Cat lymphoma - how did you treat? What were costs like
January 8, 2024 11:43 AM Subscribe
Our cat, aged fifteen, has kidney disease and intestinal thickening. For a variety of reasons, I suspect lymphoma rather than IBD. Did/does your cat have small cell lymphoma? How do/did you treat?
Cost is a factor here. We're getting an ultrasound which will already run almost a thousand dollars. If we need a biopsy, how much is that? Preliminary chat with the vet made it sound - although I did not ask directly - as if she has read recent research suggesting that it can make sense to proceed to chemo without biopsy.
What was your outcome? I'm especially interested in outcomes for already medically fragile cats.
Cost is a factor here. We're getting an ultrasound which will already run almost a thousand dollars. If we need a biopsy, how much is that? Preliminary chat with the vet made it sound - although I did not ask directly - as if she has read recent research suggesting that it can make sense to proceed to chemo without biopsy.
What was your outcome? I'm especially interested in outcomes for already medically fragile cats.
Our cat (12 years old) was in a similar position this past summer, post an ultrasound which strongly suggested lymphoma rather than IBD. Our vet also recommended that, if we wanted to do chemo, proceeding without a biopsy, since it would just induce unnecessary stress.
We, like greta simone, decided to jump straight to palliative care (steroids), and didn't do chemo, due to (1) cost, (2) complications involving the chemo drugs (we had a baby, and all the warnings were very KEEP AWAY FROM PREGNANT PEOPLE AND SMALL CHILDREN), and (3) just, the clarity that kitty was not doing well and wasn't happy (lots of vomiting, diarrhea, and weight loss). The vet was very supportive of this, and I even got the vibe that we could've made the decision to euthanize right when we got the diagnosis and she would've respected that.
We got about 6 more weeks of decent kitty times, which is about what the vet predicted, before we had him euthanized, at home, with lots of cuddles.
On the flip side, I do know folks with younger/healthier cats, with less advanced lymphoma, who did opt for chemo.
I'm so sorry for what you're going through. It's so hard to have to make these decisions.
posted by damayanti at 12:25 PM on January 8 [3 favorites]
We, like greta simone, decided to jump straight to palliative care (steroids), and didn't do chemo, due to (1) cost, (2) complications involving the chemo drugs (we had a baby, and all the warnings were very KEEP AWAY FROM PREGNANT PEOPLE AND SMALL CHILDREN), and (3) just, the clarity that kitty was not doing well and wasn't happy (lots of vomiting, diarrhea, and weight loss). The vet was very supportive of this, and I even got the vibe that we could've made the decision to euthanize right when we got the diagnosis and she would've respected that.
We got about 6 more weeks of decent kitty times, which is about what the vet predicted, before we had him euthanized, at home, with lots of cuddles.
On the flip side, I do know folks with younger/healthier cats, with less advanced lymphoma, who did opt for chemo.
I'm so sorry for what you're going through. It's so hard to have to make these decisions.
posted by damayanti at 12:25 PM on January 8 [3 favorites]
We are in a very, very similar situation. Our 12 year old cat had an ultrasound in mid-December that showed likely lymphoma and our vet said we could do an endoscopy and biopsy but that there wouldn’t be a significant difference in our first steps with or without the biopsy and we decided to skip it. Our cat is a bit anxious and he would have absolutely hated a long ride (he’d need to be seen at a specialist rather than at our regular vet a block from our house) plus the sedation and procedure, etc etc. The vet started him on .1 ml of liquid prednisone, once per day, and it has been INCREDIBLY helpful. He told us to think of IBD and lymphoma as being on the same spectrum of disease and that in some ways IBD could be considered something that may, over time, develop into lymphoma. He told us the specialist would have prescribed the prednisone if we’d done a biopsy and confirmed lymphoma but they would have added other drugs as well.
If I were you, honestly, I would consider skipping the ultrasound. It’s expensive and it sounds like your vet feels confident about what is going on. I know your cat has kidney disease and I understand that may make you or your vet hesitant to start steroids, but it is a small dose and it is very likely that lymphoma treatment will involve steroids as well. Our cat is healthier and happier now, three weeks into the treatment, than he was before his diagnosis. He hasn’t thrown up in three weeks which is ASTONISHING for him. His appetite is good, his energy is good, he is well-groomed and personable. If your cat doesn’t respond to prednisone, you can schedule an ultrasound then, but I would consider trying a few weeks of a steroid first.
