Featuring Demian Dressler, DVM and Susan Ettinger, DVM, Dip. ACVIM (Oncology), authors of The Dog Cancer Survival Guide.

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Is It Wrong To Treat Dogs for Cancer?

There has been a lot of press and debate lately about the high costs of veterinary medicine. Being in New York, I’m thinking of several NY Times articles.

On the front page on April 5th, there was the article “New Treatments to Save a Pet, but Questions About the Costs.”

This article highlighted the advances in veterinary medicine and the associated high costs, including bone marrow transplants for dogs with lymphoma at NC State, urinary stents for blocked kidneys or bladders, and radiation therapy for brain tumors. These procedures can cost $10,000 to $15,000, and total bills may exceed $25,000 for all medical care. There are also advances in diagnostic tests such as CT scanners and MRI imaging. These tests (including anesthesia) can cost $1,000-2,000.

There were over 300 comments posted by readers before the paper closed comments. Clearly, this article generates a lot of interest and many opinions.

These debates appear from time to time. Last September a client of mine shared his experience with his dog Newman, who had tumors in his lung and brain, in the NY Times Well blog. Chemotherapy was less grueling for dogs that for humans, he wrote.

In the comments on his post, debate erupted when a human doctor commented:

“Awful and wasteful when there are so many *humans* unable to afford chemotherapy. The entire pet industry, for which we spend something like 11+ BILLION dollars in the US is sick when we have 44 million uninsured humans and hungry children in poverty. Priorities.”

The ethics debate continued on April 9th in Room for Debate: One Sick Dog, One Steep Bill

So what do I think?

I don’t believe people should feel guilty about spending money on their pets, nor do I believe it is unethical to spend money (a lot or a little) on pets.  You can spend your money on whatever you choose. If a Guardian wants to pay $15,000 for treatment of their pet’s cancer, it is their choice. Spending that money is no less ethical than the purchase of a new car, a new computer, or a dream vacation. We all have a choice.

I am not suggesting treating a dog is a good choice if the pet’s bill interferes with one’s ability to pay bills, to feed the children, or to support the family.

But choosing to treat your pet does not deny money for human health care, as some seem to argue in these comments. If we spend less money on pets, is that money somehow going to support human healthcare? Our society just doesn’t work that way.

I agree that adequate health care for all humans should be a priority, but I don’t understand the argument that we should spend less on our pets in order to achieve better human health care. It is not that simple.

So yes it bothers me to read that that treating our pets is “deplorable” when poor people do not have health insurance or adequate medical treatment, and that treating animals indicates moral decline of our society. I guess it bothers me because treating pets is personal for me. And it is also personal for each Guardian and each pet.

As a vet, I am obligated both ethically and legally to provide all available treatment options to the pet Guardian. This will range from aggressive and often expensive options, alternative protocols, palliative plans, no treatment, and in some cases, euthanasia.  I cannot make assumptions about what one can afford or is willing to spend. One’s background, upbringing, religion, past experience with pets or family or one’s own health may all play a part in the decision making. The decision will be very different for each Guardian.

How would you feel if you were willing and able to pay for a treatment for your pet, but it was not offered to you because the vet assumed you would not or could not pay for treatment? The decision to treat is a balance between quality of life, the benefits of extending it, the cost of treatment, and the Guardian’s financial situation.  Vets cannot decide what to offer nor make that decision for you.

These are such difficult decisions, and there is no one-size-fits all solution. For example, I know of Guardians who were upset that they were advised to euthanize because their dog’s cancer was not treatable. They were never even given the option to treat. The lack of options was upsetting to them.

And yet, my job as a vet is to tell you that NOT treating is always an option, too. While some Guardians are upset when I mention not treating, others tell me they wish their own vet had encouraged them to at least consider euthanasia, rather than to continue aggressive treatment.

I am often asked what I would do about a dog’s diagnosis, if this were my dog. It’s almost impossible to answer this question. It’s not a decision that a vet can, or should, make for you. The best I can do is to provide medical information, my expertise, guidance, and support. I have to give you everything I know, so that you can make the decision. Client empowerment is an important part of my practice, and an important part of why I chose to join Dr. Dressler in co-authoring the second edition of The Dog Cancer Survival Guide. It’s an extremely empowering book.

