我们在伴侣动物中看到的常见癌症（例如，淋巴瘤和肥大细胞瘤）是我亲切地称为兽医肿瘤学家治疗曲目的“面包和黄油”。有丰富的信息有关治疗这些疾病和大多数案件预后和结果的理想方式的理想方式。
尽管常见的事情经常发生，但在我作为肿瘤医生行医的这几年里，我注意到一个特殊的趋势。最近，我似乎越来越少看到那些“直接”的病例，而越来越多的是不寻常类型的肿瘤。
人们可能认为这是疾病频率降低/增加的结果;然而，狗和猫仍然经常在前几年的经常发展“常规”癌症。那么面包和黄油案件发生了什么？
似乎在更多“直截了当”的情况下，主人们选择让他们的宠物接受初级护理，而不是专家的治疗。
在表面上，有几个因素可能影响这一趋势，包括：
地理位置:虽然你可能会在我工作的地方附近找到几家专科医院，但在许多其他地区，情况并非如此，找到专科医生可能很困难。缺乏便利性是导致较低的推荐率和较低的业主依从性的一个主要因素。
所有者舒适：在许多情况下，他们的主要兽医是他们的宠物在幼年或幼年时就信任的人。尽管我受过高级训练，经验丰富，但他们对常规兽医的信心仍然很高，如果他们的医生对治疗计划表现出信心，他们甚至不会考虑要求转诊。
业主财务：运行兽医专业服务的开销远远大于一般兽医办公室，这是在定价方案中传输的。与业主谈论钱永远不容易，我不能真正争辩，当时所有者问：“让我的兽医完成的治疗不那么昂贵？”
It’s difficult to translate to an owner that the increased price at my hospital covers so many hidden aspects of their pet's care, from the high cost of the specialized closed containment system we use to make sure our chemotherapy treatments are administered safely, to the maintenance for the biosafety hood we use to draw up the drugs.
较高的价格也涵盖了技术人员的工资，他们可以在治疗的并发症患者治疗他们的宠物，并确保我能够参加持续的教育研讨会，以保持最先进的疗法可用于他们的宠物护理。
推荐兽医财务：如果主要的兽医人舒适且自信地管理普通癌症“在房子里”，他们往往不会将患者推荐给专家，因为保持案件更接近家庭，不仅与业主保持密切关系。
在某些情况下，业主甚至可能甚至不知道转诊是一种选择，因为他们的初级保健兽医并不建议它。A recent study showed that (among other reasons) veterinarians were more likely to refer cancer cases when they had positive perceptions of 1) the pet’s health status, 2) the interaction and bond between the client and dog, and 3) the client’s financial status. The study also showed that about half of the primary care veterinarians did not even feel cancer was as worthwhile to treat as some other chronic diseases. Those factors are extremely subjective and not things doctors should be deciding for owners.
The issue of not offering a referral to an oncologist isn't limited to general veterinarians, but also can be a problem amongst non-oncology boarded specialists (e.g., internists, neurologists, surgeons, veterinary dentists, etc.) who routinely prescribe chemotherapy treatments for their patients. When one of “my own” fails to stress to owners the benefit of seeing me for even what would be considered a routine cancer case, it further contributes to the lack of valued perception of my profession.
一个合理的问题是，如果宠物与专家对其初级保健兽医治疗有所不同，它会有所不同吗？Though I’m not aware of this question being asked directly for tumors treated solely with chemotherapy, an older study which examined the outcome of cats undergoing surgery for presumed injection site sarcoma found that the prognosis was significantly longer when surgery was performed by a veterinary surgeon versus a primary practitioner. I would venture a similar benefit would be seen in pets with cancer treated by an oncologist versus a general practitioner.
理想情况下，每只患癌症的宠物都有机会接受专家的治疗。事实是，对于绝大多数宠物来说，这不是一个选择。当经济或地理因素是主要因素时，我可以接受这些是我们的职业无法控制的。
However, if the issue is simply a lack of owner perception of the value of undergoing treatment with a specialist versus a primary veterinarian, and we wish to pride ourselves with offering standard of care on par with our human counterparts, don’t we owe it to our patients and owners to discuss all options and empower them to make the best decision possible for their pet?
Joanne博士Intille.
图片：ThinkStock.