This brilliant expression is borrowed from John Diamond (1953-2001), a British broadcaster and journalist. “Cancer is a word, not a sentence”… what a witty statement.
As pet owners provide better vaccinations, better dental care, better food, better medications, better medicine and better surgery, our pets live longer and longer. Sadly, as the pet population ages, pets face diseases similar to people, including cancer.
Fortunately, there are many types of cancers that we can help – and occasionally cure. He same cannot be said about other diseases, such as chronic kidney disease, chronic heart disease or chronic liver disease.
Even if survival is not very long, based on statistics, it is important to understand the difference between quality of life and quantity of life.
Quantity of life, aka survival, is how long your pet might live based on statistics: 3 months, 6 months, 1 year… It is important to understand what this means.
What do we mean when we refer to a study that says that with cancer X, pets survive an “average” of 1 year? It means that some (rare) pets lived for 2 months and some (rare) pets lived for 2 years. But on average, most lived around 1 year. Remember the bell curve? Of course, we have no way of knowing how long your particular pet might live.
You also may hear about the “median” survival time. The median is different from the average. As a reminder, the median is the number separating the lower half of a group from the higher half. In other words, if the median survival age is 10, half the dogs were younger and half the dogs were older when they died.
Quality of life is a whole different story. Quality of life means that we want our pets to be capable of doing certain basic things. In other words, a pet should be able to eat, drink, breathe, pee, poop, walk, sleep and be comfortable. And hopefully, seem happy in the process.
If one of these basic functions is not possible, then we need to decide if we can correct the problem, or if the pet’s quality of life has become unacceptable.
Clearly, this is a very difficult and subjective proposition. In addition, things change over time. Life can be happy in March, tough in June, and miserable in September. Sometimes, because the changes are so subtle, pet owners may not even realize the progression. One of the best ways to look at things in an objective manner is to use the “Quality of life scale” designed by Dr. Alice Villalobos, a cancer specialist in California*.
You can find and print the “Quality of life scale” at: QualityofLifeScale.pdf (pethospicevet.com)
Please note that this chart should not be used only for a cancer patient, but for any pet who is starting to have health issues. If you ever question your pet’s quality of life, please use the chart.
I usually suggest that my clients print several copies, and assess the situation once a week (for example). It can be tough, but it is one way to face reality objectively. Denial is the worst thing you can do for your pet.
Speaking of quality of life: I consider that pain is unacceptable in this day and age (in pets or people by the way). Sure, it’s tough to eliminate discomfort 100%, but we should be able to decrease pain very significantly. We have made tremendous progress in the past few years, and we now have access to a large number of safe options to help cats and dogs live comfortably.
There are even a few veterinary specialists throughout the country who specialize in pain management only! Even if you don’t have one near where you live, some accept to do phone consultations or practice telemedicine.
Another important piece of advice, based on personal experience: if you don’t find the help you want from your family vet, then find yourself a new one. I am aware that it may sound harsh, but I say that with a lot of respect for my colleagues. Over the years, I have heard all kinds of stories from my clients that lead me to believe that some vets consider cancer as a death sentence, and are simply not willing to explore certain perfectly acceptable and ethical options.
In fact, a practice owner recently told me: “we don’t believe in chemo in this practice, so we don’t recommend it.” I was so surprised, I didn’t know what to reply, or I didn’t want to argue. Chemo is not a matter of believing or not believing. It’s a matter of science. There are thousands of scientific articles that show that chemo helps patients, while providing a good quality of life. Some vets dedicate their lives to find better, gentler protocols.
A pet lover called me recently asking if I would give chemo to her dog, who was amputated a few months prior for bone cancer (osteosarcoma). For the record I don’t give chemo, I am strictly a surgeon. Her family vet never even mentioned chemo as an option, although we know that chemo can significantly increase (ie double) survival in this situation. Sadly, by the time she called me, it was probably too late to consider chemo.
Which leads me to another point: as your pet’s best advocate, you have to find other sources of information if you feel like you are not getting the answers you deserve from your family vet. Rather than ending up in some chat room with clueless people, ask for a second opinion, or better yet, ask for a referral to a specialist. There are specialists in just about every area of medicine, similar to human medicine.
So of course, there are cancer specialists, called oncologists, who treat cancer every single day. You may not like what they have to say, or may not be able to afford the treatment they offer, but that’s a different story. At least, they will tell you what they have to offer based on the latest scientific information available.
And on the surgery side, there are clearly some surgeons who deal with cancer more often than others. For example, in my practice, cancer is pretty much a daily occurrence.
Based on the information you have received, you can make an informed decision. Not based on junk read in a chat room, or stories heard from your neighbor or a stranger met at a barbecue.
Speaking of the Internet, there actually are some excellent sources of information, but I am aware that it may be tough for pet owners to know which is which. Info given by vet schools and specialized clinics should be reliable. Some Yahoo groups are excellent, as long as you remember that they can only be as good as the people who visit those sites. The vast majority of people who share their opinion are pet owners, who may or may not have a clue what they are talking about. I would generally trust a “veteran” over a “rookie.”
I don’t want to deny that there are some rare forms of cancer with which we feel completely helpless. Either because the owner has procrastinated so much, that there is not much we can do anymore. Or because it is, quite simply, an incredibly aggressive type of cancer.
But in the vast majority of cases, we can help our patients live for a decent amount of time, while preserving their quality of life and their dignity.
If you would like to learn how we can help your pet with safe surgery and anesthesia, please contact us through www.HRVSS.com
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Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified