Managing adverse effects of chemotherapy

Chemotherapy administration can pose challenges for the veterinary team, clients and patients. In a dvm360^® interview, Lindsay Hallman, CVT, CCMT, VTS (Oncology), and Katelyn McDonald, CVT, VTS (Oncology), veterinary technician specialists at Mount Laurel Animal Hospital in New Jersey, discussed adverse effects of chemotherapy that patients may experience. In this video, showing part of the interview, they also address medications that can help alleviate these effects.

The following is a transcript of the video, lightly edited for clarity:

dvm360: What adverse (or side) effects of chemotherapy typically occur with chemotherapy administration in companion animals?

Lindsay Hallman, CVT, CCMT, VTS (Oncology): Only about 20% of pets actually have side effects to chemotherapy. The ones that do, it's generally about 2 to 3 days after they receive their chemotherapy. And usually people say, “they wake up in the morning, they're a little bit lethargic, they don't really want to eat breakfast,” but, generally by the evening time, they're completely back to normal. We do send people home at the beginning of their [pet’s treatment] protocol with a little goodie bag of antinausea medications and sometimes some antidiarrhea medications, depending on which chemotherapy they're going with.

We usually tell people [they] can either choose to give an antinausea medication, like ondansetron or meropenem. You can give that for the next 4 or 5 days, just because, if your dog is one of the 20% and you never have to find out. So a lot of people end up just holding on to it, using it as needed. And we have a lot of people who come back at the end of their [chemotherapy] cycles and say, “we never actually ended up using any of these medications.”

We also do have a lot of different chemotherapy options. So if they get sick on, let's say, an injectable chemotherapy, we can always switch them to maybe a less aggressive form of an oral chemotherapy, or we can a metronomic chemotherapy, which is a low dose, steady instead of a spike of an [intravenous] higher dose that they tend to react with better. So, there we have tons of options of where we can go if a pet does happen to have side effects.

Katelyn McDonald, CVT, VTS (Oncology): Correct.

The other thing that we do keep in mind, and we always explain to owners, is if you have the 1 in a million pet that really doesn't read the rule book and has a terrible time with chemotherapy—because there are outliers that on a rare occasion we will see that —owners are not under any obligation to continue forward with chemotherapy.

Once it is started, it is always up to the owner whether they want to continue forward down that path. If an owner ever says, "we've done this, we tried, we're done," then we are here to continue to support them as the care goes on going forward without necessarily administering chemotherapy to that pet. So, at that point, it then becomes a conversation of, how do we keep your pet as happy and comfortable for while their remaining time with us is now.