Our two primary goals are to give our patients the best possible life quality for as long as we possibly can. Life quality, however, is the most important goal. Ideally, we’d want our patients taking walks on the beach, playing Frisbee in the backyard, eating their favorite treats, and spending quality time with the families they love.
A cancer diagnosis and the prospect of treatment can be terrifying for owners. In a very few cases, the cancer is so aggressive or advanced at diagnosis, that little that can be done. Most of the time, however, we can help.
It’s well known that most cancer treatments can have side effects. In humans, they are usually more severe because the doses used are much higher and more drugs are combined at once. Even at the doses we use, treatment risks exist that are weighed against the potential benefits. If cure or long term control (one year or more) is the goal, short-term treatment risks are more acceptable. A few days of decreased life quality are worth months to years of good life quality.
If the cancer is highly aggressive or advanced, the primary treatment goal is palliation. That means we focus on improving life quality without expectation of significant increase in life extension. Palliative treatments are less likely to cause adverse effects. These treatments focus on improving nutrition, clearing infection, and treating pain. Sometimes, radiation or chemotherapy treatment may be used to shrink the tumor and diminish associated pain. However, dosing is adjusted so that short-term risks are minimized.
Unfortunately, veterinary patients cannot tell us how they feel. We have to rely on their behavior. We consider 5 important aspects:
- Mental status
- Body condition
- Activity level and ability
- Elimination (urination, defecation)
Dogs that are otherwise healthy and have few additional disease processes at diagnosis tend to tolerate treatment well. Older dogs, as long as they are healthy, tolerate treatment well.
Many owners also express concerns about the stress placed on their pet from more frequent visits to the hospital. We don’t want treatment to be a stress and take time to play with and pet our patients during the visit. We use positive reinforcement and treats and have a variety of toys in the treatment room. One of the most satisfying statements for us to hear is that our patients actually enjoy their visits, as many of them eventually do. If we believe visits are too stressful for a particular patient, we will let you know.
Quality of life is ultimately subjective and can mean different things to different people. Sometimes, it declines gradually, and changes are more notable to those who observe the patient less frequently. As veterinarians, we consider ourselves the pet’s advocates and try to help you assess when quality of life has diminished too much. At a minimum, we believe a patient should be able to eat and eliminate normally, sleep comfortably, breathe without undue effort, and interact with the family willingly.
If a pet comes to a point where these actions are not possible and we can do nothing to improve quality of life, we believe euthanasia is the appropriate option to avoid prolonged suffering. Our pet’s lives are in so many ways gifts to us, and if they are suffering, it’s sometimes the last kindness we can offer.