Clinical Approach to Oncology (Objectives Only)

Define CR.

- Complete remission/response: Complete disappearance of tumor(s) and symptoms of disease

Define PR.

- Partial remission/response: At least 30% reduction in the sum of diameters of target lesions.

Define SD.

- Stable Disease: Less than 30% reduction or 20% increase in the sum of diameters of target lesions

Define PD.

- Progressive disease: Either the appearance of one or more new lesions at at least a 20% increase in the sum of diameters of target lesions

Define PFI.

- Progression free interval/survival: The amount of time elapsed without evidence of progressive tumor growth or death

Define DFI.

- Disease free interval: The amount of time that elapses without disease recurrence

What is ORR?

- Overall response rate = CR and PR

What is BRR?

- Biological respnose rate = CR + PR + SD

Define adverse events.

- Any unfavorable and unintended clinical sign or disease temporally associated with the use of a medical treatment that may or may not be considered related to the medical treatment

Define adjuvant treatment.

- Treatment with chemotherapeutic agent after achieving control of the primary tumor with surgical resection or radiation therapy

Define neoadjuvant treatment.

- Chemotherapy used prior to treatment with other modalities for local tumor control, with the intent of decreasing the tumor size

Define induction therapy.

- Chemotherapy treatment with the intent of a cure. Initial chemotherapy protocol

Define rescue therapy.

- Use of chemotherapy after a tumor fails to respond to a previous therapy or after tumor recurrence

Define MTD.

- Maximum tolerated dose: Highest dose of a given drug that can be administered in the absence of unacceptable or irreversible side effects (used in most chemotherapy protocols)

Define BED.

- Biologically effective dose: Targeted therapy (Palladia): esponse at a putative target that is related to the mechanism of action of the agent

Define metronomic drug dosing:

- Low-dose chemotherapy given on daily to every-otherday schedule. Aimed to slow progression of tumor through multiple mechanisms (angiogenesis, tumor immunology)

What are normal cells in the body that are always replicating?

- Bone marrow

- GI cells

- Hair follicles (more so in people)

What is the half-life of neutrophils, platelets and RBCs?

- Neutrophils: Hours to 1 day (shortest - why we monitor them closely)

- Platelets: 7-10 days

- RBCs: 100-120 days (dogs); 70-80 days (cats)

1:10:100 rule

What is the timeline for the nadir of most chemotherapeutic agents?

- 5 to 7 days post-dose

Be able to assess blood work of a patient receiving chemotherapy and know when antibiotics/hospitalization may be indicated.

- Grade 2/Mild toxicity -> 1000 neutrophils/microliter -> No ABX

- Grade 3/Moderate toxicity -> 500-999 neutrophils/microliter -> Oral broad-spectrum ABX, repeat CBC in 2-3 days; Do not hospitalize; No parenteral fluids (SQ or IV) or supportive care unless pt is febrile

- Grade 4/Severe toxicity -> >500 neutrophils/microliter +/- fever -> Oral broad spectrum ABX, IV if fever, recheck CBC in 24 hours, hospitalize if febrile

What are some pain management options for cancer in a palliative setting?

- Medications: NSAIDs, Gabapentin, Opioids, amantadine (good for chronic bone pain)

- Bisphosphonates (Clinically apparent analgesic benefit is often in excess of one month; Controversial if true pain relief)

- Acupuncture

- Radiation

In what contexts should NSAIDs vs. steroids be used for palliative management of cancer pain?

- NSAIDs -> Carcinomas (high COX-2 expression)

- Steroids -> Round cell tumors (cause apoptosis of neoplastic round cells at immunosuppressive doses)

What are some options for encouraging anorectic animals to eat?

- Different flavors, formulations, toppers, broths

- Paper plates: Dogs and cats have way better sensory olfactory - smell things in tupperware

- Feeding tubes

True or false: Just because a patient is eating does not mean they are eating enough

- True

True or false: Anorexia/cachexia is an extremely common paraneoplastic condition in veterinary medicine.

- False; Can occur but is less common in vet med, many patients are overweight

What are some medical management options available for nutritional support of cancer patients in a palliative setting?

- Anti-nausea: Maropitant, Ondansetron, Metoclopramide

- Gastroprotectants: Sucralfate, Omeprazole, Famotidine

- Anti-diarrheal: Metronidazole, Tylosin, Loperamide Immodium, Crofelemer Canalevia (FDA approved specifically for chemotherapy-induced diarrhea)

Define caregiver burden.

- Response of distress to difficulties encountered while providing care for an individual with an illness. Includes time and physical demands, as well as perceptions and emotional responses.

Define QOL.

- Quality of life = sense of life's 'goodness'. Client's subjective evaluation of positive and negative aspects of own life

Define grief.

- Bereavement reaction. Feelings of sadness and despair owing to a loss or anticipated loss

What are some management practices to support clients in a palliative cancer management setting?

- Treat every client as an individual

- Avoid minimizing the feelings of burden

Share the power of knowledge (www.petcaregiverburden.com)

- Collaborative care plan

- Help client problem solve

- Offer words of encouragement

- Elicit owners understanding of pet's illness and current state of health

- Ask how much the owner wants to know about the pet's situation

- Give the pertinent information according to what was discovered in point number two

- Respond empathetically to the owner's emotional response and include our own reaction to the information

- Summarize strategies and review decisions that are made concerning goal and care decisions

Tumors grow in a _________ fashion.

- Sigmoidal

What is the limit of detection for neoplasia? Limit of symptoms?

- 10^9 cells

- 10 ^11 cells