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

How to Make Decisions About Dog Cancer Treatments

Updated: December 9th, 2021


Overwhelmed and anxious, and unsure how to make decisions about dog cancer treatments? Read this article to find out how to “think like an entrepreneur” and calculate the risk.

How to Break Analysis Paralysis and Make a Confident Decision

With hundreds of thousands of readers of The Dog Cancer Survival Guide over the years, we’ve gotten a fair number of emails and comments. And the most-asked questions are how to make decisions about dog cancer treatments. They usually go something like this: “How should I choose between X and Y treatments?”

As Dr. Dressler reminds us, the most important question to answer first is a different one. The first question to answer is what is your general approach to cancer?

Are you a Type A, who will do anything, no matter what?

Or a Type C, who only wants to focus on comfort and palliative care?

Or are you somewhere in between, a Type B, who wants to optimize longevity but not at the expense of life quality?

Even when we know the answer to that question, though, we can never know “for sure” which option will be best for our dog.

No One Has a Crystal Ball

We want things to be simple. We want it to be like getting on a highway. Do I want to go North, or South? If I want to go north, I get on THIS ramp, and if I want to go south, I get on the other one!

But cancer decisions are almost never that straightforward. Nothing is sure.

So if you don’t know what will definitely help (and think nothing will) … how do you make a decision?

Argh. Many of us fall into a state called “analysis paralysis.”

We overthink it. We look for the right and best answer, and when we can’t find it, we get paralyzed with indecision.

And more information doesn’t help! In fact, the more facts we’re given, the more we feel overwhelmed.

To unbind your mind, sort your thoughts, and organize your options, I suggest using a simple tool that any entrepreneur or business person in your life uses every day.

In fact, you might use it yourself, even if you don’t realize it. It’s called risk analysis.

First: Hard Decisions are Not Easy

So, let’s say you’ve been given two treatment options by your veterinarian, and you’re trying to decide which to go with.

Good luck!

You’ll need it, because unless there is a clear “winner,” your vet will probably leave it to you to make the choice.

(This is also true, I’ll point out, of human physicians, who don’t like to make decisions on our behalf, either.)

You’ll have to weigh the risks yourself, and then make the best of the situation.

Here’s what to do.

Basic Risk Analysis for Making Confident Dog Cancer Decisions

Risk analysis is a way to look at the potential benefits AND potential risks of a situation so you can make the best decision possible, given what you know at this time.

For any decision you’re making, lay out the possible gains and the possible risks. Then see which one “outweighs” the other.

If you stand to gain more than you risk, do it.

If you stand to lose more than you gain, don’t do it.

Let’s go through risk analysis step by step with a concrete example.

A few years ago my dog Kanga was diagnosed with a massive ovarian tumor, so I’ll use her situation as an example.

First Step: Outline The Scenario

Really take some time to outline the scenario you are considering, in writing. Be complete in your description, including details like timing, cost, emotional resources it might take.

For example, here’s what we were looking at with Kanga:

  • She’s ten years old, and the average lifespan for a dog her size/breed is 13-15. So she has a good three to five years of expected life left.
  • She’s extraordinarily healthy — no other health problems, and her bloodwork is excellent, especially for her age. (Thanks, excellent diet and EverPup since the age of 2!)
  • She’s extremely sensitive and really hates being uncomfortable.
  • She hates hates hates the vet hospital.
  • She loves loves loves Dr. Dressler, who would be doing the surgery.
  • We work from home, so we would be with her 100% of the time to help recover.
  • It’s a stretch to cover the costs of the surgery, but we could do it.
  • She will probably not need to stay at the hospital after the surgery, because she is so very healthy.
  • If she does need to stay, I know she will be well cared for by staff who know her.
  • The recovery will take about 14 days, and she won’t be able to walk on the beach or play during that time.
  • Dr. Dressler thinks her scar will be barely noticeable.
  • We don’t know whether the tumor has metastasized.
  • We DO know the tumor has grown quickly, because it wasn’t palpable just three weeks ago. So it’s aggressively growing.
  • We don’t know what the tumor type is, or how malignant it is in terms of metastasis.
  • We don’t know whether there will be other problems found during surgery.
  • If it’s one type of ovarian tumor, it’s unlikely to recur and she may never have complications from this.
  • If it’s another type, she may only have a couple of months left anyway.

Second Step: List ALL the Possible Gains

List, in writing, what your dog could gain from the scenario if it works out.

Be as comprehensive as you can. Your dog has his own loves and joys – how are those affected? Be as specific as possible.

