How much help will chemo be for our cat?
May 4, 2017 6:09 PM   Subscribe

Our 15 year old cat has liver cancer - a diffuse carcinoma. We've just got the news from the vet and are trying to figure out the best course of action. Prior to this he's been hiding away, barely eating and drinking, not grooming and having trouble using the litter box. His mobility is now pretty poor. Chemo could extend his life, but should we?

He's a beloved family pet but I worry that we'll be sinking money into making his life miserable for a few months and then losing him anyway. We're told that for a cat his age it's only likely to extend his life another 6-9 months.

Purely practical questions would be:
If we get him chemo and he responds will we be giving it to him until the end? How much money is that likely to run to?
Is he likely to recover from his present state given chemo or is it just delaying the decline?
We're currently giving him pain meds, which add to his drowsiness, is that likely to be for the duration?
posted by Artw to Pets & Animals (28 answers total) 3 users marked this as a favorite
I would recommend asking the vet for a quote-- they should be able to tell you what the costs will look like. Also factor in the less tangible costs: how much of your time will be spent running to the vet? does the cat hate traveling in the car and/or going to the vet?

Chemo is probably just delaying the decline, but if it improves his quality of life and you can afford it, that's not the worst thing in the world.

Remember that you can always decide to start the chemo and then change your mind if it isn't working! I've been told that animals frequently tolerate chemo better than humans, but if that isn't the case for your cat, or it doesn't seem to be improving his quality of life, you aren't required to keep doing it.

Sorry about your kitty. I recently lost my dog to a similar situation and it's rough.
posted by Blue Jello Elf at 6:19 PM on May 4, 2017 [6 favorites]

I will weigh in on the side of palliative care/no chemo. I lost three cats within 5 years, and because I was younger and they were dear companions, I sunk a lot into their care - an amount of money I hate to recall now. And in not one case did it extend life longer than about 8 months. Not that they were a bad 8 months; but the cat really can't understand the treatment, and can't see the end point that you have in mind - they just know they are feeling bad. At this point I've become a believer in no heroics for pet ailments. There is increasingly more and more you can do to try to sustain a pet's life. But I think we owe them a peaceful end of life every bit as much as we owe them life extension - maybe more.
posted by Miko at 6:36 PM on May 4, 2017 [97 favorites]

My advice would be to end his discomfort and consider making a donation to your local humane society instead of doing chemo.
posted by bq at 6:37 PM on May 4, 2017 [21 favorites]

I can only tell you my experience with chemotherapy and my cat, who was 8 or 9 when we started. He was fine with chemo. It did not slow him down at all. But he also did not need pain meds for his cancer (the surgery was of course another thing).

After having been through this with a healthy cat, and losing him 2.5 years later, I can say that I think in your situation, I would not do this with an older cat who already needed pain meds to manage his condition. I would instead figure out his hospice situation, and ensure that an at-home vet could come take care of the end at the appropriate time.

I am so very sorry. I know what it is to want to fight for my best little friend. Love and light to you all.
posted by Medieval Maven at 6:41 PM on May 4, 2017 [4 favorites]

I am sorry you are going through this. We put down our beloved 16 year old cat the day after Christmas. We found out only a few weeks prior that she had lymphoma- a large growth popped up on her neck that I thought (hoped?) was a goiter, as she had thyroid issues as well. She had been getting skinnier for months, but was still eating and getting around and toileting ok, although not grooming much. Her world was clearly getting smaller.

We did not do chemo. She hated the vet, hated, hated, hated, taking pills. After talking with our vet, we did liquid prednisolone (which she hated very slightly less) for, maybe a week or two? Just to give her some symptom relief while we coped with the fact that we had to let her go. The vet was great and did not push, she offered chemo as an option but clearly did not think that at our cat's age and state of health that the benefit from chemo would be worth putting her through it. We felt that any life extension that might be gained would be for our benefit, because she was the best cat (as I'm sure yours is), not for hers But she would suffer the consequences of our desire to keep her with us, by having pills forced down her throat, enduring terrifying vet visits, possibly experiencing side effects from the drugs that would be rough on her tiny bony body.

She was still eating and purring a little on the day we decided it was time, which is what we wanted. Cats don't care, they don't know about death. We selfishly wanted to keep her until her last good day and I think we came close. Maybe we let her go a day early (no more than that, I think. She was fading, there was very little joy left) but that only hurt us- it was a gift to her not to make her wait until her life was a total misery to her.

