Taking into account the multifunctional disorders and consequences of oncological diseases and their treatment, rehabilitation in oncology has many goals and is aimed at restoring the physical, emotional, social, role and cognitive functioning of the patient, as well as returning the patient to previous labor activity. The principles of rehabilitation measures vary considerably from country to country, depending on the social security system in which they are included. In most European countries and in theUnited States of America, rehabilitation activities are mainly carried out on an outpatient basis. Whereas inGermanythere is a unique system in which rehabilitation is performed mainly in a hospital environment. This article presents an overview of rehabilitation measures in oncology practice conducted in different countries.

The supportive care programme in St. Petersburg has existed for more than 10 years and works mainly with breast cancer patients. It includes physical procedures, psychotherapy and support given by volunteers of the Hope/ Nadezhda Association, who operate in accordance with the Reach to Recovery International Programme. In the last stages the pain relief service is activated and has good results. The Anticancer/Antirak Society in St. Petersburg provides cancer patients with help and information. Our experience with this kind of care is described and some outcomes are reported.

Введение. Психологическая помощь, являясь сутью психологической реабилитации в онкологии, основывается на работе с переживаниями больных, вызванными заболеванием раком. Специфичность переживаний пациентов определяется локализацией опухоли и тем, какое значение придает пациент больной части тела. Гинекологический рак затрагивает важные для женщины сферы, связанные с женственностью, материнством, влияющие на ее сексуальную жизнь и на семейные отношения. Цель-психологическое исследование переживаний онкогинекологических больных, специфику которых необходимо учитывать в процессе психологической реабилитации. Материал и методы. Обследована 41 больная в возрасте от 19 до 45 лет с онкогинекологическими заболеваниями на различных этапах лечения. Данные клинико-психологической беседы дополнялись результатами психодиагностических тестов-ТОБОЛ, Гиссенский опросник соматических жалоб, EQRTCQLQ-C30. Результаты исследования. Для онкогинекологических пациенток не характерен длительный период отрицания злокачественного характера заболевания. На фоне эргопатического реагирования на заболевание в структуре отношения к болезни у больных на этапе «до операции» доминировал тревожный компонент, у больных «после операции»-дисфорический компонент. Выявлена высокая интенсивность жалоб пациенток по поводу здоровья, в том числе неспецифических, свидетельствующих о психосоматической составляющей страдания больной. Качество жизни больных взаимосвязано с их представлением о видах лечения, их опасности. Показано, что заболевание раком является психологическим кризисом не только для самой онкогинекологической пациентки, но и для других членов ее семьи, особенно ее мужа. Выводы. Психологическая помощь онкогинекологическим больным в процессе психологической реабилитации должна основываться на учете их глубинных переживаний, которые определяются самоотношением женщин и принятием себя и которые могут больными не осознаваться, но влиять на их отношение к болезни и лечению и, тем самым, определять их качество жизни. Психологическая помощь, направленная на выстраивание новых взаимоотношений, адекватных ситуации заболевания, необходима всей семье больной.

Relevance: early breast cancer is detected in more than 60% of cases. Maintaining the quality of life of patients with early breast cancer at the highest possible level is a priority, along with the treatment of patients. Under a complex antitumor treatment as well as after its completion, more than 60% of patients with early breast cancer report the occurrence of functional disorders.An important aspect is to improve the effectiveness of the rehabilitation process of patients with early breast cancer taking into account scientifically-based and proven recommendations.Objective: to evaluate the event-free survival rate (EFS) of patients with EBC undergoing rehabilitation within a biopsychosocial approach.Materials and methods: 228 patients with breast cancer who received complex treatment from 2015 to 2019 were included in the study. The prospective part of the study included 114 patients with early breast cancer undergoing rehabilitation measures within the biopsychosocial approach. The control group which was selected retrospectively, using the method of "pairwise selection", included 114 patients with early breast cancer comparable in age, stage of the disease, volume of surgical treatment and menopausal status, undergoing physical and psychological rehabilitation prescribed by a doctor. Patients in both groups were stratified depending on preoperative chemotherapy. EFS was calculated over a 2-year follow-up period. Events that were censored were a disease progression, the appearance of metastases, the occurrence of another cancer, a new concomitant disease, an exacerbation of the concomitant pathology and death.Results: Rehabilitation measures within the biopsychosocial model improve the indicators of EFS in the group of patients with EBC: EFS was 18.3 months against 14.5 months in the control group (HR=0.91, 95% CI [0.83; 0.99]; p=0.0034). In a multi-factor analysis the key factors affecting EFS were neoadjuvant chemotherapy (HR=0.79, 95% CI [0.69; 0.94]; p=0.0025), age (HR=0.87, 95% CI [0.71;1.09]; p=0.0027) and menopausal status (HR=0.85, 95% CI [0.84; 0.95]; p=0.0022) (table 1). Conclusions: Rehabilitation measures within the biopsychosocial model improve the indicators of EFS in the group of patients with early breast cancer, the key factors affecting EFS were neoadjuvant chemotherapy, age and menopausal status. Table 1 Multi-factor analysis of event-free survival of patients with early breast cancer in the group of biopsychosocial model of rehabilitation versus control group.CharacteristicNumber of patientsHR (95% CI)Preoperative chemotherapyyes1520,84 (0,77; 1,1)no760,79 (0,69; 0,94)Menopauseyes1300,84 (0,77; 1,04)no980,85 (0,84; 0,95)Age group25-44610,87 (0,71; 1,09)45-601030,89 (0,74; 1,1)61-75641,01 (0,82; 1,24)EventDisease progression281,11 (0,86; 1,26)Exacerbation of the concomitant pathology160,83 (0,74; 0,96) Citation Format: Valeria Kluge, Tatiana Semiglazova, Petr Krivorotko, Elena Melnikova, Vladislav Semiglazov, Kristina Kondrateva, Svetlana Nazarova, Margarita Tynkasova, Bahtiyar Adhamov, Roman Pesotsky, Konstantin Zernov, Valentina Chulkova, Boris Kasparov, Denis Kovlen, Vladimir Semiglazov, Alexey Belyaev. Biopsychosocial approach in the rehabilitation of patients with early breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-62.