JAVMA, Vol 242, No. 12, June 15, 2013 Scientific Reports 1679 SMALL ANIMALS/ AVIAN T he practice of veterinary medicine has changed considerably over the past 20 years. A major de- terminant of success and professional satisfaction in veterinary practice is the ability to address the needs of patients and their owners with empathy and compas- sion. Social concerns about animal well-being have fo- cused attention and research on the concept of QOL (ie, having adequate food, water, and shelter and being free from signs of pain or distress). 1–3 The terms QOL, wel- fare, and well-being are used interchangeably in veteri- nary medicine. It is very challenging to define QOL for animals because we can only infer psychological states in our patients. Thus, it is more difficult to assess the impact of health problems, environmental conditions, husbandry factors, nutritional adequacy, and other changes on a patient’s QOL. Freedom from hunger and thirst, freedom from physical and thermal discomfort, Development of a survey instrument to assess health-related quality of life in small animal cancer patients treated with chemotherapy Maria A. Iliopoulou, DVM, MS; Barbara E. Kitchell, DVM, PhD, DACVIM; Vilma Yuzbasiyan-Gurkan, PhD Objective—To develop a quality of life (QOL) survey for use in a canine cancer chemother- apy setting, validate the instrument’s utility, identify key questions that facilitate client and clinician communication regarding decisions in patient care, and use human and veterinary QOL literature to develop a comprehensive yet simple proxy survey instrument. Design—Survey. Animals—29 canine chemotherapy patients. Procedures—Patients were evaluated by both owners and veterinarians at the time of ini- tial visit to the clinic and at 3 and 6 weeks after the initiation of chemotherapy. This survey consisted of a longitudinal evaluation of QOL with 6 components addressing the animal’s QOL retrospectively, before onset of cancer; changes in the animal’s QOL since manifesta- tion of disease; changes in the animal’s QOL with regard to treatment response; owner’s QOL and its impact on priorities in decision making; clinician’s impression of the owner’s priorities and QOL; and clinician’s impression of the dog’s QOL. Results—Multiple regression analysis indicated 3 significant predictors of canine cancer patient QOL to be play behaviors, signs of illness, and canine happiness as perceived by owners. Conclusions and Clinical Relevance—The QOL instrument was easy to use and en- hanced client perception of patient care and clinician concern. Owners enjoyed the op- portunity to complete the survey. Since questions regarding play behaviors, clinical signs of disease, and canine happiness were significant indicators of changes in QOL, these should be included in future studies. Quality of life assessment may facilitate treatment decisions and assessment of canine patients undergoing chemotherapy. (J Am Vet Med Assoc 2013;242:1679–1687) freedom from pain and injury, freedom from fear and distress, and freedom to express normal behavior (ie, the so-called 5 freedoms 3 ) are considered essential to define a good QOL for animals. 4 McMillan 5 states that unpleasant experiences in- cluding fear, anxiety, boredom, loneliness, separation anxiety, grief, depression, frustration, anger, hypoxia, pain, thirst, hunger, cough, dizziness, full bladder, con- stipation, nausea, and pruritus should be considered to negatively impact animal QOL. Pleasant experiences are defined as joy, play, social companionship, mental stimulation, physical contact, gustatory sensation, nur- turing young, and sexual activity. 5 The balance between these pleasant and unpleasant aspects determine the QOL of the animal. 5 Increasingly, owners of animals afflicted with life- threatening illness opt for treatments that offer the po- tential for prolonged survival time. In canine cancer patients that are treated with chemotherapy, associated transient adverse effects might be considered a reason- able trade-off for increased survival duration. Thus, an important factor in selecting a treatment is to consider the QOL of the animal during the treatment period. 6 From the Department of Small Animal Clinical Sciences and the Comparative Medicine and Integrative Biology Program, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824. This manuscript represents a portion of a thesis submitted by Dr. Iliopoulou to Michigan State University as partial fulfillment of the requirements for the Master of Science degree. Presented in abstract form at the American College of Veterinary Be- haviorists–American Veterinary Society of Animal Behavior Veteri- nary Behavior Symposium, St Louis, July 2011. Address correspondence to Dr. Iliopoulou (iliopoul@msu.edu). ABBREVIATION QOL Quality of life