Palliative Care & Quality of Life in Veterinary Patients with Cancer

Elizabeth Hugger, DVM, Lap of Love Veterinary Hospice, Apollo Beach, Florida

ArticleLast Updated July 20233 min read
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In the Literature 

Repetti CSF, Rueda JR, Porto CD, et al. Palliative care for cancer patients in veterinary medicine. Vet Med (Praha). 2023;68(1):2-10. doi:10.17221/76/2022-VETMED 

The Research … 

The incidence of cancer is increasing as companion animals live longer due to medical advancements.1 Systemic spread of cancer contributes to deterioration of patient quality of life, and palliative care can help alleviate and prevent suffering when curing the disease is not a viable option. 

Pain and cachexia are common clinical signs in companion animals diagnosed with cancer.2-4 Addressing these common signs early in the disease process can improve overall patient quality of life. Signs of cachexia are typically easy to recognize, but pain is often more subtle. Understanding and recognizing the different types of pain, as well as helping pet owners recognize them, is crucial. Multimodal pain control is recommended and can include NSAIDs or corticosteroids, opioids (eg, codeine, tramadol), anticonvulsants (eg, gabapentin), tricyclic antidepressants (eg, amitriptyline), and potentially cannabinoid therapies. Nutritional support for cachexia includes highly palatable diets, appetite stimulants, and antiemetics. 

Cancer disease progression should be discussed at the time of diagnosis. Tools to quantify quality of life can help provide an objective measurement of something otherwise subjective (see Suggested Reading). Quality-of-life scales provide information on the evolution and progression of disease. 

Most cancer patients are euthanized before unassisted death occurs. Patient comfort should be prioritized if euthanasia is elected. Ensuring the patient is able to stay with the owner is essential, regardless of whether euthanasia is performed in the home or at the clinic. Pre-euthanasia sedation should be provided to reduce stress and discomfort. 

… The Takeaways 

Key pearls to put into practice: 

  • Management of clinical signs is the cornerstone of palliative care. Early intervention in cancer palliative care via multimodal pain control and nutritional support provides the most significant benefits. 

  • A quality-of-life scale can provide quantitative measurements to monitor progress over time and should be reviewed with owners to assist with the decision to euthanize. Numeric values can help remove emotion from the decision-making process and reveal trends when euthanasia is contemplated. 

  • Owner quality of life should also be considered. Owners typically have financial and emotional limits. Euthanasia may be the best option if an owner has met or exceeded their emotional capacity, even if other treatment options exist. 

  • Disease progression (up to and including patient death), euthanasia, and quality of death should be discussed with owners. Although clinicians and owners often focus on quality of life, quality of death and the owner’s vision for the end of the patient’s life are equally important. 

Related CE: Hospice & End-of-Life Care