I don't know how helpful this it, because I can't tell you how chemo might affect your kitty. But it is a decision process that is very fresh and raw for me so hopefully I can offer one useful perspective.
posted by acanthous at 6:43 PM on May 4, 2017 [17 favorites]

I'm so sorry--one of my elder cats died of cancer. In her case, I elected not to do chemo: she was about fourteen when diagnosed and the initial prognosis was three months (ironically, she lived for nearly two more years, as the cancer progressed very erratically). Had she been much younger, I would have gone the chemo route; at her age, though, it seemed like it would be a lot of discomfort for very little payoff in terms of quality-of-life, even if the discomfort was only the added stress of even more vet visits than she was already having to deal with.
posted by thomas j wise at 6:43 PM on May 4, 2017

Having put a cat who was in good condition with a fairly treatable cancer through months of chemo, honestly, I suggest that you not do it.

It is a lot of money, and a lot of stress and heartbreak. Your cat already has what I would consider poor quality of life, and I don't know if it would really help very much. Cat deserves better, as do you.

I believe that relief from their suffering at the expense of our own is the best gift we can give to the pets we love.
posted by monopas at 6:48 PM on May 4, 2017 [17 favorites]

If it were my cat, I would not treat his cancer.

Make him comfortable, see if you can entice and intrigue him with things worth eating, and euthanize him, maybe early next week.

Of the 13 sizeable animals I've been responsible for, one disappeared, two died naturally, and I've had to euthanize all the rest in old age. I always did it later than would have been the very best, and I still feel bad about that.
posted by the Real Dan at 6:50 PM on May 4, 2017 [7 favorites]

Your purely practical questions are good questions to ask a board certified veterinary oncologist during an initial consultation. A veterinary oncologist should be able to give you some specialized information that can help you determine whether chemotherapy is the right choice for your family and your cat.

For me, when making treatment choices for my pets quality of life over quantity has always been my personal guiding principle. For my cats I have always felt their quality of life was most impacted by difficulty or inability to groom and freely access the litter box, appetite, and enjoyment of high value naps spots. I would probably not choose to do chemo if it meant that my cat would live longer but would have moderate to significant difficulty grooming, using the litter box, or didn't enjoy his food. If there were palliative options that might give him a decent QOL for a short time, I would probably do that, and make arrangements for an at home euthanasia.

I'm sorry about your cats illness and you wish all the best.
posted by OsoMeaty at 6:51 PM on May 4, 2017 [1 favorite]

I don't know about liver cancer, but I guess I will be a dissenting voice. Our cat was diagnosed with lymphoma around age 13. He was pretty sick when we got him to the vet. 9 months of prednisone+chemo later, he's gained weight and is purring next to me as I type. It made a huge difference to his quality of life, and beyond the cost of the initial diagnosis, the price to us has been ~$100/month, which is not nothing, but doable. The stress of giving him medication in the beginning was a lot on us but I'm so glad we treated and got these extra months. However, if I felt l were just prolonging his agony, I wouldn't have done it. But I think that if you can afford the medicine and your vet doesn't insist on expensive tests frequently, it's worth trying for a month or two to see how it goes.
posted by ch1x0r at 6:53 PM on May 4, 2017 [1 favorite]

I've got two dogs who have kind of abruptly reached the "declining health" stage and I am pretty clear on where my lines will be drawn; this would be a palliative care and end of life plan situation for me.

My philosophy is this: we get very attached to the idea of not "robbing" them of any remaining good days, as if the bad days in between get negated by a subsequent good day. But afterwards, when you're a little removed from the situation and you think about sheer bad hours versus good, and bad memories and the stress and fear of bad days (and the animal knows you are stressed and afraid, on top of feeling sick or pain or no energy or hunger/thirst that can't be sated) and you realize you frog-boiled everyone involved into being kinda okay with torture when it was unnecessary. Those are the days that still wake me up at 3am.

Provide comfort for as long as real comfort is possible. Make some last good memories. Get some good photos, in the sunshine, to have for later. Feed some really excellent treats, have some really excellent petting, and say goodbye when it starts to get bad rather than gets "too" bad, when you can do it calmly without a rush or panic or real bad pain or the kind of gore that's difficult to un-remember. They don't all pass peacefully in their sleep, you can't bet on that.

