Skip to main content
SpringerLink
Log in

Quality-of-Life Measurements for Patients Taking Which Drugs?

The Clinical PCASEE Perspective

  • Review Article
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Summary

Of the many publications on quality of life in medicine over the last 2 decades, only a minor fraction have been devoted to drug trials. The most frequently investigated are classes of drugs within cancer disorders, hypertension and depressive illness.

Health-related quality-or-life (QOL) measurements arc typically applied in chronic or subchronic disorders where the balance between effectiveness (disease-modifying drug effects) and safety (adverse drug reactions) are assessed by patients in terms of subjective well-being. In this context, quality of life is an attempt to help the doctor to listen to his or her patient.

The components of QOL measurements are to be found within the PCASEE model where: P = physical indicators; C = cognitive indicators; A = affective indicators; S = social indicators; E = economic-social stressors or negative life events; and E = ego function or personality problems.

Most variance in QOLmeasurements arises through operating in the cognitive (e.g. lack of control, concentration difficulties) or affective (e.g. depressed mood or anxiety) components. The most specific components of course adverse drug reactions, which are typically gastrointestinal symptoms in cancer therapies and circulatory symptoms and sexual function with antihypertensive drugs. However the affective and cognitive components also have different weights within subclasses of drugs such as antihypertensive agents. Thus angiotensin convertingenzyme inhibitors act on the affective component (depression and anxiety) and calcium channel blockers on the cognitive component (neurasthenia). In general, patients with cancer or hypertension give more reliable assessments of their cognitive and affective symptoms than their doctors do, while patients with primary depression are less reliable than their doctors or relatives in measuring changes in the affective components of their illness when they are ill. Health-related QOL measurements have not only an impact on the doctor patient relationship but also involve a holistic approach to drug treatment by checking all the PCASEE components.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. WHO. International statistical cIassification of diseases and related health problems. 10th revision (ICD-10) Volumes 1 and 2. Geneva: WHO, 1992

    Google Scholar 

  2. WHO. International classification of impairments disabilities and handicap (ICIDHWHO). Geneva: WHO, 1980

  3. WHO. The WHO adverse reaction terminology. Geneva: WHO, 1990

  4. Bech P. Rating scales for psychopathology health status and quality of life. A compendium on documentation in accordance with the DSM-III-R and WHO systems. Berlin: Springer-Verlag, 1993

    Google Scholar 

  5. Juul P. Lægemiddelbivirkningsregistrering i Danmark (Adverse drug reactions registrated in Denmark). Nord Psychiatr J 1969; 23: 314–9

    Article  CAS  Google Scholar 

  6. American Psychiatric Association. Diagnostic and statistical manual or mental disorders. 3rd ed. (DSM–III). Washington, DC: American Psychiatric Association, 1980

  7. Maslow AH. Motivation and personality. New York: Harper, 1954

    Google Scholar 

  8. Gerard K. Cost utility in practice: a policy makers guide to the state of the art. Health Policy 1992: 21: 249–79

    Article  PubMed  CAS  Google Scholar 

  9. Aaronson NK, Beckmann J. The quality of life of cancer patients. New York: Raven Press, 1981

  10. Fallowfield L. The quality of life. The missing measurement in health care. London: Souvenir Press, 1990

    Google Scholar 

  11. Johnson JR, A regulatory view. In: Walker SR, Rosser RM, editors. Quality of life assessment. Key issues in tile 1990’s,Dordrecht: Kluwer Academic, 1993: 393–400

    Chapter  Google Scholar 

  12. Barofsky I, Sugarbaker PH, Cancer. In: Spilker B, editor. Quality of life assessments in clinical trials. New York: Raven Press, 1990: 419–40

    Google Scholar 

  13. van Holten-Verzantvoort ATM, Zwinderman AH, Aaronson NK, et al. The defect of supportive pamidronate treatment on aspects of quality of life of patients with advanced breast cancer. Eur J Cancer 1991; 21: 544–9

