Question 1

What is a board-certified veterinary medical oncologist?

Accepted Answer

A board certified veterinary medical oncologist is someone who went through vet school and generally a 1-year general internship after which time they pursued a residency. A residency is 3-4 years of additional learning about a specific field of medicine (ie medical oncology, radiation oncology, surgery, internal medicine, radiology, etc).  Board-certification indicates they completed all the requirements of their college (generally involving publications), and passed all of the rigorous testing for their college. 
 
A board-certified veterinary specialist's expertise complements that of an animal's primary care veterinarian. An animal owner may be referred to a board-certified veterinary specialist if diagnosing or treating an animal's health problem requires specialized equipment and/or expertise that the primary care veterinarian does not have.

Question 2

What is cancer and why did my pet get cancer?

Accepted Answer

Cancer is the uncontrolled growth of cells, or inappropriate DNA division.  While there are some factors which contribute to the development of cancer (viruses, metallic implants, sun exposure, etc), often the exact cause of cancer is unknown and cancer is often due to multiple causes.  Cancer is partly genetic (mishaps in our DNA), and partly environmental.  Up to 50% of dogs that make it to the age of 10 years will develop cancer and 1in 4 dogs will develop cancer in their lifetime. Less is known about the frequency of cancer in cats.  Most clients have no ability to prevent cancer in their pets, though limiting chronic sun exposure and cigarette smoke are recommended.  Also spaying dogs and cats earlier in age can reduce the incidence of mammary tumors. There are numerous types of cancers recognized in cats and dogs and prognosis can be quite variable ranging from cure with treatment to short term quality of life.

Question 3

What are treatment options for pets with cancer?

Accepted Answer

Treatment options may involve surgery, radiation therapy and/or chemotherapy.  Surgery is often used to remove a localized tumor. Radiation therapy is often used when a tumor is too extensive to be removed, or to reduce the recurrence of a previously removed tumor.  Chemotherapy is often used for more systemic cancers or cancers with a high rate of spreading (metastasizing). The exact treatment plan will depend on the diagnosis and extent of cancer in each pet.  
 
Palliative options are also available. Palliative treatment aims to keep the pet as comfortable as possible, maintaining as normal a life as possible without pursuing aggressive treatment to slow progression of the cancer. This can often involve pain medications, appetite stimulants, anti-nausea medications, and sometimes radiation therapy or surgery, etc.

Question 4

What is chemotherapy?

Accepted Answer

Chemotherapy is drug therapy designed to kill or slow the growth of cancers. Many of the drugs used in pets are human chemotherapy agents though designed for use in pets to keep quality of life acceptable. 
 
Chemotherapy is sometimes used by itself or may be used in combination with other treatments for certain cancer types.  In some cases, chemotherapy can be used to try to shrink large tumors prior to surgery, or to help eliminate microscopic cancer cells that cannot or have not been completely removed surgically.  For cancers that are at high risk for spread, chemotherapy can be used after surgery to help delay or prevent the appearance of cancer in other parts of the body.

Chemotherapy protocols vary by the type of cancer, the extent of the disease, your goals, and concurrent health conditions your pet may have. Chemotherapy may be given intravenously, orally, or subcutaneously depending on the drug and the protocol.  There are numerous chemotherapy protocols available and the exact protocol would depend on the patient’s diagnosis and the owner’s goals as well as the veterinarian’s comfortability with administration.

Chemotherapy is often associated with side effects as we are often familiar with treatment in friends and family members.  Pets develop fewer side effects from chemotherapy with 70-80% of pets maintaining a good quality of life during treatment. Chemotherapy may target normal, healthy cells in an effort to kill the cancer cells, and damage to these normal cells is what causes the side effects, most notably, gastrointestinal side effects (vomiting, nausea, diarrhea and/or decreased appetite) or bone marrow suppression which can lead to infection and fever.  Some pets will also lose hair.

Question 5

What diet should I feed to my pet with cancer?

Accepted Answer

There is no one best diet for a pet with cancer. A common belief is that carbohydrates are not recommended for pets with cancer. There is no strong scientific evidence that survival in pets is improved on a lower carbohydrate diet. It is most important to find a diet that your pet enjoys, to help maintain adequate caloric intake as well as to help ensure a good quality of life. Ideally, a commercially available, balanced diet is best. In 2023, Hills introduced a new cancer support diet called Hills Onc Care, available in both wet and dry formulations for dogs and cats. This diet is highly palatable with a more dense concentration of calories. Also it has high-quality protein, omega-3 fatty acids. It is not recommended for pets that have a history of pancreatitis or who are overweight.

