Page 310 - Withrow and MacEwen's Small Animal Clinical Oncology, 6th Edition

CHAPTER 16 Supportive Care for the Cancer Patient 289

Assessment of Cancer
Patient
VetBooks.ir Reassess at
regular
intervals
Activity
Physical
Quantitative
examination Clinical metrology parameters sensory testing
instruments

Pain
Unrelated to Pain No Pain
cancer

Treat as Initiate base (NSAID;
appropriate grapiprant; steroid;
acetaminophen)
+/- adjunctive
Switch base

Side effects Reassessment Adjunctive drugs and
therapies to consider
adding in to the
Pain therapy (if response
improvement Pain is poor, consider
persists increasing dose
where possible):
Analgesic Ladder or Reverse Initiate multiple NMDA antagonists
Pyramid approach adjunctive TCA’s (amitryptiline)
treatments Gabapentin
Tramadol
Acupuncture
Other treatments to Transdermal opioids
consider: Reassessment Bisphosphonates
Multiple drug
“wind down” therapy
Palliative radiation
therapy Pain
Drug intravenous persists
infusion
Mouthwash Pain
Palliative surgical Persists or
resection side effects
Epidural catheter unacceptable Consider
Neurolytic procedures when relief euthanasia
obtained
• Fig. 16.1 Scheme illustrating the strategic planning process of the author (BDXL) to assess and treat pain
in cancer patients. NSAID, nonsteroidal anti-imflammatory; NMDA, N-methyl d-aspartate; TCA’s.

42
of the effects of various cancer treatments. Recent publications has been shown to detect increased activity in response to nonste-
have advocated rigorous assessment of the validity and reliabil- roidal antiinflammatory drugs (NSAIDs) 50,68,69 and an anti-nerve
70
ity of these metrology instruments. 42,65 Table 16.3 shows QOL growth factor (NGF) antibody in dogs with OA. Objective
instruments and validation criteria that have been developed for measurements of mobility or activity may be a particularly good
use in veterinary cancer patients. outcome measure in cats, whose activity is spontaneous and not
influenced by owners taking them on walks; improvements in this
Activity spontaneous activity in the home environment have been detected
71
in cats with OA that were fed a diet rich in omega-3 fatty acids,
Reduced mobility is a common symptom in pain conditions. In the NSAIDs, 56,57,72 and anti-NGF neutralizing antibody. Activity
73
mid-2000s, accelerometers were validated as surrogate measures of monitors may allow for disruption of sleep-wake cycles associated
67
66
distance moved in dogs and cats, and since then accelerometry with pain, although recent initial work in this area by the authors