Медицинский совет (Jul 2020)

Biopsychosocial approach in the rehabilitation of patients with operable breast cancer

  • V. A. Kluge,
  • T. Yu. Semiglazova,
  • P. V. Krivorotko,
  • E. V. Melnikova,
  • V. V. Semiglazov,
  • K. O. Kondrateva,
  • S. G. Nazarova,
  • M. A. Tynkasova,
  • B. S. Kasparov,
  • B. M. Adhamov,
  • R. S. Pesotsky,
  • K. Yu. Zernov,
  • D. V. Kovlen,
  • V. F. Semiglazov,
  • A. V. Belyaev

DOI
https://doi.org/10.21518/2079-701X-2020-9-196-204
Journal volume & issue
Vol. 0, no. 9
pp. 196 – 204

Abstract

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The relevance: more than 60% of cases are due to early breast cancer (EBC). Priority is the treatment of patients with early breast cancer, provided that the maximum quality of life (QL) is maintained. During or after complex treatment, more than half of patients with EBC report the occurrence of functional disorders that reduce the QL. Aim: to evaluate the event-free survival rate (EFS) of EBC patients undergoing rehabilitation within the framework of a biopsychosocial approach in the course of complex antitumor treatment. Materials and methods: the study involved 228 patients with EBC who received complex treatment from 2015 to 2019. In the prospective part of the study, 114 patients were subjected to rehabilitation measures in the framework of a biopsychosocial approach that considers both biological features of functional restriction and psychosocial disorders, a multidisciplinary team of specialists worked with all patients. In the control group, 114 patients were selected retrospectively and underwent physical and psychological rehabilitation as prescribed by a doctor. Patients of both groups are divided into subgroups depending on the availability of preoperative chemotherapy. Event-free survival was assessed over a 2-year follow-up period. Events were accepted as censored events: relapse, metastases, the occurrence of another cancer, a new concomitant disease, an exacerbation of concomitant pathology, and death. Results: Rehabilitation measures within the framework of the biopsychosocial model improve the indicators of EFS in patients with EBC. The use of a biopsychosocial approach in rehabilitation increased EFS by 3.8 months. The results of multivariate analysis, reducing the risk of occurrence of the event EBC patients undergoing rehabilitation within the framework of the biopsychosocial approach in the presence of neoadjuvant chemotherapy was 28%, in patients of younger age group (25–44 years) was 29%, in patients in menopause – 25%.

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