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The Daily Vet by petMD

The Daily Vet is a blog featuring veterinarians from all walks of life. Every week they will tackle entertaining, interesting, and sometimes difficult topics in the world of animal medicine – all in the hopes that their unique insights and personal experiences will help you to understand your pets.

Too Old for Cancer Treatment?

I’ve just completed a particularly lengthy and emotionally charged new consult with a middle aged couple, and a soft silence fills the room. Ben, their beloved 13-year-old Golden retriever, was recently diagnosed with lymphoma, and they are here to learn everything they can about his disease and what options are available for treatment.

Overall he’s feeling fairly well. However, subtle signs of disease have started to set in. He’s showing a slight but perceptible reluctance to rise from bed in the morning. Meals are still being consumed, but at a less than usual frenetic pace. Ben’s been panting more, and his owners noted two instances where he stopped abruptly during their routine two-mile evening walk, where he seemed to “need to catch his breath.”

Ben is currently lying on the floor, with his head resting patiently over his paws, awaiting a cue from either of his owners that it’s time to go home. His soft brown eyes anxiously dart between mom, dad, and me, yet he remains simultaneously calm. For a moment, likely because the silence is proverbially deafening to my ears, I consider the scene from his perspective. I think about how during his 13 years of life, Ben must have experienced his fair share of veterinarians and exam rooms, but how many times would he have spent over an hour in the same room while a doctor did so much talking? What could he possibly make of his owners’ tears or their frequent sad glances in his direction? What does he think about the strange scene before him?

I’ve always felt animals have powers of perception far greater than anything we humans are even capable of understanding, and I’m thinking about this old dog and what his life at home on a "normal" day must be like when Ben’s female owner finally breaks the silence:

"You know, if he were a 5-year-old dog we might consider treating him, but Ben’s 13 now, and we just can’t see putting him through all of that just for another year or two of time. He’s been a great dog, and we love him very much, but I think we’re just going to let things happen naturally, and when it’s time, we will let him go."

I’ve heard these words so many times before, maybe not following the exact same dialogue or tone, but I’m familiar with the phrasing. I glance downwards at Ben and smile. "I understand completely," I say. I state this plainly, but inside I’m thinking, Do I really understand choosing to not treat cancer based on age?

As a veterinary oncologist, I find it interesting how age factors into the decision for owners to pursue diagnostic tests or treatment for their pets with cancer. Owners often raise concerns about their elderly pets’ ability to withstand surgery, chemotherapy or radiation therapy. They are worried the side effects will be magnified or their pet won’t do as well overall because they are "too old."

The age of an animal doesn't particularly influence my recommendations or my opinion of a prognosis as long as the pet is systemically healthy otherwise. I would much rather treat a healthy older pet with cancer than manage a young pet with diabetes or Cushing’s disease or heart failure. Ultimately, I feel as though I can actually better predict how an older, relatively healthy animal will do with treatment than a younger animal with concurrent health issues.

As in people, cancer occurs more frequently in older animals. In fact, it is estimated that close to 50 percent of dogs living to 10 years of age or older will die from cancer. Although the average age at the time of diagnosis will vary with a particular tumor type, most cancers occur in older animals. Therefore, the majority of statistics reporting efficacy and/or side effect rates pertain most accurately to older pets. When I explain this to owners, I often see their relief in knowing they are not alone in considering treatment for their elderly companions.

There is certainly an emotional angle when considering treating geriatric pets with cancer. But what I think is most fascinating is how truly double-edged the angle really is. I’ve treated pets as "youthful" as 18 months and as "ancient" as 18 years. I’ve heard owners of young pets say, "We have to give him a chance! He’s so full of life" just as easily as they say "I can’t see him going through so many months of treatment just to have his already too short life cut even shorter."

Owners of beloved senior animals are just as likely to treat their pet because "he was such a great companion for 15 years, I need to take care of him now” as they are to not treat because “he’s too old and frail to undergo treatment, and I wouldn’t want that for myself if I were his age."

