Canine Osteosarcoma - Palliative Care

Having one of your beloved patients heading deeper into inevitable pain can be a huge strain on your mental health. Yet, our hands aren’t tied. Working with clients and pain practitioners we can achieve good quality of life (QoL) for our patients. Even those with severe and often incurable conditions such as osteosarcoma.

Sally (34kg Female Labrador X)

At the ripe old age of 13 years old, Sally came in for progressive lameness originating from her right forelimb and some swelling around her antebrachium. She had been being treated for osteoarthritis from the age of 9, which included NSAIDs once daily as required for pain flare-ups, bi-annual courses of cartrophen injections and an oral green-lip mussel neutroceutical.

Up until this point the clients couldn’t be convinced to radiograph Sally, however, her recent elevated level of discomfort and reduced appetite (considering she’s a lab!) convinced them they needed to do some diagnostics.

Her comprehensive bloods came back within normal limits for her age and her veterinary team went ahead with sedation and radiographs. Her left forelimb showed arthritic changes, however, the teams’ hearts dropped when they saw the moth-eaten appearance of her distal radius. Thankfully it was a small lesion, and they promptly did an FNA and took survey chest rads to look for metastasis. 

Photo by MarvistaVet

The diagnosis was confirmed a week later by the laboratory. Sally’s owners couldn’t afford surgery or chemo, and opted to palliate her. Below is what we did: Step 1: Pain Assessment: We sat down with the owners and filled in a validated pain assessment tool. The Canine Brief Pain Inventory (CBPI) freely available from Penn Vet. The CBPI allows owners to rate the severity of their dog’s pain and the degree to which that pain interferes with function. Initially developed to assess pain related to osteoarthritis, however the CBPI has also been shown to be an appropriate measure for pain caused by bone cancer as well. We then asked the owners to complete this weekly, and to report any significant changes to the veterinary team. . Our palliative care pain plan was as follows:

1st line

• NSAID: maintenance dose, q24
• CBD Oil: 2.0 mg/kg, q12
• Amantadine: 5 mg/kg PO, q24
• Pamidronate: 2 mg/kg IV over 2 hrs, q28 days
• Pain vacation: see below, q1-2 months

2nd line

• Gabapentin:10 – 20mg/kg, q12–24
• Amitriptyline:1 – 2 mg/kg PO, q12–24

3rd line

• Paracetamol: 10 mg/kg PO, q12h

Pain vacation regimen:

• Ketamine: 5-10 µg/kg/min IV for 12 to 24 hr
• Lidocaine: 30 – 50 µg/kg/min IV for 12 to 24 hr
• Physical therapies at home:
  1. Warming
  2. Massage

Through this program we were able to maintain a high level of QoL for Sally with excellent to moderate levels of pain cover up until 24-48 hours prior to her owners electing to euthanasia. Sally was euthanised on her birthday 10 months after her diagnosis.