How To Assess Pain and Quality of Life in a Dog with Cancer

Making sure that our patients are comfortable and have a good quality of life is a top priority for an oncologist.

As a dog owner, you play a large role in helping your dog achieve an excellent quality of life, whether he has cancer or not. You know your dog best and spend the most time with him, so you're in the best position to notice subtle changes that might suggest he's not feeling well. Your job is to learn common signs related to a decrease in quality of life (pain, nausea, etc.) and report any changes to your oncologist (or veterinarian) so they can help decide if intervention is warranted.

Most cancers do not cause pain, however, plenty of cancers (and other conditions) can cause a dog to feel terrible and have a poor quality of life. Clients always ask if their dog is in pain, but they rarely ask how I think their dog feels overall or about their dog's quality of life. We need to reframe the question a bit and instead of just inquiring about a dog's pain level (as this only takes one component of quality of life into account) ask about their quality of life overall - think big picture.

This is important. A dog that is feeling so nauseous that he is no longer eating is suffering just as much as a dog that is painful (if not more). So, the next time you're curious about your dog's quality of life, make sure you ask if your vet still thinks your dog is loving life, not just about his pain level.

When we're trying to gauge whether a dog has a good quality of life, or whether there is room for improvement, we can ask ourselves the following four questions:

(1) Is my dog losing weight?

If a dog is losing weight, it's a sign that he's not eating as much as normal, which could be a sign that he's not feeling well. This could be due to nausea or pain or many other reasons. He could also have an inability to appropriately absorb nutrients from his intestines and is, therefore, losing weight due to malnutrition.

If you're not sure if your dog is losing weight, weigh him today and again one week from today using the same scale (different scales can vary by a few pounds). If he's losing weight, let your care provider know so that they can begin to figure out the cause for the weight loss and find a solution.

(2) Is my dog painful?

Sometimes signs of pain are obvious in a dog, other times the signs are more non-specific and more difficult to interpret. Your job is to notice a change and report it to your care provider so that they can help figure out if your dog is painful; this will often require a physical exam.

If your dog is determined to be painful and you initiate treatment (oral pain meds, etc), give the new medication a few days to work. If the sign has resolved, great. If the sign persists, call your care provider again so that further recommendations can be made. If an oral pain medication is added, you should notice an improvement within a few days (if it is going to work) - don't wait 1-2 weeks. We want your dog to feel better as soon as possible.

Signs of pain: limping, pawing at the mouth, squinting, licking a tumor

Possible signs of pain: drooling excessively (nausea vs. pain), downward dog stretch (abdominal pain vs. just stretching), reluctant to go upstairs/jump into car/truck (could be painful), lethargy, decreased appetite, panting at rest, chewing slowly

(3) Is my dog feeling sick or otherwise unwell?

If your dog develops any of the following signs, it suggests that they are not feeling as well as they should and intervention is warranted to try to help them feel well again.

Nausea - Signs of nausea can include decreased appetite, increased drooling, lip-smacking, anorexia, walking to the food bowl then walking away without eating, vomiting.

Lethargy, exercise intolerance - If these signs occur suddenly, we shouldn't just write them off as a result of 'old age'. They often indicate that something more significant is going on to cause a dog to feel unwell.

Lack of play, behavior changes (hiding or acting clingy) - All of these signs indicate a pet is not feeling normal and further investigation is warranted.

Diarrhea - This leads to dehydration and does not feel good. If your dog has diarrhea (or soft stool), let your vet know. This could be a result of medication your dog is receiving, a gastrointestinal disease/problem, etc. Diarrhea warrants workup (or at the very least, medication), so have your dog evaluated if he develops diarrhea.

(4) Is my dog still loving life?

Our dogs have given us nothing but love, loyalty, and support for years. We should make sure that we're demonstrating the same for them when they become older or sick. We should really make sure that they're still loving life...and that we're not just keeping a sick or suffering pet around because we can't bear the thought of living without them. I understand that this is easier said than done, but it's really important.

One technique that is helpful is to name three things your dog used to love before cancer (or before becoming sick). Then ask yourself, does he still love to do these three things and can he still do these three things. Is there anything he loves to do and can do (aside from sleep)? Keep in mind that no matter how sick your dog feels, he will always get excited to see you, so things of this nature shouldn't make the list.

Big Picture

Assessing a dog's quality of life is something that should be done on a routine basis. We always want our canine companion to feel as well as possible.

If you go through this checklist and determine that there is room for improvement, it's nothing to feel bad or guilty about. This is just about establishing a baseline, then determining what can be improved.

And again, if you determine that your dog is in pain or feeling nauseous or otherwise unwell, call your vet and schedule a visit, don't put it off. We want him to feel better as soon as possible.

Dr. Lori Cesario

Board Certified Veterinary Oncologist

PS: I'm happy to now offer online oncology consultations. Learn more about how this service can help by visiting the Vet Cancer Consultants site.

A few other articles you might enjoy...

(1) Dog Breeds and Their Associated Cancers

(2) Mast Cell Tumors - The Great Imitator in Canine Cancer

(3) Canine Splenic Tumors - What You Need To Know

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