Development and Evaluation of a Caregiver Reported Quality of Life Assessment Instrument in Dogs With Intracranial Disease

Abstract

In veterinary medicine, quality of life (QOL) assessment instruments, which are important components of the holistic evaluation of treatment success, have largely not included organ-specific concerns that may be broadly relevant to caregivers of dogs with intracranial disease. The objective of this study was to identify core questionnaire items and domains that contribute to health-related QOL (HRQOL) in dogs with intracranial disease. A questionnaire was developed that contained 39 QOL-related items encompassing physical, social/companionship, and brain-specific domains associated with the treatment of dogs with intracranial disease, and administered to caregivers of 56 dogs diagnosed with genetic, inflammatory, neoplastic, traumatic, and vascular brain diseases, 52 healthy dogs, and 20 dogs with non-neurological illnesses. Clinician derived functional measures of each dog's health status including chronic pain, Karnofsky performance, and modified Glasgow coma scale scores were also recorded. Principal component analysis refined the final questionnaire, termed the CanBrainQOL-24, to 24-items within the three domains with a minimum Cronbach's alpha of 0.7, indicative of good internal consistency. The CanBrainQOL-24 discriminated between healthy and diseased dogs. Physical and brain-specific domains were significantly different between dogs with intracranial and non-neurological diseases. Significant correlations were observed between owner reported visual analog scores and CanBrainQOL-24 scores, as well between clinician derived functional status measures and owner reported QOL. The CanBrainQOL-24 contains core questions relevant to caregiver assessment of HRQOL in dogs with a variety of intracranial diseases, and provides information that is complementary to clinician derived functional outcome measures.

Risk factors for adverse events occurring after recovery from stereotactic brain biopsy in dogs with primary intracranial neoplasia

“…1,27 Therefore, it is possible that some of the tumors were not correctly graded, but more likely reflects overlapping MRI characteristics between tumor grades. [20][21][22] Dogs were also more likely to have hemorrhage present on postbiopsy diagnostic imaging if gradient echo signal voids were present on MRI exams obtained before biopsy. Intratumoral hemorrhages are common findings in canine brain tumors, including 30 to 40% of gliomas.…”

“…Brain herniation, ventricular distortion, and midline shift are associated with increased intracranial pressure, and as tumor size increases, so does intracranial pressure. 20,21,28 Historically, there has been concern that SBB could precipitate herniation and exacerbate intracranial hypertension, ultimately leading to AE, although quantitative evidence supporting this is lacking in both people and in veterinary medicine. 12,29 Similar to previous reports, we also found that pneumocephalus is common finding on imaging studies after SBB, and is frequently asymptomatic.…”

“…Gliomas can often be heterogenous in nature and small biopsy samples may not reflect geographic tumor histology 1,27 . Therefore, it is possible that some of the tumors were not correctly graded, but more likely reflects overlapping MRI characteristics between tumor grades 20‐22 …”

“…Data extracted from medical records included the breed, age, weight, sex, body condition score (BCS), type and duration of clinical signs before presentation, duration of corticosteroid treatment before presentation, type of anticonvulsant treatment the dog was receiving, neurolocalization, and KPS (Supplemental File 1) before SBB 18‐21 . Clinicopathologic variables that were recorded included the tumor type, grade, and location within the brain, red blood cell (RBC) count, platelet count, total white blood cell (WBC) count, creatine kinase (CK), albumin, globulin, alanine transaminase (ALT), and alkaline phosphatase (ALP) 14 …”

“…Data extracted from medical records included the breed, age, weight, sex, body condition score (BCS), type and duration of clinical signs before presentation, duration of corticosteroid treatment before presentation, type of anticonvulsant treatment the dog was receiving, neurolocalization, and KPS (Supplemental File 1) before SBB. [18][19][20][21] Clinicopathologic variables that were recorded included the tumor type, grade, and location within the brain, red blood cell (RBC) count, platelet count, total white blood cell (WBC) count, creatine kinase (CK), albumin, globulin, alanine transaminase (ALT), and alkaline phosphatase (ALP). 14 Pre-and postbiopsy diagnostic imaging studies were independently reviewed by 2 investigators blinded to the biopsy and clinical outcome results, and the following data recorded as previously described: the total T2W tumor volume, the total T2W brain volume, the total tumor:brain volume, tumor shape (ill-defined, ovoid, or spherical) and margination (smooth or irregular), growth pattern (focal or diffuse), intrinsic T1W and T2W tumor signal characteristics (hypointense, isointense, hyperintense, or heterogeneous), and intrinsic CT attenuating appearance of tumor parenchyma (hypoattenuating, isoattenuating, hyperattenuating, or heterogeneous).…”