The right choice isn’t always the easiest one for owners, and so rarely would such decisions be defined in black and white. The best I can hope for is to help guide owners through the difficult times and help provide as much factual information and support as possible. Even if my instinct doesn’t agree with their conclusion, ultimately, we all have the animal’s best interests in mind.

Ben’s owners ultimately elected for palliative care for him, and I’ll admit, it was hard for me to see this. I knew that despite his advanced age he would probably do very well with treatment, and chemotherapy would likely afford him the chance of being able to enjoy another summer chasing waves at the beach and going for hikes in the park. I also knew it was not my place to pass judgment and no matter how much I wish I could, I am never able to predict the outcome for my patients, and he might not do as well as the "average dog."

What mattered most for his owners was Ben’s happiness now, not the prospect of his happiness six months from now, and that kind of logic, though slightly difficult to swallow, will always remain perfectly acceptable to me.

Dr. Joanne Intile

Image: mtstradling / via Flickr

Comments  8

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  • Cancer treatment?
    01/30/2013 12:34am

    This story hit very close to home. We just went through this agonizing decision with our senior rescue Becca this past year. There is no right answer, you always second guess yourself. You can only do what you feel is right in your heart for the dogs entrusted to your care. I will write about our experience with Becca on our SlimDoggy blog tomorrow.

  • 18 Yr old cat w/ cancer
    01/30/2013 07:54am

    Last year our beautiful 17 yr old Russian Blue cat was diagnosed with breast cancer. Our vet drew a diagram that looked just like a mammogram. I was devastated, but he told us indicators to look for b/c at her age (almost 100 "people years") that cancer surgery was probably too stressful an option. Well, she lived happily almost another whole year, but two months ago began losing weight, not eating very much, preferring to stay where it was warm (probably b/c she had lost fat and muscle tone). Three weeks ago she even bit me (requiring my needing a 3-day hospital stay with IV antibiotics.) Once I got home from the hospital, it was all downhill from there. She began hiding under our antique cast iron stove next to the heat grate. Then a week later at 7 AM, when I usually feed her, I heard a "death rattle," and went over to her, crawling under the stove to stroke her during her last minute or two. A friend suggested she waited for me to get up at my usual time so I could be with here at the end. I like to think that.

  • Worst Decision ever...
    01/30/2013 11:42am

    I think for a pet owner this is one of the worst decisions ever to be confronted with. In June 2011 my then 8 year old DSH, FIV+, Deaf w/ Cerebral Hypoplasia cat was diagnosed with Lymphoma. She was immediately referred to an Oncologist and was given 3-6 weeks to live, if she wasn't treated. I couldn't fathom putting her down at such a young, tender age. She underwent Chemo, wound up on a feeding tube for months and survived! Here's the downfall. At present day, she is now 10 and still with us, I keep looking back at the past two years of daily medications, hospitalizations, boughts with anemia, anorexia, Stomatitis, etc. and I question my decision two years ago. Should I have let her go then? I think she's happy and content. She will play with the puppies and "yell" for attention. I keep questioning was this fair to her? At no point did or does she suffer or was in any kind of pain. I wouldn't allow that. I had an honest conversation with her vet and we made a pact that they would tell me when she is in pain or suffering and when they felt it was time to let her go. The lymphoma has been in "remission" for close to 2 years. It's the FIV that is eating away at her, slowly. I think another factor that goes into owner's decision making is finances as well. Not everyone is prepared for the expense of treating a pet for cancer. Once they are diagnosed, and the decision is made to treat, the costs can be astronomical. So the question remains, with a 12 year old cat just diagnosed with an emerging mass on her intestine, would I do the same for her? I am not sure. I am not sure not because of the money, I have insurance on all my pets, I'm not sure I want to "drag" her through what the other has and is going through. While I know at anytime I can put the younger one down, that is not an option considering how successful treatment has been for her. It is the worst decision I've ever been confronted with.

  • Years
    01/30/2013 06:14pm

    "we just can’t see putting him through all of that just for another year or two of time."

