Introduction

• Palliative therapies are intended to improve quality of life of the patient and thus prolong survival by relieving suffering.
• These therapies may be the sole method of treatment or they may be used in conjunction with more curative treatments (ie treatments aimed against the disease process itself).
• The most common quality of life concerns related to pets come from a wide variety of conditions involving one or more of the following: pain, inadequate nutrition, gastrointestinal symptoms, and loss of bodily functions (urination and/or defecation). Specific diseases (eg brain tumors) may have specific therapies directed at problems associated with that disease (eg seizures, peritumoral edema). These specific diseases are beyond the scope of this chapter, which instead will highlight general pet owner concerns noted with a range of diseases and therapies used to address them.

Palliative care for pain

Radiation for cancer pain

Palliative care for adequate nutrition

Palliative care concerns around bodily function

Palliative care for anxiety

Quality of life

Further Reading

Publications

Refereed papers

• Recent references from PubMed and VetMedResource.
• Bishop G, Cooney K, Cox S et al (2016) 2016 AAHA/IAAHPC End-of-Life Care Guidelines. JAAHA 52 (6), 341-356 PubMed.
• Tollett M A, Duda L, Brown D C et al (2016) Palliative radiation therapy for solid tumors in dogs: 103 cases (2007-2011).  J Am Vet Med Assoc 248 (1), 72-82 PubMed.
• Fan T M (2014) Pain management in veterinary patients with cancer. Vet Clin North Am Small Anim Pract 44 (5), 989-1001 PubMed.
• Steagall P V, Monteiro-Steagall B P, Taylor P M (2014) A review of the studies using buprenorphine in cats. J Vet Intern Med 28 (3), 762-770 PubMed.
• Blackburn A L, Berent A C, Weisse C W et al (2013) Evaluation of outcome following urethral stent placement for the treatment of obstructive carcinoma of the urethra in dogs: 42 cases (2004-2008). J Am Vet Med Assoc 242 (1), 59-68 PubMed.
• Lesman S P, Boucher J F, Grover G S et al (2013) The pharmacokinetics of maropitant citrate dosed orally to dogs at 2 mg/kg and 8 mg/kg once daily for 14 days consecutive days. J Vet Pharmacol Ther 36 (5), 462-470 PubMed.
• KuKanich B (2013) Outpatient oral analgesics in dogs and cats beyond nonsteroidal antiinflammatory drugs: an evidence-based approach. Vet Clin North Am Small Anim Pract 43 (5), 1109-1125 PubMed.
• Tan-Coleman B, Lyons J, Lewis C et al (2013) Prospective evaluation of a 5 x 4 Gy prescription for palliation of canine nasal tumors. Vet Radiol Ultrasound 54 (1), 89-92 PubMed.
• McDonald C, Looper J, Greene S (2012) Response rate and duration associated with a 4Gy 5 fraction palliative radiation protocol. Vet Radiol Ultrasound 53 (3), 358-364 PubMed.
• Catbagan D L, Quimby J M, Mama K R et al (2011) Comparison of the efficacy and adverse effects of sustained-release buprenorphine hydrochloride following subcutaneous administration and buprenorphine hydrochloride following oral transmucosal administration in cats undergoing ovariohysterectomy. Am J Vet Res 72 (4), 461-466 PubMed.
• Coomer A, Farese J, Milner R et al (2009) Radiation therapy for canine appendicular osteosarcoma. Vet Comp Oncol 7 (1), 15-27 PubMed.
• Knapp-Hoch H M, Fidel J L, Sellon R K et al (2009) An expedited palliative radiation protocol for lytic or proliferative lesions of appendicular bone in dogs.  J Am Anim Hosp Assoc 45 (1), 24-32 PubMed.
• Narishetty S T, Galvan B, Coscarelli E et al (2009) Effect of refrigeration of the antiemetic Cerenia (maropitant) on pain on injection. Vet Ther 10 (3), 93-102 PubMed.
• Gieger T, Rassnick K, Siegel S et al (2008) Palliation of clinical signs in 48 dogs with nasal carcinomas treated with coarse-fraction radiation therapy. J Am Anim Hosp Assoc 44 (3), 116-123 PubMed.
• Sedlacek H S, Ramsey D S, Boucher J F et al (2008) Comparative efficacy of maropitant and selected drugs in preventing emesis induced by centrally or peripherally acting emetogens in dogs.  J Vet Pharmacol Ther 31 (6), 533-537 PubMed.
• Shaw J R (2006) Four core communication skills of highly effective practitioners. Vet Clin North Am Small Anim Pract 36 (2), 385-396, vii PubMed.

Other sources of information

• Veterinary Anesthesia & Analgesia Support Group: http://www.vasg.org/newer_options_for_chronic_pain_management.htm