Navigating the Tough Decision of Whether to Treat Your Pet's Newly Diagnosed Cancer (Or Not)

& how to cope with that

One day you notice that your pet seems a bit off.

Maybe they’re a bit more tired than usual, only ate half their breakfast, or just seem a littleeeee more thirsty than they normally are. You say to yourself “Ah, it’s probably nothing” but being the concerned parent that you are, you decide to get it checked out. After some time at the vet, they break the news — your pet has the dreaded capital C — Cancer.

Approximately 1 in 4 dogs will, at some stage in their life, develop neoplasia (cancer). And for dogs lucky enough to live over the age of ten, that number is almost 1 in 2 (for cats the numbers are less clear).

Facing a cancer diagnosis (and whether to treat it) is an emotionally turbulent journey for any pet owner.

This is the kind of news that blindsides you on some idle Tuesday, thrusting you into a realm of uncertainty and difficult decisions. In such moments, it's vital to ensure that you’re adequately informed, and that you approach the situation with calmness, clarity, and compassion.

This article aims to provide a guiding light amidst the darkness, offering insights and considerations to help you navigate the complex decision of whether or not to pursue treatment for your beloved pet’s cancer.

Throughout this post, we'll delve into various facets of the decision-making process. From understanding your pet's diagnosis to assessing treatment options, considering financial implications, evaluating quality of life, and aligning personal values with practical choices, we’ll explore every angle. I’ll also address the emotional toll that accompanies such decisions and offer guidance on seeking support during this challenging time.

Ultimately, my goal is to empower you with the knowledge and resources you need to make the best decision for your entire family.

While the road ahead may be fraught with uncertainty, arming yourself with the appropriate information will enable you to approach the decision with love and understanding, and to navigate this journey with grace and compassion.

Understanding Your Pet's Cancer Diagnosis

Receiving a cancer diagnosis for your pet can be overwhelming.

As soon as you hear the word, you’re flooded with a number of memories or assumptions. But while many think of cancer as one disease, it’s actually a whole number of different diseases. Before we jump to making any decisions, it’s important to understand exactly what we’re dealing with.

Understanding the specifics of your pet's diagnosis is crucial in making informed decisions about their care and treatment.

Dogs and cats can develop various types of cancer, each with its own characteristics and prognosis. Common types of cancer in pets include lymphoma, mast cell tumors, osteosarcoma, mammary tumors (breast cancer), and melanoma, among others.

Some types of cancer can be further classified based on cell type. For example, lymphoma can be B cell or T Cell, depending on which line of cells the cancer is arising from. Depending on the location, each of these cell types behave differently.

In addition to the type of cancer, we need to determine the:

• Grade: how aggressive the cancer is

• Stage: how far the cancer has spread

Understanding the specific type of cancer affecting your pet, as well as the grade and stage is essential in determining the prognosis.

The prognosis refers to the likely outcome of the disease, including the anticipated speed of progression, response to various treatment options, likelihood of a cure, and other potential outcomes.

The complexity of cancer diagnoses can sometimes lead to confusion or misunderstanding, but it’s important that you understand — to the best of your ability — what exactly is going on inside your pet and how they feel. Have an open and honest conversation with your veterinarian about what to expect, including potential treatment outcomes and any uncertainties surrounding your pet’s specific case.

Pro tip:

• After you hear the word cancer, you’ll probably go blank and be unable to hear or remember anything else your vet says that day. After your appointment, when you’ve gathered yourself a bit, generate a running list of questions to ask during subsequent veterinary appointments to ensure you have a thorough understanding of your pet's condition and treatment options.

Evaluating Treatment Options

Once you've received a cancer diagnosis for your pet, the next step is to explore the available treatment options.

Each treatment modality comes with its own set of benefits, risks, and considerations, and differs from treatment in people in several ways. There are an increasing number of treatment modalities available to pets with cancer, including interventional oncology, immunotherapy, targeted vaccines, etc. I could go into them all, but for now I’ll stick with the three mainstays of aggressive treatment: surgery, chemotherapy, and radiation therapy.

“A chance to cut is a chance to cure!”

-Every surgical oncologist everywhere

Surgery: In many cases, surgical removal of the tumor is the primary treatment option. Surgery is also, often, the best method we have in achieving a cure. This may be followed with additional therapies depending on the type and stage of cancer.

