Tips and Questions for the Oncologist
Office Hours
- What are the regular hours?
- Are they compatible with your schedule?
- Will they accept e-mails or appointments electronically?
- Who covers the practice when the doctor is unavailable?
- What is the average wait time for making a non-emergency appointment?
Emergency Care
- How are emergency calls handled during regular office hours and after office hours?
- Is there an emergency facility in your area should you need it?
Fees and Payment
- What methods of payment are accepted?
- Does the hospital treat patients of clients that have pet insurance?
Professional Affiliations
- Do the doctors belong to a professional veterinary association such as the American Veterinary Medical Association or a state or local veterinary association?
- Are the doctors Board Certified ? (in which case they should have the letters DACVIM after their names – Diplomate, American College of Veterinary Internal Medicine)
- What is the hospital policy regarding continuing education for the professional staff?
Experience with Canine Osteosarcoma (Interview the ONCOLOGIST)
- Where did they go to school?
- How long have they been in practice?
- How many cases of OSA do they see a year?
- Do they have experience administering the chemo agents?
- If so, how many cases have they treated that had side-effects
Staging the disease (common diagnostic methods)
- Review the primary site – take xrays to the consultation
- Chest x-ray – to determine if it has spread to the lungs (most common place of metastasis)
- Blood work (complete panel) – obtain copy for your records
- Bone Scan – to be done if you want to see if it has spread to another bone. Although the most likely place to spread first is the lungs, it is not that uncommon to have multiple bone lesions. Usually requires an overnight stay.
- Bone Biopsy – often recommended when xrays do not show a “classic” picture. First ask what else could it be: for example, fungal infections – unless you are in the Southwest US, or your dog spent a lot of time there, the chances are extremely slim that the bone problem is a fungal infection. The other possibility is “osteomyelitis”, a bacterial infection of the bone.
If you do get a biopsy, obtain a copy. Review to see if it indicates the type of OSA, the grade, the prognosis. Check the mitotic index and the pathologist’s summary and recommendations.
Understanding the Terminology in the Histopathology Report
- Mitotic index – the higher the number of mitoses (cell reproduction), the faster the tumor is growing at the cellular level (low index is good)
- Well differentiated malignant cells – a lot of “parts”. The cells are more complicated and have more stuff in them. The more differentiated a cell is, the longer it takes to reproduce, so tumors with well differentiated cells don’t grow as fast.
- Poorly differentiated malignant cells – not a lot of “parts”. The cells are less complicated and do not have a lot of stuff in them so they can reproduce faster, which makes the tumor grow faster.
If you choose not to have a biopsy, and you do proceed with amputation, make sure the limb is sent for post-amputation pathology examination and biopsy
Discuss most common options for management
- Amputation alone
- Amputation plus chemotherapy
- Limb-sparing procedures
- Palliative radiation therapy
- Pain Management
- Bisphosphonates
Discuss other options for management
- Just make the dog comfortable
- Radiation and/or chemotherapy and/or bisphosphonates without amputation
- Gene Therapy
- Ask about current research trials being conducted in the area and around the country
- Ask if doctor is aware of any other options that are showing promise
Chemo agents (common)
Discuss the pros and cons of each. Also discuss single agent versus dual agent. Single agent will be carboplatin or adriamycin only. Dual agents would be carboplatin OR cisplatin and adriamycin alternating. Most treatments are done 3 weeks apart.
Bisphosphonates
- zoledronic acid
- Pamidronate
- alendronate
Diet and Supplements
- Discuss how they feel and their approach
Questions for each option
- Are we a good candidate for this option? Why or why not?
- What does it consist of?
- Will my dog be in pain? How do you normally treat the pain?
- What is the recovery time?
- What is the survival time?
- What kind of quality of life will my dog have?
- What are the costs?
- What would you do if it was your dog?
- Basically, ask any and all questions until you feel comfortable with each option and know that you have enough information
Making the decision
- Write down all your questions
- Write down all the answers – even give the paper to the doctor to spell out the options
- Ask for supporting documentation or studies if they have them
- Do not be afraid to walk away
- Tell them you need time, that you will call
- Ask them if they can go see the next client and come back to you
You have to be comfortable with the option you choose and only you know what that will be. So, since we make our decisions with the best information we have at that time, GET ALL THE INFORMATION you can. Ask a lot of “whys”, then ask a lot of “why nots”.
Listen to what they say, but do what you feel is right. It is your money, your dog, your decisions.
Then go forward with strength and confidence and never look back. There are no wrong decisions, ever.
