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Complications
of cancer and chemotherapy are often the most difficult for owners. When
treating the veterinary cancer patient, the clinician needs to clearly
communicate treatment goals with owners. If animals are apparently made
worse by the treatment, owners may be reluctant to continue. Because
anorexia, nausea, vomiting and diarrhea are obvious outward signs they
may be more disturbing than neutropenia, hypercalcemia, lymphadenopathy
or other complications. These signs may also be due to the tumor itself
and distinguishing what is caused by the treatment and what the disease
causes may be difficult. Supportive care should be timely and
aggressive.
Long-term
complications are described as chronic or lingering problems after the
cessation of therapy, while late effects are delayed problems occurring
months to years after treatment. Long-term follow-up will not
necessarily eliminate chronic or delayed effects of therapy, but it will
enable pet owners to make more informed decisions about issues affecting
the quality of their pet’s lives. Awareness of risk can encourage
changes in behavior that promote health (e.g., proper diet) and early
detection of tumor recurrence (e.g., regular veterinary examinations),
thus optimizing the chances for long-term survival.
System-specific
and/or organ damage, failure, or premature aging due to chemotherapy,
radiation therapy, biologic modifiers, surgery, or any combination of
the above have been described.
Some examples include:
1) cardiomyopathy,
renal insufficiency, bladder damage, cataracts, muscle atrophy;
2) compromised immune systems causing increased risk of infection (viral,
bacterial or fungal) and possible increased risk of malignancy,
3) damaged endocrine systems leading to thyroid dysfunction,
hypothalamic-pituitary dysfunction, or reproductive problems,
4) recurrence and second malignant neoplasms,
5) increased risk associated
with certain therapies (e.g., bladder cancer as a result of cyclophosphamide therapy)
Related
problems associated with cancer therapy may include:
1) functional
changes (e.g., incontinence, immobility due to weakness or orthopedic
problems, orthodontic problems, lymphedema, sleep disturbances, pain
syndromes, fatigue, mucosal dryness);
2) cosmetic changes (e.g.,
amputations, ostomies, skin and hair changes);
3) chronic illnesses (e.g., osteoporosis, arthritis, scleroderma,
hypertension);
4)
psychosocial effects related to physiologic morbidity (e.g., anxiety,
mood changes, depressed behavior)
Cooperation
is required between oncologists, primary care veterinarians and other
veterinary care staff for continued follow-up appropriate to the pet's
cancer history. Once cancer therapy begins, emphasis on health promotion
and wellness is necessary (e.g., nutritional and pain support).
Furthermore, everyone involved in the care of the cancer-bearing pet
should have a clear understanding regarding the role of cytotoxic
agents, radiation therapy, or combinations of both on the incidence and
type of long-term and late effect of the prescribed cancer treatment
plan. Offer appropriate owner education that includes full disclosure of
all potential long-term or late complications of treatment; warning
signs of possible problems; and symptom management strategies. Promote
appropriate behavioral modifications such as proper nutrition and
exercises in order to improve and strengthen damaged immune systems and
prevent future iatrogenic late effects.
Drs. King, Carreras and Endicott are available to consult
with your veterinarian if they have oncology cases requiring further diagnostic
workup or treatment.
Please call if we can help:
Phone: 713-693-1166
Fax: 713-693-1167
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