Oncology Patient FAQs

What is chemotherapy?

Chemotherapy typically refers to cancer-fighting medications that may be given by mouth (orally) or as an injection. Injections may be given beneath the skin or directly into the veins using an intravenous (IV) catheter. Chemotherapy is recommended to treat cancer in the whole body (as opposed to surgery or radiation, which treats cancer in a single location). Chemotherapy is considered the mainstay of treatment for systemic cancer, such as lymphoma, that can affect the whole body or in types of cancer that have spread or may spread to other areas (metastasize).

You may find a video detailing the chemotherapy patient experience here.

Chemotherapy Side Effects: How will my pet feel?

Veterinary oncology differs from human medicine in that our goal with cancer treatment is maintaining a good quality of life. Consequently, chemotherapy is well-tolerated in the majority of our patients. Around 25% of patients will experience a self-limiting side effect that is manageable at home with supportive medications. Less than 5% of our patients experience more serious side effects, possibly requiring hospitalization. Even these patients generally recover within 24 hours if no additional complicating factors exist. Chemotherapy-related deaths occur in less than 1% of patients treated.

The most common side effect is stomach upset, usually occurring 3 to 5 days after treatment. Side effects can manifest as vomiting, diarrhea, or a decreased appetite. These signs are often mild; most can be managed at home with anti-nausea or anti-diarrheal medications.

Many types of chemotherapy can also cause a decrease in the white blood cell count, which usually occurs 5 to 7 days after treatment (timing varies with certain drugs). Low blood cell counts can put patients at risk for infection. Most patients with a low white blood cell count still feel well at home, and antibiotics can prevent infection. Patients with a low white blood cell count and a fever (temperature over 102.5° F) often require hospitalization for intravenous antibiotics and fluids.

Infection resulting from low white blood cell count is usually caused by normal bacteria in the body, NOT by exposure to germs in the environment. For this reason, we do not recommend restrictions on activity or interaction with other pets.

What should I do if my pet experiences vomiting or decreased appetite?

If your pet experiences vomiting or decreased appetite, you should administer any anti-nausea medications as provided, such as Cerenia (maropitant) or Zofran (ondansetron). You may also feed a bland diet such as boiled (unseasoned) chicken and rice.

What should I do if my pet has diarrhea or soft stool?

If your pet experiences soft stool or diarrhea, we recommend starting treatment with a probiotic such as Fortiflora, Visbiome, or Pro-Pectalin. In some cases, we may recommend Flagyl (metronidazole). You may also feed a bland diet such as boiled (unseasoned) chicken and rice. Probiotics may be continued indefinitely and help prevent diarrhea in some patients. If metronidazole is used, discontinue this medication once no diarrhea is observed for 24 hours or more.

My pet seems excessively tired following chemotherapy or radiation treatment. Should I worry?

• Mild lethargy (decreased energy) is relatively common for pets receiving cancer treatment. If you note decreased energy in your pet, no action is needed, as this typically resolves on its own after a few days.
• If your pet is very lethargic (slow to move, reluctant to rise) or experiences complete appetite loss (i.e., no food) for more than 24 hours, please call or have your pet evaluated by a veterinarian.

Chemotherapy Safety and Handling: What precautions should I take?

Most chemotherapy is excreted in small amounts in the patient’s urine and/or feces for up to the first 48 to 72 hours after treatment, depending on how the drug is processed in the body. Though the amounts excreted are typically minimal, we recommend limiting contact with urine and feces during this time using the following guidelines:

Dogs

• People who are pregnant, nursing, or actively trying to conceive and children should not handle their dog’s urine or feces for 48 to 72 hours after treatment.
• We recommend that dogs urinate and defecate in a low-traffic area of the yard for 48-72 hours after chemotherapy treatment
• If your dog urinates or defecates in the house during this time, wear gloves when disposing of waste. Wash your hands afterward and clean the soiled area with soap and water.

Cats

• People who are pregnant, nursing, or actively trying to conceive and children should not clean the litterbox for 48 to 72 hours after treatment with chemotherapy.
• When cleaning the litterbox during the first 48 to 72 hours, wear gloves and wash your hands afterward.
• You can use flushable litter and flush litter/waste down the toilet, or use scoopable litter, place stool in a plastic bag, and throw it in the garbage. Change all the litter in the box 72 hours after treatment and wash the box with soap and water.

At-home chemotherapy administration

• If you’ve been sent home with a chemotherapy pill to administer, wear gloves when handling this medication. Do not cut, crush, or open tablets or pills.
• Do not handle this medication in areas where people eat or drink. Do not allow this medication to come into contact with any food for human consumption. If you give the medication with peanut butter or another food, use a specially designated jar for only that purpose.
• People who are pregnant, nursing, or actively trying to conceive and children should avoid handling these drugs.
• See above for precautions regarding contact with urine and feces.

