Quality of Life Survey for the Canine Cancer Patient

Dear Canine Cancer Patient Owner/Guardian, We really appreciate that you are taking time to complete the questionnaire about your dogs well-being and health related quality of life. This will help us assess your dogs quality of life. All your answers will be treated with the strictest confidence. Please observe the Instructions below: Only one owner, the person with whom the dog relates mostly should answer the questions and they should do so on their own. Read each question carefully, if you do not know the answer, please indicate so, by writing: Don't know. 1. Have you had your dog since he/she was a puppy? Yes __ No__ 2. If not, how many years ago did you adopt it? ____ A) BEHAVIOR OF YOUR DOG 6 MONTHS BEFORE ANY SIGNS OF DISEASE: Please circle the one that applies most: (This part of the questionnaire was used in order to establish baseline of QOL for the individual animal) ABOUT YOUR DOG 6 MONTHS BEFORE: 1. Your dog's behavior towards you was: a. Friendly, easily excited, b. Friendly, alert c. Mostly friendly, appropriate, d. Passive, indifferent, e. Aggressive 2. Your dog's activity level in the past: a. Very active, b. Somewhat active c. Average, d. Reduced, e. Poor 3. Your dog's appetite in the past: a. Excellent b. Very good, c. Good, d. Fair, e. Poor 4. Your dog's overall quality of life in the past was: a. Excellent b. Very good, c. Good, d. Fair, e. Poor 5. Your dog's playfulness and activity level in the past was: a. Excellent b. Very good, c. Good, d. Fair, e. Poor 6. Your dog had signs of illness in the past: a. Never, b. Seldom, c. Sometimes, d. Often, e. All the time

Quality of Life Survey for the Canine Cancer Patient

7. Your dog experienced pain/discomfort level in the past: a. Never, b. Seldom, c. Sometimes, d. Often, e. All the time 8. Your dog enjoyed human interaction in the past: a. Always, b. Often, c. Sometimes, d. Seldom, e. Never 9. Your dog was happy according to you in the past: a. Always, b. Often, c. Sometimes, d. Seldom, e. Never 10. Overall, your dog was healthy in the past: a. Always, b. Often, c. Sometimes, d. Seldom, e. Never 11. How often did your dog experience signs of anxiety and fear (shivering, increased salivation, panting, whimpering, howling, barking and growling) or any other type of behavioral problems in the past? a. Never, b. Seldom, c. Sometimes, d. Often, e. All the time 12. How often did your dog experience mobility problems (stiffness, limping, difficulty to stand up, increased resting) in the past. a. Never, b. Seldom, c. Sometimes, d. Often, e. Always 13. Your dog's role in the household (please circle all that applies): Guard Dog Working Dog Companion Hunting Dog Family Member Show Dog

14. Things that your dog enjoyed (please circle all that applies): Food Human-animal interaction Staying at home Car ride Walking All of them Play Exercise Other

Quality of Life Survey for the Canine Cancer Patient

B. INFORMATION ABOUT YOUR DOG'S QUALITY OF LIFE NOW (This is the part of the survey that was identical and repeated the same questions for all 3 consecutive visits in order to identify QOL changes in response to treatment) ABOUT YOUR DOG NOW: 1. How much is your dog bothered by the cancer? a. Not at all, b. Somewhat, c. Moderately, d. A lot, e. Extremely 2. Does your dog still enjoy his favorite activity? a. Always, b. Often, c. Sometimes, d. Seldom, e. Never 3. Did you notice any changes in your dog's sleeping/resting patterns? a. None, b. Minimal, c. Moderate, d. A lot, E. Extreme 4. Your dog's behavior towards you is: a. Friendly, easily excited, b. Friendly, alert c. Mostly friendly, appropriate, d. Passive, indifferent, e. Aggressive 5. Your dog's appetite now is: a. Excellent b. Very good, c. Good, d. Fair, e. Poor 6. Your dog's quality of life now is: a. Excellent b. Very good, c. Good, d. Fair, e. Poor 7. Your dog's playfulness and activity level now is: a. Excellent b. Very good, c. Good, d. Fair, e. Poor 8. Your dog has signs of illness now: a. Never, b. Seldom, c. Sometimes, d. Often, e. Always 9. Your dog experiences pain/discomfort now: a. Never, b. Seldom, c. Sometimes, d. Often, e. Always 10. Your dog's enjoyment of human interaction now: a. Always, b. Often, c. Sometimes, d. Seldom, e. Never 11. Your dog is happy according to you:

Quality of Life Survey for the Canine Cancer Patient

a. Always, b. Often, c. Sometimes, d. Seldom, e. Never 12. How often does your dog experience signs of anxiety and fear (shivering, increased salivation, panting, whimpering, howling, barking and growling) during your visits to MSU VTH? a. Never, b. Seldom, c. Sometimes, d. Often, e. Always 13. How often does your dog experience mobility problems (stiffness, limping, difficulty to stand up, increased resting) a. Never, b. Seldom, c. Sometimes, d. Often, e. Always

C. INFORMATION ABOUT YOU DURING THAT STRESSFUL PERIOD OF YOUR LIFE ABOUT YOURSELF NOW: 1. How worried are you about your dog's illness? a. Not at all, b. Somewhat, c. Moderately, d. A lot, e. Extremely 2. Rate the amount of worry each of these are causing you: Potential Factors Not at all 1. The chemotherapys administration and side effects (weakness, anorexia, nausea, vomiting) 2. Your pets QOL 3.Urinating/defecating/vomiting in the house 4. Financial concerns 5. Perceptions of others about me seeking advanced care for my pet 6. Time concerns and scheduling visits Somewhat Moderately A lot Extremely

3. Please rank how much of a limitation your animal's current condition is to your regular activities: a. Not at all, b. Somewhat, c. Moderately, d. A lot, e. Extremely

Quality of Life Survey for the Canine Cancer Patient

D. EVALUATION OF OUR SURVEY: 1. How easy was for you to complete the questionnaire? a. Extremely easy, b. Very easy, c. Moderately easy, d. Somewhat easy, e. Not at all 2. Did you like this opportunity to do this survey in order to evaluate your dog's situation? a. Very much, b. Quite a bit, c. Moderately, d. Somewhat, e. Not at all 3. Please comment on how this survey can be improved: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

This is the end of the survey. Thank you for completing the QOL questionnaire!