Chemotherapy: Chemotherapy involves the administration of drugs (orally or by injection) to kill cancer cells or inhibit their growth. It may be used alone or in combination with other treatments.

The use of chemotherapy in pets is very different from chemotherapy in people. In people, the goal of treatment is usually always to cure, so they treat very aggressively. But that isn’t always the case in pets.

Your dog doesn’t have to walk their daughter down the aisle. They don’t have to live to see their son graduate from college. All your dog has to do is live a good life — so that’s our goal in veterinary medicine.

We dose chemotherapy differently, so your pet doesn’t experience the extreme side effects that you’re familiar with in people.

No hair loss, no violent vomiting or weight loss. This isn’t to say that they’ll never throw up while they’re on chemo, but for the most part, your pet should be feeling good. And if at any point they’re not, we make adjustments to the treatment plan.

Radiation Therapy: Radiation therapy (RT) utilizes high-energy beams to target and destroy cancer cells.

It is often used to shrink tumors or alleviate symptoms in localized areas. This can be used alone, but is often also used in combination with other treatments.

One of the key differences about RT in pets is that we can’t tell them to lie perfectly still, so they will need to be put under general anesthesia for each treatment. Because of this, it’s important to determine if your pet can handle general anesthesia before we can determine if they’re a candidate for RT.

Palliative Care: Think hospice care.

In cases where a cure or remission is not possible, palliative care focuses on improving your pet's quality of life and managing symptoms to ensure their comfort and well-being. This can involve less aggressive surgery, chemo, or radiation, or in cases where the above 3 are not possible, this may just involve steroids, pain relief, and other supportive medications. The type of treatment available depends on your pets type of cancer, grade, stage, their age, and overall health status.

But the goal, in one way, is always the same: to extend or improve their quality of life.

If we’re able to cure the disease permanently — great! If we can achieve remission for some time — also great! If we’re just able to temporarily stop it from spreading and improve your pet’s symptoms — that’s good too. But if treating your pet’s cancer means that they’re going to spend the rest of their days feeling stressed and miserable — then it’s an absolute no-go.

That leads me to my next point:

Assessing Quality of Life

This is the name of the game. I want your pet happy, comfortable, feeling like themselves, and at home with you where they belong. We’re only in the business of extending life if it’s a good one.

If your pet was just diagnosed with cancer, they either:

• (a) were diagnosed early or incidentally, and are currently feeling pretty OK; or

• (b) feel like absolute crap

If they’re in situation (b), their quality of life likely isn’t so great at the moment.

The goal of treatment would be to cure them of their disease or to attack it such that your pet feels better, and then continues to enjoy a high quality of life for some time. Understanding the prognosis is important to understanding the likelihood that your pet’s quality of life will improve. And if you do choose to treat, quality of life assessments are something that you and I (the vet) will need to do continually throughout treatment to determine whether it’s right to continue therapy, or best to stop.

When assessing your pet’s quality of life, you want to consider their ability to enjoy daily activities and interact with you, other pets, and members of the family.

Are they eating, drinking, and voiding normally or have they lost control of those bodily functions? Do they seem anxious, confused or in pain? Are they able to move around comfortably?

In the midst of emotional turmoil, it might be difficult to keep an honest record in your mind. Create a log of their symptoms and behaviors so you can better keep track.

When considering QOL, we also need to consider the impact that treatment will have on your pet’s daily life.

Maybe one surgery will be curative and they only need to go for a follow up appointment once — great. But if they’re in need of chemotherapy or radiation, they’re going to be going in a lot. How are they going to feel about that?

Is your pet pretty easygoing or do they panic and become extremely aggressive at the vet?

Are they able to tolerate car rides or are they anxious and vomiting the entire ride? Treatment itself shouldn’t make your pet feel sicker, but if the means to receive that treatment makes them sick and miserable every week, maybe that isn’t the best option for them.

Considering the Costs

Nobody wants to discuss it, but I would be remiss to exclude it.

Cancer treatment can be expensive, ya’ll. If you’re fortunate enough to say that costs aren’t an issue, that’s fantastic. But for many, costs are an important part of the equation when deciding whether or not to treat.

In either case, understanding and planning for these expenses is essential in making decisions about your pet's healthcare.

Before we can begin treatment, we may need to perform a number of additional diagnostic tests to further classify the type and extent of the disease, and to determine if your pet can handle treatment. This means additional up front costs for:

• Blood work

• Urine tests

• Biopsies

• X-rays

• Ultrasound

• Echocardiogram

• Etc.