Tell your vet that's the plan, because vets are extremely gun-shy about talking about the end game unless you are crystal clear that it's your choice. Vets get physically threatened for bring up the Big E when an owner isn't ready. So let them know very specifically that you want to make a plan, you want to know how to decide where the line is.
posted by Lyn Never at 6:58 PM on May 4, 2017 [11 favorites]

I'm so sorry. This is a really hard to handle situation but your cat is already telling you not to do chemo with the hiding and not eating/drinking. Listen to your cat.
posted by fluffy battle kitten at 7:04 PM on May 4, 2017 [7 favorites]

As a note, the fact that it is liver cancer colors my feelings on this. There's some other cancers that might be pretty slow-moving but, in many years of fostering and rescue and just having pets and knowing people with pets, major organ or bone cancer would be a very short timeline for me. I would be willing to do serious steroids if it'd buy some time and comfort, but I wouldn't do chemo. Abdo cancer hurts, mouth or bone cancer is a fucking nightmare and virulent as hell, lung cancer means eventual oxygen starvation. I would be very very conservative in those cases, and maybe a little more aggressive for a lymphoma or brain or skin issue for as long as mobility and pain is okay.
posted by Lyn Never at 7:06 PM on May 4, 2017 [3 favorites]

What follows here is just an anecdote, ok?

I would have blown our retirement savings to extend our dog's life a year. I would have done anything. I may have sold our house.

The choice was this: painkillers which would have mitigated the pain but not allowed her to eat; eating which would have caused her pain and disallowed the painkillers.

I was presented with her starving or dying in pain.

She was one of the great loves of my life and I let her go.

I am so sorry.
posted by A Terrible Llama at 7:26 PM on May 4, 2017 [7 favorites]

Let him go. It's his time. A cat that can't move or enjoy life – their whole world is physical. Pass him with love.
posted by fritillary at 7:28 PM on May 4, 2017 [2 favorites]

Your cat is already quite weak and suffering. That, plus the type of cancer and his age would push me to say goodbye and not cause him more pain. It's heartbreaking to have a beloved pet die, but it's far more painful to let them go with the realization that you should have done it much earlier. I'm so sorry that you're going through this, but based on my own experiences, I'd say it's time to say goodbye. Extending his life in any way would be for you, not for him, and that's not a good enough reason.
posted by quince at 7:34 PM on May 4, 2017 [3 favorites]

Sorry brother, I would not do this.

My sister-in-law runs a rescue in Sydney and she says the only reason they don't have a "no kill" policy is because of an experience with a cancer cat, and how badly it knocked the organisation around even with understanding vets who gave significant discounts and were happy with a payment plan.

She's one of the most compassionate and big-hearted people I know and she said she would never put a cat through cancer treatment (admittedly she didn't specify what kind of cancer, and she didn't specify chemotherapy, but I can't think of too many other approaches) again.
posted by turbid dahlia at 7:37 PM on May 4, 2017 [4 favorites]

Incidentally, this is a day that is fast approaching for my eldest cat, Bella, who is about 16. I'm not removed from your upset, and I love her and wish it wasn't so, but she has made it obvious it is time, the decision has been made, and the rest is just logistics and making sure her last weeks are as joyful as possible.
posted by turbid dahlia at 7:43 PM on May 4, 2017 [3 favorites]

I am a human doctor who sees a lot of cancer patients, both under palliative care and not.

I would not do chemo for my cat in this situation any more than I would want chemo for myself in the same situation, which is to say, not at all.

Studies show that palliative care can help humans live longer than getting chemo in similar situations. Although this will not likely be studied anytime soon in cats, I would not be surprised if it were true for them as well.
posted by treehorn+bunny at 12:53 AM on May 5, 2017 [6 favorites]

One of my kids works in the veterinary field, she tells pet owners this:

Unlike people, your wonderfully loved pet comprehends neither death nor life. Our pets just exist.
They are.
They eat and sleep and play. They don't make plans for tomorrow because they have no concept of tomorrow. When considering end of life decisions, pet owners need to understand that the sadness we feel about ending their lives is a sadness that our pets will never feel. The work is in taking our own knowledge of the world and our egos out of these moments, knowing that our job is to honor and love our pets by giving them healthy lives, to recognize their suffering, and to give them compassionate relief.