    Google Scholar 

  14. de Haes JCJM, Raatgever JW, van der Brug MEL, et al. Evaluation of the quality of life of patients with advanced ovarian cancer treatment with combination chemotherapy. In Aaronson NK, Beckman J. editors. The quality or life or cancer patients. New York: Raven Press, 1987: 2 15–26

    Google Scholar 

  15. de Haes JCJM, Pruyn JFA, van Knippenberg FCE. Klachtenlijst voor Kankerpatienten: Eerste Ervaringen. Ned Tijdschr Psychol 1983; 38: 403–22

    Google Scholar 

  16. Fallowfield L, Baum JM, Maguire GP. Do psychological studies upset patients? J R Soc Med 1986; 80: 59

    Google Scholar 

  17. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 61: 361–70

    Article  Google Scholar 

  18. Essink-Bot ML, Bousel GJ, van der Maas PJ. Valuation of health states by the general public: feasibility of a standardized measurement procedure. Soc Sci Med 1990; 31: 1201–6

    Article  PubMed  CAS  Google Scholar 

  19. Kind P. The EURO Qol–an ew approach to measuring health related quality of life. Paper presented ar Management Forum: 28 Sept 1993: London

    Google Scholar 

  20. Bergman B, Sullivan M, Sörensen S. Quality of life during chemotherapy for small cell lung cancer. An evaluation with, generic health measures. Acta Oncol 1991; 30: 947–58

    Article  PubMed  CAS  Google Scholar 

  21. Bergman B, Cytostatikaterapi kan förbättra livskvaliteten vid smacellig lung cancer. Läkertidningen 1992; 89: 1681–5

    CAS  Google Scholar 

  22. Middelboe T, Ovesen L, Mortensen EL, et al. Depressive symptoms in cancer patients undergoing chemotherapy. A psychometric analysis. Psychother Psychosom 1994; 61: 171–7

    Article  PubMed  CAS  Google Scholar 

  23. Feinstein AR. Clinemetrics. New Haven: Yale University Press,1987

  24. Wortman PM, Yeaton WH. Cumulating quality of life results in controlled trials of coronary artery bypass graft surgery. Controlled Clin Trials 1985: 6: 289–305

    Article  PubMed  CAS  Google Scholar 

  25. Bergner M, Bobbitt RA, Carter WB, et al. The sickness impact profile: development and final revision of a healh status measure. Med Care 1981: 19: 781–806

    Article  Google Scholar 

  26. Hunt SM, McKenna SP, McEwen J. Reliability of a population survey tool: a study of patients with osteoarthrosis. J Epidemiol Community Health 1981: 35: 297–300

    Article  PubMed  CAS  Google Scholar 

  27. Dupuy HJ. The Psychological General Well–Being (PGWB ) Index. In: Wenger NK, Mattson ME, Furberg CD, et al. editors. Assessment or quality ofli fe in clinical trials of candiovascular therapies. New York: Le Jacq Publishing. 1984: 184–8

    Google Scholar 

  28. Goldberg D. The detection of psychiatric illness by questionaires. Oxford: Oxford University Press, 1972

  29. Croog SH, Levin S, Testa M. The effects of antihypertensive therapy on the quality of life. N Engl J Med 1986: 314: 1657–67

    Article  PubMed  CAS  Google Scholar 

  30. Zubenko GS, Nixon RA. Mood–elevating effect of captopril in depressed patients. Am J Psychiat 1984: 141: 110–1

    PubMed  CAS  Google Scholar 

  31. Testa MA, Anderson RB, Nackley JF, et al. Quality of life and antihypertensive therapy in men. A comparison or captopril and enalapril. N Engl J Med 1993; 328: 907–13

    Article  PubMed  CAS  Google Scholar 

  32. Oparil S. Antihypertensive therapy — efficacy and quality of life. N Engl J Med 1993; 328: 959–61

    Article  PubMed  CAS  Google Scholar 

  33. Dinan TG. The role of calcium in the pharmacology of mania. Hum Psychopharmacol 1989: 4: 139–44

    Article  CAS  Google Scholar 

  34. Ranadive SA, Chen AX, Serajuddin ATM. Relative Iipophilicities and structural–pharmacological considerations of various angiotensin–converting enzyme (ACE) inhibitors. Pharm Res 1992; 9: 1480–6

