Fred's Case Study  

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Other Diseases/Conditions: History of FUS, currently undetermined skin condition. Story: Fred was diagnosed in June 2005 after his face swelled massively in the course of a weekend. He had a 9 month history of sneezing and coughing that the vet had diagnosed as allergies (it may have been early signs of the disease, but maybe not). The vet recommended a 1-2 year course of chemo together with radiation. They assured me that cats tolerate chemo well, but I was unsure of the radiation. We started chemo (I believe the COP protocal) but had to wait on the radiation anyway because of an upcoming cross country move. The cytoxin made him sick, so we switched to the Madison protocal. I had a very low tolerance for side effects, so was never happy with the chemo. Finally in Oct 2005 he did a 3 week course of radiation (5 days/week). The vets recommended the highest possible dosage because he had some lymph node involvement. After the radiation, they came as close as possible to guaranteeing that the cancer would not come back in his nasal cavity, but warned that it could return somewhere else in his body, most likely as a more systemic version of lymphoma. The vets said that they did not have the research to say for sure whether or not chemo on top of radiation would increase his survival. So, since I was unhappy with the effects of the chemo before the radiation, we decided not to continue it afterwards. I want to add a couple of personal notes to help explain Fred's story and my choices. I am a feminist medical sociologist who studies the psychosocial impacts of cancer treatment on women. My experiences with my own mother's death from lung cancer, and my research have left me questioning whether or not all the treatments we have for cancer are helpful or worthwhile even in the case of humans. In other words, if the choice is between 3 months of high quality of life and 6 months of incredible pain and suffering,I choose the first. Oncologists however, will often recommend the second. Since animals don't have any choice, I think the ethics are even more complex. Now, I don't want to make it seem as if I would ever judge someone else for their choices, as a friend told me right after Fred's diagnosis, "there are no right or wrong choice here." But for me personally, the highest consideration had to be Fred's quality of life. The only reason I agreed to the radiation was because the oncologists nearly quaranteed that it would kill the nasal carcinoma and that he had a very high chance of not having a recurrence. Doctors and vets do not like to promise outcomes (and rightly so), but my vets assured me that they would be very surpised if Fred didn't get 2 years or more (he is already 15). So, I decided that if the radiation caused a month of serious pain and stress for Fred, it would be worth it for a 2 year survival. I am 100% happy with my choice, but I do wish there were some things the vets had been more honest about. I think they downplay the traumatic aspects of cancer treatment for both the human and the pet because they want to encourage treatment. Whether that is a good thing or not, I don't know. But I wish the doctors had not kept saying, "cats tolerate chemo very well" without explaining more what they meant by that -- I think their idea of tolerance and mine were very different. I wish the radiation therapists had told me that the side effects would not start until the very end of treatment, and that my cat would be in unbearable pain for the 3-4 weeks following the treatment (even with pain meds). What I though would be a month of pain and trauma was more like 2 months. And finally, I wish they had told me that their list of "possible side effects" was not comprehensive. For instance, they did not expect and so could not warn me about Fred's chronic nasal infection. But they could have warned me that nature throws curve balls and sometimes the outcomes are unpredictable. I know that as good health care consumers we should know all this anyway, but I asked all the right questions from multiple sources, and did not get the full answers that I think I deserved. Outcome: Nasal lymphoma seems to be gone. Lasting side effect of radiation: chronic nasal infection, loss of tear production in one eye, will probably develop cataract in that eye. All in all, very tolerable. - By Karen Fred's Mom -

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