Quality of Life Shapes Owner Decision-Making in Canine Cancer Care: Insights From Large-Scale Online Discourse

Canine cancer imposes substantial emotional, financial and decisional burden on owners navigating complex referral pathways and treatment options. Understanding how owners experience and interpret these pathways is essential to improving care delivery. We conducted a retrospective social media listening study using Pulsar Platform to retrieve public Anglophone posts relating to canine cancer across multiple platforms. After cleaning, de-duplication and zero-shot large language model relevance filtering (accuracy 88%-99%, F1 93%-98%, with precision up to 99% on Reddit), 11 878 posts were analyzed (of those that could be geolocated, most originated from the USA). Sentiment and emotion classification, thematic extraction and non-negative matrix factorization topic modelling were applied. Pre-specified subsets examined cost-focused (n = 2008), referral-focused (n = 341) and steroid-focused (n = 438) discourse. Overall, negative sentiment predominated (66%), with sadness the most frequent emotion (64%). Across platforms, quality of life (QoL) functioned as the primary decision-making framework, operationalized through appetite, mobility, comfort, engagement and "good days". Referral narratives highlighted delays, diagnostic sequencing uncertainty, travel burden and perceived gatekeeping within referral pathways. Financial constraint frequently shaped treatment feasibility, influencing decisions regarding chemotherapy, surgery, steroid-only palliation and euthanasia. Steroids were often described as a palliative bridge or cost-constrained alternative when advanced oncology care was inaccessible. General practise (GP) veterinarians were consistently referenced as trusted information anchors, influencing referral uptake and treatment trajectories. Topic modelling suggests a cancer-care pathway experienced as structurally constrained despite strong owner willingness to pursue treatment. QoL consistently supersedes cure as the dominant evaluative metric. Earlier cost transparency, clearer shared-care communication and strengthened GP-oncologist coordination may reduce decisional distress and help mitigate avoidable barriers to specialist care.