Episode 3 – Treating Cancer in Pets with Melissa Miller, DVM
Dr. Melissa Miller is a Medical Oncologist for Partner’s Richmond Hospital. In our interview, Dr. Miller discusses why she chose to practice oncology, the biggest misconceptions in cancer treatment, what families should do if their pet’s been diagnosed with cancer, and much more.
What You’ll Learn…
- How common is cancer in pets?
- What are the most common cancers in cats and dogs?
- What is the biggest misconception about cancer and cancer treatment?
- How do you choose which cancer therapy to use for a pet?
- What do you recommend for families preparing for an oncology consult?
But before we dive into the deep stuff, here are some quick facts about Miller…
What does Dr. Miller do when she’s not fighting cancer? She enjoys spending time with family, cooking with her fiancée Nick, and entertaining their energetic rat terrier, Lucky Liam. She is also an avid houseplant gardener and essential oil enthusiast. certified pet grief support specialist and is currently pursuing additional training in veterinary aromatherapy and herbal medicine.
More to come … in a future podcast, we’ll learn about Dr. Miller’s work as a certified pet grief support specialist and her additional training in veterinary aromatherapy and herbal medicine.
[Music]
Narrator:
Welcome back to “Did You Know,” a podcast by Partner Veterinary. In this series, we will explore all things veterinary medicine and all things Partner. In each episode, we will answer some of the most common questions we are asked—from oncology to emergencies and everything in between. If it happens at Partner, we’ll cover it. We hear from Dr. Melissa Miller, Medical Oncologist from our Richmond location this episode
Are there misconceptions around cancer and pets? Are there things that every pet parent facing a cancer diagnosis should know? Yes—listen in and find out.
Jen Mellace:
Dr. Miller, thank you so much for joining us today. Can you please introduce yourself and just tell me a little bit about how you came to the veterinary profession?
Dr. Miller:
“Sure. My full name is Melissa Miller. I have been a Veterinary Oncologist for 11 years now. I came into the profession—I always wanted to be a veterinarian, that was my life goal even as a child. I took a particular liking to cancer treatment after raising dogs for The Seeing Eye and then watching my own grandfather go through cancer treatment when I was in high school. It’s always been a fascinating specialty to me and something that’s very near and dear to my heart, both on the human side and now veterinary side. And yeah, that’s pretty much how I came to be.”
Jen Mellace:
“What is your role with Partner?”
Dr. Miller:
“At Partner, I am the sole medical oncologist at the Richmond practice. I primarily see patients that have either been diagnosed with cancer and are coming specifically for treatment, or pets that have a suspected cancer diagnosis that need workup to confirm and then have a treatment plan designated.”
Jen Mellace:
“How common is cancer in pets?”
Dr. Miller:
“Unfortunately, it’s far more common than any of us want it to be. About one in four dogs in their lifetime will develop some form of cancer, and about 50% of dogs over the age of 10 will be affected. Cats have a little bit less commonality, but about one in six will also be diagnosed with cancer, so it’s fairly prevalent in both species.”
Jen Mellace:
“What are the most common cancers in cats and dogs?”
Dr. Miller:
“In dogs and cats across the board, lymphoma is one of the most common ones that we see. In dogs specifically, after lymphoma, we see a fair number of mast cell cancer—a form of skin cancer. Melanoma is actually the most common oral tumor that we see in dogs, and then a fair number of bone cancer as well as soft tissue sarcoma.
Cats, aside from lymphoma and similar type intestinal cancers, we unfortunately see a fair amount of oral cancer. Squamous cell carcinoma, especially in the geriatric population, is very prevalent. We also see a fair number of soft tissue sarcomas, but that has died down in recent years since most of them have been injection-related. We’ve changed a lot of the vaccine protocols over the years to try to get the prevalence down. We still occasionally see them and spontaneous-forming ones, but not anywhere near as much as we did probably 10-15 years ago.”
Jen Mellace:
“What is the biggest misconception about cancer and cancer treatment?”
Dr. Miller:
“Hands down, the biggest misconception is that every dog is going to feel poorly going through therapy. It’s understandable that a lot of families have that perception because unfortunately, we see a lot of human cancer patients go through fairly trying times with some therapies. While we use a lot of the same modalities with chemotherapy, surgery, radiation, and even immunotherapy and some of the newer targeted medications, the approach is very different. Side effects can happen, but they’re nowhere near as extreme because our focus is always primarily on quality of life.
Stressing that to families that get a cancer diagnosis before they’re even considering any type of treatment—that’s the one thing that we try to instill in them. They’re always in the driver’s seat. We’re always focusing on whether that pet is living their best life, whether they’re on therapy or not, because if they’re not, then we need to make adjustments. Most of us, especially in the oncology world, feel very strongly that just because we can do things doesn’t always mean that we should. We tailor every plan to each individual patient to make sure that their quality of life is truly as good as it can be, regardless of the cancer that they’re being treated for, for as long as possible—because it is truly quality over quantity.”
Jen Mellace:
“How does age play into the factor of whether or not to treat cancer patients?”
Dr. Miller:
“We get this question all the time. Age is a factor but not always the highest factor. Certainly, older patients may have coexisting conditions that may influence what we’re able to do safely, and that truly becomes one of the areas of focus. Older pets can a lot of times be treated, but we manipulate their protocols either to make their anesthesia safer, or if we’re talking about something like radiation, maybe we’re not doing a daily protocol that’s really taxing, but we’re doing more palliative care so that they’re still getting the benefit but we’re not rocking the boat.