    Another YEAR OR TWO??? In my opinion, that's a loooooong time.

    I'm a firm believer in treating the individual critter. I sent an otherwise healthy 18 year old cat for Radioactive Iodine to fix her hyperthyroidism. I'd do it again in a heartbeat.

    If the treatment will alleviate suffering or possibly cure the problem, I'm all for it regardless of the critter's age. If the treatment itself might cause suffering, that's another consideration. If the critter has other health problems that might hamper treatment or recovery, that's another consideration.

    For my critters, the whole animal is taken into consideration, but age isn't something that weighs the decision one way or the other.

  • 01/31/2013 01:55pm

    I agree, a year or two is an extraordinarily long time, especially considering that it would bring that poor dog to above the average age for a large dog. I recently wrote a little about this for my quarterly legislative column for my parent breed club magazine. The article discussed the consequences of the Guardian Movement, to change 'owner' to 'guardian', not only in our daily language, but in official regulations, ordinances, all the way up to state law (Rhode Island made this language change a state law).

    This seemingly innocuous change in our language could have unintended consequences for people whose animals get very ill. It could make decisions like this impossible. Who will be granted this authority if we are merely a guardian? Already, people have been falsely accused of animal cruelty and neglect, in spite of the fact that the animals were very old, or very ill and being treated by a vet. When I was researching the topic, I was shocked to learn how often this happens. I was also horrified to learn of the guilt trips that a few vets have laid onto people - someone I talked to was a single mom with a very sick disabled child. Her 9-year-old lab had an aggressive nasal tumor that had spread into the jaw, and she took the dog to her vet (who had been treating the original tumor) to be euthanized, the dog was starving, unable to eat properly, suffering from a lot of pain. The vet tried to talk the owner into very expensive (into 5 figures) chemo and radiation treatments, making this owner feel terribly guilty because she couldn't possibly afford it, and there was a less than even chance of only a few extra months, not more than that. Eventually the vet agreed to euthanize the dog - the family had prepared themselves, including the child, who had grown up with the dog. But the experience was even more heart wrenching than it should have been, and all the preparation became bitter sadness, unnecessary guilt, and feelings of being inadequate, financially. The suggestion appeared to be that this woman shouldn't have had a dog if she 'knew' she couldn't afford up to $10,000 in medical bills for him.

    Shame on that vet, and absolutely NO shame on this loving owner.

  • Great Post
    01/30/2013 08:21pm

    This was an excellent post ... thank you.

    Over the years I have heard a number of people say they wouldn't do "X" for their pet because the pet was "so old."

    One person said they would only buy the rock bottom cheapest pet food in the grocery store, because their dog was "so old."

    Huh? That's like saying, "Grandma is so old now, we'll just give her white bread to eat until she dies." I couldn't believe they didn't consider that a senior pet needs good nutrition just as a younger pet does.

    This post has certainly changed my perspective permanently. For even I have said, "If my pet was beyond a certain age, I wouldn't do 'X'."

    Now, having read this, I will never think or say that again. Situations are more complex than that, and my dear animals deserve more consideration and compassion than that!

    As one veterinary blogger has said, "Age is not a disease!"

  • 01/30/2013 11:43pm

    I think the sentiment also depends on what experiences people have had, what stories they know.

    Jasmine's best buddy got lymphoma at the age of 7. His parents decided to treat. The treatment was making him totally miserable, though, and a month and a half after his diagnosis he couldn't breathe and was let go. If one knows enough stories like that, it's not a surprise that they would not want to put their dog through that kind of stuff.

  • Decisions...
    01/31/2013 04:49pm

    I agree with a few of the comments. Each decision should be based on the animal, not necessarily the age.
    Working in the medical field (humans), I see persons going through tough decisions for their own treatment n regards to cancer. There is no "right" or "wrong" answer. Some patients choose to do nothing and that is an option, given that they are educated thoroughly in treatment options versus non-treatment and considering their prognosis....it's difficult no matter who you are or who you are caring for....human or animal.


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