There are tangible things you can put on your list. Does your dog get to stop taking a medication that makes her constipated? Does she get to reduce her tumor burden? Live longer? Avoid a second surgery?

There are also intangible things you can add, too, like your own sense of relief at knowing your dog is out of severe, unrelenting pain.

Be realistic and honest, thorough and clear.

Here the gains we came up with for Kanga’s surgery, if it turned out well:

  • She could live a normal lifespan if it’s a “good” tumor type.
  • If there is no metastasis, there would not be any other conventional treatment needed.
  • It’s likely that the entire tumor can be removed based on the imaging.
  • She will walk, play, and do all the things she’s always done.
  • She can go to the beach, snuggle, and enjoy her life, just as she always has.
  • We would feel great about taking the chance and giving her more time.

I should note here that at age ten, another three years was our goal — and as of this update, we’ve achieved it, because it’s three years past the surgery date as I type this!

Step Three: How Likely Is It?

Now, attempt to answer this question: how likely is this best-case scenario to come true?

You probably won’t be able to get a concrete answer to this question. You might just be able to say “better than 50/50” or “very likely” or, sadly “not likely at all.”

But you can get a sense of how likely it is by using a simple chart like this:


Assign a number that seems right for likelihood for each item on your list. Then assign a number for how successful it will be. The place they meet in the chart indicates how likely success is.

Don’t be afraid to get a reality check from others about your best-case scenario. You can ask your veterinarian, for example, to tell you how likely he/she thinks that wonderful description is.

For Kanga, we really didn’t know how to calculate how likely a successful surgery would be.

We knew that Dr. Dressler would do everything in his power to make it successful, and we trust his skills and knowledge.

We also knew that Kanga was healthy and strong.

But we didn’t know what type the tumor would be. If it was the “good kind” this surgery would likely be the last treatment we’d need to do, though.

In the end we decided the surgery was highly likely to be successful: a 3. And since the likelihood of a “good tumor” was pretty high — but this tumor had grown so fast, we thought it might be aggressive … we split the difference and gave it a 2 for success.

That landed us in square 6, a green square indicating a successful possible outcome.

So for us, this was a surgery that was probably worth doing … but we still had to calculate the risks to make sure.

Step Four: List ALL the Possible Risks

Now list, in writing, all the risks you can think of associated with this scenario. With as much honesty, clarity, and detail as you used in step two, think about what you possibly stand to lose.

Money? Sleep? Time? Does your dog get worse? Feel worse, even if technically he’s “better”? Suffer?

List tangible AND intangible risks.

Here are some of the risks we were looking at with Kanga:

  • The surgery is relatively simple, but there could always be complications you can’t foresee.
  • Anesthesia carries its own risks, but Kanga’s heart and lungs are both strong.
  • Kanga doesn’t like to be confined, so she would have a hard time with recovery.
  • The wound would be big, and it would make us feel guilty just looking at it.
  • She would have at least a few weeks of recovery.
  • She will be on pain meds and antibiotics after the surgery.
  • She wouldn’t eat for, like, three days and that would be worrisome.
  • We might go through all this, find out it’s a bad type of tumor, and she would die in a few months anyway from spread we just can’t see right now.
  • She might hate us or start hating Dr. Dressler because of this.
  • She would hate the vet hospital even more than she already does.

Step Five: How Likely Is It?

For each of those risks, it’s good to use a chart like this:

In our case, here’s how the risks broke down:

  • Surgical complications are unknown by definition, so we gave them a 2 for likelihood. We trust Dr. D to be able to handle them, so we gave them a 1 for severity. That landed us in a green, low-risk square.
  • Anesthesia risks with Kanga’s strong heart and low were unlikely, so we gave them a 1 for likelihood. We trust that Dr. D can handle it, so we gave that a 1 for severity. Another green, low-risk square. 
  • Kanga hating confinement was very likely — a 3. For severity, we scored a 1, because she’s a compliant dog who would tolerate it if we asked her to. Here’s our first yellow, medium-risk square.
  • The wound would be big, and it would make us feel guilty just looking at it. Likelihood: 3, severity: 3. We have a red, high-risk square for our own emotional upset!
  • Several weeks of recovery was very likely, a 3. The severity was probably a 2, because she is a tolerant dog. Yellow, medium-risk square.
  • She will be on pain meds and antibiotics after the surgery, that’s a 3 for likelihood. She hates taking anything by mouth, so that’s a 3 for severity. Another red, high-risk square for her emotional well-being.
  • Our worry about her not eating for a couple of days was very likely, a 3, and the severity of our anxiety would also be severe. We landed again in the 9 square for another red, high-risk square for our emotional upset.
  • The tumor being a bad type we ranked as a 2 for likelihood. The severity of that, however, would be a 3, because it meant she would die in a few months anyway. So that’s square 6, a red, high-risk square.
  • She might hate us or start hating Dr. Dressler because of this was pretty unlikely in the long-run: 1 for likelihood. If it happened, it would be a 3 for severity, so that was another yellow, medium-risk square. *Note: this did NOT happen. 
  • She would hate the vet hospital even more than she already does … well that was pretty likely: 3. And severity? Also a 3, because we knew that we might opt for quality over quantity and skip a bunch of vet visits or wellness checks unless they felt really necessary. So she would likely go without routine medical care in her elderly years. That’s a 9, a red high-risk square.

