Veterinary cancer treatments can be expensive. The options I offer to owners are completely elective in nature, and affordability of care is a subject discussed on a daily basis. For many of the different cancer types I treat, the long-term prognosis can be very good, but such fortunate outcomes often come at a costly price, and sometimes the most effective plan is absolutely financially out of reach for owners. The struggle is palpable: owners want to do the best for their pets, yet know the cost of the treatment is beyond their means.
Specialty medicine is a unique aspect of the veterinary profession. We are able to offer pet owners diagnostic and therapeutic options on par with those available to humans, and we work hard to advance our different areas of expertise by developing research projects and clinical trials. I can walk through the hallways of my hospital and pass a young dog with orthopedic disease undergoing a CT scan, an older cat with a brain tumor having an MRI, a ferret having an abdominal ultrasound, endoscopy equipment being used to retrieve a mistakenly ingested toy from the stomach of a puppy, a rabbit receiving radiation therapy, and a geriatric Labrador walking on the underwater treadmill as part of a rehabilitation program for arthritis. The demand for specialty veterinary medicine is high and many educated owners seek referral to a specialist based on their own personal health care experiences.
I rely on the advanced diagnostic tools that are so readily available to me to help achieve a definitive answer as to what is causing a particular pet's illness and to help perform what are known as staging tests for various cancers. Staging refers to examining where in the body the cancer can be found, and many tumor types have a specific staging scheme, which is often found to correlate with prognosis. The results of staging tests will influence treatment recommendations. For example, in cases where tumors are localized to a single anatomical area of the body, I will often recommend a localized form of treatment such as surgery and/or radiation therapy. However, in cases where the cancer is more widespread, I will typically recommend systemic therapy (e.g., chemotherapy or immunotherapy).
These tests are pricey, however, and one of the biggest problems faced by pet owners is that fees for services need to be paid up front, whereas in human medicine, insurance helps to defray the majority of costs of healthcare. Often the price of a particular test or treatment option for an animal is significantly less expensive when compared to the cost of the same test for a human. The increased fee for human healthcare is often buried in insurance claims, so the only demonstrable cost comes in the form of a co-pay. Contrast this with the fact that only about 1% of owners have health insurance for their pets, so the vast majority of pet owners are faced with financing their pet’s cancer care out of their own pockets.
What this means for me as a veterinary oncologist is I need to be aware of not only the ideal plan for treating a particular type of cancer, but also to be able to provide alternative options for owners when that ideal plan is not feasible for them financially. I will always discuss with owners what the ideal plan for testing and treatment would be for their pet’s disease and explain the rationale behind my recommendations, but I need to be cognizant that this may not be realistic for every owner.
For example, sometimes pets will undergo an ultrasound test at their regular veterinarian’s office as part of a diagnostic work-up for chronic vomiting, and the scan will reveal a tumor within an intra-abdominal organ. The animal then has surgery to remove the tumor, and a diagnosis of cancer is confirmed on a biopsy. Owners are typically then referred to see me in order to discuss various treatment options for the tumor. In most cases, I recommend that a repeat post-operative ultrasound be performed fairly soon after surgery to provide a baseline before starting treatment, and that recheck exams be performed every three months or so for at least the first year following the diagnosis.
The initial recheck exam is very important because structures and organs will look differently after surgery when compared to the pre-operative scan. If a portion of the gastrointestinal tract was removed, this can be detected on the scan and that particular region of the tract will appear differently. The scan provides new information from which future comparisons can be made and eliminates the question of "Was this abnormality present after surgery?” that is asked several months down the line when the next scan is performed. If owners cannot afford the post-operative ultrasound, we will postpone this test until later in the treatment plan, with a full understanding that though not ideal, we are still providing the pet with its best chance for survival in the long run.
If cost becomes an issue, there needs to be flexibility in planning on my part, and the ability to present owners with alternatives. As long as full disclosure is met, and we are all aware that the expected outcome for substitute options may not be as good as the initially proposed plan, or in some cases, the outcome is virtually unknown because we are electing for a more "experimental" approach, I am comfortable doing so.
I feel fortunate that the majority of clients I meet are able to afford diagnostic and treatment options for their pets and that together we are able to provide their pets with a great quality of life and truly control their cancer for months to years. I understand that the services I provide are a luxury for many, and not always attainable for every owner. And for cases where the "ideal" plan is out of reach, I am happy to provide substitutes designed to achieve a similar goal. Specialists can work together with primary care veterinarians as well as make sure that pets with cancer can have every opportunity to tackle their disease and live longer, healthier lives. It’s truly an honor to do what I do and I appreciate all the owners who care so deeply for their companions and allow me to be a part of their pet’s cancer care.
Dr. Joanne Intile
Image: Thank you… by Mark Stradling / via Flickr