Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors, C7-Q, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands.
Pituitary. 2018 Apr;21(2):208-216. doi: 10.1007/s11102-017-0860-4.
After treatment for a non-functioning pituitary adenoma (NFA) health-related quality of life (HR-QoL) improves considerably. However, the literature about the normalization of HR-QoL after treatment is inconclusive. Some researchers described a persistently decreased HR-QoL compared to reference data, while others did not. Considering this variety in observed HR-QoL outcomes, the aim of the present review was to provide a literature overview of health outcomes in patients with a NFA, using a conceptual HR-QoL model. A concrete conceptualization of the health outcomes of patients with a NFA can be helpful to understand the observed variety in HR-QoL outcomes and to improve clinical care and guidance of these patients. For this conceptualization, the Wilson and Cleary model was used. This model has a biopsychosocial character and has been validated in several patient populations. In the present review, health outcomes of patients with a NFA were described at each stage of the model e.g. biological and physiological variables, symptom status, functional status, general health perceptions and overall HR-QoL. The Wilson-Cleary model elucidates that elements at each stage of the model can contribute to the impairment in HR-QoL of patients with a NFA, which explains the reported variety in the literature. Furthermore, by applying the model, potential interventions targeting these elements can be identified. While optimal biomedical treatment has always been the focus, it is clearly not sufficient for good HR-QoL in patients with a NFA. Further improvement of HR-QoL should be supported by a pituitary specific care trajectory, including psychosocial care (e.g. self-management training), to beneficially affect characteristics of the patient and the (healthcare) environment, with the utmost goal to optimize HR-QoL in patients after treatment.
治疗无功能性垂体腺瘤 (NFA) 后，患者的健康相关生活质量 (HR-QoL) 会显著改善。然而，关于治疗后 HR-QoL 正常化的文献结论并不一致。一些研究人员描述了与参考数据相比 HR-QoL 持续下降，而另一些研究人员则没有。考虑到观察到的 HR-QoL 结果存在差异，本综述的目的是使用 HR-QoL 概念模型提供 NFA 患者健康结果的文献概述。对 NFA 患者健康结果的具体概念化有助于理解观察到的 HR-QoL 结果的多样性，并改善这些患者的临床护理和指导。为此，使用了 Wilson 和 Cleary 模型。该模型具有生物心理社会特征，并已在多个患者群体中得到验证。在本综述中，描述了 NFA 患者在模型的每个阶段的健康结果，例如生物学和生理学变量、症状状态、功能状态、一般健康感知和整体 HR-QoL。Wilson-Cleary 模型阐明了模型每个阶段的元素都可能导致 NFA 患者 HR-QoL 受损，这解释了文献中报道的多样性。此外，通过应用该模型，可以确定针对这些元素的潜在干预措施。虽然优化生物医学治疗一直是重点，但对于 NFA 患者的良好 HR-QoL 来说显然是不够的。进一步提高 HR-QoL 应通过特定的垂体护理轨迹来支持，包括心理社会护理（例如自我管理培训），以有利地影响患者和（医疗保健）环境的特征，最终目标是优化治疗后患者的 HR-QoL。
