Age is not a disease ...

September 19, 2016
Sue Ettinger, DVM, DACVIM (oncology)
Sue Ettinger, DVM, DACVIM (oncology)

Dr. Sue Ettinger is a practicing veterinary cancer specialist, international speaker and book author. She is one of about 300 board-certified specialists in medical oncology in North America and is currently practicing at the VCA Animal Specialty & Emergency Center in the Wappingers Falls, New York.

... but here are client communication and philosophical tips for the moments in a veterinary hospital when a pet's age and difficult diagnoses and prognoses come together.

Moral calculus

"My motto as a cancer specialist is: Live longer and live well," says Sue Ettinger, DVM, DACVIM, a CVC educator, busy oncologist and book author. "And I think it's really important we're addressing both of those for our patients."

In the case of Ettinger's specialty, pets tolerate chemotherapy very well, she says.

And if something changes? "I always promise pet owners we will stop and we can adjust treatment," she says, "because, again, it's not just the time, it's the quality of time that the pets have with us."

Too old for treatment?

Do you get this question with a cancer diagnosis? Ettinger does.

"Pet owners often ask me, 'Does it matter the age of my pet in whether I should treat them for cancer?'" says Ettinger. "I think it doesn't. There are so many other factors that go into the decision to treat."

Consider concurrent conditions, for one.

"You could have a 7-year-old dog with a ton of concurrent condition: diabetes, Addison's, heart disease," she says. "But I also have 12- and 14-year-old pets with no concurrent diseases, and they're really healthy cancer patients, which I know sounds like an oxymoron."

As you know, age is just one factor. And for Ettinger, it isn't anywhere near a deal-breaker when it comes to diagnoses, prognoses and decisions to treat.


Palliative care: Cancer

Cancer doctor's No. 1 tip for talking through a scary diagnosis

Use the power of the open-ended question.

"What I think is really important when you're talking about bad news, including cancer, is that you start by investigating," say Ettinger. Ask the client open-ended questions, like:

> What are your concerns with treating Eddie?

> What are your fears?

> Do you have scheduling concerns?

"I try to investigate what the client knows before I dive in to talk about the cancer," she says. "Then I can tailor the conversation to [address] their concerns and their fears."

For people who can't or don't want to aggressively treat a cat or dog's difficult condition, there are still options available for palliative care, Ettinger says. Pain management and appetite stimulants are top of mind for her.

"It's really difficult for a lot of owners, if the pet is not vomiting but just not eating, to make sure the pet is getting good nutritional support," Ettinger says.

Last but not least, Ettinger focuses on emotional support for pet owners ("helping them make the decision"), the pets ("keeping them comfortable") and, yes, a list.

"While the pet is still healthy, I tell owners to make a list of four or five things the pet likes to do," she says. "And when you start to see some of those fall off the list, that may tell us the quality of life is decreasing."

That means it's time to improve the appetite and pain management support, or consider that it might be time to make the difficult but compassionate decision to euthanize.

Sue Ettinger, DVM, DACVIM (oncology), is a practicing veterinary cancer specialist, international speaker and book author. She is one of about 300 board-certified specialists in medical oncology in North America and is head of the busy oncology department at the Animal Specialty & Emergency Center in the Hudson Valley in New York. Her chance celebrity encounter? She served Ralph Macchio-aka the Karate Kid-frozen yogurt in high school.