuitive, right? How can specialty care actually save money?
The most common ways that oncologists save clients money are by (1) making sure that cancer is treated appropriately from the beginning, and by (2) avoiding unnecessary procedures, tests, and treatments.
Get It Right The First Time
I recently saw an Irish Setter that had a very large tumor in the armpit. Two months prior to our consult, she had a low-grade soft tissue sarcoma removed from that area by the family veterinarian; it had grown back in a very short amount of time. After surgery, the family was supposedly told that everything was "good"; they were not offered additional treatment.
Unfortunately, the original biopsy report showed that the cancer was not completely removed and that it was likely to return. If that dog had received a local treatment such as electrochemotherapy or radiation to kill the remaining cancer cells in the skin, she would likely have lived for many years after her original surgery, and would not have died from the sarcoma.
Instead, when the sarcoma returned two months later it was high grade and carried a much worse prognosis (when tumors grow back, sometimes they become much more aggressive than the original diagnosis). The family opted for a second surgery ($4200) and electrochemotherapy ($2600) and chemotherapy ($4200), which was likely to extend the dog's life only by 6 months.
If the family was offered an oncology consultation after the original surgery, we would have told them that the tumor is likely to return if additional treatment is not pursued; we would have offered electrochemotherapy to kill the remaining cancer cells in the skin for $2600; the expectation would have been that she would have lived for years with this treatment.
In this case, this poor family could have spent $2600 (plus the cost of the original surgery) to have years of their dog in remission but instead spent $11,000 to have an estimated 6 months (not to mention all of the extra procedures the dog went through).
This is not a one-time incident. I see patients in this situation multiple times per week in my practice. It's really sad and frustrating.
Why does this happen? Family veterinarians are not oncologists. Oncology is not their area of expertise and many are not able to successfully read a biopsy report and figure out if a tumor is likely to regrow or spread to other organs.
Often a cheaper version of a full biopsy report is requested to save clients money. This cheaper version doesn't have a microscopic description. The trouble is that the microscopic description includes very important details that help us determine if cancer is going to return or spread (metastasize). This information helps us figure out if additional surgery or chemotherapy is needed and even helps us determine how long the patient will live. The microscopic description usually doesn't cost more than $60 - it's worth it.
Don't Forget About The Lymph Nodes
Some types of cancer will commonly spread to lymph nodes. For these cancers, it's important to check the local lymph node to see if they're affected by cancer BEFORE surgery is performed.
In general, it doesn't help the patient if we remove a cancerous skin tumor, but leave behind a cancerous lymph node. This doesn't help the dog feel better and usually doesn't help them live longer.
So, we always want to sample the lymph node (even if it feels normal) before removing the tumor (this can be done with a simple aspirate). If the lymph node is affected, the lymph node AND the tumor should be removed at the same time. If there is cancer in the lymph node, this is usually an indication for chemotherapy. There are some cases where survival is quite short (just a few months) if a lymph node is affected and appropriate treatment is not pursued - so this is important information to have.
Avoiding Unnecessary Tests and Treatments
An oncologist diagnoses and treats cancer all day every day. We find many types of cancer really easy to diagnose, just because we've seen so many of the same cases over and over again.
Unfortunately, there are many times when a dog's cancer will go undiagnosed for weeks or months by a family veterinarian, just because they are not used to seeing that disease. They can't be experts at everything - that's why we have specialty medicine.
During these weeks and months of bringing the pet back and forth to the vet, the bills add up, and often, by the time the dog even gets to the oncologist, the family has spent 2-3 thousand dollars.
If you think your dog has cancer, or if your dog is sick and isn't getting better, get a second opinion. Your dog might have a disease that your vet never sees but that an oncologist or internist see frequently. Getting a diagnosis fast will save you money (and might save your dog's life).
Once you have a diagnosis, make sure that the doctor providing treatment (chemotherapy for example) is very experienced with the medications your dog is receiving. Your dog will have a much better experience (fewer side effects, better quality of life, live longer) if an experienced individual is running the show. They'll know what to look out for (toxicity, side effects), how to get the best result out of the chemotherapy, how frequently to run blood work, when adjustments in dosage are indicated, etc.
Oncologists want to help you find a treatment option that you're comfortable with and one that will help your dog. We know many treatments for all different types of cancer, and for all different types of budgets, so we're able to find treatments that work for everyone.
Dr. Lori Cesario
Board Certified Veterinary Oncologist
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