Oncology Options For Treatment - Aug 16, 2010

On Thursday, Aug. 12, 2010, we had our anxiously awaited oncology appointment.  Hardee did not like going back to the same hospital after what he had been through earlier that week on Monday and Tuesday.  He was nervous as they put us in a room waiting for the oncologist, and he kept looking for an escape route.  My heart wanted so badly to take him out of there, but I knew we had to stay and find out the options to beat the enemy, the tumor.

The first option discussed was palliative care.  Palliative care is supportive care only until you feel your baby has suffered enough.  An example of palliative care would be pain meds, etc.  With palliative care only, they gave us 1-2 months.  This choice was not an option for us, as we could not sit back and watch Hardee die.  He is such a young dog (5 yrs) with so much working drive, accomplishments, and joy for life.  There are some newer treatments out now that others, who chose this option for their dogs, did not have as a choice at the time.  I do NOT find fault or judge others who have chosen this option; it is such a personal decision; it just wasn't the decision for us.  Price on this option varies, but it is minimal.

Treatment for nasal tumors is aimed at controlling the tumor in the site where it originates.  Surgery for most nasal tumors is not an option, as far as removal of the whole tumor.  Generally, surgery isn't even attempted because by the time the dog starts showing symptoms, the tumor is too large, and the anatomy of the nasal passage and the location make removal too difficult and too invasive.  Sometimes surgery is considered to debulk the tumor to give the dog a better quality of life for their remaining days.  The surgery is quite difficult for the dog.  The surgeon has to go through the bones of the face instead of up the nose.  The cost that was quoted to me was $2,500.00 and up.  Surgically removing Hardee's tumor is more of a consideration than other dog's tumors because we caught it early, and it is smaller than most nasal tumors.  We did not select this option...not yet anyway, but the option is still there for later use, if needed.

Since treatment is aimed at controlling the tumor in the site, radiation is considered to be the most beneficial therapy, but only if the cancer has not metastasized.  There are 3 types of radiation therapy: palliative, definitive, and gamma knife.  There are no radiation therapy facilities here in the Las Vegas Valley, with the closest being in Southern California.  I was referred to the radiation oncologist, Dr. David Proulx, at California Veterinary Specialists in Carlsbad, CA.  They are one of the two facilities only in the world using gamma knife radiation on dogs.  I will tell you a story about this wonderful man, Dr. Proulx, later.

Palliative radiation uses low doses of radiation to try to reduce the pain, inflammation, and swelling associated with the tumor.  This type of radiation has much less side effects than the definitive radiation.  Palliative radiation is provided in daily doses over 5 straight days.  Many dogs respond well to this type of radiation with reduced clinical signs and shrinkage of their tumors.  Survival time for these dogs are generally 2-4 months, but some can get better benefit with survival of 1-2 years.  Some owners choose palliative radiation of only 1-3 days (doses) and derive longer tumor control.  This type of radiation is generally around $2000.00.

Definitive radiation therapy, also known as traditional radiation, is much, much, harder on the dog.  It uses small doses of radiation on a daily basis over a month-long period.  Though for most nasal tumors a cure cannot be obtained, definitive radiation can be used to control the tumor for long periods, and in some cases it can cure it.  The typical range of survival time (cancer control) with this radiation is 12-16 months though there is much variability between dogs.  On occasion, surgery is performed also.  If surgery and definitive radiation are performed, cancer control is a small study reached 2 years.  Side effects for this radiation are substantial, especially for this area of the body.  Inflammation and burning of the nose and mouth, eye damage, and neurological changes are common and expected with definitive radiation, depending on the extensiveness of the tumor.  These side effects can last 2-4 weeks, but they can occasionally become permanent.  Let me stress how hard these side effects are on the dog, and Hardee's radiation oncologist would never put his dog through this radiation, nor would I.  The cost of this radiation is around $7,000.00.  Remember that with all radiation, the dog must have general anesthesia with each daily treatment.

The last type of radiation therapy is gamma knife radiation.  With this radiation, the dog must have another CT scan under general anesthesia that is very precise and done at a human facility, as is the gamma knife radiation.  It closely measures the nasal tumor, and then radiation is focused to the exact area limiting side effects to the surrounding tissues thus sparing the eye and the horrible side effects of definitive radiation.  Relatively conservative side effects can be expected.  It takes a couple days for the radiation oncologist to formulate a plan before the radiation treatment can begin.  Since this is new to the canine world by about a year, statistics aren't available and the hope is that it is as good or better than definitive radiation.  You are taking a big monetary risk with gamma knife and there are no guarantees.  Treatment with gamma knife radiation takes about a week, and the cost is greater than $15,000.00.  A limited number of dogs have undergone such therapy for nasal tumors.  Hardee will be one of them.

Chemotherapy can be used and is an option if the tumor returns after radiation therapy.  There are 2 different drugs that can be used.  One is given intravenously, and the other is a pill given at home.  Sorry, but I kind of quit listening after I heard the gamma knife radiation option because I knew instantly that was my choice for Handsome Hardee.  I just had to convince Hardee's Dad, but Jim needed no convincing and was on board as soon as I told him the options.  Good boy, Jim!!

Monetary decisions seem to drive the options chosen by most owners, or in our case, selfishness, because we can't imagine our lives without Hardee.  Just so everyone understands the costs involved with all the options, we have already spent close to $5000.00 for all the procedures of last week trying to get a definitive diagnosis and to see if the cancer had spread.  Then add in the cost of whatever option of treatment you choose, in our case at least $15,000.00, and then add in roughly $1,500.00 every 3 months or so to monitor the tumor, with the potential for surgery to remove as much tumor as we can, another $3,000.00.  It is not for the faint of heart nor for the average person.  Even though we are average people with lots of bills due, Hardee is not an average dog.  The amount of happiness he has brought into our lives is immeasurable, and we would go to the ends of the earth for him as long as we thought it wasn't too hard on him.  The question you have to ask yourself is.....is my dog worth potentially more than $30,000.00???  To us, Hardee is, and we will find a way.  We figure that is what home improvement loans are for.  Might it all be for naught?  Yes, but if it is, Hardee will leave this world to wait for me elsewhere knowing that I have done everything in my power to give back to him what he has brought to us....total joy!  Only people who truly love their dogs more than life will understand this choice, and we are okay with that if you don't.  I won't judge the decisions you make for your dog.

Since this post has gotten so long, I will tell you the story of Dr Proulx tomorrow, and tell you about the plan for next week and where we will be getting our treatment.  Until then, it is all about joy and all about Hardee!!