June 29, 2017
Until recent years, few people thought the restorative treatment of oncological patients; doctors treated him with great scepticism and fatalism. However, this type of treatment is becoming increasingly important in connection with the increasing number of cancer patients who received radical treatment. So, in Russia, registered in oncological hospitals is about 2 million patients with malignant tumors with follow-up term of more than 5 years.
It is well known that malignant tumors most commonly occur in the elderly, but among cases comparatively large and also the proportion of young people in the Prime of his creative and professional activities. So, with lung cancer often suffer men from 41 years to 55 years, choriocarcinoma of the uterus is most common in women 20-40 years of age, tumors of the bones of the lower extremities, as a rule, affect individuals aged 10-30 years, etc. Thus, the rehabilitative treatment of these patients, the return of their ability to work are important.
It should be noted that the concept of survival of cancer patients is not identical to the notion of full recovery. Extensive surgery and intense radiation, cytostatic and hormonal therapy used in Oncology, leads to serious violations of various body functions.
The program of rehabilitation treatment should be planned individually for each patient depending on General condition, sex, age, stage of tumor, its localization, histological structure, anticipated methods of treatment, prognosis, state of the neuro-psychiatric patient, his / her employment orientation, profession and working conditions. Despite the fact that it is impossible to accurately determine the prognosis of the disease at the beginning of treatment, it is necessary to set the goals of rehabilitation measures, to be able to make their plan. Doctors need to anticipate all possible causes of disability that may occur as a result of illness or treatment, to be able to reduce or prevent.
The presence of malignant tumors or even suspicions that it is itself a powerful stress factor. Changes in the psyche of patients having regardless of the type, shape and localization of malignant tumors, the patient's condition, sex, age, intellectual level and education. While the patient is psychologically easier to tolerate removal of the inner invisible body than, for example, the amputation of a limb, removal of the breast, or surgery in the head and neck.
One of the most important events within the program of regenerative treatment of all without exception of cancer patients is psychological work with the patient. The beginning of it should fall at the time of examination of the patient, and the dynamic supervision of a psychologist and a psychiatrist to continue not only for clinical but also distant recovery period of treatment.
Repeated, everyday conversations of the attending physician, the psycho-therapeutic behavior of the entire staff, differentiated use of individual and collective group activities reduce the confusion, anxiety, neurasthenic syndrome. Effective use of the combined method with elements of auditory training. In the subsequent good results provides a rational psychotherapy with autogenic training.
A powerful psychotherapeutic effect has physiotherapy, also included in the program of regenerative treatment of cancer patients. In the preoperative period the purpose of training, along with psychological impact is teaching patients proper, full breath, clearing techniques, turns and landing in the bed, i.e. those skills that needs to find its application in the postoperative period. In cases of incurable patients of similar classes continue at the minimum level, pursuing only the psychotherapeutic goal. If successful, the surgical treatment of the intensity of physical activity in the postoperative period significantly increased. At this time, in addition to General goals for all patients (prevention of pneumonia and atelectasis, the suppression of hypostatic phenomena), and solve specific challenges for specific types and localizations of lesions. Patients who had undergone radical mastectomy, offer a complex of exercises promotes full recovery of function of the shoulder girdle and the shoulder joint on the side of the operation. In patients after lobectomy have made persistent attempts of compensation of respiratory function due to the remaining lung tissue. Patients undergoing amputation of the lower limb, undergo special training to prosthetics, which includes not only exercises for the muscles of truncated limbs, but also training the shoulder and pelvic girdle. Patients with laryngeal cancer undergoing laryngectomy, preparing for subsequent learning sonorous speech with the help of certain breathing exercises.
In the late postoperative period goals and methods of rehabilitation treatment even more varied and individual. For example, in malignant tumors of the maxillofacial area main treatment is surgery, in particular electrosurgical. Radical removal of the tumor is accompanied by disfigurement of the face, impaired speech, chewing, swallowing, salivation. As a restorative treatment gives good results orthopedic way of closing the extensive damage to the face. Elimination of cosmetic defects it is possible in a shorter time than through a multi-step plastic surgery. Supply patients with temporary and permanent maxillofacial prosthetics with regard to their functionality reduces postoperative disfigurement of the patient and allows for restoration of function of the oral cavity.
For patients operated for cancer of the stomach, in the forefront among the rehabilitation measures are diet, and rational nutrition.
Patients operated on for cancer of the rectum and colon; in the postoperative period gives an idea about how to care for artificial anus, methods of regulation of intestinal motility, the means of dealing with the uncontrolled discharge of gases and odor. By individual adjustment provides the reliable sealing of colostomy bag. The ability to use common recovery measures, as a rule, patients soothes, gives confidence in yourself, the desire to return to family and community work.
Rehabilitation treatment of patients after lower limb amputations for malignant tumors is one of the most difficult problems. Despite the timely radical surgical intervention, a large number of patients die in the early stages of metastasis. However, this circumstance is not a sufficient basis to deprive the patient of active life, even under unfavorable prognosis.
The basis of restorative treatment in lower limb amputations is an immediate prosthesis on the operating table. It allows you to restore lost limb function, as well as employment and professional activity of the patient. Early use of therapeutic prostheses significantly reduces the timing of the final prosthesis.
When obtaining educational training of the prosthesis on the operating table, patients are up within 2-3 days after amputation of the thigh or lower leg. 2-3 weeks almost all patients able to walk with one or two canes, and after 30-35 days without them. The majority of patients are well mastered walking on primary permanent prosthesis.
The main methods of treatment of malignant tumors of female genital sphere constituting 1/3 of all malignant tumors in women, are surgery, radiation and chemotherapy, and combinations thereof. Restorative treatment of such patients should be conducted on ways to address the functional consequences associated with the loss of organs (uterus, ovary) in the surgical treatment; eliminate changes in the neighboring organs and tissues the application of radiation and chemotherapeutic effects; save possible normal functional ability of organs and, in particular, reproductive functions, and also resolve neuropsychiatric disorders associated with disease and treatment. The majority of the operated women after 2-4 weeks after the operation revealed violations, characteristic for the post-castration syndrome. Vegetative-vascular disorders in the form of feelings of heat, the tides to the head, sweating, pain in the heart area and headaches, dizziness, numbness of extremities significantly reduces work capacity and in severe (hot flashes up to 30 times a day) to completely violate her. Complex sedative therapy (medication, psychotherapy) with elements of physiotherapy (indifferent baths and showers, electric) bring significant relief to patients, reduced ability to work.
Thus, the restorative treatment of oncological patients has the following objectives:
1) restoration and recovery is expected without significant loss of capacity for work; an example is the patient following a radical mastectomy, which has stiffness of the shoulder joint on the side of the operation;
2) support - the disease ends with the disability, but it can be mitigated with adequate treatment and proper training. An example is the patient with an amputated limb;
3) palliative care - with the progression of the disease can prevent the development of certain complications (bedsores, contractures, pains, mental disorders).