James Jacobson: The next question we have here is dealing with chemotherapy. Are there certain cancers which are best treated with chemotherapy? For that I will give it to you Dr. Ettinger, as a Veterinary Oncologist. What are the best cancers that response the best to chemotherapy?
Dr. Susan Ettinger: Well, the number one cancer that we treat almost exclusively with chemotherapy would be lymphoma which is one of the more common malignant cancers in dogs and a very, very treatable cancer in one where chemotherapy makes a significant difference in the dog’s life, not only from how long they lived but to the quality of life. Just a quick example, dogs with lymphoma without treatment in general sadly only live about a month to really quickly, very rapidly progressive cancer. But with chemotherapy in which most dogs feel phenomenal in quite normal during treatment, they lived over a year on average thirteen or fourteen months. So, that’s probably the number one cancer that we treat exclusively with chemotherapy and are related cancer would be leukemia which is cancer of the bone marrow. Again, that’s another cancer that we treat with chemo. There are a lot of solid cancers, cell cancer that starts in one part of the body, but if they have a very high chance of spreading, typically, chemotherapy will be recommended after the primary cancer is treated either with surgery or radiation. So again, that’s gonna be really important information to ask your Veterinarian or an Oncologist if your dog has a solid cancer that’s a malignant cancer, does it have a high chance of spreading and what are the chances that chemotherapy will delay that, and have your dog live longer which is everyone’s call.
James Jacobson: Dr. Dressler, when do you like to use chemotherapy?
Dr. Demian Dressler: Well, I think after a good discussion with the guardian on the treatment plan analysis. What I mean by treatment plan analysis and we talked about this in the Dog Cancer Survival Guide is a breakdown of what do you get, compared to what does your dog put in, and what do you put in? So, it’s almost like a bank account, you make deposits and you make withdrawals. So, on the withdrawal side, we need to look and say “Okay, if we’re gonna be doing chemotherapy, what do we get? What’s the gained life expectancy?” By gained life expectancy we’re saying “Okay, here we have a dog, here’s a typical life expectancy for this dog.” We talk about again the different life expectancies in the book and we say, “What do we gained from a certain chemotherapy protocol with this individual cancer and as Doctor Sue was alluding to, different cancers respond more or less well to chemotherapy. So, maybe we’ll gain an extra so many months however long it is, or a year, or whatever so it’s gained life expectancy. Then we say, “Okay, what do we have to put into this? What do we have, what are the deposits that our dog is gonna need to make and we’re gonna need to make?” By deposits I’m talking about what is our special family member have to go through to receive the chemotherapy? What do we have to go through both in terms of the financial investment and also in terms of the time and logistic investment? So we need to have a clear idea of side effects, what the odds are, what the costs are and what the commitment is and what the lifestyle adjustment is on the part of the guardian and also of the love dog. Then you, as an empowered primary advocate for your dog, you make the decision as to whether or not the chemotherapy is the good choice.
Dr. Susan Ettinger: I think there’s a couple of things to add that we all want our beloved dogs to be with us as long as possible. A lot of people get very shocked when a Veterinarian or Oncologist says like I just said for lymphoma that the average or the medium survival is thirteen to fourteen months cause that doesn’t sound long enough for me for how long I want my dog to be with me. But you have to put it into perspective of couple of things one is, how long again is, as Demian is saying will they live without treatment but again, also the overall life span of our dogs. They don’t live seventy, eighty, ninety years like people. In people they often talk about five-year survival time, so a year or two survival time for our dog’s cancer is a significant chunk of time that your dog may live with this cancer. I think it’s important to think of cancer sometimes as a chronic disease. We would all love to cure cancer but again a lot of times dogs can live with their cancer and live relatively normal lives. They may require treatment long term but again, it may be something that they can live well with and I think that’s an important thing to remember.
James Jacobson: Well, when you talked about the thirteen or fourteen months that’s what for a particular type of cancer and particular type of chemo. Is that the average what do you call extended life the average amount of time that you get with chemotherapy or is it the average?
