Managing oncology cases requires special equipment, supplies, and training. While some general practitioners feel comfortable treating cancer, others may prefer not to provide chemotherapy, and few will have access to radiation therapy without referral. In most cases, however, it is the general practitioner who makes the diagnosis of neoplasia and breaks the news to the pet owner.

The referring veterinarian’s role varies depending on several factors, such as the cancer type, treatment plan, treatment modalities, client’s proximity to the specialist, and the referring veterinarian’s comfort level with the disease process and treatment. The following list, though not exhaustive, highlights the responsibilities of the general practitioner following the diagnosis:

Getting started

• Deliver the diagnosis with empathy to the owner (see full discussion in the full version of the guidelines).
• Stage the disease and form a prognosis.
• Create an initial treatment plan.
• Meet with the owner to discuss the prognosis, recommended treatment, and the pet owner’s preferences.
• Discuss with the pet owner the need or desire for referral to a specialist.

Referring the patient

• Communicate with the referral specialists, including, but not limited to, oncologists, surgeons, internists, and radiologists.
• Consult the specialty practice(s) to determine what patient information they require. The information required varies depending upon the specialist, the case, and the patient.
• Compile a complete copy of the patient’s medical records to make available to the specialist, including
  • Description of current disease process
  • Previous medical history
  • Cytology/fine-needle aspirate results
  • Histopathology reports
  • Lab work (blood work and urinalysis)
  • Radiographs
  • Current medications
• Consult with the specialty practice(s) to select a preferred method of communication: phone, email, or other.
• Educate staff about the referral process and all aspects of working with a specialist, for example, preferred method of communication and sharing medical records.
• Educate staff about the patient’s cancer, including diagnosis, treatment, prognosis, disease progression, and the reasons for referring the case.

Developing the treatment plan

• After the specialist sees the patient, develop a treatment plan. The treatment plan may be created by the specialist, the referring veterinarian, or both.

Providing treatment

• The referring veterinarian’s responsibilities depend on the treatment plan. The referring veterinarian may
  • Provide all care.
  • Perform monitoring lab work during chemotherapy protocols, for example, serum chemistry, urinalysis, or weekly CBC tests, and send results to the specialist.
  • Perform surgical procedures (for example, amputation).
  • Monitor and assess surgical sites as well as postsurgical complications.
  • Administer all or some doses of chemotherapy.
  • Dispense medications (antibiotics, anti-emetics, nutritional supplements, gastrointestinal protectants, etc.) as prescribed by the specialist or as necessary due to side effects or complications.
  • Perform serial radiographs to monitor disease and/or metastatic progression.
• Provide hospice care.

Communicating

• Support owners through the process, even if the referring veterinarian is not directly involved in treating the patient.
• Maintain communications among the general practice and referring veterinarian, specialty practice(s) and specialists, and client.