An in-depth look at how laser therapy or photobiomodulation (PBM) can be used in veterinary oncology to reduce treatment side effects and improve healing, pain control, and quality of life.
Veterinary oncology has evolved dramatically over the past decade. With broader access to advanced diagnostics, multi-agent chemotherapy protocols, precision radiation therapy, and complex surgical options, cancer patients are now living longer and receiving higher levels of care than ever before. But with these advances comes an increased need for robust supportive-care tools — modalities that can help patients tolerate intensive therapies, recover more effectively, and maintain function and comfort throughout their treatment journey.
Photobiomodulation therapy (PBM), often referred to as laser therapy, has become one such tool. Once viewed cautiously in the context of oncology, PBM is now being recognized — based on emerging veterinary and human data — as a safe and versatile modality when applied appropriately in cancer patients (see sidebar on page xx). Its use over inflamed, painful, or traumatized tissues in cancer patients is not only safe but highly beneficial. This shift in perspective is grounded in decades of accumulating evidence contradicting early, overly cautious assumptions.
What sets oncology patients apart is not simply the presence of cancer, but the cascading physiologic disruptions that result from the disease, its treatments, comorbidities, and age-related vulnerabilities. When applied appropriately to affected tissues, PBM interacts with nearly every physiologic system affected during cancer treatment. PBM’s broad cellular and tissue-level mechanisms make it exceptionally effective as a supportive modality. This article will discuss PBM’s growing role in oncology — improving comfort, mitigating treatment side effects, and preserving quality of life by supporting healthy tissue recovery.
Surgical trauma and extravasation injuries
Surgical intervention remains a cornerstone of cancer management in veterinary medicine. Tumor excision often requires wide margins, complex closures, or reconstructive techniques, all of which increase surgical trauma. Geriatric oncology patients may experience delayed healing due to age-related changes, systemic inflammation, or concurrent disease, and may tolerate certain analgesics or anti-inflammatory medications poorly.
Both in vitro and in vivo studies demonstrate that PBM positively influences all phases of wound healing. PBM enhances angiogenesis, increases collagen synthesis, downregulates pro-inflammatory mediators, and promotes fibroblast and keratinocyte proliferation and migration (Hawkins and Abrahamse, 2006a, 2006b; Chaves et al, 2018; Lanzafame et al, 2007). PBM also accelerates granulation tissue formation, improves re-epithelialization, and enhances wound tensile strength (Stadler et al, 2001; de Lima et al, 2016).
Veterinary studies support these findings, demonstrating improved postoperative comfort, faster return to eating, and improved cosmetic healing of surgical incisions following PBM (Alves et al, 2024; Wardlaw et al, 2019). PBM is most beneficial when applied proactively in the early postoperative period, reducing inflammation before prolonged edema, seroma formation, or delayed epithelialization occur.
The one exception in which the authors do not recommend post-operative treatment is in the case of mast cell tumor (MCT) removal, especially as histamines and other vasoactive substances may worsen bleeding in combination with temporary local vasodilation from laser therapy.
Chemotherapy extravasation injuries, while uncommon, represent another area where PBM may be particularly valuable. Vesicant chemotherapeutics — most notably anthracyclines such as doxorubicin — can cause severe tissue injury when inadvertently extravasated during intravenous administration (Kreidieh, 2016). Clinical signs may progress from acute swelling and pain to blistering and necrosis over several days, sometimes necessitating surgical intervention.
Traditional treatments for extravasation injuries have been varied and inconsistently successful, and include saline dilution, cold packing, hyaluronidase injection, topical dimethyl sulfoxide, corticosteroids, and systemic anti-inflammatories (Biller et al, 2016; Hamblin, 2023). Freitas et al (2022) demonstrated that PBM significantly reduced tissue damage following anthracycline extravasation, with treated patients exhibiting less hyperemia, bleeding, exudate, and necrosis, as well as improved granulation tissue formation. Similar benefits have been described in other severe inflammatory tissue injuries of a similar nature, including snake envenomation (Silva et al, 2018; Hamblin, 2023).