Dr. Susan Ettinger: It’s very cancer dependent, for lymphoma, that’s the median. I have dogs with lymphoma; I just had a dog that the owners found me on Facebook that I treated out in California, that dog’s out six years with lymphoma. So obviously, that dog’s on one end of the spectrum which is great. Then sadly there are some dogs that are treated very aggressively with the recommendations that an Oncologist makes and they may only live a couple of months. So these numbers are never written in stone and you always hope that your doctor’s wrong in a sense that your dog’s gonna live longer that the statistics. I think statistics are just to give you a reasonable expectation but realize there are no guarantees hopefully, your dog will live beyond the statistics. But it’s very, very cancer specific and I think that’s again an important time to talk to an Oncologist service specialist and get the information that’s specific to your pet your pet’s cancer.
James Jacobson: Dr. Dressler, you alluded to making deposits and talking a little bit about money. Is there an average price tag if you decided to go with a traditional route like an Onco… like chemotherapy?
Dr. Demian Dressler: That’s a little bit tough to answer with a single answer. Cause it’s gonna depend on cancer, it’s gonna depend on what the chemotherapy protocol is. It’s also going to depend on where you’re located because Veterinary prices an Oncologist prices will vary depending on the geographic location because cost of living is different and these types of things. There’s gonna be a lot of variability, I would say that on the average, many thousands of dollars over the entire course of the chemotherapy would be the magnitude of the expenditure. When we talk about the sort of published numbers with conventional cancer care, five to eight thousand dollars for some combination of surgery, radiation and chemotherapy, how much of that is going to be consumed by chemotherapy, well that’s gonna vary. It’s an excellent point that you bring up Jim, because it’s important to get an itemized estimate, it’s an estimate so it needs to be taking with some grain of salt. But of what it is gonna be costing because it’s, not just the chemo drugs, you’ve got the monitoring, you’ve got a little hospital stay, you’ve got catheters, fluids, blood test whatever, these things can be built in to the treatment plan to give you an idea because you do have to budget for these things. Back to the idea of making deposits, what will your dog, the deposit that your dog has to make? What about these side effects and there are things that can be done. As Doctor Sue pointed out, the side effects are not what they are compared to human chemotherapy, but nonetheless, there are some side effects that do really need to be contemplated here and some of them can be severe. You need to be advised of those, the frequency of them. Also, take some steps when we talk about this in the guide there’s steps that one can do to deal with, to manage side effects and we talk about this in the guide so you really need to look at that. Also sometimes, pre-emptively minimize side effects by getting information about your particular dog. There’s a test that can be run called BMDR1 test, mutant, this genetic mutation that can increase the odds of side effects. There might be certain heart condition; there could be a tendency towards pancreatitis, anyway, all these things before you jump in to chemo as much as you can, you need to be taken into account so you go about this in an intelligent way, and in a very, very kind way for you love dog.
James Jacobson: Dr. Dressler, oh go ahead Dr. Ettinger…
Dr. Susan Ettinger: No, I just wanna add one quick thing. A lot of people when I tell them what I do for a living they just can’t imagine dogs getting chemotherapy and they manage, or they imagine them hooked up to injections for long periods of time. Most of my patients are outpatients, they come in weekly or every other week or every third week for their chemotherapy. They’re in and out in about an hour to two on a good day where they hang out with us during the day where my mom and dad goes to work. Most of these patients really live well, they’re doing all of their things that they really enjoy doing, going on walks, hiking, swimming with the family. Most of these dogs are really living well and most of the people look back and they say “Gosh, you told me that, but I really couldn’t imagine it then I’m so happy that I did it. I think chemotherapy is overwhelming reasonably for a lot of people cause we think about people going through chemo, but most dogs just really tolerate treatment phenomenally well. Most people that decide to do it, though it’s not for everyone, are truly happy that they did. So if it’s something that you’re thinking about doing, do and talk to a specialist and find out more about your dog’s cancer and the recommended protocol and I think it’s gonna be really helpful for everyone.
James Jacobson: There’s lots more information on chemotherapy if you’re considering that in the Dog Cancer Survival Guide. Dr. Ettinger in New York, and Dr. Dressler in Hawaii, thanks so much for being with us.
Dr. Susan Ettinger: Thanks.
Dr. Demian Dressler: Thanks.
