FAQ-Cancer Resource Center-Chemotherapy

Let your pet decide their activity level. Every pet is going to be different, but the majority of our patients have no appreciable change in activity level the day of chemotherapy.

Depending on the pet, the cancer and the chemo there are safer times than others. Please check with the doctor.

 

Other pets can be around the chemo patient with no risk, but obviously should not be allowed to lick urine or ingest stool of the patients, though they would need to ingest a lot of it for it to be a problem. Most metabolized chemotherapy is out of the patients system in 72 hours. If you have concerns about this please speak to your oncologist.

 

Treatments should be as close to schedule as possible. A one or two day schedule variation is usually all right, but we prefer to stay on schedule. Depending on the protocol, your pet is receiving and where in the protocol your pet currently is, timing of treatments can be extremely important.

Why is this important?

The timing of chemotherapy administration is designed to maximize treatment effectiveness and minimize the toxicity. By giving chemotherapy too early, you can increase the likelihood and/or severity of toxicity; by giving chemotherapy too late, you can decrease the effectiveness.

How is the schedule/timing of treatments determined?

Most protocols are based on years of study and altered based upon our years of experience with the specific drugs in the drugs in the protocol.

What should I do if I cannot make my appointment within 7 days?

Please call one of our staff members to let them know as soon as possible. We may be able to make arrangements that enable your pet to stay on schedule. Alternatively, we will reschedule your appointment to keep your pet as close to schedule as possible.

When is it too late?

It is never too late to reschedule your appointment.

Where else can I go?

If you are traveling and cannot make your appointment, please let us know and we will try to find a veterinary oncologist as near to where you are traveling as possible.

The metabolites (by-products) of chemotherapy will stay in the system for different lengths of time depending on what drug has been given. Most chemotherapy drugs are cleared from the body’s systems in 48-72 hours. This does not mean that the effects of that chemo go away in that time period.

Why is this important?

Knowing when your pet’s urine or stool is free of chemotherapy metabolites is important for your safety. We always try to keep you and your pets safety forefront in our recommendations.

How is it still effective after 48-72 hours?

Chemotherapy kills cancer by targeting rapidly dividing cells – and the cancer cells are usually among the fastest growing in the body. The cancer cells may take more than 48-72 hours for them to die.

What are the precautions I need to take while chemotherapy is still in my pets system?

You should limit your exposure to your pets urine and fecal matter and vomitus if your pet vomits. If you must handle these waste products, either use gloves or wash your hands thoroughly.

When is it safe to allow my dog or cat to lick me?

The amount of chemotherapy in animal saliva is extremely low, so it is usually safe. If you have a medical condition, are immunosuppressed, very old or have very young children, please contact your physician for the best medical advice for your particular situation.

Where is chemotherapy excreted?

Most chemotherapy is excreted either in the urine or in the stool and sometimes both. It depends upon the type of chemotherapy drug as well as the method of administration—orally versus intravenously.

If your dog is on prednisone, as many cancer patients are at some point during treatment, this could be causing urinary accidents in the house as the medication makes them more thirsty than usual. If your pet is not on prednisone, please check with your oncologist as there are several causes for an increase in urination.

Depending on the type of chemotherapy given, it is possible that in the first 48-72 hours after treatment, your pet might excrete some of the metabolized drug in their waste (urine, feces, vomit). 

Why is this important?

Knowing when your pet’s urine, stool or vomitus is free of chemotherapy metabolites is important for your safety. We always try to keep you and your pets safety forefront in our recommendations.

How should I clean up after my pet?

It is a good idea to use gloves whenever cleaning up after your pet. You should limit your exposure to your pets urine and fecal matter and vomitus if your pet vomits. If you must handle these waste products, use gloves, pet waste bags, or wash your hands thoroughly.

What should I use if I need to disinfect?

To disinfect in the house, use 1 part bleach to 10 parts water with a disposable cloth/towel.

When is it ok to let my pet go the bathroom when outside?

For the first 72 hours after you pet receives any chemotherapy, it may be good idea to try to have your pet urinate/defecate away from areas where children may play.

Where can I get gloves?

Gloves can be purchased at any local drug store, pharmacy or surgical/hospital supply store. If you cannot find the appropriate gloves, please contact our office for assistance.

Dogs will very quickly learn that sometimes if they decline their regular food that you may give them some people food – cold cuts, chicken and rice, etc. If they get used to this it may be difficult to get them back to a dog-food exclusive diet.

Cats may get very finicky with what they will and will not eat, and can develop aversions if, for example, they are given medications with a particular food.

Our goal needs to be to keep your pet eating as close to a normal, balanced diet as possible. We can provide contact information for a nutritionist if there are questions.

Do not give the next dose of Palladia and contact our office for advice.

 

Yes, both medications should be started the same day the injectable chemotherapy is given.

Why is this important?

The reason that both medications are to be given on the same day is that this particular protocol works best with a combination of chemotherapy agents.

How do you administer the drug?