    Article  PubMed  CAS  Google Scholar 

  35. Frimodt–Møller J, Loldrup D, Kornerup HJ, et al. Quality of life side–effect and efficacy of lisinopril compared with metoprolol in patients with mild to moderate essential hypertension. J Hum Hypenens 1991, 5: 215–21

    Google Scholar 

  36. Bech P. Quality of life in psychosomatic research. Psychopathology 1987; 20: 169–79

    Article  PubMed  CAS  Google Scholar 

  37. Bech P, Loldrup D, Garre K, et al. Livskvalitetsmaling ved behandling af essentiel arteriel hypertension (Measurement of quality of life as outcome in the treatment of essential arterial hypertension). Ugeskr Lager 1990: 152: 383–6

    CAS  Google Scholar 

  38. Holmes TH, Rahe RH. The social readjustment rating scale. J Psychosom Res 1967; 11: 213–8

    Article  PubMed  CAS  Google Scholar 

  39. Dimenäs E, Dahlöf C, Olofsson B, et al. An instrument for quantifying subjective symptoms among untreated and treated hypertensives: development and documentation. J Clin Res Pharmacoepidemiol 1990; 4: 205–17

    Google Scholar 

  40. Beto J, Bausal V. Quality of life in treatment of hypertension. A metaanalysis of clinical trials. Am J Hypertens 1992: 5: 125–33

    PubMed  CAS  Google Scholar 

  41. Bech P. The borderline syndromes of depression mania and schizophrenia: the coaxial or temperamental approach. Acta Psychiatr Scand 1994: 89 Suppl. 379: 45–9

    Article  Google Scholar 

  42. Heinrichs DW, Hanlon TE, Carpenter WT. The quality of life scale: an instrument for rating the schizophrenic deficit syndrome. Schizophr Bull 1984; 10; 388–98

    PubMed  CAS  Google Scholar 

  43. Meltzer HY, Burnett S, Bastana B, et al. Effects of six months of clozapine treatment on the quality of life of chronic schizophrenic patients. Hosp Community Psychialry 1990: 41: 892–7

    CAS  Google Scholar 

  44. Storr A. Human aggression. London: Allen Lane Press, 1968

  45. Hogan TP, Awad AG. Subjective response to neuroleptic and outcome in schizophrenia: a re–examination comparing two measures. Psychol Med 1992: 22: 347–52

    Article  PubMed  CAS  Google Scholar 

  46. Beck AT, Ward CH, Mendelson M. et al. An inventory for measuring depression. Arch Gen Psychiatry 1961: 4; 561–71

    Article  PubMed  CAS  Google Scholar 

  47. Bech P, Dunbar GC, Stoker MJ. The challenge of measuring quality of life in psychiatric patients. In: Jönsson B, Rosenbaum J. editors. Health economics of depression. Chichester: John Wiley, 1993: 111–28

    Google Scholar 

  48. Peselow ED, Filippi AM, Grodnick P, et al. The short and long–term efficacy of paroxetine: data from a double–blind crossover study and from a year–Iong term trial vs imipramine and placebo. Psychopharmacol Bull 1989: 25: 272–6

    PubMed  CAS  Google Scholar 

  49. Bech P. Clinical properties of citalopram in comparison with other antidepressants: a quantitative meta–analysis. ln: Montgomery SA, editor. Citalopram, the new antidepressant from Lundbeck research. Amsterdam: Excerpta Medica, 1989: 56–68

    Google Scholar 

  50. Jachuk SJ, Brierly H, Jachuk S, et al. The effect of hypotensive drugs on the quality of life. J R CollGen Pract 1982; 33: 103–5

    Google Scholar 

  51. Mayer DY. Psychotropic drugs and the ‘anti–depressed person’ personality. Br J Med Psychol 1975: 48; 349–57

    Article  PubMed  CAS  Google Scholar 

  52. Bech P, Cialdella P. Meta–analysis of citalopram; wanted and unwanted effects. Int J Psychopharmacol 1992: 6 Suppl. 5: 43–52