Good luck, and lots of love. It sounds like you are a wonderful steward of a very sweet cat.
posted by kate blank at 12:41 PM on January 8
If I were you, honestly, I would consider skipping the ultrasound. It’s expensive and it sounds like your vet feels confident about what is going on. I know your cat has kidney disease and I understand that may make you or your vet hesitant to start steroids, but it is a small dose and it is very likely that lymphoma treatment will involve steroids as well. Our cat is healthier and happier now, three weeks into the treatment, than he was before his diagnosis. He hasn’t thrown up in three weeks which is ASTONISHING for him. His appetite is good, his energy is good, he is well-groomed and personable. If your cat doesn’t respond to prednisone, you can schedule an ultrasound then, but I would consider trying a few weeks of a steroid first.
Good luck, and lots of love. It sounds like you are a wonderful steward of a very sweet cat.
posted by kate blank at 12:41 PM on January 8
My sweet Bella was diagnosed with IBD/lymphoma about a year and a half ago, when she was sixteen. We skipped the biopsy at the vet's recommendation because she was elderly and it would have been too hard on her, but she's been on steroids and chemo since then, and it's only in the last week or so that her health has started failing. (The issues might not even be related to her lymphoma; we haven't figured out what's going on yet.) I don't know what her prognosis would have been without treatment, but as it stands, I got months of time with her that I might otherwise not have had, and she's been happy and healthy (and spicy!) up until very recently. She's on my lap having cuddles right now. :)
As for costs...it's pretty expensive. I want to say it's been around $400 every three weeks or so. I have pet insurance, so that helps, but I was lucky that I got it *before* she got sick, so it wasn't a pre-existing condition.
posted by velvet_n_purrs at 12:58 PM on January 8
As for costs...it's pretty expensive. I want to say it's been around $400 every three weeks or so. I have pet insurance, so that helps, but I was lucky that I got it *before* she got sick, so it wasn't a pre-existing condition.
posted by velvet_n_purrs at 12:58 PM on January 8
My understanding was the treatment for IBD and lymphoma was the same, so we never did the biopsy as there was no need - the treatment plan was the same. This was a fairly easy choice since like yours, my kitty was considered medically fragile as well. We treated with cerenia for the vomiting, plus prednisolone (for life) and a round of chemo drugs (but I don't recall what they were specifically as it was a few years ago). The chemo is very well tolerated in cats, much better than humans. The vets were more concerned with making sure I handled the pills safely than they were about adverse side effects for my cat.
I got a good couple of years out of her with this treatment, and I have no regrets not doing any more medically invasive treatments than necessary.
posted by cgg at 1:30 PM on January 8 [1 favorite]
I got a good couple of years out of her with this treatment, and I have no regrets not doing any more medically invasive treatments than necessary.
posted by cgg at 1:30 PM on January 8 [1 favorite]
Sadly, I went through this two weeks ago. When Pico came home from her ultrasound, we planned for palliative care, but she told us it was her time, and we had a truly wonderful final week with her.
posted by avocet at 1:35 PM on January 8 [1 favorite]
posted by avocet at 1:35 PM on January 8 [1 favorite]
Our 12-year-old cat (not medically fragile, previously very healthy) was diagnosed with lymphoma around this time last year. We decided to treat it aggressively, and I regret it. It was stressful for him and for me, as the person taking him to multiple appointments every week. Constantly knowing that he might die soon, and that he was suffering, took a toll on everyone in our house. I wish we had just let him go right away. He had chemo, as well as lots of daily meds, and while we saw some improvement occasionally, his quality of life was never as it was before he got sick. It was also very, very expensive, definitely nearing the five digits for five months or so of care.
I would ask your questions of your vet, and be really clear about what you are hoping for. What quality of life is acceptable to you? What results do you want to see in order to continue treatment?
I'm sorry not to have a happier story for you. Give my love to sweet kitty.
posted by chaiminda at 1:45 PM on January 8 [1 favorite]
I would ask your questions of your vet, and be really clear about what you are hoping for. What quality of life is acceptable to you? What results do you want to see in order to continue treatment?