Recommended wound-healing dosages typically range from 2–5 J/cm² for superficial wounds and 4–15 J/cm² (or higher) for deeper or more complex wounds, depending on tissue depth, infection status, and chronicity (Al-Watban et al, 2007; Hawkins and Abrahamse, 2007; Peplow et al, 2012). Treatments should be delivered in a non-contact manner, with inclusion of a 2” to 4” margin of surrounding healthy tissue. Initial sessions may be daily or every other day, followed by gradual tapering as healing progresses. Since tumor reoccurrence is possible, and sometimes even likely given the behavior of certain tumor types, it is recommended that the veterinarian have an informed consent discussion with the pet owner anytime PBM is used post-surgically, so that the owner understands the risks vs. benefits and the likelihood (or not) or tumor reoccurrence regardless of laser therapy.
GI toxicity and dysregulation of the microbiome
Gastrointestinal toxicity is a central and often treatment-limiting issue in veterinary oncology. Published retrospective analyses report GI side effects in 20% to 50% of dogs receiving vincristine or cyclophosphamide (Mellanby et al, 2002; Tomiyasu et al, 2010), and up to 37% of dogs undergoing radiation therapy experience GI complications (Farrelly et al, 2018). These effects range from transient anorexia to chronic diarrhea, malabsorption, and weight loss.
Chronic GI dysfunction alters microbiome composition, disrupts nutrient absorption, and contributes to cachexia and muscle wasting. For oncology patients — who often exist in a state of negative energy balance — maintaining GI function is essential not only for comfort, but also for treatment continuity and survival.
Alves et al (2022) demonstrated that PBM significantly outperformed psyllium husk in reducing episodes of chronic large-bowel diarrhea and improving stool quality, body condition, and body weight. While PBM’s clinical benefits likely arise in part from reduced inflammation, decreased smooth-muscle spasm, and improved mucosal healing, emerging research suggests PBM may also play a role in modulating the gastrointestinal microbiome.
Chemotherapy and radiation therapy disrupt microbial diversity, increase pro-inflammatory metabolites, weaken epithelial barriers, and impair nutrient absorption. In a murine model, 808-nm PBM produced a 10,000-fold increase in the beneficial organism Allobaculum after two weeks of treatment (Liebert et al, 2019). Other studies suggest PBM reduces dysregulated microbial populations while supporting beneficial species. Proposed mechanisms include reductions in pro-inflammatory cytokines and macrophage polarization toward an anti-inflammatory M2 phenotype (Hamblin, 2017; Fukuda et al, 2013).
For oncology patients, these effects may translate into improved chemotherapy tolerance, reduced diarrhea, enhanced appetite, modulation of systemic inflammation, and potentially altered tumor-related immune responses.
For diarrhea management, a dose of 6–10 J/cm² is recommended, treating the entire abdomen on-contact with continuous motion, as if performing a scanning abdominal ultrasound of the intestines. Acute cases may benefit from daily treatments, while chronic cases often transition to maintenance sessions every two to four weeks alongside appropriate dietary and pharmacologic management.
Cystitis – UTI and SHC
Chemotherapy, especially cyclophosphamide, and chronic steroid use predispose cancer patients to two main urinary tract problems: infectious cystitis (UTI) due to immunosuppression and sterile hemorrhagic cystitis (SHC) due to cyclophosphamide metabolite acrolein (Peterson et al, 2012, Wong et al, 2015; Seguin et al, 2003). Both UTIs and/or cases of SHC are extremely painful, and current pain medication options may be insufficient and/or unable to be administered to the patient, depending on other factors including renal function.
PBM’s anti-inflammatory effects can help reduce hematuria, pain, urinary urgency, and bladder wall inflammation — providing support while standard therapies (e.g. antibiotics, and other anti-inflammatory management) address underlying causes. Additionally, reducing C-fiber activation (a major contributor to the development of the allodynia responsible for the symptom of urinary frequency and bladder pain) may also be of significance for these patients, making laser therapy an essential part of a multimodal plan. PBM does not replace antimicrobials when a bacterial infection is present; rather, it accelerates the resolution of inflammation and improves comfort, helping maintain appetite, mobility, and hydration — all critical in oncology care.