My kid said it helps to remember that our pets don't comprehend life or death or time or mortality -- that it's the humans with this knowledge. Our pets just don't want to suffer and the most wonderful thing a pet owner can do is stop a pet's suffering.

(she also said in your wonderful cat's case, she wouldn't advise chemo)
posted by yes I said yes I will Yes at 2:43 AM on May 5, 2017 [5 favorites]

My 16yo cat had cancer a year and a half ago. We gave her chemo. We regretted it.

I would not do it again, with an older cat, especially given such a poor best case scenario.

Our vet told us that cats don't really get terrible side effects from the chemo, but our cat did. We hadn't really internalized that the extra time was just extra time being uncomfortable from chemo upsetting her stomach and pills every day. We felt like she finally told us that enough was enough when she entirely stopped eating. The vet wanted to take her for the weekend and put her on an IV, but that's when we decided we had to listen to our cat instead of our vet.

I'm so so sorry to hear that you're going through this too. It's so hard, and your love really shines through here. I guess my moral is - no one knows the full story as well as you, and no one can read your cat's body language as well as you can. You're the one who's in the best position to figure out the right thing to do here. Trust yourself.
posted by 168 at 4:51 AM on May 5, 2017 [2 favorites]

I'm so sorry. It sounds like you are working really hard to provide your guy the best quality of life you can while you can, and I'm sure he knows he is loved and cared for. That will be true whichever course you choose.

For what it's worth, I've watched a cat go through chemo, and I probably would not do it to a cat of my own unless maybe it were a very early catch in a young cat of a type of cancer with a high likelihood of remission. Her owner agrees in retrospect, even though she was a quite young cat and it seemed worth the risk to try to give her another decade or more.

Given the situation you describe, I think I would opt for in-home palliative care and focus on whether I could make him happy and comfortable again and give him another good month or three, or whether it's time to let go now. I would not be looking at anything heroic beyond that.
posted by Stacey at 5:45 AM on May 5, 2017 [1 favorite]

Our 10 year old ultra healthy cat suddenly fell ill in December. If we would have been able to give him chemo and extend his life a few more years, we would have done it. It was caught too late in our case.

15 years is ... a good life for a cat. I don't know that I would try to extend his life for 6-9 months if it meant a lot of trips in the car, scary vet visits, and such - but you know your pet.

My thoughts are with you and your sweet kitty.
posted by getawaysticks at 5:48 AM on May 5, 2017 [1 favorite]

I think it really depends on the type of chemotherapy and the cat. For example, our cat had lymphoma, and the chemo was part of his palliative care. It was a pill that we gave him 2x a month and it helped manage his symptoms. We got it from a compounding pharmacy and it cost $40 a month.
posted by amarynth at 6:20 AM on May 5, 2017 [1 favorite]

Shoot, I just noticed that I only posted half of my post. Anyway, my cat also loved pill pockets, so he made it very easy on us. If he had been difficult to pill, we might have made another decision, as he was on a lot of medications, and, for his sake, we wouldn't have wanted to be having really unpleasant interactions with him multiple times a day during his last few months.

I'm sorry that you're going through this. I know these decisions are hard to make. Your vet should be able to help you decide on the best course, especially if you are clear about your goals (for example, quality of life over quantity).
posted by amarynth at 6:56 AM on May 5, 2017

We lost two wonderful cats--not to cancer, but to kidney failure--at 15 and 18. But we were faced with the same dilemma. Chemo may extend your cat's life, but not its quality. You don't want to let him go, and you want to do right by him, but with his symptoms, it's time. I've probably said this before here, but cats are fragile creatures...when one system starts to fail, it creates a domino effect. Your cat is more ill than he appears, from what you've described. Letting him go now is the best thing you can do for him.

I'm so sorry. I'm sitting here crying as I write this response.
posted by tully_monster at 8:33 AM on May 5, 2017

Response by poster: Thank you all for your kind comments. In the end we decided that it was time, and after spending some time with him to say goodbye called the vet.

RIP Griffin the cat, loved by all. He was a good cat.
posted by Artw at 7:13 PM on May 7, 2017 [5 favorites]

My condolences on the loss of your friend. You did the right and merciful thing. You gave a pet a great life, beginning to end.
posted by Miko at 9:03 PM on May 7, 2017

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