If we determine your pet is a good candidate for treatment, surgery, chemotherapy, and radiation therapy all range within the thousands, with costs towards the higher end if you have a big dog.

You should also budget for additional supportive treatments or unexpected veterinary visits. Your vet can help you get an idea of what that might look like. Following treatment, you will also need to budget for ongoing/follow-up care.

Cancer patients require ongoing labs and imaging monitoring, follow-up appointments, and supportive care to manage side effects and monitor treatment response.

These ongoing expenses can add up over time. Make sure you have a budget for the worst and best case scenario (your pet lives a long time). If you’re insured, pet insurance may cover a good chunk of all of this, but most likely they won’t cover everything.

Many insurers also have exclusions based on breed or other medical history.

Make sure you have a clear picture of your coverage before you make any big financial decisions. Depending on your situation, certain assistance or research programs might be available to you. But whatever assistance you find, you should still be prepared to shoulder the majority of the financial burden.

Quality of Life vs. Cost

While there are many factors to consider when deciding on your pet’s cancer treatment, I find that quality of life and cost are two of the most important factors; and, incidentally, two areas where people tend to struggle the most.

It’s hard to put a price tag on quality of life and time with your pet. You’ll likely experience shame at some point in the process, but there is absolutely no shame in this. Let’s discuss this openly.

Consider the following graphic:

Situation 1: You have unlimited resources and treatment is likely to extend or improve your pet’s QOL. This is the ideal situation — let’s treat.

Situation 2: You have unlimited resources but treatment is unlikely to extend or improve your pet’s quality of life. It’s not wrong to say goodbye now. And perhaps that’s the best thing — you should aim to say goodbye before your pet really begins to suffer. Better a day too early than a day too late. But if your pet isn’t particularly suffering at this moment and you want to throw a Hail Mary, I support you. As long as we’re realistic about the future and agree to stop when your pet begins to decline.

Situation 3: Your resources are limited but treatment is likely to improve or extend your pet’s quality of life. This is the toughest situation to be in, and if this is where you’re at, my heart is with you. Maybe you have a family member that can help you out. Maybe you can start a GoFundMe. Maybe you just need to treat long enough for your partner to get home from their business trip to say goodbye. If this is the case, I’m on board. But if you’re going to have to liquidate your assets or drain your kids college fund, you have to ask yourself — is it worth it? I can’t answer that for you, but I will tell you that it is absolutely not wrong to say goodbye here. At the end of the day, you have to realize that your pet (likely) has a terminal illness. Nobody will judge you for this.

Situation 4: You have limited resources and it’s unlikely that your pet will improve with treatment. Deep down, you already know the answer. Better a day too early than a day too late.

When weighing treatment options, it's essential to strike a balance between providing the best possible care for your pet and managing financial constraints.

Navigating the financial aspects of cancer treatment for your pet can be challenging, but it's crucial to approach the decision-making process with honest financial awareness and preparedness. Understand the costs involved, explore insurance coverage and financial assistance options, and consider the long-term financial commitment. There is an option that allows you to make the most compassionate decision for your pet while managing your financial resources responsibly.

Caregiving Capabilities and Capacity

When considering cancer treatment options for your pet, it's also essential to assess your own caregiving capabilities and capacity.

Your mental and physical health, as well as your schedule, lifestyle, and available support network, play a crucial role in your ability to provide your pet with the necessary care and support throughout their treatment journey.

Consider how your own mental and physical well-being may impact your ability to provide care for your pet. Cancer treatment for pets can be emotionally taxing, and it's essential to prioritize self-care to avoid caregiver burnout.

Do you have the emotional resilience and coping strategies necessary to navigate the challenges of caring for a pet with cancer? Do you have a good therapist or counselor in your corner? A spouse or other family members that you can lean on?

When considering your caregiving capacity, you also need to determine whether you (and your lifestyle) can logistically accommodate caring for a pet with a chronic illness.

Consider whether you have the flexibility to accommodate veterinary appointments, medication schedules, and any necessary home care routines. You have to remember that you have other obligations and responsibilities to attend to, and you can’t abandon yourself or your obligations just to care for your pet. That won’t serve either of you.

This is the point where we need to lean on our people.