For treating the urinary bladder in the case of either UTI or SHC, a dosage of 6–10 J/cm2 is recommended (scaling up with the size of the patient), as described for diarrhea above –treating the entire caudal abdomen on-contact utilizing a similar technique to scanning the area for a diagnostic ultrasound, aiming for all aspects of the bladder where it is positioned in the abdomen. In cases of mild UTIs, one to three treatment sessions may be sufficient. For more serious infections or SHC, begin with daily to every-other day treatments, then wean the frequency of treatment sessions (twice weekly, then once weekly, and so forth) as the patient improves, until resolution.
Oral mucositis and radiation dermatitis
A recent consensus review by the World Association of Laser Therapy (WALT) Guidelines for the Use of PBM to Mitigate Cancer Therapy Side Effects (Robijns et al, 2022) stated that in humans, PBM has been shown to be effective for the treatment of several cancer-therapy side effects including radiodermatitis (RD), oral mucositis (OM), dysphagia, alopecia, lymphedema, peripheral neuropathy, and other problems. Without treatment, some of these side effects may lead to the alteration or potential discontinuation of therap(ies) with consequential risk to patient(s). For the purposes of this article, the authors will focus on oral mucositis and radiation dermatitis, as these are also frequently noted in veterinary patients undergoing similar therapies and significantly affect eating, comfort, and treatment tolerance.
Characterized by the ulceration of non-keratinized mucosa, oral mucositis is one of the most severe complications arising from certain cancer treatments in humans. A recent summary of the systematic reviews for oral mucositis was published, including outcomes from 16 clinical trials (Nascimento et al, 2023). Regardless of use as either a prophylactic or therapeutic treatment, six studies indicated a statistical difference in favor of PBM therapy for the former and all studies reporting outcomes for the latter demonstrated statistical significance favoring PBM therapy for reducing the severity of OM.
Most studies reported doses in the range of 1–6 J/cm2 (a superficial tissue dose) as effective for OM prevention across the different cancer treatments, which is consistent with the dosimetry for many veterinary oral conditions, such as gingivitis or post-dental application(s). The frequency of treatment sessions most recommended was daily to every other day throughout the entire cancer treatment, or until the resolution of OM lesions (Lai et al, 2021; Anschau et al, 2019; da Silva et al, 2022).
Acute radiodermatitis is an inflammatory skin reaction caused by radiotherapy that occurs in up to 95% of patients undergoing this treatment (Cox and Ang, 2010). Developing after two to four weeks following the first radiotherapy treatment, the progression and severity of skin reactions can vary and are graded based on severity. In severe cases of RD, premature interruption of radiotherapy might be necessary, which may impact treatment outcomes and overall patient survival. Management strategies to reduce the risk of radiotherapy interruptions and morbidity have primarily utilized topical products for skin care, improved daily hygiene, and at times, the use of topically applied steroids (Wong et al, 2013).
As previously described for wound healing, there are several physiological benefits to using PBM in inflamed and painful tissues, especially in cases where healing and re-epithelialization is needed. Doses ranging between 2–6 J/cm² for superficial tissues and 6–10 J/cm² if deeper dermal inflammation is present are recommended. The authors recommend treatment sessions two to three times weekly during radiation therapy with continuation one to two weeks post-radiation course.
Overall, the clinical benefits of PBM in patients suffering from OM and/or RD include:
- Reduced ulceration severity
- Improved comfort during eating
- Decreased dermatitis and pruritus
- Reduced risk of treatment interruption.
Chronic pain
Chronic pain is often underestimated in veterinary patients, and strategies should be integrative to help the patient’s condition. A recent meta-analysis in human oncology patients revealed that about one-third of patients experienced uncontrolled pain (Greco et al, 2014). Cancer pain is complex and multifactorial — inflammatory, neuropathic, visceral, ischemic, and musculoskeletal components often coexist.
Several validated quality-of-life and pain assessment scales have been published which are of particular use in oncology patients (Lynch et al, 2011; Yazbek and Fantoni, 2005). In both human and veterinary medicine, the advantage of a multimodal analgesic plan over single-agent therapies has been demonstrated. The efficacy and use of pharmaceuticals for managing chronic pain in the veterinary oncology patient, while important, will not be discussed in this article.