So these articles will continue to appear from time to time, and the debate about ethics, costs, and treating sick pets will continue. Part of my frustration is that these articles often leave out the alternative, less expensive options, many of which are FREE and are covered at length in our book. They paint my work and your life as a Guardian into little boxes, rather than acknowledging how complicated treating cancer is.

It does not have to be all or nothing when treating your pet. I recommend you seek a second opinion and hear ALL the options. And I hope people can remember what is right for you and your pet is not necessarily right for the next Guardian and her pet. When someone else makes a decision about how to treat, it does not reflect on anyone else. Everyone makes their own choices for their own reasons.

If you are dealing with dog cancer, get The Dog Cancer Survival Guide for a much more empowering experience. You can find out all the options and get actual reassurance that treating according to what you feel is best is not only OK, but one of your major responsibilities as a dog owner. If you’re not in charge, who is?

About the Author: Susan Ettinger, DVM, Dip. ACVIM (Oncology)


Susan Ettinger, DVM. Dip. ACVIM (Oncology) is a veterinarian oncologist at Animal Specialty Center in New York and the co-author of Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog's Life Quality and Longevity. She blogs about dog cancer at http://www.DogCancerBlog.com.

  • Andi Morse

    I really appreciate your candid thoughts on cancer treatment for pets, Dr. Ettinger. My family and I got surprising news last year when we learned that our beloved cockapoo, only 7 years old, had intestinal cancer. He was such a special member of our family and we had the finances to have him treated…so we tried. Unfortunately he lost his battle 5 months later. Would I do this again? Probably not. It was expensive but that’s not the issue for us. Instead, it’s knowing that cancer in animals is different than cancer in people and pets are less likely to survive this insidious disease for any length of time. Still, I am grateful to have been given options and feeling like my family and I had a say in our Marley’s care. He handled the chemo fairly well and was playful and loving throughout. He literally wagged his tail until the very end. It is hard to lose such a special friend but I remember what my sister asked me…would I have still wanted to spend 7 years with such a wonderful animal if I had known that’s all the time I could have? The answer was a no brainer for me…of course!

  • RuGown

    My dog Looka is almost 15 years old. She was diagnosed 2nd stage nasal cancer last August when she was 14. My husband and I decided to give her all the treatments including surgery, radiation till chemo therapy. Up till now, the total bill is more than 27,000 dollars. ( I believe the treatment costs will depends on where you live, we live in DC area, so the price will be much higher) Why we choose to go ahead for the treatments because she was still a very strong, happy dog. We know if we don’t treat her and the tumor getting worsen she could suffer more. And, of course, we are in deed, love her because she is our only child. Now, she is much better. We are now give her the cancer diet based on The Dog Cancer Diet Guide but If her tumor come back again, we wouldn’t consider to treat her the radiation or chemo again due to her old age. We just want her have a good life. She gave us more joys than what we gave her.

  • Diane Nicholson

    It’s the age-old argument than is brought forward any time that consciences are involved. As a vegan and animal rights activist, I often hear about how it’s ridiculous when there are starving/abused/neglected children in the world.

    This is, of course, assuming that I do nothing to help those children or to help stop other human rights violations, which is not true.

    As humans, we tend to spend our funds where are hearts are. It’s why charities advertise to the emotions; if they hit the mark, our hearts will open our pocketbooks.

    Since human chemotherapy has such a dismal record for actually helping a 5 year survival (2.1% average), but contributes to 25% of its victims’ death, I think our ethical obligation is more to the consideration of the reasons we still insist on using it as opposed to whether our companion animals should have money spent on them.

    Of course, that money is not being thrown at a black hole. Although far too much is given to the pharmaceutical and medical devices industries, there certainly is a good deal that trickles back into our economy. Veterinarians, techs, building construction, cleaning companies and so on, all benefit, and in turn will often donate to charities.

    I have gone through all the cancer nonsense with my husband in the last year and a half and at the same time, tried to figure out what to do with my elderly dog who has a large splenic tumour. I decided to take her home with anti-nausea and pain meds, to allow her to die. She didn’t. Although it seems obvious that she doesn’t have hemangiosarcoma, as originally thought, she has outlived the initial 2 week to 2 month time frame and it is now 15 months later. She had small bleeds twice a week at the beginning, but has had nothing in that department for 8 months. She has lots of energy (and uses a lot of it to walk in her senile circles), hasn’t needed pain or anti-nausea meds since the beginning, loves life, eats well and seems to have no intention of quitting any time soon (she’s over 16 and a 45 pound dog). Because of my husband’s illness, I’ve not had the money to re-x-ray her although I’d love to see what it looks like. My vet wonders if Suki’s body encapsulated the tumour.

