Never mind the length, feel the quality.

Abstract

Improving both the quality and quantity of life are the main goals of veterinary oncology and remain the primary concerns of owners. In veterinary oncology, it is common practice to report quantity of life after a particular intervention, but quality of life often takes precedence over quantity for many owners. At present, objective quantitative measurement of quality of life is in its infancy in veterinary medicine, making it difficult to provide owners with the relevant evidence-based information to guide their decision making. In a recent review article examining 2000 reports on companion animals receiving chemotherapy, only 11 studies met the authors’ inclusion and exclusion criteria for evaluating quality of life (Vols et al. 2016). Similarly, only 16 of 144 prospective studies examined in another review on cancer treatment in dogs and cats between 2008 and 2013 included measurements of quality of life; only a single publication reported sufficient detail to allow their methodology to be repeated (Giuffrida & Kerrigan 2014). Over the last decade, improvements have been made in standardised reporting of treatment-related adverse events for oncology patients, through the use of standardised reporting mechanisms (Ladue et al. 2001, Veterinary Cooperative Oncology Group 2011). This does address some aspects of quality of life measurement, but incompletely. The development of quality of life and pain questionnaires represents the next step in better assessment of quality of life of veterinary patients (Iliopoulou et al. 2013). Since veterinary oncology, and veterinary medicine in general, aims to practise evidence-based medicine, we need more tools to address quality of life. In a preliminary study published in this issue of Journal of Small Animal Practice (JSAP), Helm et al. (2016) looked at the use of an accelerometer in measuring physical activity in a group of dogs receiving single agent chemotherapy as part of their treatment for a variety of tumours. They found that chemotherapy had little impact on physical activity compared to a control group and slight increases in the physical activity of treated dogs compared to their baseline, pre-chemotherapy measurements. While this study shares many of the limitations often faced by veterinary studies, including small numbers of patients and reliance on a historical control group, it does provide a potential methodology that can be used to more objectively measure quality of life. Several accelerometers are now available for use in dogs and cats and, while each one would need to be individually validated for clinical use, their affordability, portability and the relative ease of collection of large amounts of data promise to make them an important adjunct to measure quality of life and add to the evidence base in veterinary medicine. As with any technology, data from accelerometers present their own problems and limitations. These include lack of agreed upon reporting standards, choice of intensity cut-off points, measurement of activity but not intensity of movement and whether the data measured in one study are generalisable to the target population (Pedisic & Bauman 2015). There is also the question with regard to whether increased activity is always related to better quality of life. For example, patients with neurological disease may have increased activity associated with circling or pacing and dogs with bladder tumours may require more frequent trips to urinate, where increased activity could actually represent poorer quality of life. Overall, Helm et al. (2016) illustrate a good first step in being able to improve quality of life data for owners so that they can make more informed decisions as to whether they want to pursue a particular therapy.