Episode 20 – Part 1: navigating cancer with Dr. kyle renaldo, DACVIM – Oncology
Cancer doesn’t only affect people, it’s one of the leading causes of death in dogs and cats, and for millions of families each year, a veterinary cancer diagnosis turns their world upside down. In this 2-part series, Partner’s board-certified veterinary oncologist Dr. Kyle Renaldo joins us to demystify the entire journey: from that first difficult conversation to understanding chemotherapy protocols, managing side effects, assessing quality of life, and navigating the hardest decisions that come at the end.
In this first part of our conversation, we’ll talk about what happens in that first appointment after a diagnosis, how oncologists decide whether chemotherapy is the right path, which cancers tend to respond best to treatment, and what families can realistically expect when it comes to side effects—both from chemotherapy and radiation. If you’re trying to understand your options and what lies ahead, this episode will give you a solid foundation.
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Narrator:
Welcome back to Did You Know?, a podcast by Partner Veterinary. In this series, we dive into everything veterinary medicine and everything Partner. In each episode, we tackle some of the most common questions we hear — from HR to emergencies and everything in between. If it happens at Partner, we’ll talk about it.
Few conversations are harder for a pet owner than hearing your pet has cancer. Suddenly, you’re faced with unfamiliar terms, difficult decisions, and questions about what the future holds. In this two-part series, Partner’s board-certified veterinary oncologist, Dr. Kyle Ronaldo, joins us to guide pet owners through the cancer journey—from diagnosis and treatment to quality of life and end-of-life care.
In part one, we discuss what happens after diagnosis, what to expect during your first oncology appointment, how treatment plans are developed, which cancers are most responsive to therapy, and the realities of chemotherapy and radiation. Whether you’re navigating a diagnosis now or want to be better informed for the future, this episode will help you understand what lies ahead.
Dr. Kyle Renaldo:
I’m Dr. Kyle Ronaldo, a medical oncologist with Partner. I grew up in Tampa, Florida, and lived there for about 25 years. I went to veterinary school at Kansas State. The reason I went to Kansas is, well, honestly, it was one of the few places I got in, and they took a lot of out-of-state students. I ended up meeting a lot of great people and really enjoyed my time there.
After vet school, I did additional training—internships. I did my rotating internship at the University of Georgia, then an oncology internship at Blue Pearl in Tampa, where I grew up. After that, I completed my residency at The Ohio State University, finishing in 2018. When I finished, I worked in Annapolis for about seven and a half years. I chose Partner because I really like the culture here; people genuinely treat each other well.
Jen Mellace:
Dr. Ronaldo, welcome to Partner and thank you so much for joining me today. Today we’re going to talk about understanding life during chemotherapy and the journey forward with veterinary oncology. I wanted to start by just asking you: when a pet is diagnosed with cancer, what does that initial conversation with the family look like? How do you help them understand their options?
Dr. Renaldo:
I’d say the initial conversation—one of the things that’s always disappointed me in veterinary medicine, even when I was a student, is that oncology is an elective course. When you go through clinics, you’re not required to take oncology, which seems odd since we see cancer all the time. It’s a rapidly growing specialty and probably one of the most common diseases we see in both cats and dogs. So, not all veterinarians get much exposure to oncology until they’re out in practice.
One of the key points upfront with clients is explaining: this is what your pet has. This is the type of cancer your cat or dog has been diagnosed with. Let’s talk about what that means. Depending on what’s left to do diagnostically, we discuss what can be done to gather more information to help you make an educated decision about treatment. And then we talk about treatment options—what’s out there.
To simplify, I’d say we have three, maybe four, major options: surgery, radiation, chemotherapy, and sometimes immunotherapy, though that depends on the type of cancer. I usually walk clients through what the standard of care is, what the minimum is, and if an owner can’t afford standard care, what intermediary options we can consider. It might not be perfect, but it could still help and be an important treatment for their pet.
I try to give as many options as I can. I don’t tend to be black and white; it’s more shades of gray.