I'm sorry not to have a happier story for you. Give my love to sweet kitty.
posted by chaiminda at 1:45 PM on January 8 [1 favorite]
To ease your heart a bit - I suggest you find some scientific reports on what chemotherapy would entail. We're probably talking many, many visits to the vet where you either have to leave the cat there or sit with the cat for 4+ hours. From my reading (different kind of feline cancer) - it would have required 17 visits over the course of half a year and the life expectancy was a year. I don't know enough about clinical trials to know, if that life expectancy was AFTER the 1/2 year of hell, or not, but for us in a similar situation it just didn't seem emotionally sustainable, even if cost wasn't an issue.
Your cat had a good life. Please make sure she can enjoy her last days to the fullest surrounded by people who love her, not subjected to vet visits and to getting probed.
posted by Dotty at 1:48 PM on January 8 [1 favorite]
Your cat had a good life. Please make sure she can enjoy her last days to the fullest surrounded by people who love her, not subjected to vet visits and to getting probed.
posted by Dotty at 1:48 PM on January 8 [1 favorite]
My experience was canine, and even older than yours, but I agree with the sentiments to push back on the necessity of the ultrasound in order to try chemo and either go ahead with the chemo and support or just steroids. It's not just the stress of the visit, it's sedation/anesthesia in a fragile cat.
You should also ask the vet point blank how much time chemo will buy you. I had to ask extremely blunt questions to get my vet to say the hard shit out loud, which has increasingly been my experience in the past 10ish years (I don't know if this is just the state of the vet industry or just much more likelihood of seeing a non GenX/Boomer vet, who I always felt were pretty comfortable being frank.)
Have another conversation with your vet, line up all your questions before you talk, and tell her you are okay hearing hard news. It will help her if you can tell her where you fall on boundaries - for me, I'm not putting a senior animal through unnecessary sedation for imaging if we can reasonably guess what the answer is and the treatment isn't going to change much without it. My goal at that age with an animal in that situation would be to facilitate non-invasive low-stress primarily home treatment to get one last good block of time together and then we'll call it when things go downhill. It is okay to be real specific, and also to put a price cap on what you think is appropriate to invest for a senior pet. Then they can tell you what can be done that meets that goal.
posted by Lyn Never at 2:15 PM on January 8 [1 favorite]
You should also ask the vet point blank how much time chemo will buy you. I had to ask extremely blunt questions to get my vet to say the hard shit out loud, which has increasingly been my experience in the past 10ish years (I don't know if this is just the state of the vet industry or just much more likelihood of seeing a non GenX/Boomer vet, who I always felt were pretty comfortable being frank.)
Have another conversation with your vet, line up all your questions before you talk, and tell her you are okay hearing hard news. It will help her if you can tell her where you fall on boundaries - for me, I'm not putting a senior animal through unnecessary sedation for imaging if we can reasonably guess what the answer is and the treatment isn't going to change much without it. My goal at that age with an animal in that situation would be to facilitate non-invasive low-stress primarily home treatment to get one last good block of time together and then we'll call it when things go downhill. It is okay to be real specific, and also to put a price cap on what you think is appropriate to invest for a senior pet. Then they can tell you what can be done that meets that goal.
posted by Lyn Never at 2:15 PM on January 8 [1 favorite]
My 12-year-old cat had a sizable mass - she had an ultrasound but no biopsy, so I don't know if it was small or large cell lymphoma. I did palliative care with steroids, which gave her several weeks of quality time.
If she'd had a better prognosis, I would have considered buying chemo pills from an online pet pharmacy (to save money). The fact that chemo can be administered at home made it seem like a reasonable option to try, though the cost can be prohibitive.
Age is certainly a factor to consider, and it's important to have an end of life plan as soon as treatment begins. I'm sorry about your kitty.
posted by toastedcheese at 2:21 PM on January 8
If she'd had a better prognosis, I would have considered buying chemo pills from an online pet pharmacy (to save money). The fact that chemo can be administered at home made it seem like a reasonable option to try, though the cost can be prohibitive.