Both prednisone and procarbazine are to be given orally. We also suggest handling the procabazine with gloves as it is chemotherapy, and we want to minimize exposure to you.

What are the side effects?

Side effects of prednisone are excessive panting, increased appetite, increased thirst, and increased urination (more frequent and larger amounts). The side effects of procarbazine can be loss of appetite, nausea or vomiting, diarrhea and loss of energy level. These side effects are uncommon and if they do occur are typically mild. If you have any questions about side effects, contact your veterinary oncologist.

When should I give these medications; the morning or evening?

Medically it does not matter, but some pets handle these drugs better in the morning and some better in the evening. Whatever you decide to do regarding the time of administration, please try to be consistent.

Where should I store the procarbazine?

Procarbazine can be stored at room temperature and should be out of reach of any children in the household. 

Yes, you can give the Cerenia; remember it is given once daily. If your pet continues to vomit or vomits up the medication, please contact us or your referring veterinarian.  We may suggest he/she come in for an injection to control the vomiting, or in more severe cases, to supplement with some fluids to avoid dehydration.

Although Palladia is not a "chemotherapeutic", similar side effects may be observed. These reactions are usually mild to moderate and temporary. The most common of side effects is associated with gastrointestinal (GI) toxicity, with presenting symptoms such as: diarrhea, bloody diarrhea, loss of appetite, vomiting, and weight loss. Other less commonly reported side effects are temporary lameness (difficulty moving) and lethargy (lack of energy), but these issues will often resolve on their own. If you notice your pet is experiencing any of these side effects, please give our office a call as soon as possible.

Why is this important?

It is important to address these side effects immediately as patients left untreated for gastrointestinal toxicity may develop more serious clinical signs. GI toxicity is relatively simple to treat, as long as symptoms are detected early on. Dependent upon the severity of side effects, the veterinarian might decide to lower the dose of Palladia or to stop treatment. If you notice your pet is experiencing any side effects from Palladia, please give our office a call as soon as possible.

How can these Issues be prevented?

There are a number of commonly used drugs that one of our doctors may prescribe to your pet to be administered at home, treating prophylactically(i.e. Metronidazole and/or Cerenia). In most cases, these side effects can be treated easily with some additional medications or by adjusting the treatment schedule.

If your pet vomits after receiving medication, please check to see if the medication is in the vomitus and note how long after the medication was given the vomiting occurred. Please call our office for recommendations. Please do not just administer another dose.

Why is this important?
It is important to know how long after receiving a medication or what medication it is that was so we may better assist you into taking the next best step.

How do I know if they got any of their medication into their system?
If you are unable to find the pill or capsule within the vomitus, it would probably be safe to assume that the pill remained within the pet. Please call our office if you have any questions in regards to this.

What should I do if this happens?
If your pet happens to vomit after getting an oral medication we have no way of determining how much of that drug was absorbed during that period of time so it is best to consult with the prescribing veterinarian.

Side effects of chemo can be seen (depending on chemo) anytime from immediately after treatment to more than 1 week. Most commonly we see nausea, diarrhea, loss of appetite and loss of energy. Every animal reacts differently to the chemotherapy they are receiving. Be observant of your pet starting immediately. If side effects do occur, please let us know so that we can offer supportive care and hopefully prevent future occurrences.

For most patients, as long as they start antibiotics within 24 hours of getting the chemotherapy, it should not make a difference.

Why is this important?
Chemotherapy kills the rapidly dividing cells in the body. There are 3 groups of rapidly dividing cells in the body--the cancer cells, the bone marrow cells and the cells lining the gastrointestinal tract. When chemotherapy kills some of the bone marrow cells, they tend to kill the cells that make white blood cells (WBC). These WBCs are the cells that protect pets from infection. If the WBC count gets too low, infections can occur. We therefore recommend antibiotics to try and prevent infections from taking hold and therefore preventing your pet from feeling ill due to the low WBC/infection.

How do doctors check for low WBC counts?
A simple blood test, either run in the hospital or sent to a lab is a complete blood count (CBC). This blood test indicates the number of red blood cells, white blood cells and platelets that your pet has. These tests are very routine and are run before each and every time your pet receives chemotherapy.

What are the signs of infection?
The most common signs of infection are fever (high temperature--in dogs and cats the normal temperature is 100-102.5). The other common signs are lethargy (loss of activity level), anorexia (loss of appetite) and sometimes diarrhea and nausea.

When will my pets WBC count drop?
This low WBC counts may occur anytime from 1 to 14 days after chemotherapy, depending on the drug.

Where should I go if my pet shows greater than mild signs of infection?
If your pet is showing any of the above signs and they seem more than just mild to you, please contact The VCC, your local veterinarian or the closest 24 hour emergency center.

When handling chemotherapy drugs, it is best to be as careful as possible so as not to expose yourself or others to these drugs. Splitting a pill or opening a capsule could potentially aerosolize the drug and increase your and your household’s exposure to these medications. The other reason why chemotherapy tablets should not be split is that the active drug is not always evenly distributed throughout the tablet.

