Treating your pet's cancer is an emotionally draining experience. Some cancers are successfully treated, while others
experience only a short-lived response before the cancer comes back.  At that point, the focus shifts from trying to cure the
cancer to providing comfort for your pet, including adequate
nutritional support and controlling cancer pain. In human
medicine, this type of treatment is called hospice care, which aims to provide terminally ill patients with the opportunity to
spend their last days at home surrounded by comfort and family. In veterinary medicine, this type of home care is
sometimes called 'Pawspice care'. Some veterinarians may not offer this option to their clients but pet owners should
openly discuss Pawspice care during their visits to ensure that their pets will spend their final days in a pain-free, safe,
comfortable and warm environment.

Pawspice : An end of life home care for pets with cancer
The concept of Pawspice care was developed by Alice Villalobos, a medical director of the VCA Coast Animal Hospital and
Cancer Center in Hermosa Beach, California (
www.pawspice.com). In the Salt Lake Tribune, Villalobos was quoted as
saying, "Just because a pet has cancer is not reason enough to euthanize it. Cancer is not an automatic death sentence."

When considering the home-based end of life care, the veterinary team will conduct a comprehensive evaluation of the pet
in order to develop a plan tailored to the unique needs of the pet's condition. The plan will focus on effective
pain
management, administration of medication to control the symptoms, adequate nutrition, hydration, hygiene, maintaining
muscle mass and healthy joints, and mental stimulation and interaction with the pet. It is imperative that pet owners are
trained by their veterinary team to ensure that the home care of their pet is done properly from bandage changes,
nutritional support to injection administration.

Quality of life scale for pets with cancer
Pawspice care is not a substitute for euthanasia and it is up to the pet owners to make the difficult decision when the
quality of life becomes unacceptable for their pet. Many pet owners feel conflicted about euthanizing their pet and almost
all will struggle with the question "How do I know it's time?". The following quality of life scale may help you evaluate some
of the issues that are difficult to face and objectively evaluate. Each issue can be graded from 0 to 10 (10 being best) and
generally speaking, a score above 5 on most of these issues is typically acceptable for maintaining a pet on the Pawspice
program.

Pain (0-10)
Does your pet appear to be in significant pain despite pain management regimen? Adequate pain control is of utmost
importance to maintain your pet's comfort, and pain medication can be administered orally, via skin patches or injections.
For more information, please see the
Cancer Pain Management section. Pet owners also need to be trained to monitor the
pet's breathing patterns, as being able to breath is ranked at the top of the pain scale in human medicine.

Hunger (0-10)
Does your pet get adequate nutrition? Pets can develop malnutrition quickly if their care takers are not educated about the
minimum caloric requirements. Before considering the placement of a feeding tube, pet owners are encouraged to hand
feed their pets with special, tasty foods such hamburgers, turkey, chicken, sausages, cheeses, etc. You can also try to
feed your pet small portions but more frequently or try to blend the food to make it soft and easier to swallow. You can also
try to use a syringe to squirt the blended food to the side of the pet's mouth. For more information, please see the
Nutritional Management section.

Hydration (0-10)
Does your pet get adequately hydrated? Every pet should consume certain amount of fluids per day (10mL of fluid per
pound per day) and proper hydration can have a substantial effect on the quality of your pet's life. If your pet is not getting
properly hydrated on its own, administration of subcutaneous fluids is an excellent way to supplement fluid intake. Pet
owners can be trained on how to do this procedure properly at home without having to go to the hospital every time.

Hygiene (0-10)
Can your pet get properly cleaned and brushed? Some pets, especially those with oral cancer, can't keep themselves
clean, and the owners need to take special care to clean their pets' face, paws, and legs with a soft sponge soaked with
very dilute solution of lemon juice and hydrogen peroxide.

Happiness (0-10)
Can your pet still experience some moments of happiness and joy? Does your pet still interact with family members? Is (s)
he responsive to surroundings and petting? Does (s)he respond to his/her favorite toy? Does (s)he have a fun routine
activity to look forward to? Does (s)he show signs of depression and apathy? Pets communicate these feelings via their
eyes, purring, wagging their tail, jumping, etc and pet owners are the only ones who can make these observations since
they spend the most time with their pets.

Mobility (0-10)
Can your pet move around on his/her own? If not, is medication, a harness, a sling, or a cart helpful in improving the pet's
mobility? If the pet is largely immobilized, is the bedding soft and is there a schedule in place to change the position of the
pet at least as often as every 2 hours? The mobility scale seems to differ from one pet owner to another as well as from
one pet to another. While this will be a largely personal decision, pet owners should keep in mind that their pet's comfort
and pain-free life should always be the top priority.

More good days than bad days
Does your pet experience more good days than bad days? Have there recently been many bad days in a row? Are the bad
days filled with experiences such as vomiting, nausea, diarrhea, falling down, seizures, progressive weakness? Does your
pet show apathy to favorite activities and toys?

Euthanasia
The decision to euthanize your pet is one of the most difficult decisions you will ever have to make. Many care givers
struggle with this decision not only from an emotional standpoint but also religious standpoint. The decision can perhaps
become clearer by evaluating the quality of life scale discussed above at regular intervals (days or even hours) during the
course of the pet's disease. Some people choose to let their pets go once the quality of life scale reaches alarmingly low
marks, and some people often want their pets to die at home naturally, surrounded by those who have loved them and
cared for them. It is a personal decision that has to be respected by veterinarians but pet owners should ensure that the
last days of their pets' lives are as comfortable and pain-free as possible. For more information, please see the
Euthanasia
and
Grief Support sections.

Finding a qualified veterinary oncologist to discuss end of life care for your pet with cancer
To locate a qualified veterinary oncologist in your area who can discuss with you appropriate end of life care for your pet's
cancer condition, please visit the "
Locate a veterinary oncologist" section.  Many clinics now offer this service as a key
component of the overall cancer management plan.

Useful handouts from the Ohio State University Veterinary Teaching Hospital
Helping Children Cope with the Serious Illness or Death of a Companion Animal
Coping with the Loss or Death of a Companion Animal
Difficult Decision-Making
Do Companion Animals Grieve?

Source
  • Withrow Stephen J, and David M. Vail. Small Animal Clinical Oncology. St Louis: Saunders Elsevier, 2007. Downing
  • Robin. Pets Living With Cancer: A pet owner's resource. Lakewood: AAHA Press, 2000.
End of Life Care for Your Pet with Cancer
© 2007 Pet Cancer Center. ALL RIGHTS RESERVED.
Last updated 4/10/13
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End of Life Care for Cats
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Comprehensive guide to cancer diagnosis and treatment in cats and dogs