Cancer is one of the most common causes of death and illness in older companion animals; despite this there are many treatments available to maintain optimum quality of life. Compassionate care requires that patients are kept as free as possible from the adverse effects of cancer and its treatment. Cancer can be a debilitating disease; therefore those involved in the care of these patients should always consider the importance of good monitoring and of treating the patient, not just medically, but as a whole. Cancer and wellness nurse clinics can encourage and facilitate this.

Following diagnosis of their pet's cancer, many owners will undergo a range (or combination) of emotions, which may include shock, sorrow, anger, confusion, denial and painful memories of another loved one (it is important to remember that cancer is a serious health concern of people and many owners will have had personal experience of the disease). Owner circumstances will vary - some may decide to euthanase pets as soon as the diagnosis of cancer is made, others will want to pursue every treatment option available. Whatever decisions owners make, a trained and dedicated veterinary team can extend compassionate care of cancer patients and their owners through well run clinics.

Cancer and wellness clinics should be aimed at keeping cancer-bearing pets enjoying great, long-term quality of life and should provide advice on achieving this, taking into account the patient's life-stage and clinical condition. They should be run in conjunction with the clinician and not aim to replace routine veterinary care and monitoring. Staff involved should be empathetic, patient and honest, as well as well informed and current so as to provide all the information the client may require. It is important that nurses involved in these clinics understand the human-animal bond, which has elevated the importance of pets to that of family members for many owners and also that each relationship is different.

These nurse clinics offer owners of cancer-bearing pets the opportunity to just to chat about their pet, rather than their disease. It often can help owners to talk informally with a nurse, without feeling that they are 'bothering' the clinician with non-essential questions. The clinics should take a personal approach to caring for both the pet and the owner, and should not be rushed. Nurses should be well informed and should communicate carefully, treating the subject sensitively and honestly. Nurses should have a good working knowledge of common tumour types, their likely prognoses and response to therapy, diagnostics (i.e., grading and staging) and treatment options (e.g., surgery, radiotherapy, drug therapy), as well as their side effects.

Owners may ask questions to clarify their pet's condition and its treatment and to understand what to expect from it and will often wish to discuss any concerns they may have about their pet's progress or response to therapy. It is useful to encourage owners to write down any questions they may have in advance, especially at the beginning when they may be upset, nervous and/or unfamiliar with the staff or routine.

Frequency of visit will depend on the tumour type, treatment regime and clinical condition of the patient, as well as the wishes of the owners. Whilst there should be a certain structure (checklists/questionnaires are useful), these clinics are often guided by what the owner wants to discuss. With careful questioning and listening, nurses may be able to detect the subtle signs of pain, nausea, food aversions, adverse effects of cancer therapy, owner anxieties, etc., and be able to prevent/reverse problems by timely intervention, in liaison with the clinician:

 At each visit a salient history should be taken and a minimum database (weight, body score and vital signs) should be assessed and recorded. Specific tests may be performed as requested by the clinician, e.g., blood and/or urine sampling, blood pressure. Any concerns raised about the patient's health should be discussed with the attending clinician. Detailed and accurate record-keeping at these clinics is essential. Questions to ask could include:

 Abnormal bleeding or discharges?

 Problems with eating or swallowing?

 Difficulty breathing?

 Loss of appetite; marked weight losses or gains, or excessive water consumption?

 Difficult, abnormal or uncontrolled waste elimination?

 Uncharacteristic behaviour (e.g., unexplained aggression, or lethargy)?

 Newly discovered lumps; rest/sleep patterns; limping, or difficulty getting up or lying down?

 Excessive scratching, licking or biting any part of the body?

 Dramatic hair loss, sores, an unkempt/dull coat; or unusually smelly breath?

 Any obvious changes since the last visit? Other questions specific to the patients' condition?

 Medications may be given and/or re-prescribed (under the clinician's guidance). Specific questions should be asked, depending on which therapeutic regime the patient is following to ensure compliance, reveal any difficulties, adverse effects, etc.

 The patient's general quality of life (QOL) should be assessed, in conjunction with the owner, remembering the importance of the owner's perception of their pet's QOL.

 Nutritional advice may be offered where appropriate. Owners often require reassurance/advice on feeding when dealing with pets with finicky appetites. Generally, cancer patients will be fed on a diet appropriate to their current clinical needs, which should be continuously reassessed (e.g., on initial presentation the patient may be anorexic and cachexic, but after 3 months of corticosteroids, it may be polyphagic and obese). Meeting nutritional requirements is an important part of the care of cancer patients. Good nutrition has been shown in both people and in animals to improve not only quality of life but also length of life by enhancing the beneficial effects of surgery, chemotherapy and radiation therapy while at the same time reducing the side effects of these therapies.

 Some patients have (temporary or permanent) feeding/fluid therapy tubes in place (e.g., following surgery or radiotherapy) to allow stress-free administration of medication, fluids and nutrition to patients in the home setting. Nurses should be well informed about the use and indications for use of these tubes and be prepared to instruct owners, under the direction of the clinician.

 Comfort should be assessed and pain recognised and treated appropriately. Whilst there have been few clinical studies into cancer pain in animals, it must be assumed that veterinary cancer patients experience pain, which brings with it many deleterious effects. Nurses have a role in managing pain, by constant re-evaluation, tailoring of analgesic protocols in liaison with the clinician, to address patients changing needs. Various regimes may be employed and a range of doses and/or drugs may have to be tried to meet an individual's needs, which the nurse can monitor in conjunction with owners. In addition to drug therapy, patient comfort may be optimised by provision of excellent home nursing, on which the nurse should advise.

 Chemotherapy safety should be discussed with owners. Explain that excretions from chemotherapy patients may be harmful, but assure them that, with certain precautions, the pet is safe to be around family members. Interaction with family members is important to both pets and owners. Owners should be provided with written information about how to prevent exposure to chemotherapeutic agents and on dealing with drug-contaminated urine and faeces. Discussion and clear instructions for at-home administration and handling of the drugs is important.

 Bereavement and euthanasia advice may be offered. When living with a terminally ill pet, it is common for owners be stressed and to wonder whether they are doing 'the right thing'. When it comes to decision making, how and when to let go is often the hardest decision. Veterinary nurses may be able to give time and empathy and, although difficult, sometimes helping to plan a euthanasia can take away a lot of stress from owners; e.g., owners may wish to consider when and where they would like to have their pet put to sleep, which vet they would like to be present and what they would like done with their remains, etc. Following euthanasia, many owners are surprised by the emotions that surface after losing a pet. It is important to recognise this need to grieve and to offer support, but in some circumstances it may be appropriate to advise professional counseling. It is not unusual for owners to wish to continue to come to the clinic after the loss of their pet.

 Through regular contact and the emotional nature of the subject, it is common to become close to owners of cancer-bearing pets and to share their 'journey' with them. With this in mind, it is important that veterinary staff continue to provide objective advice to owners.

In conclusion, in veterinary oncology, the most important goal of therapy must be maintaining the pet's quality of life, and veterinary nurses may play a vital role in dispelling cancer myths and worries for owners and ensuring they feel comfortable with the decisions they've made for their pets. In their support of owners through cancer and wellness clinics, veterinary nurses can make a real difference to the lives of owners and their pets.