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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:

• Appetite
• 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.

We strive for a “holistic” approach and focus both on quality of life and longevity. You can play a crucial role in maintaining your pet’s quality of life. Keeping your pet on a high quality diet and providing plenty of play time and exercise can help. Keeping your pet lean and fit helps. Inform us about supplements you may be using so that we can make sure there are no negative interactions with treatment. Ask for preventive medications such as anti-nausea drugs in advance so that should a problem arise, it can be treated and ended quickly. Stick to the recommended schedule provided by the oncology department. Read the discharge instructions and ask questions if you don’t understand what is written or if there is anything of concern. Maintain a positive focus and try to minimize stress for both you and your pet. Keeping a log of activity level, elimination, appetite, and other quality of life parameters can also help you provide an accurate picture to us during treatment so that we can make the best treatment decisions and provide the best possible care for your pet.

Admittedly, it’s harder in pets. They can’t tell us what’s wrong, but we can observe changes in behavior that can signal potential pain. Decreased activity, change of routine, limping, and decreased interest in daily walks or normal activities can signal pain. If a dog is not only limping but only toe touching or – worse – not bearing weight on a limb, then that pet is experiencing significant pain.

Some patients may appear dull or depressed. Others may lose appetite or become “snappy” when certain areas of the body are manipulated or touched. They may be restless and unable to sleep comfortably. They may sit or stand even when they seem exhausted. Some will vocalize or chew at themselves. Some with acute pain may have rapid, shallow breathing. These patients may also stare into space with pupils dilated and be unwilling to interact.

It's important to note that cancer is not always painful. For example, when lymph nodes are enlarged because of infection, they are often painful. With lymphoma, more often they are not. Even large abdominal masses just take up space in the body and only cause problems when they enlarge enough to push on normal structures. However, bone and joints tumors, gastrointestinal or pancreatic tumors, and advanced staged tumors, particularly those that fill the lungs with disease, can cause significant distress and pain. Mast cell tumors, while not considered painful, can cause stomach ulcers and are often irritating and itchy.

We will let you know if we believe your pet is in pain and will let you know whether we believe treatment can help. Most often, we can provide pain medications or preventives that help diminish the ill effects of a tumor, though we also depend on you to help us know how your pet behaves outside in the normal household environment.

Nutrition plays an important role in a cancer patient’s overall health and fitness. In general, we recommend a patient stay in optimal health, which means maintaining ideal body weight and not gaining or losing too much weight. It means exercising daily if possible, and eating a balanced, well rounded diet. Fortunately, most canine meals are well rounded; however, both human and canine data indicate that cancer patients may benefit from minor alterations from the daily diet.

Cancer cachexia is a condition of muscle wasting associated with advanced stage disease. It’s relatively uncommon in canine cancer patients. Because we strive to maintain life quality through treatment, most often we deal with weight gain. However, cats sometimes have a harder time with maintaining weight through treatment.

Data extrapolated from human and canine research show that the cancer patient’s diet should be based on the following principles:

1. Simple sugars should be reduced, as tumors use these preferentially as an energy source.
2. Preservative-free, high quality protein and fat sources (fish or meat) should be used. If fish is consumed, the pet owner should be savvy about the potential for elevated mercury levels.
3. Supplementation with omega-3 fatty acids (fish oil) is recommended.
4. Vitamins and supplements should be used in moderation and only as recommended. Commercial canine diets have been developed based on research into the nutritional needs of dogs and have been supplemented to meet canine needs. Recent human studies have shown that mega doses of vitamins can be detrimental. They feed the tumor, too.

A diet with more than 30% protein and less than 20% carbohydrates is optimal. In general, we recommend you stick with a commercial diet and can make recommendations. However, some owners want to home cook. If so, we can provide recipes for home diets. We DO NOT recommend using raw meat diets. These can make a patient ill with bacterial infections just as eating raw meat can make a human ill. As for vegetables, avoid onions. The darker the vegetable, usually the healthier it is. Finally, cats are obligate carnivores. They should never be fed vegetarian diets.

Alternative medicine comprises treatments generally not recognized by the medical community as standard-of-care or conventional. This is because these treatments have only anecdotal accounts to support their use and do not have sound scientific backing to support claims of effectiveness. Should these treatments undergo testing and evaluation and be proven to work as well as or better than conventional ones, alternative treatment can then gain wide acceptance and become standard-of-care.

Complementary medicine comprises treatments used to enhance or complement conventional strategies. While many complementary approaches are not recognized by the medical community because of lacking proof or evidence of conflicting information or potential harm, some can improve or enhance patient quality of life. Some of these approaches involve dietary changes, lifestyle habit or exercise changes, acupuncture, massage therapy, magnet therapy, and the addition of supplements or vitamins. In general, it’s best to discuss these approaches with your pet’s oncologist. He or she may not know of the specific treatment but will strive to learn about and evaluate these treatments to make the best recommendations for your pet’s health and safety.