Jen Mellace:
I imagine when you have a pet diagnosed with cancer, having those options is really welcomed—it’s probably an overwhelming experience for an owner.
Dr. Renaldo:
Yeah, and I’ve been on the other side of it in human medicine. My mother has cancer, so I’ve seen those conversations. It’s not the same. Especially in the United States, with people, it’s often, “We’re going to do this, we’re going to do that,” with not much choice. In vet med, I also make a point to talk about prognosis. That’s never set in stone, but we have numbers we can quote. They’re not perfect—they’re averages that vary a lot—but at least people can have an idea of what they’re getting into upfront. You don’t get that in human oncology unless you ask for it—they don’t tell you survival time.
So I try to have that conversation, too, because I feel like that’s often lacking.
Jen Mellace:
How do you decide whether chemotherapy is the right path for a pet, and how do veterinary oncology protocols differ from human ones?
Dr. Renaldo:
To answer the second part first, our focus is more on quality of life. We aim to eliminate or really minimize side effects, because pets can’t make the decision for themselves—we have to make it for them. It’s not benign; there’s usually about a 15 to 20% risk of side effects with treatment. But compared to human medicine, where it’s over 80%, it’s much better. We don’t push pets as hard.
For example, there’s a protocol for non-Hodgkin’s lymphoma in people and in canine lymphoma called CHOP, which includes multiple chemo agents. In people, they give all of them on the same day. In vet med, we do one drug at a time, once a week. I attended a lecture last year by a human oncologist who said if we pushed our patients more, we’d probably achieve cure more often. He called our chemo “palliative,” and some people took offense, but I actually think it’s accurate. Because we don’t push as hard, we don’t always achieve cure—but it’s all about quality of life. Every owner I’ve ever spoken to agrees that’s the goal.
As for deciding whether chemo is the right path, it really depends on the cancer. Some cancers—chemo is the treatment of choice. Sometimes it’s adjunctive: you need surgery, then chemo. Some cancers, chemo isn’t appropriate. And some don’t require chemo at all. It just depends on what’s in front of us and whether it makes sense.
Jen Mellace:
What cancers do you most commonly treat, and which tend to respond best to chemotherapy?
Dr. Renaldo:
The top four I see are lymphoma, osteosarcoma (primary bone cancer), melanoma, and mast cell tumors. Mast cell tumors are a veterinary-specific disease—we don’t have anything quite like them in human medicine. They’re not even the same between dogs and cats. The fifth big one is hemangiosarcoma—a blood-borne cancer, often experienced as a bleeding splenic or heart mass. Those are more acute, emergent situations and are common, especially in emergency settings.
Jen Mellace:
How do families weigh the cost and commitment of treatment against the potential benefits?
Dr. Renaldo:
A lot of it is just going through options and giving the financial information: this is standard care and what it costs, these are intermediary options and their costs, and this is more palliative care and what it would cost if you did nothing else. Usually, “nothing” isn’t really nothing—it’s still something.
I think talking about prognosis is important because every owner is different. Some feel a year isn’t enough; others are happy to get three more months. They weigh if the cost and time investment is worth the potential time they’ll get with their pet.
Jen Mellace:
One of the biggest fears pet owners have is that treatment will make their pet miserable—that quality of life will diminish. How do you address this?
Dr. Renaldo:
I talk about it a lot in the initial conversation to set expectations. It’s better to talk about it upfront than when there’s a problem, so people know what to look for at home.
Generally, the side effect rate is about 15 to 20%. Hair loss in veterinary medicine is rare unless you have a poodle. The main things are GI upset, decreased appetite, lethargy, and less commonly, vomiting or diarrhea. Drops in white blood cell count can put patients at risk for secondary infection.
One of the misconceptions is that patients are immunosuppressed. I think they can be myelosuppressed (low blood cell counts), but their white blood cells are functionally normal. If there aren’t enough cells, though, they can’t fight off infection. So, I think the risk for immunosuppression is low—much lower than with drugs like cyclosporine, which truly immunosuppress.
