Chiara Penzo has been interested in oncology since her final-year at vet school, and her career has been built upon it. Her job is as much about increasing awareness as treating cancer in pets, she says
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MY interest in oncology started as a final-year veterinary student, and I became interested in comparative research as part of my undergraduate and PhD research studies. I had a great learning opportunity in pursuing a year-long externship within the clinical oncology services of the universities of Turin (Italy) and then Madison-Wisconsin (USA).
Cancer is a common and serious disease of pets and human beings. I feel that the profession frequently takes a negative approach to the disease, which is detrimental to the pet and negatively reinforces unfounded fears in owners about the disease in humans. I decided to approach pets with cancer and their owners in a positive, compassionate and knowledgeable way. Moreover, pets with spontaneously developing disease provide an excellent opportunity to research many aspects of cancer that may unlock clues to improving the outlook of this disease in animals and humans.
Pursuing my professional dream – a career as a clinical scientist in oncology – I left my country (Italy) to begin postgraduate specialist training. I was lucky to be supported in this, professionally and personally, by my family and my husband, an equine vet. After a year in the USA, I completed a residency in small animal oncology at the University of Edinburgh, and, in 2009 I was the first person to be awarded the title of European Veterinary Specialist in Oncology by examination. I then did further radiotherapy training in the USA and comparative research in the field of cancer stem cell biology.
For the past three years, I have provided a specialist referral oncology service at Vets Now Referrals, Glasgow. Moreover, I am actively involved in using web-enhanced services to disseminate quality of care research findings among primary care veterinary surgeons and owners and to increase awareness about this disease in pets.
Veterinary oncologists have a special role for pet owners. The word ‘cancer’ represents a threat to the relationship between an owner and their pet. It is rewarding to be able to help the animals, but also to help owners in understanding cancer as a disease. The goal of my daily work is to inform vets and owners of up-to-date options to prevent suffering and protect the quality of life of pets with cancer, so that they can enjoy as much good quality time as possible.
Cancer is an emotive disease because of its potential life-threatening nature, and counselling skills are essential when dealing with upset and worried owners. This is complicated by having to dispel diffuse negative preconceived notions about the disease and its treatment that may prevent pets from receiving effective and worthwhile options for care. Many owners may have had a personal experience of cancer, but few have experienced anti-cancer treatment in veterinary patients. Some may have outdated experience from when the science and specialism of clinical veterinary oncology was less well developed, and offered poorer outcomes and quality of life for treated veterinary patients.
The main desire of owners of pets with cancer is to prevent their pet from suffering – either from the disease or the treatment. It is important to try to understand owners' fears and doubts, as well as the background knowledge on which they may be based. The owner must be reassured that, thanks to recent advances in clinical oncology, it is possible to help and even to cure some pets with cancer, when appropriate therapy is pursued promptly. In fact, many owners refuse to pursue treatment, or delay a decision to opt for anti-cancer treatment, when they not appropriately informed. By wrongly comparing treatment for their pet with anti-cancer treatment in people, they may believe that their pet will suffer severe side effects, and that treatment represents a selfish choice rather than one made in their pet's best interest.
Treatment for pets with cancer
Vets have an important role in explaining to owners that, although anti-cancer therapy is performed to try to prolong survival, the real goal of treatment is to maintain the pet's quality of life and prevent deterioration, suffering and death, which would inevitably happen if the pet were left untreated or treatment was delayed. In fact, anti-cancer treatment in pets, in particular chemotherapy and radiotherapy treatments, are generally less aggressive than human treatments. The serious side effects that may be seen in human oncology are unacceptable in non-consenting veterinary patients.
Although for many pets with cancer there is a cure, for others the goal of treatment is to maintain their quality of life for as long as possible. This could be anything from a few months to two years or longer. Many owners happily accept and treasure any time that they can enjoy with their pet, as long as quality of life is maintained; after all, one or two years of life are a long a time in the context of a pet's lifespan. For other owners, a lack of guarantee of a cure – independent of length of survival with a good quality of life – is a strong enough reason not to treat, despite veterinary recommendation and scientific evidence. Vets have the difficult role of guiding and respecting owners' decisions in a compassionate way.
Working with primary care vets
As a referral clinician in oncology, I work closely with primary care veterinary surgeons. It is of paramount importance to offer the highest level and continuity of care to patients. Referral consultations are generally 45 minutes to one hour long, allowing appropriate time to make a thorough clinical assessment, as well as an opportunity to answer the owner's questions, before making the delicate decision on treatment.
It is increasingly difficult for general practitioners to have experience and up-to-date knowledge about prognosis and current treatments for different tumour types in this quickly developing field of veterinary medicine. This is why I encourage primary care vets to embrace the idea of shared case management for oncology cases, and to contact an oncologist early on to obtain advice and guidance, and/or to offer the client an early referral for consultation with an oncologist to get up-to-date information and help in deciding on best course of action. The necessary diagnostic tests and/or therapy can be performed at the referral centre or at the primary care practice. In this way, by using the referral specialist consultant as an extension of the service offered in-house, pets receive appropriate treatment in a timely manner, increasing the chance of a cure and avoiding tumour progression that may require more extensive and expensive treatments, and could worsen prognosis to the point of preventing a cure. Sadly, for many oncology patients a referral or specialist advice is sought too late.
I am also an online consultant in oncology for veterinary surgeons in Europe (TeleVetDiagnostics, www.televetdx.com). Through this service, I review clinical history and results forwarded by vets, advising them (within a turnaround time of 48 hours maximum) on selecting appropriate diagnostic tests or interpreting results, formulating a prognosis, selecting the appropriate treatment, and providing information and personalised protocols for up-to-date treatment. Teleoncology can offer a valuable and cost-effective service that may improve the level of cancer care within a practice, as a substitute or a prelude to referral, depending on the practice and patient situation.
My job and specialism offers me the opportunity to help to protect the human-animal bond. A good partnership between primary care veterinary surgeons and specialists in oncology in the clinic and online, and increased awareness favoured by web- enhanced services, will help to dispel the false negative myths surrounding diagnosis and treatment of cancer in pets, and increase diffusion of the highest level of compassionate care for pets with cancer.
Web-oncology – a tool to support owners
Owners of pet cancer patients often seek internet-based information as a way of ensuring that they are doing everything possible to help fight their pet's disease. Chiara believes that vets have an important role in directing such clients towards educational websites and forums, administered by trusted experts or professional bodies.
On her Facebook page – Chiara Penzo Vet Oncology – she posts weekly, brief oncology updates, and there is also a Facebook Group ‘Cancer Pet Forum’ for owners who want to know more about the disease. She says that the updates have been well received and that the group currently has over 1000 worldwide members, both veterinary professionals and lay people. ‘While no clinical advice is offered, owners benefit from emotional support by sharing their experience with other owners in similar situations. Owners of pets with cancer can feel isolated because of the negative preconceived notions surrounding treatment, and a lack of owners who have experienced anti-cancer treatment for their pets to whom they can turn for advice outside the veterinary clinic.’ She adds that veterinary professionals also find updates about diagnoses and treatments useful.