    Although I’m not a big fan of modern cancer treatments, the last thing that the animals’ humans need is guilt about spending on a loved one. There are many reasons to forego certain treatments, but if the humans can afford them, have done their research and have decided they want to take that route, the rest of society needs to put itself in their shoes and come up with a healthy dose of empathy.

  • http://Www.hartfarmva.com Dr. Hart

    I read the NY Times article and found it concerning that people feel it is their business to tell others what’s right or wrong when treating their animals. My wife and I just lost our best friend, our dog, to lymphoma. He had chemo and a BMT and his quality of life was really good for an extra year and a half. Was it worth it? We do not regret one penny we spent as he gave us so much joy. We both work long hours 7 days a week and we are not wealthy. It was a personal decision that we made together and I counsel all my clients to do what they feel is best for them and their pets.

  • Shavonne

    I agree 100% with Dr. Ettinger. Every point was extremely valid and well thought out. I happen to have treated my three year old dog for lymphoma for 18 months. So many people with so many opinions on what I should do for my sick dog who I consider a family member. Just like the doctor said, people spend money on all sorts of things and who is to judge. I would rather miss out on all the vacations in the world than to not try to save my dog. Excellent article.

  • Jessica Clark

    Thanks for your article. When my precious Rio (a neutered male, rescued dalmatian mix) was diagnosed with lymphoma, I was given the options & decided to have him treated, even though it would be expensive. When I told my sister I planned to go ahead with treatment, she told me I should have him put down. If I HAD to have a dog, “just get another one.” (her words) When I spoke to her again, she asked about Rio. I told her the subject was not open for discussion. Many people would have their pet put to sleep, who either don’t love their pets like I do, or who don’t have the money. Fortunately, I’m in a position where I can afford it without a strain on my finances. If there were a strain, I’d find something else to cut back on.

    Rio was diagnosed toward the end of October 2011 & has just completed his CHOP protocol at the wonderful veterinary school at Texas A&M. I have new admiration for the staff & veterinary students who work there. Over a period of almost six months, he was a “regular” & they treated him like he was a member of their family. He is feeling well & is in remission. No one has deluded me into thinking he might be cured. Rio is now seven years old & I hope we can give each other another couple of quality years.

    BTW, people who argue that money spent on treatment of pets would be better spent on humans, don’t realize that much of that treatment & research flows into human treatment. Much is learned, & drugs & treatments are developed first in animals that can be used in people, too.

  • Dr. Nancy

    I agree with Dr. Ettinger and the other posts regarding this topic. NOT treating animals in no way advances care for humans in our society. People should stop judging others – particularly when it comes to such a personal decision as to how to handle a cancer Dx with a beloved family member. I hope in the future the care will be more accessible as it can be very expensive if you go the conventional chemo/radiation route but Drs Dressler and Ettinger have put all the options into their book so people can read it and make informed decisions as the guardians. As Dr. Ettinger points out — there are a lot of other options and as a nutrition researcher I am grateful that APOCAPS were developed and that info re: diet selection is provided. THANKS!

    • Dr. Susan Ettinger

      Thanks everyone for your comments in this debate. Obviously this is a topic with differing opinions by people. Thanks for reading and sharing your thoughts.
      All my best, Dr Sue

  • Ellie

    I have a 3 year old Golden Retriever who was diagnosed with lymphoma in his brain, 7 months ago. The vets at UC Davis have been wonderful, and advised the 6 month CHOP chemo protocol. Rocky tolerated this very well for most of the treatments and is still doing well . One of the best things the oncologist told me was that I should continue doing whatever I would normally be doing with Rocky so long as he was physically able to do it. As a result, he has completed his CDX title in obedience and has qualified 3 times at the Master level of AKC hunt tests while getting chemo treatments. How long this remission will last, or if he is going to be one of the rare dogs whose lymphoma is cured, I don’t know. What I do know is that it is my choice to spend the money on his treatment, which has been expensive . His treatment has nothing to do with wether people can afford their own health care.

