What palliative care strategies best maintain quality of life in dogs and cats with advanced-stage cancer?

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Palliative-intent radiation therapy (RT) is the most consistent and durable non-surgical option for cancer-related pain in dogs and cats when disease-specific treatment is not feasible, reducing pain significantly in 70–90% of patients with cancer-related pain, with response durations ranging from a few months to more than a year depending on tumor type.2 Multimodal pain management is the standard of care for oncology patients. Pain may originate from the tumor itself (e.g., osteosarcoma), from treatment modalities such as RT or chemotherapy, or from concurrent disease such as osteoarthritis, and each source warrants targeted management.2 Two monoclonal antibody therapies targeting nerve growth factor are available: bedinvetmab for dogs and frunevetmab for cats.2 Injectable buprenorphine controls pain for 24 hours in feline patients, while buprenorphine transdermal solution provides 4 days of pain control.2 Gabapentin and pregabalin have mixed effectiveness as adjunctive pain management in dogs and cats, including in chemotherapy patients.2 Intravenous bisphosphonates reduce bone pain.2 Palliative care should be initiated early in the course of disease, not reserved for the terminal phase — human data indicate that early initiation increases both quality and quantity of life.1 The initial palliative appointment may extend up to 3 hours and should include a complete physical examination with pain assessment, a thorough discussion of diagnosis and prognosis, and development of a goals-of-care plan tailored to the client.1 Hospice represents the end stage of palliative care and adds services for later-stage, terminally ill patients: planning for disease-specific decline, crisis management, and a defined plan for death — whether by euthanasia or palliated natural death.1 For cats specifically, establishing a "budget of care" and integrating the caregiver as an active member of the care unit are foundational to the hospice consultation.4 Compromised physical health, incl