Notice that most of the high-risk items have to do with our own ability to cope. Most of the risks associated with the actual surgery or outcome were low- or medium-risk.

We had 2 green squares. Both of these were associated with the surgery itself — it was relatively low-risk.

We had 3 yellow squares. These were mostly in the areas around recovery being physically uncomfortable.

We had 5 red squares. Four were around our emotions as a family. We would definitely be upset by this. One was about the possibility of a bad tumor type.

So it looks like a 50/50 risk profile, right? Half are high risk, and half are not… but that’s not really accurate.

The majority of the red squares were about upset feelings (ours and Kanga’s). But James and I were already upset, and would be whether we went ahead with the surgery or not.

Since the four red squares would remain whether we DID the surgery or DID NOT do the surgery, we disregarded them.

That put us in 2 green, 3 yellows, and 1 red square.

Overall, t was a medium – to – low-risk operation!

Step Six: Compare the Gains with the Risks

Next, you compare the gains with the risks.

If you stand to gain more than you stand to lose, you do the treatment.

If you stand to lose more than you stand to gain, you don’t.

In our case, we were looking at a pretty good scenario. If it went well, Kanga could live a normal lifespan in a completely healthy, normal fashion with no loss of life quality once she recovered from the surgery. (This is actually what happened!)

We had a GREEN square for success, and a probable GREEN or YELLOW square for risk.

The benefits definitely outweighed the risks. If we went ahead and it was a bad tumor type, we would be in the same place as before, but we would have given our ten-year-old dog a chance at a normal lifespan for her age and breed.

If we went ahead and it was a good tumor type, she was so healthy otherwise that we could expect her to live a normal, happy life for a lot longer.

[Remember: 1 human year is 7 dog years. So giving her three more years of life is like 21 human years!]

For us, the decision to go ahead was the right one — even with the risks involved.

End Analysis Paralysis with Risk Analysis

Here are the basic steps to take:

  1. Outline the scenario in detail.
  2. Make a list of ALL the gains you could get from this choice, and lay odds on how likely it is to come true.
  3. Make a list of ALL the risks you are taking on with this choice and rank them as low, medium, or high risk.
  4. Make a list of things to do to LOWER the risks you’re taking.
  5. Compare the relative gains to the relative risks.
    1. If you stand to gain more than you risk, do it.
    2. If you stand to lose more than you gain, don’t do it.

There’s your answer. Does it take bravery to do something even though there is risk? YES.

Almost all cancer treatments, in my experience, require us to take a deep breath and forgive ourselves for not knowing whether they will work out.

If you stand to gain more than you risk, do it. If you stand to lose more than you gain, don’t.

Almost always, the risks don’t outweigh the gains when it comes to cancer treatments. Most people who read The Dog Cancer Survival Guide are looking at making low-risk, high-reward lifestyle changes, and they are choosing treatments that really do offer tangible benefits to their dogs. Most can see that they stand to gain more than they risk by committing to the treatments in the book.

But what if it’s too risky? What if you think the risks are too high?

What If It’s Too Risky?

But if that’s not you, and you can’t make the numbers work, then your analysis is telling you something: the plan you’re looking at is just too risky. See how you can reduce the risk. Look for as many ways as possible to reduce your risks and increase your gains.

If you still see too much risk, then maybe your analysis is revealing that you are near the end of your dog’s options. In that case, it may be time to read about hospice and euthanasia. Please see chapter 25 of the book for a compassionate and loving discussion of your options. You can also take a look at this article.

Be Well, and Remember Your Dog Loves You More Than You Could Bear,


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