Yesterday's mast cell tumor patient was not atypical for an advanced case of this common canine cancer. Nor was the cat with the malignant mammary tumor poorly representative of her ilk. While each patient's disease differed dramatically from the other, they shared a common bond: their respective owners had declined to treat their cancers with "chemo."
It happens on a weekly basis (at least). These are the dogs and cats whose chemotherapeutic treatment options are denied. It happens for lots of reasons, but the most commonly uttered rationale is some permutation of this simple phrase:
"I don't want to put her through it."
Which, in case you're wondering, I can totally get behind. I wholly comprehend the sentiment that says, "I do not want my pet to suffer any more than he has to now that he's been diagnosed with a terminal disease."
The trouble, however, is that most pet owners who reject chemotherapy on these grounds have a mistaken notion of what it is that veterinary chemotherapy is designed to do.
I know this to be true because almost no owner is immediately prepared to euthanize their pet at the time of the cancer diagnosis. What they invariably ask for once the spectrum of treatment options have been discussed and discarded is "just something to make her feel better, Doc." Which is exactly what veterinary chemotherapy is for.
Unlike human medicine's approach, in which the most common goal of chemotherapy is definitive treatment (AKA the almighty "cure"), the goal of chemo in pets is palliation.
While we'd love to cure them (and in some cases we actually can), in veterinary medicine we're largely unwilling to incur suffering in our bid for a cure.
It's just not fair, we reason, to have pets undergo prolonged, uncomfortable treatments when they have: a) no conception of what they're suffering for; and b) no hope of a future in which they might come to understand the purpose of their suffering — unlike human children.
So the goals for treatment are very, very different, I tell my clients. Chemo for pets is designed to elicit only minimal side effects, so that if patients do start to suffer uncomfortable symptoms we can terminate the treatment. In that way it's almost exactly what our clients asked for in the beginning: "something to make her feel better."
Despite the reasonableness of this explanation (I think), many who continue to deny chemotherapy often do so on these grounds: "So then it's just prolonging the inevitable. How can I live with a feline time bomb?"
To be honest, here's where I'll sometimes start to get frustrated. OK, so you want something to make him feel better because you're not ready to let him go, but you don't want something that's actually been proven to make him feel better because — let me make sure I got this right — it'll prolong his life.
It's here where I too often realize I've got no choice but to give up. Either the owner's conception of chemotherapy is indelibly and irrevocably imprinted as something horrendously stressful (which happens quite a bit, I'm sure), or "I don't want to put her through it" is code for "I can't pay for it."
Now if it's this latter rationale, then I can absolutely, unreservedly get behind it; which is why it's too bad that my patients' treatment options are so inextricably intertwined with their owners' concern with what it'll cost to make them feel better.
In a perfect world, teasing out the role of physical welfare versus cost in a client's mind shouldn't be my first order of business when a suffering patient sits before me. And yet, it almost always is.
Dr. Patty Khuly