Delivering compassionate care is the single most important item of cancer therapy. Understanding the disease and the health status of the patient through the “TLC” approach is the first assistance the veterinary pharmacist may be able to provide as a part of a dedicated, well-educated, cohesive and caring veterinary health care team. The acronym TLC represents Tissue diagnosis, Location of the tumor and Condition of the patient and the ACVP pharmacist is prepared to partner with the veterinarian treating cancer patients while recognizing the importance of each component of the methodology. Tissue diagnosis is critical to understanding therapy because each tumor is discrete and different. The location of the tumor gives important clues as to the stage and extent of disease as well as any involvement of distantsites through metastasis. The condition of the patient must be assessed and reassessed to determine the presence of any paraneoplastic syndromes that will also affect the well-being of the patient. In many cases, correcting underlying problems such as renal failure, urinary tract infections, heart disease and metabolic disturbances may significantly improve the overall health of the patient and improve the potential for successful cancer care.
The goals for treating feline cancer are the same as for treating humans with cancer: attempt a cure, and along the way, do not let the patient hurt, vomit, or starve. In order to facilitate accomplishment of these treatment goals, the veterinary pharmacist must be familiar with signs and symptoms, diagnosis, pathophysiology, therapeutic options, and patient monitoring for cats diagnosed with cancer. ACVP pharmacists have been provided with a great deal of information on these topics, and are anxious to learn more from the veterinarian. Cancer is the number one natural cause of death in geriatric cats, and according to a recent Morris Animal Foundation report, the number one health concern of pet owners. Therefore care of the cancer patient must be included in any progressive veterinary pharmacy practice. Tremendous advances in cancer treatment have developed over the last 10 years resulting in improved response rates, longer disease free intervals, and increased survival times.
The first challenge of the veterinary care team is to accept the diagnosis and not view it as something dark and hopeless. Images of invasive, painful surgeries, vomiting from chemotherapy and giant expense often cause the cat owner to wonder, “Is it worth it?“ Should I put him through it?” Providing information to the owner prevents the diagnosis from stealing their hope for a long, happy life for their pet. The veterinary pharmacist, upon receiving a prescription for cancer therapy in a cat, should never assume a defeated or sad tone of voice when dealing with the owner. Instead, the pharmacist should be positive and congratulate the owner on taking such an important step to reclaim the health and longevity of their cat. The veterinary health care team is not only responsible for the medical needs of the patient, but also for the nonmedical needs of the caregiver. Providing preemptive, effective and ongoing pain management for the cat is essential throughout therapy and assures the owner that the quality of life for their pet is optimal.
The cancer health care team must never tolerate pain. The veterinary pharmacist can play a vital role in providing these therapies in the most palatable, least invasive manner possible. By providing flavored medications and transdermal delivery systems, the veterinary pharmacist can help assure the owner that they are not inflicting any unpleasant experiences or inducing resentment on the part of the cat. There is a wide misconception that cats treated with chemotherapy will experience extreme nausea. With recent advances in cancer care, nausea and vomiting are no longer necessarily associated with veterinary cancer care. The veterinary pharmacist can provide powerful anti-emetics that can be administered prior to chemotherapy in the veterinary clinic as well as by the owner at home should any signs of nausea or vomiting occur.
Once the diagnosis of cancer has been confirmed and staging of disease has been determined, the cancer care team is prepared to select a therapy. Before implementing that therapy, the veterinary health care team (including the owner) needs to know:
- The importance of compliance and following the treatment protocol completely.
- The potential expense associated with chemotherapy and the commitment to complete a
- The potential benefits and risks associated with each drug or treatment, recognizing signs of toxicity and preventing them or resolving them as soon as they occur.
The ACVP pharmacist can play a number of roles in veterinary oncology. All chemotherapy drugs used in animals are human-approved products, procured easily by pharmacists. The dosage forms necessary for use in veterinary oncology patients is best prepared by pharmacists. The pharmacist is an important resource for both veterinary staff and pet owners, for instructions on proper storage and handling procedures, drug information including side effects and drug interactions, and on proper administration of drugs, and disposal of animal waste. Risks associated with the handling of antineoplastic agents include genotoxicity, carcinogenicity, teratogenicity or fertility impairment and organ or other toxicities. Humans can be exposed through ingestion, inhalation, and direct skin contact from the drugs themselves, discarded items associated with the drug and from animal waste. Assistance in developing a safety protocol for handling chemotherapy drugs is available from ACVP pharmacists and include axioms for handling hazardous drugs, safety precautions in the pharmacy, examples of policies and procedures, and a template for spill kits. In addition, quick references for use and safe handling of chemotherapy drugs, some geared to veterinary clinic staff and some for clients, are also available. Please feel free to ask your ACVP pharmacist for these materials.