Accounting for the cause of at least 80% of lameness diagnoses and affecting around 20% of adult dogs in the United States, clinical signs of osteoarthritis occur in over 90% of elderly dogs (Anderson et al, 2020; Venable et al, 2008). In cats, a similar scenario is observed. Osteoarthritis has a prevalence of over 90% in animals above 12 years of age (Lascelles, 2010) and this prevalence is expected to increase due to increased life expectancy and obesity rates (Anderson et al, 2020).
While no published studies specifically look at the prevalence of arthritis in veterinary oncology patients, with cancer affecting pets of all ages, it is safe to assume the numbers are very similar. These patients often develop compensatory pain due to altered biomechanics from tumor-related discomfort, limb amputation, or surgical recovery, and keeping these patients mobile and active with worsening arthritis and body condition changes is imperative.
Current treatment strategies in veterinary medicine for arthritis are aimed primarily toward controlling pain, improving joint function, and minimizing functional incapacity in patients through pet owner education and home environmental management. Multimodal management of patients with osteoarthritis includes appropriate weight management, nutraceutical supplementation, pharmacological therapy, and the use of modalities including PBM, alongside rehabilitation therapy.
PBM reduces inflammation, pain, and stiffness in these regions. Recent studies have demonstrated its efficacy in treating pain from OA, even compared to nonsteroidal anti-inflammatory medication (Alves at el, 2022; Looney et al, 2018). All veterinary oncology patients exhibiting signs of pain should undergo a thorough orthopedic and neurologic examination. In order to be effective, PBM must be applied to the correct tissues. As mentioned previously, many of these patients in addition to having joint pain from arthritis, also have other localized painful areas due to compensatory changes in biomechanics. Pain examinations should be repeated regularly on all patients, to evaluate for improvement after therapy has begun, and to ensure there are no “new” issues that should be treated.
Prescribed treatment areas for PBM should primarily be based on the orthopedic and pain assessment examinations performed by the veterinarian. For osteoarthritis and compensatory musculoskeletal pain, a dose range of 6–20 J/cm2 is recommended (Looney et al, 2018; Alves et al, 2022), scaling up with the size of the patient. Though the specifics are device- and design-dependent, the power used to achieve the desired fluence should be lower for smaller patients, areas with increased sensitivity, or areas with very little soft tissue. For any acute or chronic painful condition such as osteoarthritis, an “induction phase” of initial, more frequent treatment sessions is recommended (i.e. every-other-day treatments until significant improvement is seen).
Once a significant improvement in clinical signs is noted, a “transition phase” of treatment sessions begins. During transition, treatments are decreased to twice weekly, then once weekly, and so on as the patient improves, until a “maintenance phase” of treatment is established (typically once every two to four weeks) so that clinical symptoms are kept to a minimum.
PBM integration: how to make it work in practice
Photobiomodulation can be a valuable component of supportive care in modern veterinary oncology. By targeting inflammation, mitochondrial dysfunction, impaired perfusion, chronic pain, mucosal injury, microbiome imbalance, and tissue healing deficits, PBM addresses many of the most pressing challenges faced by cancer patients. But how do we integrate this into our busy veterinary practice for our cancer patients?
- Build PBM into chemotherapy rechecksand any diarrheaor cystitis cases
Chemotherapy-induced GI and urinary toxicities typically flare three to seven days post-treatment. Scheduling PBM during this window reduces discomfort and helps maintain treatment continuity. Patients presenting for diarrhea or signs of cystitis should undergo a regular examination, as always, but consider adding PBM alongside other treatments to gain clinical improvements faster and manage their pain better.
- 2. Integrate PBM into postoperative care
Postoperative PBM reduces swelling and pain and accelerates healing. Include these short treatments in any pain management package for surgeries, and educate staff around performing treatments for surgical sites, planning at least one to three treatments depending on the surgery recovery.
- Don’t forget to treat osteoarthritis or other chronic pain
Schedule OA patients for ongoing PBM treatment sessions, which can be coordinated with their oncology rechecks, to keep them comfortable and mobile.
