This is a really hard dilemma and one I help clients with most days in my life as a mobile vet.
What do you do when you find out your pet has cancer? Do you go for chemotherapy or surgery and try to extend life so you can share every precious moment with your pet? Or do you decide that limited intervention is the best option and opt to keep your pet comfortable until the time is right to let go?
The answer is not simple. There’s no black and white formula for every pet and every family. Here are some principles I use to guide my clients – I hope you find them useful when you’re facing these difficult decisions.
The first thing I do is help you to understand as much as possible about the cancer. Knowledge is power and helps you make a good decision.
In most cases we have gathered information through tests and we know what we are dealing with. So for example we know the average life expectancy of patients with the same condition, how the disease will affect the patient and, importantly, whether surgery or chemotherapy have any realistic chance of curing the disease or significantly extending the patient’s life, and the impact these will have on the patient.
We also have a chat about your pet’s overall health. The decision to operate on a tumour will be influenced by whether your pet is otherwise fit and well or not. Other factors like your financial circumstances are also very important.
When I am considering if it is right to do something invasive like surgery I want to be as confident as I can be that I will extend good quality life for the patient in my care. So if I see a fit middle-aged dog with a cancer that we have a good chance of removing completely through surgery, chances are I’ll recommend the operation. After all he’ll likely recover from the op in a day or two and go on to have a long and happy life. But in an elderly dog with a concurrent major heart problem we might opt not to operate on the same tumour because of the potential serious risk associated with these other diseases, and also the significantly decreased life expectancy that may be present.
My approach to chemotherapy is similar to that of surgery with regard to the decision to proceed. In veterinary medicine, the approach to chemotherapy is different to that in humans. The individual human suffering from cancer will consent to the various chemotherapy options understanding the total impact this may have on him or her. We usually treat with the highest possible chemotherapy doses in the hope of complete remission or even cure, and we are prepared to suffer the terrible side effects, sometimes life threatening in themselves, in doing so.
The human paradigm is typically to prolong life at all costs. Nowadays this philosophy is being intensely scrutinized which could be the subject of a whole entire other blog. Because our pets are wholly dependent on us and cannot consent to this degree of suffering in order to potentially be cured, we cannot humanely put them through it. So the philosophy in veterinary cancer treatment is to use the highest possible chemo dose that will result in the lowest potential side effects balancing the best outcome possible for the patient with these restrictions in place. And so for this reason, in many cases chemotherapy is less effective in dogs and cats than in humans, with shorter remission times. There are certain cancers where we see great results – but for some cancers chemotherapy has a genuine risk of making your pet feel really unwell without significantly extending their life.
It comes down to balance. If there’s a treatment with limited side effects that will extend life significantly then I’m happy to recommend it. But if the drugs are just going to make my patient feel bad and not significantly improve the outcome I find it hard to recommend that as an option.
In many cases where pets are elderly or the cancer is incurable, veterinary cancer care involves keeping a patient comfortable and helping them to enjoy a good quality of life for as long as possible. This might mean that we use supportive drugs like painkillers and antibiotics to treat secondary infections and offer you advice and support on the best way to care for your pet.