The following article was submitted to the Journal of the American Veterinary Medical Association by Dr. Steve Withrow, a giant in the field of Veterinary Oncology, and cornerstone of the Colorado State University Flint Animal Cancer Center. I have greatly admired his work and philosophy for the past 30 years and have had the pleasure of knowing him personally for much of that time. He is a very compassionate and humane advocate for our four legged patients who cannot speak for themselves.
Dealing exclusively in an oncology practice, I am constantly amazed by the new excuses for not anesthetizing, operating, or treating the older patient with cancer. It is easier to accept not treating a patient because of owner financial constraints than it is because the animal happens, through no fault of its own, to be 12 years old. It also is easier to accept no intervention based on an established poor prognosis.
Growing old is a natural process for all living things. It is not a disease to be used against the patient. Traditional thinking of “old” for a dog or a cat has changed considerable over the last 10 years as pets are now living to more advanced ages. In large part this is due to better disease prevention, nutrition, and improved treatments of formerly fatal conditions.
The proposed risks of anesthesia for the older animal are often touted as the reason not to treat. In fact, most anesthesia deaths at our hospital are in the younger “healthy” patient, not the older animal. Many factors may influence this data but it probably is fair to say that more precautions are taken with older patients to ensure anesthetic safety and well-executed surgery. We have removed over 30 primary lung cancers in the past four years in patients with and average age of 12 years (range 4 to 18). No operative or perioperative deaths occurred. In the last 5 years, over 400 patients with at least 4,000 general anesthetics (every other day for 3 weeks) have received radiation therapy at our hospital with only one anesthetic-related fatality (three year old dog). “Old” is a relative term. Old is as much a state of mind and organ function as it is a reflection of how long you have to live.
Older animals often are a key part of the household and are more vital to the family or owner than younger pets. When I am 60 years young and have a 1 centimeter nodule on my prostate, I don’t want the medical profession or my children to consider me too old for treatment.
A quote by Dr. Larry Blakely is as germane today as when it was written: “Surgery of the older dog is possible, it is justifiable in most instances and, when carried to a successful conclusion, it is the most satisfying branch of small animal medicine.” JAVMA 1953
Why do I write this? It’s not because I am fearful of my children. It is because I fear many older patients are being denied effective treatment because of something they cannot control.
Stephen J. Withrow, DVM
Chief, Clinical Oncology Service
Professor of Surgery
Comparative Oncology Unit
Colorado State University
Fort Collins, Colorado