Organization of rehabilitation programs for cancer patients based on an interdisciplinary approach

Purpose. To improve the technology of cancer patients' rehabilitation in the multidisciplinary hospital using an interdisciplinary approach at the stages of combined treatment of malignant tumors.

Patients and methods. The analysis of 845 cases of admission of cancer patients in a multidisciplinary clinic for oncological rehabilitation, including treatment of complications and co morbid diseases, diagnosis and palliative care, on the specialized treatment stages was made. Based on the diagnosis, clinical status, determination of the clinical potential of these patients the need in medical rehabilitation of cancer patients based on the principles of an interdisciplinary approach was established.

Results. A low commitment of oncologists to refer patients to multidisciplinary hospitals for supporting general medical treatment programs, which involve the work of multidisciplinary rehabilitation teams, especially at the initial stages of cancer, was revealed. In 94.1% of cases, based on oncologists' recommendation patients were presented to the multidisciplinary hospital only in the advanced stage of malignant disease. However, 64.8% of patients who came only for the purpose of "hospice" or palliative care treatment were able to continue their anticancer treatment. In 4.9% of cases among patients, who were referred for palliative care, the severity of their condition was mistakenly regarded as a relapse of cancer, whereas it was caused by comorbid pathology.

The low interest of cancer patients in rehabilitation programs in the absence of recommendations from oncologists was revealed. It was shown that supportive therapy based on the principles of interdisciplinary approach is not only needed for patients with far-ongoing manifestations of cancer process, but also for patients with stage I-II of cancer, since even at this stage various complications of cancer disease, the consequences of its treatment and also manifestations of a combined pathology are often encountered.

Conclusion. A classification of medical problems of cancer patients was proposed. Based on the newly developed methodology, the algorithm of personified rehabilitation support programs of oncological patients' and guidelines for managing patients at the stages of specialized and rehabilitative treatment using principles of an interdisciplinary approach, were created.

1. Ballyuzek MF, Stepanov BP. Goals and possibilities of therapeutic rehabilitation of oncological patients. Clinical Medicine (Klinicheskaya Meditsina). 2013;91 (9):53-7. (In Russian).

2. Stubblefield M. D. Cancer Rehabilitation. Semin Oncol. 2011 Jun;38(3):386-93. DOI: 10.1053/j.seminoncol.2011.03.008.

3. Grushina TI, Mironova EE. Sanatorium treatment in combined rehabilitation of breast cancer patients. Fizioterapiya, Bal'ne-ologiya i Reabilitatsiya (Russian Journal of Physiotherapy, Balneology and Rehabilitation). 2003;4:34-8. (In Russian).

4. Silver JK, Baima J. Cancer prehabilitation: an opportunity to decrease treatment-related morbidity, increase cancer treatment options, and improve physical and psychological health outcomes. Am J Phys Med Rehabil. 2013 Aug;92 (8):715-27. DOI: 10.1097/PHM.0b013e31829b4afe.

5. On the order of the organization of medical rehabilitation: Order of the Ministry of Health of the Russian Federation, December 29, 2012 № 1705n. Available at: http://base.garant.ru/70330294/(In Russian).

6. Herrmann J, Lerman A, Sandhu NP, Villarraga HR, Mulvagh SL, Kohli M. Evaluation and management of patients with heart disease and cancer: cardio-oncology. Mayo Clin Proc. 2014 Sep;89 (9):1287-306. DOI: 10.1016/j.mayocp.2014.05.013.

7. Zamorano JL, Lancelloffi P, Rodriguez Munoz D, Aboyans V, Asteggiano R, Galderisi M, et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). Eur Heart J. 2016 Sep 21;37 (36):2768-2801. DOI: 10.1093/eurheartj/ehw211