Tailor lymphoma treatment to each patient

Pamela D. Jones, DVM, DACVIM (Oncology), describes why lymphoma care must be individualized. Although many cases behave aggressively, a meaningful minority are indolent and require a different approach. She emphasizes practical education for veterinarians, close collaboration between primary-care and referral teams, and tailoring treatment plans to each pet family’s goals and constraints.

Transcript

Pamela D. Jones, DVM, DACVIM (Oncology): I started working in industry—meaning the pharmaceutical industry and veterinary medicine—and part of the reason I did that was because I love educating veterinarians. I love educating veterinarians on the practical side of things. The partnership between a general practitioner or primary care veterinarian and a referral specialist is so important. We need to form this ecosystem team for our pet parents and our patients, and I love doing that. I love bringing vets together and taking them one step further.

And if I were to take that entire lecture and put it in one sentence, it would be: one size doesn't fit all. The reason one size doesn't fit all is even though we think of lymphoma as one big aggressive disease, there's really a portion of lymphoma that is more indolent, behaves differently, and we need to treat it differently. Pet parents don't all have the same goals. They can't all have the same goals. They have different lives, busy lives, different careers, and different financial pictures. We need to be able to talk to them about: “What's your goal if we're going to embark on this? What's acceptable as far as quality of life and side effects, and what's not acceptable?” That leads to some great relationships.

Many of my friends often say, "How can you do oncology?" Friends usually come to me and ask, "My dog has lymphoma. What does that mean?" First of all, most of the time lymphoma is aggressive. However, there's 15% to 20% that aren't aggressive and may have a completely different prognosis. There are different types, and that's where phenotyping comes in. So, the biggest thing that I tell people is, “We're going to label this lymphoma as a diagnosis, but now we have to figure out what type to give it more information. And that's how I approach it.”

We definitely need to do that. The long-story-short answer is breaking it down into simple things. Oncology in and of itself is very gray. There's not a lot of black and white. With some diseases it's yes, the dog has it or no, it doesn't. With oncology, many times it's, “Okay, we've got a cancer diagnosis, but is it always bad, or can we get more pieces of information to help us answer that?”

Are you going to use an off-the-shelf approach? Which protocol are you going to choose? Then it comes down to being a chef and saying, when do we add more salt? When do we not add more salt? When do we take something away? It's about finding that perfect recipe for that pet.

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