    Google Scholar 

  53. Tuyman-Qua H, De Jonghe F, McKenna S, et al. Quality of life in depression rating scale. Houten, The Netherlands: Ibero,1992

    Google Scholar 

  54. Dunbar GC, Stoder MJ, Hodges TCP, et al. The development of SBQOL: a unique scale for measuring the quality of life. Br J Med Econ 1992; 2: 65–74

    Google Scholar 

  55. Mesters P, Cosyns P, Dejaiffe G. Assessment of quality of life in the treatment of major depression. Int J Psychopharmacol 1993; 8: 337–40

    Article  CAS  Google Scholar 

  56. Stoker MJ, Dunbar GC, Beamount G. The SmithKline Beecham quality of life scale: a validation and reliability study in patients with a effective disorders. Qual life Res 1992; 1; 385–95

    Article  PubMed  CAS  Google Scholar 

  57. Revicki DA, Turner R, Brown R. Reliability and validity of Health-related quality of life battery for evaluating out–patient antidepressant treatment. Qual Life Res 1992; 1: 257–66

    Article  PubMed  CAS  Google Scholar 

  58. Rost K, Smith GR, Burmanm MA. Measuring the outcome of care for mental health problems: the case of depressive disorders. Med Care 1992: 30: 266–73

    Article  Google Scholar 

  59. Thunedborg K, Black C, Bech P. Quality of life and disability in long term treatment of depression. Idiographic vs monothetic approach. Psychother Psychosom. In press. 1992

    Google Scholar 

  60. Brørup C, Unden M. Combined fluoxetine and disulfiram treatment of alcoholism with comorbid affective disorders. Eur Psychiatry 1994; 9: 83–90

    Google Scholar 

  61. Bech P, Allerup P, Maier W, et al. The Hamilton Scales and the Hopkins Symptom Checklist (SCL–90); a cross–national validity study in patients with panic disorders. Br J Psychiatry 1992: 160; 206–11

    Article  PubMed  CAS  Google Scholar 

  62. Thunedborg K, Allerup P, Bech P, et al. Development of the repertory grid for measurement of individual quality of life in clinical trials. Int J Meth Psychiat Res 1993; 3: 45–56

    Google Scholar 

  63. Bradley C. The WHO Well–Being Questionnaire. Paper presented at the WHO Europe consensus meeting on quality assurance indicators in mental health care; 1993 Aug 30–31. Stockholm. Geneva: WHO, 1993

    Google Scholar 

  64. WHO. Quality assurance indicators in mental health Care. Copenhagen: Regional WHO office for Europe, 1994

  65. Sacks O. Migraine. London: Picador, 1992

  66. Ware JE, Johnston SA, Davies-Avery A. Conceptualization and measurement of health for adults in the Health Insurance Experiment, Vol. III: mental health. Santa Monica, CA: The Rand Corporation (R–1987/3–HEW), 1979

    Google Scholar 

  67. Stewart A, Ware JE, Measuring functioning and well–being. Durham, NC: Duke University Press, 1992

  68. Ware JE, Sherbourne CD. The MOS 36–item short form health survey (SF–36): conceptual framework and item selection. Med Care 1992: 30: 473–83

    Article  PubMed  Google Scholar 

  69. Garratt AM, Ruta DA, Abdalla MI, et al. The SF–36 health survey questionnaire: An outcome measure suitable for routine use within the NHS? BMJ 1993: 306: 1440–4

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Psychiatric Institute, Frederiksborg General Hospital, Dyrehavevej 48, DK-3400, Hillerød, Denmark

    Per Bech

Authors
  1. Per Bech
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bech, P. Quality-of-Life Measurements for Patients Taking Which Drugs?. Pharmacoeconomics 7, 141–151 (1995). https://doi.org/10.2165/00019053-199507020-00006

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00019053-199507020-00006

Keywords

Search

Navigation