What kind of support do you have available to you? Do you have family members, friends, or professional caregivers who can assist with pet care tasks when needed? Do you have people to share the caregiving burden?

Honestly assessing your caregiving capabilities and capacity is essential in determining your ability to provide the level of care that your pet needs during cancer treatment.

Remember that seeking support and assistance when needed is a sign of strength and compassion, both for yourself and for your pet. Don’t be afraid to reach out to people and ask for help.  If it takes a village to raise a dog, it takes a small city to care for a sick one!

Making the Decision

After you’ve honestly reflected and reviewed all considerations, you will make the decision that is best for you, your pet, and your family.

Trust yourself to do that.

Trust your intuition as your pet’s caretaker and advocate. Remember that you know your pet best, and your instincts can guide you in making a decision that is in their best interests. Ultimately, the decision regarding your pet's cancer treatment is a deeply personal one that requires thoughtful consideration of various factors.

No one can make the decision for you.

But by educating yourself and openly communicating with your vet, considering your personal and family situation, and trusting your instincts, you can make a decision that prioritizes your pet's health, happiness, and quality of life. I know you can.

Many pet parents before you have done the same:

My neighbor recently contacted me when he was faced with this decision. His parent’s dog, Molly, was just diagnosed with lymphoma and they weren’t sure whether to pursue treatment. Their oncologist recommended chemotherapy, but they saw what that did to people and they didn’t want to put her through that.

But on the other hand, they loved her so dearly. Just six months ago, they had to put their other dog to sleep. Molly was his littermate and the two dogs were inseparable. Now, Molly was their only dog, and their last living connection to the dog that had recently passed.

Fortunately, Molly’s lymphoma turned out to be Large B-Cell Multicentric Lymphoma, which is typically very responsive to chemotherapy. She was a bit tired but otherwise feeling pretty normal. Prognostically, things looked good.

Her parents were retired and had all the time and resources necessary to take care of her. After discussing the differences of chemo treatment in dogs, they decided to move forward. And I’m so glad they did, because Molly is doing great. She has no idea that she has cancer, and hopefully it will stay that way for a long time.

Coping with the Decision

For many people, the most difficult part of the decision-making process comes after the decision has already been made.

This is especially true in cases where we decided not to pursue treatment, or to let the pet go. Because your pet can’t speak for themselves and you have to make decisions on their behalf, you feel a greater weight of responsibility. You’ll may be balancing guilt, grief, and uncertainty.

It’s natural to experience a range of complex emotions.

Acknowledge those feelings without judgment. You have to make a decision that you can live with, but know: regardless of which decision you make, you will still feel those same emotions. Eternal guilt is the curse of parenthood, regardless of how many legs that child has.

Coping with these feelings while providing comfort and support to your pet is essential for both your well-being and theirs.

Lean on those around you and prioritize your health. You can’t pour from an empty cup. And lastly, remember that not everything is set in stone.

If you mentally commit to chemotherapy, but later feel that this isn’t the right decision for your pet, you can stop.

If you’re halfway through radiation treatment and find that your pet becomes hysterical every time you try to get them in the car, you can stop. Maybe there’s an alternative therapy available, maybe we choose for palliative care — either way, there’s always something we can do to help.

And if we’ve exhausted all other options, your vet is here to help you through that too.

Coping with the decision regarding your pet's cancer treatment requires compassion, self-awareness, and resilience. Tend to your own emotions with care, seek support, focus on your pet’s quality of life and on providing them with comfort and emotional support. Pets are very sensitive to our emotional states, so tending to your own mental health means tending to your pet’s as well.

Your pet's well-being is at the heart of every decision you make, and this decision is no different.

Cancer sucks, but you got this.

Dr. Sami

• 10 Essential Tips For Managing Your Pet’s Chronic Illness At Home

• The Biggest Mistake People Make When Deciding To Euthanize Their Pet (And How To Avoid It)

• 7 Things I Did to Make Vet Visits Stress-Free for Me, My Pup, and The Vet Too

---

PS… If a friend forwarded this to you, be sure to subscribe below. And if you found it valuable, I’d appreciate it if you forwarded it to other pet lovers. It goes a long way in helping the newsletter grow.

Do you have questions about the health of your pet? Would you like to schedule a virtual consultation with Sami the Vet? Click below to schedule a once-off virtual consult, or subscribe for unlimited text, call, and video consultations each month.