Learning your pet has cancer can stir up a flood of emotions and questions: What are the signs my pet with cancer is suffering? What can I do now? How can I ensure more good days than bad? Because pets are good at hiding their pain, signs of discomfort aren’t always easy to recognize.

With a diagnosis in hand, you and your veterinary oncology team can take concrete steps to assess your pet’s comfort level and function – and track changes day by day. It starts with a pet quality of life assessment. Its purpose is to help you and your veterinary team evaluate your pet’s physical comfort, daily activities and overall well-being throughout cancer treatment or supportive care.

Why Tracking Your Pet’s Quality of Life Matters

Caring for a pet with cancer can be emotionally exhausting, especially when the disease is advanced. You may feel hopeful when your dog wags their tail or your cat shows interest in a favorite treat, even while other signs point to a decline in their health.

Anticipatory grief – the sadness and anxiety that begin before a loss – may also make it difficult to measure the seriousness of your pet’s condition. You might focus on encouraging signs, overlook gradual changes or become used to behaviors that would once have concerned you.

Tracking your pet’s quality of life provides a clearer picture: Instead of relying on how your pet seems on a particular day, a written assessment can help you identify patterns in their comfort, appetite, mobility and routine.

This kind of approach may also ease some of the emotional demands of caregiving. When you’re managing medications, vet appointments and changing needs, keeping a record of your pet’s condition helps:

No cat and dog cancer quality of life scale can make decisions for you; instead, it provides a record that helps you work with your veterinary team to determine what’s best for your pet.

The Core Framework: The HHHHHMM Scale

Veterinary oncologist Dr. Alice Villalobos developed the HHHHMM Quality of Life Scale to help evaluate the well-being of pets with a serious or terminal illness like cancer. The assessment looks at seven areas of daily life, from pain management and appetite to mobility and happiness.

Each category is scored from 0 to 10, with 10 being ideal. Seven scores are added together to provide an overall picture of your pet’s quality of life.

Although the HHHHHMM scale is a useful veterinary guide and a recognized pet hospice scoring chart, it alone can’t determine your pet’s comfort level, or when end-of-life decisions should be made. Lean on your veterinary team to help you interpret the results through the lens of your pet’s diagnosis, symptoms and needs.

A Detailed Breakdown of the HHHHHMM Villalobos Quality of Life Scale

Here’s what to look for when assessing your pet:

Hurt

Hunger

Hydration

Hygiene

Happiness

Mobility

More Good Days than Bad

Understanding Your Pet’s HHHHHMM Score

Assign up to 10 points for each category for a possible total of 70. When assessing a dog or cat’s quality of life with cancer, a score of 35 or more is a cautiously positive sign. Your veterinarian can tell you how often to do this assessment.

Remember that a pet may score relatively high in some categories yet experience serious pain or breathing difficulties – changes that need immediate medical attention.

The HHHHHMM scale is one of several recognized assessment tools, including the Lap of Love Pet Quality-of-Life Scale and The Ohio State University Quality-of-Life Scale. Whichever methods you choose, remember they are guides, not substitutes for veterinary care. Discuss your observations and scores with your pet’s oncology team, especially if the condition worsens.

Other Ways to Track Your Pet’s Quality of Life

Beyond these assessments, there are a few informal methods of tracking changes in a dog or cat with a cancer diagnosis.

The Two-Jar Marble Method: Placing marbles or beads in separate “Good Day” and “Bad Day” jars every night is an easy way to help visualize an overall trend in your pet’s health.

The Rule of Three Favorite Things: Tracking your pet’s current interest in three favorite activities or toys can give you a different perspective. Remember, though, that lost interest in one or two things isn’t a definitive sign of decline; it’s just worth mentioning to the care team.

Partnering with Your Oncology and Primary Care Team

Your pet’s primary care veterinarian and oncology specialist work together with you to form a “Triad of Care.” Your family veterinarian knows your pet’s medical history and baseline health. Your oncologist brings special knowledge of cancer diagnosis, treatment, and potential complications. As the pet owner, you provide daily observations that neither doctor can see during an appointment. Together, these perspectives help guide treatment decisions and support your pet’s journey.

Depending on your pet’s changing needs, your oncology team may also recommend supportive services, including veterinary hospice care. In addition to end-of-life support, trained hospice professionals can include palliative care and symptom management to help maintain comfort and quality of life.

Knowing when to euthanize a dog with cancer or how to assess a cat’s quality of life with cancer are decisions every owner and veterinarian weigh together – and those decisions are not always easy. The goal with a pet quality of life assessment is to ensure your pet is getting appropriate treatment, care and comfort for every day that remains.