  • kent rogne

    I spent over $18,000.00 on my babies thst have had cancer and other maladies this year, and don’t regret it one bit. We almost lost our home because it left us in a huge financial l crisis, but God made a way. They are our children. Only difference they walk on four legs! They have feelings and hurt like we do, and no way in my power will i ever let them suffer. I will go without first.

  • Mary LaMont

    “They” say, “opinions are like a__ holes; everyone has one so no one needs yours.” Well, when these so-called “ethical” writers start earning my paycheck and paying my bills, then perhaps “they” may have some right to an opinion regarding how I spend their money. Until then, I do not need nor do I want their opinion(s). The gov’t already takes an unhealthy bite out of my earnings before I ever get a dime. Supposedly a large chunk of my tax dollars (my earnings) are donated to the poor, indigent, and/or disadvantaged. That said, I already pay more than my fair share to support humans for whom I never agreed or desired to accept financial responsiblity. Mine is the only opinion of value regarding how I spend the remainder of my earnings. I have earned the right to choose. Choosing not to pay for health insurance is a choice. Choosing not to support your offspring is a choice. Choosing welfare over work is a choice. Just as the choice to work and contribute to society as opposed to choosing to be a drain on society is a “choice.” I love my pets more than I like most people for obvious reasons. If I want to spend a fortune on the lives and/or healthcare of those lives I DID agree to accept financial responsibility for, that is MY choice and mine alone. It is MY eithical responsibility.

  • Michelle Marsh

    Our 2yr old puppy has cancer. At first they thought she had valley fever, but when the medication didn’t work they did another x-ray and a soft tissue biopsy and sent it to a pathologist they said it was cancer. We then took her to an oncologist for both a second opinion and to find out what our options were. I am very sickened by the amount of money vets charge to treat our pets and the fact that the first thing they want to do is chop the limbs off. Breakdown (our puppy) has it in her right hind knee. She appears fine otherwise. We cannot afford the 1000 plus dollars for an amputation with no guarantee it will extend her quantity of life! Not to mention it would be about 400 or so dollars to do a bone biopsy to find out what kind of cancer it is for sure. They suspect Osteo but we don’t have the money to find out for sure, nor do we want to put her thru more pain to find out. So far we have tried marine plankton, and NuVet supplements along with medication for her pain. She has Novox along with Tramadol and something else I can’t think of right now for the pain twice a day. Not sure what to try next. Her leg swelling appears to be getting larger and it is hard and warm to the touch. The thing is that I am a widow with 2 kids and major debt and I don’t have money to spend here there and everywhere but I want to save our puppy. Any suggestions would be helpful. It has been 2 months since her diagnosis.

    BTW if I had unlimited funds I would pay whatever it took, but that is not the case. I have THE most loveable BEST dog I have ever had except she has cancer and I don’t have many options. I would do clinical trials if there were any available or I wish I could find someone that could help us. I have already lost my mom, my father in law and my husband to cancer and now I have to lose our puppy too? It just doesn’t seem fair.

  • Jane

    I have a 3 year old Papillon and found a golfball size lump on his neck. The vet said she thought it was lymphoma and did a fine needle aspiration. Well his blood work came back his white blood cell count was high but the fna came back “inconclusive” — something about the cells being dead. They did the fna again and the results were the same. The vet still seems to think he has lymphoma and said we could try predisone or chemotherapy. From my understanding if not treated he will die in 3-6 weeks, if we do the predisone he may live 2-3 months and chemo he may live 1 year. He is a big baby — he is afraid of his own shadow and pees if I yell at one of my other dogs. I cannot see putting him through chemo but I know if I start the predisone it will hinder trying to do chemo later. The vet said we can try another fna on a lump we just found in his groin area. What should I do? I love my dog so much and want to do what is right for him — so do I just assume it is lymphoma or is there a chance it could be something else. Any insite would be greatly appreciated.

