My dog might have cancer, but I'm worried about how much it will cost

My veterinarian found a mass in my dog's abdomen that she says is probably cancerous, based on what she could see in an x-ray and my dog's symptoms. She suggested getting a biopsy to learn more and told me I have options like surgery or chemotherapy, but they all sound really expensive. I don't really know what to do because just getting the x-ray was almost more than I could afford. Should I have caught it earlier? If I do more testing and it is cancer, I don't think I will be able to pay for treatment. Does it even make sense to do the tests? If I don't do the tests, what happens next?

—Scared in South Carolina

Hey there, friend! First of all, I'm so sorry about your dog. Hearing that your pet might have cancer can be frightening and it's even more terrifying when you don't have a lot of money. I've been in this position and it really sucks. Because the rent (and everything else) is too damn high, you definitely aren't alone. You also aren't a bad person for feeling stressed out about money at a time like this.

First, don't blame yourself for not catching it earlier. Some cancerous tumors (if this is cancer) grow really slowly and don't show signs for a while, and when they do show up, they can be ambiguous. Medical professionals don't necessarily catch these kinds of health issues either; your dog could have had a perfectly unremarkable physical exam a year ago or even six months ago that didn't raise any concerns even though the mass might have already been there.

A question that's good to ask yourself in this situation is: If this is cancer, do I want to proceed with aggressive treatment? It sounds like your answer here is probably not, because the costs of diagnosis, let alone treatment, are beyond your capacity right now. It's hard to make that choice and it can feel really weird, but it's good to be honest with yourself about your limitations. It's also good to be aware that your options for treatment here aren't a series of expensive tests and therapies or surgery, or nothing.

The first thing I'd recommend is a conversation with your veterinarian, where you have a few questions you should ask. One is what else is coming up in her differential diagnosis: She said the growth is "probably cancerous," but did any other possibilities come to mind? How treatable are those other possibilities? What tests or examinations might be necessary to rule those out? While she can't give you a definitive diagnosis without a biopsy, she can tell you which way she's leaning and how likely or unlikely these other diagnoses may be.

Next, ask her what treatment options are available if you move foreward assuming it is cancer—and, if it's something else, if those treatment options might make it better or worse. Since she doesn't know what kind of cancer it might be, be aware that treatments that work well on some cancers may not be effective for others, and could sometimes even make them worse. She can give you some broad spectrum generalities and discuss the risks and benefits of each.

Be candid about your limited budget. She should let you know about the full range of options available rather than excluding some options based on cost, but veterinarians understand that the cost of care is rising dramatically and she's not going to judge you for weighing finances in your treatment plan. If something sounds too expensive and beyond your reach, she may have suggestions or resources to help you afford treatment and open up more options for you.

These resources could include free, low-cost, and sliding scale clinics; a patient assistance fund at your veterinary clinic; local organizations that help people care for their pets; or help with costs of medications and supplies from pharmaceutical companies. Animal shelters or rescues in your area may also have programs to help out. Banfield maintains a database of organizations offering financial assistance with veterinary costs. You might also think about crowdfunding—although be aware that crowdfunding sites do take a cut, and you may be required to disclose any funds you raise on your taxes. Do not feel ashamed of asking for help: This is what these resources are here for and the people who provide them love the work that they do and want to help keep pets and people healthy and safe together. If you've got $24.37 in your bank account, know that help is out there.

The lowest level of intervention available to you is progressing under the assumption that it is cancer and providing comfort care: Don't do any more testing, wait and see how your dog's health progresses, and as issues arise, discuss how you might treat them. There may be medications to manage pain, stimulate appetite, or manage gastrointestinal issues like diarrhea, if they arise. Sometimes giving supportive fluids helps animals feel more comfortable. Medications like steroids could be an option as well. Ask the vet to explain what comfort care options might look like for you and what to expect from your dog's coming weeks and months.

Your conversation can include a treatment plan, although it might change as your dog's health changes. The treatment plan will allow you to think ahead about what you might do at various forks in the road so you're not making a huge decision when you're stressed out and scared.

I cannot stress this enough: It is okay to stop here. If you have limited financial resources, it is okay to focus on giving your dog the best life you possibly can in this moment. It is not cold or cruel to acknowledge your limited resources, or to be honest with yourself about the overall budget you have for end-of-life care. Sometimes, no matter how much money someone has, this is actually the gold standard of care and the best treatment option.

The next level would be some additional testing to see if you can get any more information. If it's cancer, the results might help you zero in on the best comfort care choices and provide some insight into what to expect. If it is not cancer, testing might open up some other treatment options. Ask your vet to be specific about which tests she recommends, why, and how they might affect the course of treatment. One question to ask is: If you can only afford to get one more diagnostic test or procedure, which does she think would be the most useful? If you're at a clinic where the vets focus on medical care and another staffer discusses costs, get your clinical recommendations first and then talk to that staffer.

Then there's the more aggressive path she suggested, with testing that might help you narrow down precisely what kind of cancer this is, how far advanced it is, and what you should do about it. It sounds like you don't want to do this or are unable to afford it, but I'm a big fan of discussing all the options and letting people choose what works best for them. The results of this testing could come with an assortment of treatment options from comfort care if the cancer is quite advanced and the prognosis is grim to surgery, chemotherapy, radiation, and other interventions. Even pet guardians with more financial resources can struggle with the costs and decisionmaking when they take this route; sometimes it takes $10,000 worth of testing only to conclude that the best treatment option really is comfort care, or you can end up on a diagnostic and testing loop where more and more tests offer conflicting and inconclusive answers.

No matter how you decide to move forward, this is a good time to think about your dog's quality of life as your dog's health declines. Every dog is different and you know your dog best: You know when your dog is happy, and when your dog is struggling. Ohio State University has a comprehensive quality of life guide with prompts to think about and information about end-of-life care options. You might also want to think about how you want to respond to issues that can come up as animals near end of life, such as limited mobility, incontinence, and other medical issues that can be stressul and disruptive for everyone. Considering this ahead of time will allow you more room to plan and make decisions based on your dog's wellbeing. This is great advice for anyone taking care of an animal: Having these conversations early and often is part of love and care.

Tell your dog I said...

...you can still enjoy good quality of life with more conservative treatment