The thoughts of one veterinary oncologist…

Deciding to Treat

When a pet is first diagnosed with cancer, owners may be overwhelmed with emotion and questions. Some will be so overwhelmed that they instantly decide to euthanize, unable to process any additional information for another minute, just knowing their pet has cancer. Other owners want information – they seek answers to the questions like what type of cancer does my pet have, how is this cancer treated, what is the prognosis, and what does treatment cost?

As an oncologist, I’m here to try and provide information and options. The decision to treat is initially based on prognosis and treatment options, both of which are usually outlined during an oncology consultation. The next big factor for owners is time, what is it worth? For some owners, if they can get an extra good week with their pet they are thrilled for other owners if they can’t have an additional 3 years they are not interested in treatment.

The time we achieve during treatment needs to be good quality time.  As an oncologist, I am a resource to discuss the quality of life with owners.  I want my patients to have the best quality of life possible during treatment. Surprisingly,  I have to make this known to most owners pretty quickly during their consultation. The primary reason I have to do this is the word “chemotherapy”. It is one of the most emotionally charged words in medicine, second to “cancer”.

Chemotherapy plays a role in treating most oncology patients. In veterinary oncology, we use palliative chemotherapy doses compared to human oncology where they more commonly use curative intent doses. This difference has a huge impact on side effects. Side effects are much less common in pets treated with chemotherapy. Side effects for pet chemotherapy occur in about 10-17% of pets. This is comforting for most owners and oncologists as it suggests there is a good chance quality of life should be good while being treated with chemotherapy. When side effects do occur they are not okay.

Owner feedback and patient assessment guide us to quickly reduce doses below standard or look for alternative treatment options. So when owners say “I don’t want to put s/he through that” I can agree and say, I don’t want your pet going “through” anything either. With this in mind, there is usually a treatment option for most situations. I try to present 3 options for every owner when every possible and encourage owners to ask for additional options whenever they are concerned. The decision to treat is a personal one and the decision should be made based on the information. An oncology consultation is the first step in getting the information needed for an educated decision.

Deciding to Say Goodbye

The first step is defining your pet’s quality of life. I often ask owners to think of the 5 things that make their pet tick. What habits or activities make them who they are, the 5 things that bring them the most joy and happiness. I recommend writing these five things down shortly after diagnosis, while things are relatively good. Once a pet has lost 3 out of the 5 they likely do not have the quality of life they deserve.

At some point, the day will come where treatment options are scant and a pet starts to suffer from their disease, adversely impacting their quality of life; essentially 3 out of 5 joys are clearly gone. At this point, it is important to consider euthanasia. This is a very difficult but a very important decision. The decision usually needs to be made by the owner and veterinarian, rather than waiting for “mother nature”. Sadly, a natural death is not typically a pleasant one. Euthanasia is the final gift, it allows the owner to say goodbye lovingly before the pet starts to suffer and panic from their body failing them. Pets should pass peacefully surrounded by their loving family not alone or afraid.

By M.J.Hamilton, DVM, DACVIM (Onc)

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