The Oncologist on My Shoulder: Veterinarians Pay for Online Consultations and Treat Cancer Patients
He may not be an oncologist, but Keith Taylor, DVM, at Rockwall County Veterinary Clinic in Texas, administers chemotherapy through veterinary access ports that are surgically implanted in cancer patients. All the information he needs to provide some oncology care is available through the Internet, he said.
“If it doesn’t need radiation, I don’t need an oncologist,” explained Taylor, who uses a telemedicine service to develop and implement cancer treatment plans. “It brings a certified oncologist into every veterinary clinic that wants it,” he added.
Taylor is one of 1,000 veterinarians in North America to join Oncura Partners, an online medical record system that connects general practitioners to veterinary oncologists for a membership fee.
While some members call the service “oncology for dummies,” specialists in the field worry that telemedicine increases the potential for misdiagnoses and for missing clues about simultaneous disease.
“This is not a trivial form of therapy,” said Barbara Kitchell, DVM, PhD, DACVIM, president-elect of the Veterinary Cancer Society. While Kitchell appreciates the fact that telemedicine extends medical treatment to pets in need, she acknowledges that consultations are only as good as the information doctors receive. As a result, she hopes that telemedicine will be used to supplement, not replace oncology visits. "There is so much emotional conetent" in an oncology meeting, Kitchell said, "Its better to have a meeting with the client so that you know a client understands the pros and cons of any treatment option, and can discuss things like, how much time has he got?"
Because cancer can be tricky, Kitchell believes that oncologists should see patients and review charts. “It’s easy to make an assumption based on the information given to you,” said Kitchell, who trains professionals in oncology and has discovered that while cases may sound simple on paper, a physical exam can dramatically change a diagnosis.
For example, patients oftentimes present with neoplastic disease concurrent with multiple tumors and there is always a chance for adverse effects once treatment has started. “There is an increased risk for error if the animal is not in front of you,” she explained.
Taylor, who has used the Oncura Partners service for several years, admitted that he was intimidated at the beginning but said, “Once I got over the fact that I [was] doing this in my clinic, it was easy.”
Established in 2001 by Brian Huber, DVM, ABVP, Oncura Partners enables general practitioners to care for patients that may otherwise be referred or — as he said — not receive treatment. Huber believes that it is the only service of its kind, though colleges and specialists have provided telephone consultations for many years.
“My clients don’t have to drive across town, and the income stays right here,” Taylor said.
That convenience may save pet lives, said Huber, who has worked in the industry for 22 years and believes that some pets are euthanized because pet owners either do not know about veterinary cancer treatment or do not have access to it.
“In the real world, out of 10 [pets] that need radiation therapy as a premiere choice, one [client] is going to choose it,” Huber said. “There are many more who need another choice, which defaults to chemotherapy,” a treatment that — he says — minimizes pain, improves quality of life, and slows cancer growth.
It is also something that general practitioners can be trained to do, he added.
Once cancer is diagnosed, member veterinarians, who pay a $10 initiation fee, send relevant data —including a patient’s physical exam, urinalysis, blood profile, and pathology reports — to Oncura Partners. If the diagnosis is confirmed, treatment programs — from surgery and radiation to chemotherapy — are recommended. The veterinarian acts as liaison with the client. Questions are usually answered within 24 hours, Taylor said.
“We train and educate online to help the veterinarian feel comfortable managing cases,” Huber said. The only limitation, he added, is a practitioner’s comfort level with required procedures, such as bone marrow aspirations and aggressive surgeries.
Taylor, who has used Oncura Partners successfully with lymphoma cases, has also referred some patients since he signed up for the telemedicine service. “One case was pretty tricky,” he said. “I didn’t feel comfortable with it. There was something I was a little afraid of.”
Consultations are available to members who are charged $135 for the first four weeks of unlimited oncology consultations and protocols. Members pay as they go for chemotherapy prescriptions, which are prepared by a compounding pharmacy and sent to veterinary clinics. After the first four weeks, there is a $45 per month management fee, Huber said. There is no limit to the number of consultations members receive.