It’s really more of a balance than anything else. People ask me all the time, ‘We see geriatric pets—should I treat?’ And my question always to them is: Is your geriatric pet acting truly geriatric, where their quality of life is already in question, or are you coming in with a 12-year-old dog that’s acting like a 2-year-old puppy? Because there’s a distinct difference between the two. If you tell me that they were struggling before their cancer diagnosis, it’s a very different conversation than if they’re feeling great and they’re really a healthy geriatric individual that can tolerate treatment. We take all those factors into account.”
Jen Mellace:
“How do you choose which cancer therapy to use for a pet?”
Dr. Miller:
“It depends first on the type of cancer that we’re treating. Some things are surgical to start, so if that is an option for primary care, then a lot of times we lean towards that and then decide if additional therapy is needed after. For some cancers, lymphoma specifically, those are usually primarily treated with chemotherapy.
Sometimes we know off the bat what treatment road to take. In other cases, when we’re talking about combined therapy, which is the case for a lot of individuals, it’s a balance between what we can combine safely and what might give us the best outcome from a starting point. In recent years, we’ve started actually having availability for genetic tumor testing, very similar to the approach on the human side, where we can specifically test for drug sensitivity and for biomarkers to be able to truly make precision plans for patients for the best possible outcome.
It’s a conversation among all of those modalities because a lot of times it’s not just one treatment that we’re using—it’s usually a combined approach for the best long-term outcome and the best remission for a lot of patients. It’s a little bit cookbook to start, as far as things that we use pretty much standard of care and what we consider gold standard as a starting point, but past that, everything is truly detailed to the patient and to the family based on their goals. If a family is looking for curative and we’re dealing with a younger patient, it’s a very different conversation than if we’re leaning more towards a palliative approach where we want to do something to slow the progression and maintain their quality of life but not really push the boundary on what they can tolerate.”
Jen Mellace:
“What do you recommend for families preparing for an oncology consult?”
Dr. Miller:
“The single most important thing that I can tell any pet parent that’s listening to this is that a consult is really meant to educate. A lot of families unfortunately go into it thinking that they’re going to be obligated to do treatment at the time of the consult, and that is absolutely not the case. Our goal for the consultation is to educate the family on what type of cancer we’re dealing with, what the prognosis potentially could be, what the workup looks like, what treatment options are available, and then the one thing that nobody ever wants to talk about, which is cost.
It is a very real thing, and for a lot of families, it’s not so much being able to do therapy—it’s being able to work within a certain budget. I encourage every family to be upfront and ask questions when they go for their consultation because our job is to help that family, whether it’s with true care or just helping them understand what the process is, even if they elect not to pursue therapy. That truly is the education piece and making sure that whatever decision they make, they are as comfortable as they possibly can be.
Our patients don’t talk, and the pet families truly are the advocates. They’re the ones that are with those pets every single day and assessing their quality of life on a day-to-day basis, so their input is just as important as our input on the medical side. I see a lot of families that don’t recognize that going into it and are afraid to schedule a consult. So whoever’s listening, I hope that gives them a little bit of peace of mind that going for a consultation is not an obligation for anything else—it’s truly meant to help and guide.”
Jen Mellace:
“What experience sticks with you the most or has made the biggest impression on you in your career?”
Dr. Miller:
“There’s been many over the years, but there are two particular experiences that really stand out and have definitely molded how I practice as an oncologist on a day-to-day basis. One is being part of a lymphoma bone marrow transplant program at the hospital where I did my residency training. It was a fascinating part of my career and one that I hold very dearly. Seeing the entire team approach because of how much planning goes into those types of procedures and how many different specialties have to come together as a true team for that patient’s care—it really just defines what a lot of us on the specialty side, and even just in veterinary medicine in general, really strive for. We work as a team for the best care for that patient. Having been a part of that was a huge part of how I practice now, moving forward and really trying to involve as many colleagues in patient care as possible.
The other is actually treating my own personal dog for lymphoma. Shortly after I finished my residency, my own heart dog that I had through vet school developed lymphoma, and he lived a great three years with treatment. I’m very grateful for all of that time, but having had the personal experience going through it with my own pet gives you a different perspective. I always appreciated what families were going through, having had experience on the human side, but having a pet of your own go through it—it’s a very different experience. Knowing what it feels like to be in that chair, so to speak, helps me on a day-to-day basis guide clients on how they can approach things and what they’re going to feel and all of the emotional roller coaster that goes through it because I’ve been through it myself, even though I do this on a day-to-day basis.”
Jen Mellace:
“That really gives you a very good perspective for people. Why did you choose Partner?”
Dr. Miller:
“There are many reasons, but one of the biggest ones is their drive to truly reimagine veterinary medicine and to make it that team approach that I just mentioned, and to really support pet families as much as we possibly can. To reinstill the fact that we are here to help, we can help, we want to help, and to make sure that families are supported in whatever fashion they need to be. Because it’s not just about the medicine—it’s about the team approach and the emotional support and the mental support and making sure that they are educated enough to be the best advocates that they can be for their own families.”
Narrator:
Thank you for listening to “Did You Know.” Is there something about Partner that you want to know? Email us at [email protected]. Who knows? We might turn your question into an entire episode! You can now find us wherever you listen to all of your other favorite podcasts. Subscribe and follow us!
[Music]