A Softer Side to Cancer Treatment: Part 2

After last month’s article in the SARC Pulse newsletter we were contacted by a large industry publication who took interest in the non-clinical aspects of radiotherapy. After a series of interviews an article is soon to be published on the all-important experiences of pets and their owners as they go through such an arduous and stressful time. The following is are number of excerpts from interviews contributing to the article casting further light on the patient-owner-practitioner bond; a bond which can mean the difference between a completely satisfied client and a bad experience, regardless of clinical outcome.

Radiation therapy, and oncology in general, often have negative connotations attached, especially with regard to the overall enjoyment and wellbeing of the patient during treatment. This is often far from the truth. Exploding some of the myths about cancer treatment, and especially radiotherapy myths, is a key part of the clinical team’s role before and during treatment which can often be the difference between a chance at cure and no chance at all.

Having completed over 100 full course radiotherapy treatments for patients at the Southern Animal Referral Centre (SARC) over the past year and a half, the experience of owners has been far more positive thanks to a number of factors not typically associated with the treatment of cancer.

What Is SARC’s Softer Approach To Cancer Care?

SARC's approach to combating the negative connotation attached to cancer care revolves primarily around creating a positive experience for the patient during treatment. Treatment lasts up to three weeks, during which time patients enter a rich and stimulating environment more like a ‘break away from home’ than a hospital ward.

During this time the patient becomes part of the extended SARC family. If appropriate, patients are regularly socialised and have the benefit of interaction with a nursing and veterinary team which attends to their needs 24 hours a day, every day. Should patients not be boarding during treatment, it is not uncommon for them to return the next day bounding in to the treatment area to play with their new friends. Often there are mixed feelings of fulfilment and sadness at the end of treatment. These feelings include satisfaction that the chances of cure are much improved after treatment mixed with the hollow feeling a ‘SARC family member’ is leaving to resume their life with their real family.

Why Has SARC Taken This Approach?

The commencement of radiotherapy signalled an evolution of patient care at SARC. Historically patients had stayed for up to one week at the most. Most patients receiving radiotherapy stay for at least three weeks. The longer term nature of the treatment meant that quality of life over this time was an ever-increasingly critical consideration. A stay in a hospital cage for three weeks could easily lead to depression and boredom, as well as a whole range of other physiological issues on top of the condition being treated. A decision was made from the outset to develop a far more open recovery and boarding area for radiotherapy patients. The area allows for constant supervision of patients as well as appropriate interaction and enrichment with both staff and other animals. Over the course of the treatment patients become extremely familiar and comfortable with the treatment team, who quickly build a close and coherent bond. This also makes all the difference to both the treatment team and the owners; the two key supports for patients during a stressful and uncertain time.

Why Are Some Owners Reluctant To Pursue Radiotherapy Or Chemotherapy?

Despite the reality of a positive and stimulating environment along with the straightforward and relatively painless nature of treatment, many owners are reluctant to pursue radiotherapy or other associated oncology treatments. This reluctance is generally based on fear of the unknown, a misunderstanding that all cancers are difficult to treat and that treatment is painful or distressing. These concerns are common but are generally far exaggerated or unfounded. In many cases this reluctance can be transformed into an informed willingness to give their pets a chance at cure. The knowledge that treatment is minimally-invasive or non-invasive and relatively quick often removes the main barrier of fear for their pet’s wellbeing. Beyond this the owner’s emotional effort can be concentrated on creating the opportunity for a better outcome or improved quality of life.

How Do Animals Tolerate Chemotherapy?

Generally the ability for animals to tolerate chemotherapy is far better than the typical side effects reported in humans. SARC has the ability to perform 5 part differential haematology tests on-site, meaning that blood screening and treatment can be completed within the same visit. This removes the need for patients to wait up to 24 hours for screening results and expedites each treatment episode. After quick and simple treatment and precautionary observation period, patients are free to go home. Patients spend less time in hospital and more time with their family.

How Do Animals Tolerate Radiotherapy? How Gruelling Are These Processes And What Do Vets And Owners Need To Weigh Up Before Embarking On Them?