Jen Mellace:
How does chemotherapy in pets compare to humans?
Dr. Renaldo:
That’s one of the big differences—humans are often immunosuppressed during chemo; pets usually aren’t. People get pushed harder, see more drugs, and have much higher risk for infection. The medical term for a drop in white blood cell count leading to infection is “chemo sepsis”—it’s really common in human medicine. In our patients, the risk is usually less than 1%, likely because we don’t push them as hard.
But there’s always variability. Two dogs, same breed, same age, same background, may tolerate the same drug at the same dose completely differently. One might have no side effects; the other could require changes in protocol. We try to reduce doses, alter protocols, add more supportive meds—whatever helps, because quality of life is key. I wouldn’t want my own dog vomiting or having diarrhea all the time; that’s not fair. I don’t want owners having to give 30 medications either—what’s essential is what matters.
Jen Mellace:
What side effects should owners realistically expect? When do you know it’s time to move on from treatment?
Dr. Renaldo:
Most diseases we treat have measurable disease—like lymphoma, where dogs often have big lymph nodes you can measure. Whether those shrink or disappear over time tells us if treatment is working. If they’re not changing, it’s probably not working.
One challenge is distinguishing between disease and chemo side effects, especially with GI-based cancers. If a pet has vomiting and diarrhea from cancer, and then from treatment, it’s tough to tell which is which. Timeline helps—GI upset typically happens three to five days after chemo. If symptoms happen more than a week post-treatment, it’s probably something else, maybe the disease itself.
Every chemo is different, though. Some dogs have delayed side effects, and you have to troubleshoot. I try to address side effects upfront. Most of the time, if I don’t mention something and owners see it, it’s probably not a side effect. Sometimes drugs do weird things, but that’s not common.
The main side effects are GI issues and drops in white blood cell counts.
Jen Mellace:
When you talk about treatment and the timeframe, what are we looking at? How long does treatment usually last?
Dr. Renaldo:
It depends on the protocol. Single-agent protocols—one drug—are often given every two or three weeks, maybe five or six doses total. So, about 15 weeks in total—three to four months.
Lymphoma protocols like CHOP are more intense—about 25 weeks, or six months, with 16 treatments over that period. Some treatments are weekly, some every other week. There are many oncologists in the US, and everyone does it a bit differently—some do 19 weeks, some do 25. It just shortens the duration, but the overall survival time is about the same.
There are oral options, too. For example, Palladia is a pill for mast cell disease, given at home three times a week. Those cases may be checked less often, every six weeks or so, but treatment can last longer—six months or more.
Jen Mellace:
We haven’t really talked about radiation therapy yet. What should owners know about that?
Dr. Renaldo:
The main thing about radiation is that side effects are more inevitable. Especially with intense treatment, side effects will happen—it’s just a question of severity. Most are mild and not quality-of-life altering, but some owners are hesitant about radiation because of side effects and because it requires general anesthesia. You can’t expect an animal to hold still for treatment, so anesthesia is necessary every time. Planning treatment also requires a CT scan under anesthesia. If you’re doing 15 to 20 anesthetic events, plus a CT, it’s a lot.
The good news is, recovery is usually quick; they’re treated on an outpatient basis and generally do well. There is risk, but we manage side effects with drugs like prednisone. The goal is always quality of life, just like with chemo.
Radiation in pets is, duration-wise, not as long as in humans. The longest protocol is maybe three or four weeks. The side effects can be similar, though, and they matter. One difference is that in people, head and neck radiation can cause issues with saliva production, eating, and swallowing. Dogs and cats have so much salivary tissue that the risk of dry mouth is rare, which is a big quality-of-life advantage.
Narrator:
If this episode helped you feel a little less alone or a little more informed, that’s exactly what it was meant to do. In part two, we’ll dive deeper into quality of life, what to watch for at home, the hardest conversations families face when treatment stops working, and what gives Dr. Ronaldo hope in his field. You won’t want to miss it.
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