Why do I not need to wear gloves when I am taking oral chemotherapy?

If you are prescribed chemotherapy then you and your physician have discussed the risks and benefits of taking and handling these medications. If you are ingesting/swallowing the drug, handling them will not increase your overall exposure.

How should I handle these types of drugs?

Chemotherapy pills/capsules should be handled carefully. Gloves should be worn to minimize any exposure to you. If you cannot or have not worn gloves, it is best to thoroughly wash your hands after touching or handling any chemotherapy pill or capsule, again, in order to minimize your exposure.

What should I do if I have already split a pill or opened a capsule?

Chemotherapy medications require special disposal. Please place them in a container and bring them to your local veterinary oncologist or us for the proper disposal. In addition, the area where the pill or capsule was opened should be cleaned/washed thoroughly to minimize household exposure.

When or if my pet bites the chemotherapy pill or capsule are we both at risk of exposure?

Yes, you both are at risk, but because the medication was prescribed for your pet, we are not worried about your pets exposure—only about yours and your household’s.

Where should I call or go if I am exposed?

Depending on the amount of chemotherapy you were exposed to, you should call your local physician. Thoroughly washing the exposed area with water is one of the quickest ways to decrease your exposure.

Some chemotherapy protocols will ask that the owner administer oral chemotherapy at home. It is important to wear gloves when handling these medications-as these medications are prescribed for your pet, not you—so we want to minimize your exposure. If you do not have gloves The VCC will provide them for you.

Why is this important?
It is best to act conservatively when handling chemotherapeutic medications. Although the possibility of having a serious reaction is rare, these drugs are known to be carcinogenic and mutagenic in humans. Using gloves and disposing of them properly minimizes any unnecessary exposure. Pregnant women and immuno-suppressed people should not handle chemotherapy drugs.

How do administer the chemo pill?
With the exception of wearing the gloves the administration of the chemotherapy pill is the same as any other oral medication. If you need assistance the first time one of our technicians will be happy to show you before you leave the office

What happens if I touch the pill without gloves? 
Most if not all of these types of medications are safety coated. Wearing gloves is a precaution to help minimize any possible contamination. Wash your hands if you accidentally touch the pills.

When should I put the gloves on and take them off?
The exterior container of prescription is contamination free. Put your gloves on, open the container, remove the pill and give it to your pet. Once you have completed pilling your pet, take your gloves off by pulling them inside out and then put the cap back on the container.

Where should I dispose of the gloves?
Again, these pills are safety coated and the chance of contamination is very low. The gloves can be disposed of in you every-day garbage. If you are still concerned you may bring them back to us and we will dispose of it for you.

Most non-chemo medications are dosed based on weight in kilograms; also it’s an easier conversion to metered square, which is the unit how most chemotherapy medications are dosed.

Cats don’t get Lasix-- a diuretic-- with Cytoxan because they are not prone to developing sterile hemorrhagic cystitis (a severe irritation to the bladder wall) that is sometimes seen in dogs.

Why don’t they?

The reason why cats don’t commonly get sterile hemorrhagic cystitis from cyclophosphamide is unknown, but it may have to do with a different way they metabolize the drug or a different way their kidneys excrete it or their bladder’s sensitivity to cyclophosphamide.

How are they different from dogs?

The saying “Cats are not small dogs” is quite accurate. Their metabolism, their dietary requirements, their susceptibility to certain drugs/toxins are different from dogs.

What is furosemide (Lasix)

Lasix is a diuretic, a drug that increases the rate of urine formation.

When does my cat need furosemide (Lasix)?

Lasix is most frequently given for high blood pressure or in certain cases of heart disease.

Where is it administered?

Lasix can be given orally and via injection.

Interestingly, cats very seldom get sick following CeeNu administration, so we opt to not stress them with daily antibiotic administration unless necessary.

Why don’t they get infections following lomustine (CeeNu)?

Despite their white blood count dropping after CeeNU administration, most cats do not feel ill. We believe this is because they don’t get septic (an infection with secondary systemic severe inflammatory response) due to bacteria from the gastrointestinal tract crossing into the blood stream very frequently.

How does giving antibiotics stress my cat?

Any oral medication can cause a cat some stress. Most cats are more difficult than dogs to give oral medication to. In addition, it has been our experience that a higher proportion of dogs will eat Pill Pockets®.

What medications do cats need with CeeNu?

Cats unlike dogs do not need any medications with CeeNU.

When does my cat need antibiotics?

There are various conditions where cats need antibiotics—abscesses, pyothorax (severe infection of the chest cavity), bacterial infections of the mouth, and many others.

Where do I call if I think my cat does have an infection?

If your cat is currently undergoing chemotherapy, please call our office, as we are available 24 hours a day, seven days a week by phone. If your pet is not on chemotherapy, or you think the infection is not related to the cancer or the treatment, please call your local veterinarian.