Age is certainly a factor to consider, and it's important to have an end of life plan as soon as treatment begins. I'm sorry about your kitty.
posted by toastedcheese at 2:21 PM on January 8
One other note: because Bella was unpillable (see "spicy" above), she got her chemo and steroids as shots every three-ish weeks rather than as daily pills, and the visits were...maybe an hour, including consultation. So that's another look at what treatment might be like. It hasn't been too grueling for us, but granted, she was in good health at the start and not an overly anxious cat. If your cat is more fragile, then palliative care may indeed be the way to go.
posted by velvet_n_purrs at 3:16 PM on January 8 [1 favorite]
posted by velvet_n_purrs at 3:16 PM on January 8 [1 favorite]
Like many here, I skipped the ultrasound/biopsy and gave my 16yo cat palliative prednisolone in this situation. We got it compounded into a transdermal gel that rubbed into the ear to minimize stress. It kept her symptoms at bay for a whole year.
Later, after she declined again, the vet was able to feel a large mass in her abdomen, so it's likely she had lymphoma over IBD.
I miss her terribly but have no regrets. I think her quality of life was mostly good during that final year.
posted by introcosm at 3:51 PM on January 8 [2 favorites]
Later, after she declined again, the vet was able to feel a large mass in her abdomen, so it's likely she had lymphoma over IBD.
I miss her terribly but have no regrets. I think her quality of life was mostly good during that final year.
posted by introcosm at 3:51 PM on January 8 [2 favorites]
I recently went through something very similar and have very STRONG feelings about this. I regret a bunch of my decisions. Roscoe was throwing up and had stopped eating. We took him in and were told that he had intestinal thickening, likely GI Lymphoma. We decided to try chemo and he did not respond well to the chemo at all. And he only had one treatment.
My mantra going forward is to do less in these situations. Do the kindest, least disruptive thing if possible. Roscoe did not like going to the vet. We would have had to take him in every week for a shot. We would have to get him in his carrier, in to the car, and drive 20 minutes. Then we would have to wait in the vet's office for who knows how long, with other animal noises and smells.
I feel like Roscoe may have been too far gone for the chemo to have done any good. We were told if we wanted to go down the chemo route that we would have to start RIGHT AWAY. I really wish I just took him home and provided palliative care. It would have been better all around.
posted by mokeydraws at 5:44 PM on January 8
My mantra going forward is to do less in these situations. Do the kindest, least disruptive thing if possible. Roscoe did not like going to the vet. We would have had to take him in every week for a shot. We would have to get him in his carrier, in to the car, and drive 20 minutes. Then we would have to wait in the vet's office for who knows how long, with other animal noises and smells.
I feel like Roscoe may have been too far gone for the chemo to have done any good. We were told if we wanted to go down the chemo route that we would have to start RIGHT AWAY. I really wish I just took him home and provided palliative care. It would have been better all around.
posted by mokeydraws at 5:44 PM on January 8
I have a social relationship with my vet and she has told me that she's hesitant to suggest palliative care/euthanasia because a high percentage of clients flip their shit at the suggestion. If you approach the question as if it were a reasonable option, your vet might be relieved to be able to talk about it.
posted by restless_nomad at 6:17 PM on January 8 [2 favorites]
posted by restless_nomad at 6:17 PM on January 8 [2 favorites]
So sorry...
Canine edition here. We put down our best girl when her back was so fucked up, her quality of life was pretty much gone. And then our second best girl got tumors in her lungs. We did the steroids, which didn't help much, and then we tried the chemo, and that went poorly, and then some surgical type things, and I really wish we hadn't. Only made her miserable.
We will all likely, sadly, outlive our pets...
Sometimes it is just time to say goodbye, and cry.
posted by Windopaene at 6:42 PM on January 8 [2 favorites]
Canine edition here. We put down our best girl when her back was so fucked up, her quality of life was pretty much gone. And then our second best girl got tumors in her lungs. We did the steroids, which didn't help much, and then we tried the chemo, and that went poorly, and then some surgical type things, and I really wish we hadn't. Only made her miserable.
We will all likely, sadly, outlive our pets...
Sometimes it is just time to say goodbye, and cry.
posted by Windopaene at 6:42 PM on January 8 [2 favorites]
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Sorry that you are going through this--it is really hard to divorce your emotions from what's best for your pet.
posted by greta simone at 12:17 PM on January 8 [17 favorites]