By Evan Sones, DVM, MS, DACVIM
Breaking the news about a cancer diagnosis has been discussed for many years as it relates to humans, although little literature exists on the topic for pets. However, based on my own personal experience, delivering this bad news can be just as devastating to clients. How these conversations are handled can play an impactful role in how pet owners deal with the situation, make decisions about their beloved family member, and view their future journey.
The following article is a brief overview of a presentation I delivered in June during our 2023 Summer Webinar Series.
The topic of cancer alone can be complex and difficult to understand. To avoid confusion that can lead to unnecessary client distress, I recommend reviewing with the owners a few basic terms. Clear communications can lead to better understanding and acceptance.
Definitions = Understanding
A few examples of the terms I reviewed in my presentations are:
- Grade versus Stage: These terms often get confused by clients. Grade refers to how aggressive a tumor is based on histology, while stage is the size of the tumor and extent of disease in the body.
- Remission versus Cure: Both can mean there is no evidence of cancer. Remission means the cancer may or is expected to come back, whereas cure means the cancer is not expected to come back.
- Margin versus Mitotic Index : Margin refers to the amount of non-tumorous tissue around a tumor and helps to determine if the tumor was completely removed.. The mitotic index is the ratio of the number of cells undergoing mitosis to the number of cells not undergoing mitosis, and plays a part in determining the grade and expected tumor behavior.
The spectrum of cancer treatments available today can be overwhelming to clients. Although an oncologist will provide detailed explanations to each of our clients, introducing some basic options is helpful early in the decision process. The approach is always unique to each individual pet’s situation. However, here are a few common options:
- Surgery: The goal of surgery can be to cure the cancer with the total removal of the tumor and surrounding margins. Or it can be used to remove as much as possible with follow up treatments needed to deal with remaining microscopic cells.
- Radiation: A full course of radiation isoften delivered in 18-20 doses with curative intent. Other options are more precise stereotactic radiation, which has the advantage of less side effects and fewer treatments, usually 1-3. Radiation therapy for palliative purposes is an option.
- Chemotherapy: This chemical treatment option can be used for a variety of desired outcomes, ranging from curative intent, life extension, or palliative care.
Delivering the News:
Many of the commonsense tips for communicating with pet owners are the same ones recommended for physicians delivering bad news to human patients. Here are a few I reviewed in more detail during the webinar:
- If in person, deliver the news in a quiet, private location with no distractions. Allow plenty of time for the session. Face-to-face is recommended, but if a phone call is necessary, try to allow the same allocation of time in a quiet place.
- Try to assess the owner’s understanding and provide clear explanations and repeating information as necessary.
- Offer hope and allow the clients to express their own stories in order to develop a relationship of trust.
- Listen to their fears and goals and be nonjudgmental.
- Assure them that their choices and decisions are their own and it’s okay to do what is uniquely best for them.
- Feel comfortable sharing their pet’s exact diagnosis and full histopathology report. This will make Google searches more effective that can lead to less confusion and misinformation.
Always remember, too, that our team is available to work with each of our client’s primary care veterinarians. We share your goal to further trusting relationships and do whatever can be done to help each pet enjoy a quality life.
Please feel free to reach out to us with any questions, concerns, or comments. You may call my clinic in Orlando at 407- 930-6679.
To view a recording of the full program, please click here: