Living well with metastatic cancer
To mark World Cancer Day, Professor Nick Bacon, Clinical Director of Oncology and Soft Tissue, reflects on the changes to cancer care for small companion animals and how we’re helping patients to live well with cancer.
A note from Professor Nick Bacon
I remember many years ago, we would diagnose metastatic cancer and conclude we were too late. The cancer had spread. The outcome was inevitable. We didn’t treat, the symptoms persisted, the cancer progressed, the patient died. Exactly as we had predicted. The same story occurred with cancer relapse – we had tried and failed, the cancer had won, and additional treatment was not appropriate, correct, or even ethical. In hindsight, this is the definition of a self-fulfilling prophecy.
Historically, cancer treatment in animals has differed philosophically and fundamentally from cancer treatment in people. In humans, with advanced local disease or distant spread, the stakes are deemed higher, treatments are intensified and novel therapies are explored. Innovation flourishes in the quest for health and longevity.
For our pets it has been the opposite approach – complex cancer cases have elicited a collective step backwards, recommending minimal intervention and letting ‘nature take its course’. It seemed impossible that we could extend both quality and quantity of life simultaneously in our animal companions, but that is precisely our goal and in precisely that order. I would suggest we move away from a cure or not cure scenario for animal cancer, it is not a binary absolute, but a sliding scale. A chronic varied condition requiring chronic personalised therapy, just like kidney disease, heart disease or diabetes.
I tell our residents and interns that our job is easy. We see a patient that arrives with a diagnosis on a piece of paper and we can calmly present all the options available to modern science in a purpose-built Oncology and Soft Tissue Hospital, surrounded by a dedicated team who want to change the way we look at cancer.
The family vet has a much harder job. Telling an unsuspecting family the cytology is suspicious, or pathology confirms their pet has cancer, or the radiographs show evidence of metastasis; delivering tough news for the first time to anxious and distracted clients when your waiting room is full of patients, your morning surgeries are due to go home, and you feel you may not have the time or the answers to the inevitable panicky questions. Many vets chose to call us before giving ‘that’ news, so we can discuss the options, predict the potential questions, and hopefully turn a difficult situation into an opportunity to console, support and educate.
We are also here to listen to families’ concerns, identify their priorities, demystify cancer and discuss options that are ever evolving and improving. Most importantly we are looking to support them on their path going forward as they follow their individualised medical plan.
To mark World Cancer Day, we are sharing the story of two brave and inspiring dogs, Monty and Casey, who are living in the moment. These dogs embody the message that life with cancer can be rich and happy, at home with their families. Cancer is not a death sentence – far from it; comfort and knowledge can bring hope. We are managing their cancer and its symptoms as a team, with them for life. Sometimes us, sometimes you, sharing the care, supporting each other.
Thank you to all of our colleagues who trust in us and hope you will continue to help us in our mission to change the way we collectively approach cancer.