- 4. Communicate with referring oncologists
Because PBM is often administered outside oncology specialty clinics, clear communication ensures integrated and consistent patient care. There are still a lot of widely held concerns and misconceptions arising from early literature and an abundance of caution. As more oncologists and general veterinarians gain clinical experience with this modality in their cancer patients, these concerns should decrease but may require extra communication in the short term.
Why early research suggested PBM was detrimental to cancer patients
The earliest hesitations around using PBM for oncology patients arose from a small number of in vitro studies suggesting increased proliferation of malignant cells under laser exposure (Sroka et al, 1999, Al Ghamdi et al, 2012). However, these experiments used isolated cell cultures under nonclinical conditions, often employing excessively high doses, and failing to account for the immune system and other factors in an in vivo situation (Hamblin et al, 2017).
These findings do not translate to real world conditions, where PBM’s effects are modulated by tissue heterogeneity, immune interactions, and physiologic repair pathways. More recent research has shown that PBM can be very beneficial in reducing side effects that occur as a result of cancer treatment (Baxter et al, 2017; Paglioni et al, 2019) without contributing to the development of new primary tumors or tumor recurrence (Brandão et al, 2018; Antunes et al, 2017).
The oncology patient’s physiologic landscape: why PBM matters
Veterinary cancer patients frequently experience:
- Pain, from tumor invasion, inflammation, neuropathy, surgery, or paraneoplastic mediators
- Gastrointestinal toxicity, including vomiting, diarrhea, and inappetence
- Altered microbiome balance following chemotherapy or radiation
- Urinary complications, such as infectious cystitis or sterile hemorrhagic cystitis
- Radiation-induced skin and mucosal injury
- Surgical trauma and delayed healing
- Neuropathic pain from nerve compression or chemotherapy
- Declining mobility due to compensatory myofascial pain
- Chronic systemic inflammation.
PBM is suited to this patient population because it interacts with fundamental cellular and tissue-level processes — mitochondrial function, inflammatory signaling, perfusion, nerve activity, and immune modulation. PBM can be an integral supportive-care tool comparable to antiemetics, gastroprotectants, analgesics, and other wound-care strategies. This recognition follows similar trends in human oncology, where PBM is included in guidelines for mucositis prevention, radiation dermatitis management, and peripheral neuropathy mitigation.
Additionally, laser therapy is non-invasive, well tolerated, and comfortable for patients. It has no systemic toxicity, making it ideal for geriatric or medically fragile animals and it is drug-sparing, complementing NSAIDs, opioids, or other medications frequently used in these patients. In an era of increasing pet owner interest in non-pharmaceutical therapies, PBM is also a modality that aligns with client expectations for low-risk options that meaningfully improve comfort and function.
Conclusion
Managing geriatric oncology patients requires careful balancing of treatment decisions with quality of life as the primary goal. Concerns about adverse effects from conventional therapies make supportive and integrative options an important consideration, particularly in palliative care, when many pet owners are eager to pursue interventions that may improve comfort and function.
Although photobiomodulation was historically avoided in cancer patients due to theoretical risks, current evidence supports its safe and judicious use when dosing and tumor location are carefully considered. Growing recognition of the role of chronic inflammation and immune modulation in cancer progression, along with emerging insights into the influence of the gastrointestinal microbiome on tumor behavior and treatment response, further supports this approach. By helping regulate inflammatory states, PBM may offer benefits in improving patient comfort and potentially enhancing therapeutic efficacy (Zhao et al, 2023). Ultimately, veterinarians should apply individualized clinical judgment, integrate available evidence, and engage in clear, informed discussions with pet owners.
When used thoughtfully and consistently, PBM does more than reduce symptoms — it improves quality of life, strengthens treatment tolerance, and helps veterinary oncology patients not only live longer, but live better.
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AUTHOR PROFILE
Dr. Miller is a graduate of the University of Tennessee, College of Veterinary Medicine. She completed an internship in internal medicine, and became certified in canine rehabilitation therapy at the Canine Rehabilitation Institute. She practiced canine rehabilitation, sports medicine, neurological rehabilitation, and acupuncture for several years before returning to general practice.