What is radiation therapy?

Radiation therapy uses high-energy radiation beams to treat cancer, either on the surface or deep inside the body. Radiation typically requires aiming at one or a few specific locations and cannot be safely used to treat the entire body. Angell provides external beam radiation, meaning patients are NOT radioactive after treatment.

At Angell, radiation is delivered using a state-of-art linear accelerator while patients are briefly anesthetized. You can view a video detailing the radiation process here.

What is a vascular access port?

A vascular access port (VAP) is a small implantable device surgically placed underneath the skin for intravenous drug delivery (i.e., repeated anesthesia). The VAP alleviates the need to maintain an indwelling peripheral intravenous catheter during treatment. It is not visible outside the skin but can be felt underneath the placement site. Two small surgical incisions are made in the skin and are closed with sutures (stitches). The VAP is typically placed on the first day of radiation treatment and removed on the last day. We typically recommend VAP placement for patients receiving more than 10 treatments.

Will my pet be radioactive after radiation treatments?

No. This external beam radiation is generated from a linear accelerator. Once the beam is off, there is no more radiation.

Will my pet experience pain during radiation treatments?

No. Radiation itself is not painful. Patients undergo a short period of general anesthesia primarily to ensure that they lie perfectly still while we put them in position for radiation. Depending on the tumor type or location, acute radiation side effects can develop during or shortly after the treatment. These side effects are temporary but can cause your pet to feel uncomfortable for a period of time. These side effects are manageable with supportive medications as needed (see below).

What are radiation side effects?

We attempt to direct the radiation beam at the tumor by using radiation techniques such as electron therapy or a CT-guided treatment plan, sparing as much normal tissue as possible. Still, side effects to normal tissue can occur. The severity of side effects can vary significantly from patient to patient, making it difficult to predict which patients will experience significant side effects.

Acute side effects typically involve irritation of any tissue or organs near the treatment area. These side effects occur during or shortly after radiation treatment and generally last 1 to 3 weeks. They are expected to be temporary but range from mild to severe. Acute side effects are more likely to occur with definitive radiation therapy; they tend to be mild with stereotactic or palliative (hypofractionated) radiation therapy.

Late side effects are those that occur months to years after treatment. These typically involve scar tissue formation in the radiation field. Most serious late effects are uncommon to rare.

Why does my pet need to wear a cone during or following radiation?

Your pet mustn’t be allowed to scratch, lick, or otherwise disrupt the radiation site. The tissues in the area are very delicate following radiation therapy. If your pet had radiation near the skin’s surface, they should wear an e-collar AT ALL TIMES following radiation until otherwise instructed. Self-trauma to the radiation site will delay healing and extend the time needed for an e-collar and topical/oral medications.

How should I care for the radiation site?

• Do not apply any creams, ointments, or other topical treatments to this area unless specifically instructed.
• Keep the area clean and dry.
• Hydrotherapy: If the area appears crusted with discharge, you may try gentle hydrotherapy (cleaning the area with water) by gently spraying or pouring lukewarm water over the area. Please allow the area to air dry or gently dab dry. Do NOT rub or wipe, as this skin will be very fragile or tender. Do NOT use shampoos, soaps, or detergents, as these could irritate.
• If you have any concerns about the appearance of the radiation site, please do not hesitate to call or email the oncology Please be sure to include a picture of the area if possible.

Recommendations related to diet:

• The veterinary oncology service does not include a veterinary nutritionist. Consequently, we cannot make any special diet recommendations for your pet. We can provide a referral to a veterinary nutritionist upon request.
• Angell Animal Medical Center and the CDC strongly discourage feeding your pet any raw food diets. The following is a link outlining the CDC recommendations regarding raw food diets: https://www.cdc.gov/healthypets/resources/raw-pet-food-p.pdf
• Angell prohibits feeding raw food diets if your pet boards with us during treatment Accordingly, your pet will be offered a commercial/balanced diet while hospitalized.
• Hill’s Science Diet currently offers a caloric-dense and balanced cancer diet designed for patients undergoing chemotherapy or radiation therapy. This diet can be prescribed through your primary veterinarian or here at Angell.

Additional information:

• Angell Animal Medical Center can no longer refill prescriptions over the weekend. We will need at least 48 weekday hours to process your prescription request. If you require a medication refill, you must contact the oncology service during regular business hours to ensure it will be available.
• Our emergency service will periodically divert patients to other local emergency hospitals to maintain appropriate staff-to-patient ratios. Therefore if your pet is experiencing an emergency, we recommend you call our emergency service before coming to this hospital.

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