The general tolerance of external beam radiotherapy in companion animals is very good. Careful planning to ensure that side effects are kept to a reasonable minimum is essential. Surrounding healthy tissues will be affected by the radiation exposure, but these early side effects typically cause nothing more than a mild sunburn effect which resolve around 4 to 6 weeks after treatment with no need for intervention. Some care needs to be taken in management of organs in the path of the beam (if relevant). For example, patients undergoing abdominal irradiation may develop mild gastrointestinal signs. These can be controlled with standard GI medications. In some cases feeding tubes are placed to allow for proper nutrition during and after treatment, especially in felines.

The treatments themselves are quite quick and painless. Patients receive a light anaesthetic and are irradiated for around 4-8 minutes per session. After anaesthetic recovery patients have their breakfast or lunch and return to the boarding area or home. The procedures themselves are not something to unduly worry about. The bigger questions to be asked are what the likely survival times and chances for cure are with radiotherapy. If the prognosis is good, owners and referring vets are encouraged to consider their overall goals for patient wellbeing in making an informed decision.

How Do You Encourage Owners To Pursue Chemotherapy Or Radiotherapy

The main weapon in our arsenal is knowledge. Once owners are aware of the basic treatment process, the likely costs and the possible/probable outcomes of treatment, they are fully equipped to make an informed and considered decision. Owners can then return home and discuss their decision with family members to ensure that they are all comfortable and that all relevant questions have been answered. If the chances of cure are good, we feel there are no clinical reasons not to proceed. We encourage owners to also consider their personal circumstances in making a fully informed decision.

Has The Soft Approach Had Any Impact On The Number Of Owners Electing To Treat Their Pet's Cancer?

This is a difficult question to answer. The wellbeing and comfort of their loved ones is foremost in the decision of whether or not an owner elects to treat. Better accommodating for non-clinical considerations during treatment will inevitably allow more owners to focus on the overall goal of curing their pet rather than the often-unfounded fear of the procedure itself. Asking owners to be referees for prospective owners is not something we often do. This is in part due to a respect for owners’ and patients’ privacy and a wish for them to resume life beyond treatment without further stress or interruption. However, we are more than happy to discuss clinical outcomes and general patient experiences with prospective owners. All information is solidly based on our experiences with previous treatments.

Do You Think That Some Veterinarians Also Have Negative Attitudes Towards Cancer Treatment In Pets?

The attitude that ‘nothing can be done’ is fast disappearing in the veterinary industry. Conversely, the attitude of ‘we can do more, far more’ is not yet sufficiently prevalent in the industry to give many patients a real chance at cure. For any vet who has attended any oncology lectures at any of the recent larger conferences in Australia, they may have realised the absolute gulf of difference between world’s best practice and what is generally offered in the local market. The rapid advancement in both diagnostic and treatment capabilities in oncology, coupled with the ever-increasing availability of specialists in oncology provides our best chance yet to offer cure to patients with cancer.

Could Some Animals Be Missing Out On Cancer Treatment Because Of Their Owner's Or Vet's Misconceptions About The Impact Of That Treatment On The Wellbeing Of The Animal?

In a word, yes. This is not due to anything more than the inability of any individual to keep up with all the latest diagnostics and therapies available. The best safeguard against this is the telephone. A call to the relevant specialist or centre, followed by a consultation, is the best way to gauge the realistic options for treatment and possible cure. At SARC there are up to 20-40 oncology treatments every week. Each of these patients has a chance of cure, or that the very least an improvement in quality of life through palliative therapy.

In General, How Are Chemotherapy And Radiotherapy Protocols For Pets Improving? Eg Shorter Treatment Regimes, Drugs With Less Adverse Effects Etc.

There is new information almost every week on innovative techniques, new protocols and improved strategies to tackle cancer. Rather than encountering difficulty in finding new and more effective diagnostics and treatments, it is almost impossible to keep up with the latest trends and techniques being researched and practiced globally. The one thing that appears certain in the field of cancer treatment is pets with cancer will continue to have more and more options for treatment when it comes to a potential cure for cancer.

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