Quality of Life
Quality vs. Quantity
The goal of cancer treatment in the veterinary patient is to achieve a good quality of life for as long as possible. Quantity of life is meaningless without quality. But quality issues are vague and changeable so it is easy to focus instead on quantity because that is a specific, well-defined goal. It is important to keep these two factors in balance. Your veterinarian should provide perspective and be objective and well-informed about cancer, its treatment and how it is likely to affect your pet. On the other hand, you know your pet the best, and criteria for determining one animal’s quality of life may not fit for another.
Assessing Quality of Life
Quality of life means different things to different people. For some people, it is their pet chasing a ball or greeting them at the door. For others, it is knowing that pets are eating and sleeping through relaxing, painless days. One of the difficulties in evaluating your pet’s quality of life is that it can decline gradually. For someone living with a pet, there may be no obvious daily changes, while to someone who only sees your pet every few weeks or months there could be a dramatic change. Because of this, we encourage owners to establish and document their own personal “minimum standards” of quality of life for their pet at the start of cancer treatment. For example, it might be a pet’s lack of interest in eating or going on walks. It might be a pet’s struggling to breathe or inability to “get comfortable”.
Because we cannot ask our pets how they feel, we have to rely on their behavior and from this infer the quality of life. Veterinary oncologists have developed measurements of quality of life. The ‘quality of life’ scale developed by Dr. Alice Villalobos (pawspice.com) allows both the pet’s family and the veterinarian to assess overall quality of life. It considers factors that affect an animal’s ability to carry on its normal activities. They are: alertness/mental status, appetite, weight/body condition, activity/exercise tolerance, and elimination behaviors. Not only is this assessment a good indicator of how your pet feels overall, it also provides 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 who score lower on the scale.
Balancing Cancer Treatment and Side Effects
Cancer treatment usually involves side effects that can affect a pet’s quality of life. The degree of side effects that are tolerable depend on the goal and expected outcome of treatment. If our hope is for a cure or control of cancer (which in veterinary medicine usually means one year or longer), then we may be willing to tolerate treatment side effects with a higher risk, severity, and duration. Some risk of temporary decreased quality of life seems reasonable in exchange for many months of good quality of life. Every owner and veterinarian will have their own opinion as to what constitutes acceptable and unacceptable risks and side effects. It is important to thoroughly discuss these concerns with your veterinarian so that together you can work toward a common goal.
Palliative Treatment
If we believe a cancer is incurable or impossible to control, then our goal becomes one of palliation, which is an attempt to maintain or improve quality of life without attempting to prolong it. We are unwilling to accept anything but minimal treatment side effects because the treatment should not be worse than the disease. Palliative care focuses on supportive measures such as controlling pain and infection and providing adequate nutrition.
End of Life
There often comes a point in the treatment of our veterinary cancer patients when we have exhausted all reasonable treatment options, and there is a low probability for quality of life in the future. We must remember that just because a treatment is technically possible does not mean that it is the best thing for our patients. We are then faced with euthanasia as the last treatment option. Just as we have intervened in the pet’s life by providing aggressive medical care in an effort to improve and prolong quality of life, we intervene when these methods are no longer effective so that we do not prolong needless suffering. It is the last act of kindness we can offer.
Quality of Life Scale(The HHHHHMM Scale) |
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Pet caregivers can use this Quality of Life Scale to determine the success or Pawspice care. Score patients using a scale of 0 to 10 (10 being ideal). |
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Score |
Criterion |
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0-10 |
HURT – Adequate pain control and breathing ability is of top concern. Trouble breathing outweighs all concerns. Is the pet’s pain well managed? Can the pet breathe properly? Is oxygen supplementation necessary? |
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0-10 |
HUNGER – Is the pet eating enough? Does hand feeding help? Does the pet need a feeding tube? |
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0-10 |
HYDRATION – Is the pet dehydrated? For patients not drinking enough water, use subcutaneous fluids daily or twice daily to supplement fluid intake. |
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0-10 |
HYGIENE – The pet should be brushed and cleaned, particularly after eliminations. Avoid pressure sores with soft bedding and keep all wounds clean. |
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0-10 |
HAPPINESS – Does the pet express joy and interest? Is the pet responsive to family, toys, etc.? Is the pet depressed, lonely, anxious, bored or afraid? Can the pet’s bed be moved to be close to family activities? |
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0-10 |
MOBILITY – Can the pet get up without assistance? Does the pet need human or mechanical help (e.g., a cart)? Does the pet feel like going for a walk? Is the pet having seizures or stumbling? (Some caregivers feel euthanasia is preferable to amputation, but an animal with limited mobility yet still alert, happy and responsive can have a good quality of life as long as caregivers are committed to helping their pet.) |
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0-10 |
MORE GOOD DAYS THAN BAD – When bad days outnumber good days, quality of life might be too compromised. When a healthy human-animal bond is no longer possible, the caregiver must be made aware that the end is near. The decision for euthanasia needs to be made if the pet is suffering. If death comes peacefully and painlessly at home, that is okay. |
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TOTAL |
A total of 35 points represents acceptable life quality to continue with pet hospice (Pawspice). |
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Feline Quality of Life Scale(The HHHHHMM Scale) |
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Feline caregivers can use this scale to evaluate the success of their Pawspice program. Grading each criterion using a scale of 0 to 10 (10 being ideal) will help caregivers determine Quality of Life for sick cats. |
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0-10 |
HURT – Adequate pain control, including breathing ability, is the first and foremost consideration. Is the cat’s pain successfully managed? Is oxygen necessary? |
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0-10 |
HUNGER – Is the cat eating enough? Does hand feeding help? Does the patient require a feeding tube? |
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0-10 |
HYDRATION – Is the patient dehydrated? For cats not drinking or eating foods containing enough water, use subcutaneous fluids once or twice daily to supplement fluid intake. |
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0-10 |
HYGIENE – The patient should be kept brushed and cleaned. This is paramount for cats with oral cancer. Check the body for soiling after elimination. Avoid pressure sores and keep all wounds clean. |
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0-10 |
HAPPINESS – Does the cat express joy and interest? Is the cat responsive to things around him (family, toys, etc.)? Does the cat purr when scratched or petted? Is the cat depressed, lonely, anxious, bored, and afraid? Can the cat’s bed be near the kitchen and moved near family activities so as not to be isolated? |
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0-10 |
MOBILITY – Can the cat get up without help? Is the cat having seizures or stumbling? Some caregivers feel euthanasia is preferable to definitive surgery, yet cats are resilient. Cats with limited mobility may still be alert and responsive and can have a good quality of life if the family is committed to providing quality care. |
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0-10 |
MORE GOOD DAYS THAN BAD – When bad days outnumber good days, quality of life for the dying cat might be too compromised. When a healthy human-animal bond is no longer possible, caregivers must be made aware that their duty is to protect their cat from pain by making the final call for euthanasia. The decision needs to be made if the cat has unresponsive suffering. If death comes peacefully and painlessly at home, that is okay. |
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TOTAL |
A total score of >35 is acceptable Quality of Life for maintaining a good Feline Pawspice. |
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Original concept, Oncology Outlook, by Dr. Alice Villalobos, Quality of Life Scale Helps Make Final Call, VPN, 09/2004; scale format created for author’s book, Canine and Feline Geriatric Oncology; Honoring the Human-Animal Bond, Blackwell Publishing, 2007. Revised for the International Veterinary Association of Pain Management (IVAPM) 2011 Palliative Care and Hospice Guidelines. Feline Scale created by Villalobos and adapted for Feline Internal Medicine |