If you are providing home cooked meals to your pet, it is reasonable to seek consultation from a veterinary nutritionist to ensure the diet is as complete as possible. https://www.vetnutrition.com/

Question 6

What is a clinical trial?

Accepted Answer

Clinical trials are research studies that help medical professionals improve the detection and treatment of illnesses. These can be designed for the purpose of evaluating the effectiveness of new drugs, finding new uses for old drugs, or investigating new approaches to treatment. Much of the information we know today is a result of clinical trials.

Each clinical trial has specific eligibility criteria that need to be fulfilled for a pet to participate, and these vary among studies. Some clinical trials are designed for animals with a particular diagnosis of cancer (i.e., lymphoma), while others are open to animals with a variety of cancer types. In general, to qualify for a trial, animals need to be feeling relatively well overall and be otherwise healthy with no significant concurrent medical issues. Owners also must be willing to comply with study protocols and commit to coming into the clinic for the visits that are required by the trial.

Question 7

What is telehealth/teleconsulting?

Accepted Answer

Telehealth, sometimes referred to as telemedicine or teleconsulting, is the use of electronic information and telecommunications technologies to extend care when you and the patient aren't in the same place at the same time. It can occur over a phone call or a video call.  It’s an option for anyone but can particularly be helpful for people that do not have access to an oncologist locally or just want information about their pet’s cancer before making decisions regarding treatment.  Given the relative rarity of veterinary oncologists in the US and the high prevalence of cancer in our pets, it may take weeks or more before you can schedule with an oncologist in person, while a telehealth appointment can often be achieved in a more rapid timeframe. 
 
There are some limitations to telehealth consultations. Because the oncologist does not perform a physical exam on the patient, they are not legally allowed to prescribe medications for these patients. (However, the oncologist is able to work with the local veterinarian on testing and treatment options and to help guide treatment.)  Additionally, if the available referral information is not complete or inaccurate, this may result in incomplete or inaccurate recommendations. It is imperative that complete medical records be received prior to your appointment so they can be adequately reviewed prior to consultation. If your veterinarian is not able to provide treatment options, you may need to see consultation with another doctor or specialist, in addition to the telehealth consultation.

Question 8

What if my pet does not have a diagnosis of cancer?

Accepted Answer

Generally, a telehealth appointment is most impactful when a diagnosis has already been made prior to the appointment, since I will be unable to provide a physical exam or perform diagnostic testing, myself. If a diagnosis is not yet available, general discussion about the case and further testing could be discussed.

Question 9

How does telehealth consultation work?

Accepted Answer

A new consultation is scheduled for approximately 1 hour to review the case and discuss prognosis and treatment options as well as answer any questions.  A recheck appointment is scheduled for 30 minutes.  Records for your pet will be requested from your veterinarian prior to this appointment. It is imperative that complete medical records be received prior to your appointment so they can be adequately reviewed prior to consultation.   A detailed summary will be supplied to both you and your veterinarian within 24 hours of the consultation.

Question 10

How much does a telehealth consultation cost?

Accepted Answer

New consultations cost $250 and recheck consultations cost $125. Emergency consultations can be requested for an additional charge.

Question 11

What if I cancel the appointment?

Accepted Answer

If the appointment is cancelled at least 24 hours from the date and time of the scheduled appointment, 80% of the cost of the appointment will be refunded. If the appointment is cancelled in less than 24 hours from the time of the appointment, no refund is given.

Question 12

What do I need to do to schedule an appointment for my pet?

Accepted Answer

An informed consent needs to be signed and payment is collected at the time of scheduling.  You will download complete medical records from your veterinarian(s). It is imperative that complete medical records be received prior to your appointment so they can be adequately reviewed prior to consultation.

Question 13

What kinds of consultations are available to veterinarians?

Accepted Answer

I can review a case in detail, discussing diagnostic testing, prognosis and treatment options, chemotherapy protocols, etc.  I can also have a general discussion about a case.  In depth case review cost $225.  Follow up questions can be submitted through the portal for $35 or a monthly subscription can be purchased for $500 per month for unlimited questions.

For general questions without full case review these can be submitted via the portal for $35 per question. Alternatively, a subscription can be purchased for $500 per month which will permit as many questions as needed.

Chemotherapy protocols (with chemotherapy handout sheets) are available for $75.

These veterinary-to-veterinary case reviews and questions are communicated through the website and response is received within 24 hours of receiving the submission Tuesday through Friday (excluding holidays). I want you to be able to provide the best care possible to your clients and patients. If you have any questions, please email Dr. Malone.

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