FAQs with BluePearl Veterinary Oncologist Dr. Jeilene Hambly

  1. How can pet owners distinguish between normal low-energy days from cancer treatment and an unacceptably compromised quality of life? Mild fatigue for 1-2 days following treatment can be expected; but persistent lethargy, loss of interest in favorite activities, or difficulty performing normal daily function may indicate a declining quality of life. I encourage owners to look at overall trends rather than individual bad days and communicate concerning changes to their veterinary team.
  2. What advice do you give when two family members have completely conflicting scores on the HHHHHMM scale for the same pet?  I encourage family members to discuss the specific behaviors influencing their scores, as each person may observe different aspects of their pet’s daily life. Keeping a shared daily log and involving the veterinary team can help establish a more objective assessment.
  3. What is the most frequently missed subtle sign of chronic discomfort or poor QOL in feline cancer patients? Subtle behavioral changes, particularly decreased grooming, hiding, or reduced social interaction, are often overlooked signs of discomfort in cats. Because cats instinctively mask illness, even small changes in their normal routines can be significant.
  4. “How do you help pet owners overcome “emotional habituation” – the tendency to gradually normalize a pet’s progressive decline because they see them every single day?  I recommend keeping a daily quality of life journal and periodically comparing their pet’s current behavior to how they were functioning several weeks or months earlier. Photos and videos can also help owners recognize gradual changes that may otherwise go unnoticed.
  5. In your clinical experience, how can caregivers distinguish between a pet refusing food due to cancer-related pain vs. treatable chemotherapy-induced nausea?  Chemotherapy-induced nausea and decreased appetite often occur within 3–5 days following treatment and are typically transient, whereas cancer-related pain may cause more persistent or progressively worsening changes in appetite. While timing can provide helpful clues, these signs can overlap, so any significant or prolonged decrease in appetite should be discussed with your veterinary oncology team.
  6. The HHHHHMM scale suggests a score of 35 or higher is acceptable. Are there specific “dealbreaker” parameters where a low score on just one item should trigger a hospice intervention, even if the total score is above 35? Absolutely – uncontrolled pain, persistent respiratory distress, or inability to eat or drink comfortably can indicate an unacceptable quality of life regardless of the overall score. The HHHHHMM scale is a helpful guide, but individual concerns should never be overlooked simply because the total score exceeds 35.
  7. When using the “Rule of Three Favorite Things” method, what is the best way to handle a pet who can no longer do their favorite physical activity (like fetching) but has substituted it with a new, low-energy source of joy? Quality of life should be assessed based on a pet’s current ability to experience enjoyment rather than strictly maintaining previous activities. If a pet can no longer play fetch but still enjoys cuddling, exploring outside or interacting with family, those new sources of happiness are equally meaningful.
  8. How do you guide pet owners when a dog has severe mobility limitations (e.g., can no longer stand independently) but remains highly bright, alert, and eager to interact (high “happiness” and “hygiene” challenges)? I emphasize that quality of life involves both physical comfort and emotional well-being, and severe mobility limitations do not automatically mean a pet has a poor quality of life. If pain can be controlled and supportive measures such as mobility aids and appropriate nursing care allow the pet to remain comfortable and engaged, continued care may be reasonable.
  9. How can owners identify if a sudden rebound in their pet’s QOL score is a temporary “honeymoon phase” brought on by palliative steroid adjustments, or a sustainable plateau of comfort?  Steroids can provide rapid improvements in appetite, energy and overall comfort, but these benefits may be temporary as the underlying cancer progresses. I encourage owners to monitor their pet’s quality of life over several weeks rather than relying on a single improvement, paying particular attention to whether their pet remains comfortable and engaged in normal activities.
  10. Because cats are masters of hiding illness, what objective, daily-life markers (beyond grooming or hiding) should feline owners track to truly gauge their cat’s comfort level? I encourage owners to monitor their cat’s appetite, litter box habits, mobility and willingness to interact with family members. Subtle changes, such as hesitating to jump onto furniture, spending more time sleeping, or showing less interest in favorite activities, can be early indicators of discomfort or declining quality of life.
  11. What is the most supportive way for a caregiver to bring their daily QOL tracking data (like the marble jar or a daily log) into a veterinary consultation to advocate for their pet’s care? I encourage owners to bring a simple daily log highlighting trends in appetite, activity, comfort and the number of good versus bad days. Sharing specific examples of changes in the pet’s behavior helps the veterinary team better understand how the pet is doing at home and facilitates discussion about treatment adjustments and overall quality of life.