Ensuring a successful oncology consultation for your clients

Conversations about cancer are tough, but the groundwork you lay makes all the difference in preparing the pet owner to make the best possible choices for their pet and situation. Try these strategies to help them get the most from an oncology consultation.

Use the "C" word when appropriate

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When delivering news of a difficult diagnosis, veterinarians do everything they can to help the pet owner understand their pet’s condition and needs. Being clear and succinct about the pet’s diagnosis and possible prognosis is helpful in setting up a successful oncology referral. Even when we think we are using the simplest possible language, we are often still talking at a level above the average pet owner’s medical understanding. For a client, the word “tumor” or “neoplasm” often signals localized disease that can be removed or treated and that will result in cure. Thus, it is important to use the word “cancer” if a particular tumor can spread so clients understand the difference between a localized tumor that can often result in cure with treatment and one that is cancerous that may or may not result in cure with treatment. This is not to advocate the overuse of the term “cancer,” nor to scare clients away from treatment, but it is a term they have heard of and are likely familiar with in their daily lives. When used appropriately with clients, it can help them come to terms with the diagnosis. There are many treatment options for the numerous cancers diagnosed in human and veterinary medicine. There is hope and cure with many cancers.

Start with a consultation

Anytime a difficult diagnosis is made, the pet owner is stressed. The moment we say, “I’m so sorry to tell you this, but...” they are likely to become overwhelmed and often won’t recall details of the conversation. This often leads to frustration on the client’s part as they don’t remember information about the diagnosis. It can also cause frustration on the veterinarian’s part as it can take multiple similar conversations before the client understands the diagnosis and prognosis. It might be very tempting to tell the client to seek an oncology consultation so the onus falls on someone else to help them understand. However, anything we can do to help pet owners experience and work through that emotional response will help them be more prepared to talk about what they want for their pet when they get to a referral appointment with a specialist.

Although discussing all treatment options and outcomes is the purpose of an oncology consultation, having clients mull over their goals for their pet is important so they get the most out of the discussion. Some questions to help them get started with their goals are: Do you want more time? Are you open to all treatment options or only some? Do you want a cure if this is possible and are you willing to be aggressive with treatment? Would you consider radiation therapy to shrink the tumor? How about surgery, chemotherapy, or combination therapies? What are the financial budgetary constraints? Perhaps the client is more interested in palliative hospice care as they do not want to consider surgery, chemotherapy, or radiation, in cases where an oncology referral may not be needed.

Having well-thought goals beforehand will allow the consultation to be tailored to the treatments and specifically line up with the client’s goals. It is also a good idea to discuss why you’re referring them to one particular oncology or surgery specialist rather than another. If you learn in that conversation that the pet owner is absolutely against surgery, for example, a medical oncologist or radiation oncologist might be a better choice.

Offer reading material or online sources of client education

Providing written information about the pet’s diagnosis that clients can refer to at home and research on their own is helpful for when they have had time to process the diagnosis. They may need to explain the diagnosis to a spouse or another family member. And as they decide about next steps, more information is better. A quick handout that they can refer to can make a dramatic difference. This does not have to be time-consuming to put together––simply include the 4 bare basics: whether the tumor is cancerous or benign, some options that can be discussed during the consultation, the prognosis, and whether the tumor is curable. This is excellent information to email to the client or provide in their discharge packet. Alternatively, there are several good sources of cancer information online to which you can direct clients.

Offer to answer follow-up questions

We know how busy you are, and offering a referral to an oncologist will give the client the most information about their pet’s diagnosis. But we also know you want the best for your patients and clients. An upset pet owner may not know what to ask when the diagnosis is first explained to them but as the information starts to sink in, they will have more questions. Allowing follow-up calls and answering questions you feel comfortable answering will have them better prepared for an oncology consultation.

Give the specialist a call

As specialists, we follow our areas of interest closely. Research in the field of oncology is moving at an incredible pace. A quick review of literature, in addition to calling your trusted oncologist, can be helpful in obtaining the most accurate and up-to-date information regarding the prognosis as well as facilitating a referral. Oncologists are happy to be a resource to referring doctors when they are making decisions about whether and to whom to refer an oncology case.

There are 3 subspecialities within oncology: medical, radiation, and surgical oncology. Speaking to an oncology doctor can help determine which oncology service is most appropriate for a referral. Getting a rough idea of possible recommendations and costs associated with next steps in diagnostics and treatments is helpful to clients.

Make sure your medical records are completed

It is imperative for the specialist and the client to have an updated copy of written medical records, laboratory work, pathology reports, and imaging studies and reports at the time of the oncology consultation. Incomplete records or missing diagnostics can often lead to delays in treatment or in unwarranted costs of repeating diagnostics. Have your client request a consultation date such that you have sufficient time for diagnostic results to come in and for you to complete your records and inform clients of the results.

Arathi Vinayak, DVM, DACVS-SA, ACVS Fellow (Surgical Oncology), is based at VCA West Coast Specialty and Emergency Animal Hospital in Fountain Valley, California. She regularly partners with academic institutions to complete surgical oncology studies, and she works to instill that same excitement in her interns about expanding medical knowledge through research. She performs specialized oncology surgeries including surgical limb spares; thoracic and abdominal wall resection and reconstructions; complex intrathoracic and abdominal tumors; minimally invasive urethral, tracheal, colonic, and esophageal stenting; and surgery for complex maxillofacial tumors. She also enjoys spending time with her husband, her 2 active boys, her Siberian cat, Kitten, and Ragdoll cat, Nettik.