Your pet’s quality of life is the biggest factor we consider as we discuss treatment options. We will work with you to make sure we are doing the absolute best thing for your pet.
Quality vs. Quantity
Our goal in treating your pet’s cancer is to cure the disease while maintaining a good quality of life, however, in many instances a cure is not possible. In these cases, our goal is to achieve a good quality of life for as long as possible. We believe quantity of life is meaningless without quality. As a result, it is important to keep these two factors in balance. We will help provide perspective by being both objective and well informed about your pet’s cancer and the potential side effects they may experience. It is important to realize that you know your pet best and criteria for determining one animal’s quality of life may not fit for another.
Assessing Quality of Life
Since we cannot ask our pets how they are feeling, we rely on their behavior to assess their quality of life and always assume that they do not want to be uncomfortable. Quality of life means different things to different people. For some people it is watching their pet chase a ball or greet them at the door; while for others, it is observing their pet eating, sleeping, and relaxing – while doing so with minimal pain. In many ways, this is a personal, subjective assessment and as an owner, you play a big role in helping us determine your pet’s quality of life.
One of the difficulties in evaluating a pet’s quality of life is the gradual decline a pet may experience. This decline is sometimes more difficult for the caretaker to notice on a daily basis and is often more apparent to people who see the pet less frequently (weeks-months). Because of this, we encourage clients, at the start of cancer treatment, to establish and document their own personal “minimum standards” with respect to quality of life for their pet. Minimum standards may include decreased interest in eating, playing with a favorite toy, or going on walks. It could also include difficulty getting comfortable or trouble breathing.
Veterinary oncologists have developed measurements to assess quality of life. The Animal Medical Center in New York City developed a “Performance Scale” that allows both the pet’s family and the veterinarian to assess overall quality of life by considering five factors that affect an animal’s ability to carry on its normal activities. These factors are:
- alertness/mental status
- weight/body condition
- activity/exercise tolerance
- elimination behaviors
This assessment is a good indicator as to how one’s pet feels overall, while also providing useful medical information. In general, animals that score high (i.e., have close to normal behaviors) tend to tolerate treatments well and do better overall than animals that score lower on the scale.
Balancing Treatment and Side Effects
It is important to point out that the majority of side effects are self limiting and resolve within a short period of time. Also, if necessary, medications are used to combat side effects and maintain your pet’s quality of life. Less than ten percent of dogs and cats undergoing cancer treatment need to be hospitalized for side effects. Each person has their own opinion as to what constitutes acceptable and unacceptable risks and side effects; therefore, it is important to thoroughly discuss these concerns with your oncologist so, that together, you can work toward a common goal for your pet.
The goal of cancer treatment is to kill cancer cells, but in doing so, normal tissues can also be affected leading to side effects which in turn can affect the patient’s quality of life for a period of time. For many families, the extent of side effects that one considers tolerable for their pet often depends on the goal and expected outcome of treatment. If our hope is for a cure or control of the cancer (which in veterinary medicine usually means survival of one year or longer), then we may be willing to tolerate treatment side effects with a higher risk, severity and duration.
Palliative therapy is considered when long term control or a cure is unlikely, or for various other reasons the family decides against aggressive therapy. The goal of palliative therapy is to improve and/or maintain your pet’s quality of life with minimal negative impact. While palliative therapy is not meant to increase survival time, this may be an outcome if the patient feels better as a result of treatment.
End of Life
There often comes a point in the treatment of our veterinary cancer patients when we have exhausted all reasonable treatment options including pain management and your pet’s quality of life has deteriorated to an unacceptable level. At this point, even with possible treatments still available, it may not be best for them. When this stage is reached most people consider humane euthanasia to prevent suffering as the cancer progresses.
For families not interested in euthanasia, we will try to provide supportive medical care and may also refer you to a veterinary hospice specialist. We believe euthanasia is a humane, painless process with minimal undue stress on your beloved pet. In fact, believe it is the last act of kindness we can offer to our beloved companions.