    • Dr. Demian Dressler

      Dear Jane,
      I would not start chemo with an inconlusive fine needle aspirate. Get a lymph node biopsy done on two different nodes. Chemo is big guns and may have side effects and cost to all…so confirm first, IMHO
      Dr Dressler

    • Dr. Susan Ettinger

      Hi Jane,
      If an aspirate is inconclusive in a suspectedlymphoma case, I recommend removing the lymph node for biopsy. While aspirates typically confirm lymphoma, in some cases you need to biopsy. I am taking care of a dog with the same issue. Biopsy is more likely to provide the diagnosis.
      And most dogs do very well on chemo. I hope you will read more about it in the Guide and check out my posts on chemo. There are quite a few.
      waveco.com/what-i-would-do-for-my-dog-with-lymphoma/
      waveco.com/the-oncologist%e2%80%99s-perspective-on-chemotherapy-and-gastrointestinal-gi-side-effects-part-one/
      All my best, Dr Sue

  • Jane

    Dear Dr Dressler,

    My vet suggested to start Fox on predisone since we were worried about doing chemo on him. So I agreed but worry that we don’t have a confirmation of what is wrong with him. She said she would not do anything different so why put him through a biopsy. She also has him on Clavomax and the other day started him on Doxycycline because she thought he might have kennel cough. I don’t know what to do — she is a new vet my vet retired and she bought the practice. I don’t know what to do — since he started the Doxy his lymph nodes are back to normal. So could it be something else or am I just wishing? If he has lymphoma I understand he will die in 2 months and I want to prepare myself for the worse. Please help — if it were your dog what would you do? Thank you for any advice

    • Dr. Demian Dressler

      Dear Jane
      two options to consider:
      1. Cancer
      2. Not cancer
      These are very different. The concern with chemo was what? In other words, if you have confirmed lympho, you can then consider chemo (with its advantages and disadvantages). THere are other options to consider for full spectrum cancer care in addition to chemo however- many more tools to use or consider (in the Guide). If you rule out cancer, you have a whole different fact pattern. The question and actionable data dictate choices far above and beyond pred or no pred.
      I’d stop playing around with this and get a diagnosis, personally.
      I hope this helps
      Dr D

    • Dr. Susan Ettinger

      Jane,
      IF Fox is on pred, which treats lymphoma, and the doxycycline, which treats tick borne disease – the other main thing that causes mutliple enlarged lymph nodes, and the nodes are normal now, we still don’t know the diagnosis. Pred works very well for lymphoma but response times are shorter, usually 2-3 months. If chemo is not an option, consider other options are discussed in the Guide. Also we do not recommend full dose Apocaps when dogs are on pred. Good luck to you and Fox!
      All my best, Dr Sue

  • Phyllis Boyd

    My 7.5 yr old smooth fox terrier has been Dx with TCC…bladder cancer. So far symptoms are some blood in urine, drinking a lot of water and urinating a lot…as well as some straining when he does this. No mets seen anywhere from xrays and ultrasound tests, but doc says its concerning that cancer is close to ureters and I am worried about blockage in the near future. We chose to treat medically…no chemo, and doc put him on Rimadyl. He’s only been on it a few days–and I am a little worried about some side effects I have read about it–watching him closely. My questions are 1: is Rimadyl the best med because I have been reading that Piroxicam is more frequently prescribed? 2: does it make sense to consider stenting if the time comes soon and he is otherwise feeling well– or do we try to accept the fact that he is prob months away from death anyway– and euthanize? Horrible for us to consider the option, but I don’ t want to see him suffer, and we are not flush with money so costs are a factor. So far, just the tests to diagnose him were $1500. Appreciate any advice…so sad these past few days to know our loving Hershey is so sick, because he seems so happy and full of life.

  • Pingback: The Ethics of Cancer Treatment For Dogs | CANCER BLOG

  • Andy

    I think everyone should provide at least basic treatment for their pets, which is to me is paying for doctor’s visits and reasonably priced drugs. I don’t care if other people spend 6 million dollars to make a bionic dog. I am probably in the lower to middle of the pack when it comes to what I will spend on a pet. There has to be a high probability of acceptable quality of life afterwards and low probability of recurrence for me to even consider any surgery or expensive treatment. Even then, I lean towards letting nature take it’s course.

    My last dog was about 15 and was pretty sick and showed signs of pain. They thought it was cancer but weren’t sure. Lots of costly testing would have been necessary at a minimum, to proceed. I decided to euthanize and she suffered far less because of it.
    My current dog has low platelet counts and the cause of it can be treated by steroids. He has a chance of dying in the next 2 days. A blood transfusion may help get him through if he starts bleeding. It’s an expensive procedure.. He is proceeding well now. The steroids themselves are saving his life right now. He has no pain from this illness.

    • Dr. Susan Ettinger

      Andy,
      Thanks for your thoughts. There is no wrong or right answer – it’s clearly very personal and complicated.
      Good luck with your dog with the low platelets.
      All my best, Dr Sue