Pocherniaieva V. F., Mukovoz O. Ye., Ivanytska O. S., Korol M. I., Sydorenko O. P., Khattou V. V., Boiko I. V.

METABOLIC REHABILITATION OF PATIENTS WHO HAVE RECEIVED CHEMORADIOTHERAPY IN OUTPATIENT AND SANATORIUM-RESORT TREATMENT SETTINGS

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Pocherniaieva V. F., Mukovoz O. Ye., Ivanytska O. S., Korol M. I., Sydorenko O. P., Khattou V. V., Boiko I. V.

Heading:

LITERATURE REVIEWS

Type of article:

Scientific article

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Oncology patients represent a distinct and highly complex category of patients in clinical practice. The specific nature of their condition is determined by several factors: the latent course of hepatic tumor lesions, the pronounced toxic effects of polychemotherapy, and profound immunosuppression caused by both the oncological process itself and aggressive treatment modalities. Modern protocols for specialized anti-tumor treatment have significantly improved survival rates among cancer patients; however, this success often comes at the cost of a substantial increase in the frequency and severity of toxic reactions affecting virtually all organs and systems. Unfortunately, the system for the post-hospital rehabilitation of cancer patients in Ukraine still lacks standardized clinical protocols that would integrate outpatient and sanatorium-resort stages into a unified, pathogenetically grounded program. The aim is to substantiate pathogenetic approaches and develop a comprehensive, staged program for the metabolic rehabilitation of cancer patients following aggressive chemoradiotherapy – conducted in outpatient and health resort settings – utilizing biological, physical, and non-pharmacological correction methods. This article is a review based on the analysis and synthesis of scientific publications regarding the pathophysiological mechanisms of metabolic disorders in patients with malignant neoplasms and methods for their correction during the post-hospital phase. Based on an analysis of current literature and the synthesis of the authors’ own clinical experience, seven key, pathogenetically interconnected areas of metabolic rehabilitation for patients who have undergone chemoradiotherapy were identified: (1) correction of mitochondrial dysfunction and tissue hypoxia; (2) restoration of melatonin synthesis and normalization of circadian rhythms; (3) health resort-based methods for alleviating hypoxia; (4) enteral detoxification and anti-carcinogenic nutrition; (5) graduated physical rehabilitation; (6) psychosocial rehabilitation and restoration of quality of life; and (7) radiological (imaging) monitoring of the effectiveness of rehabilitation measures. Chemoradiotherapy in cancer patients is associated with a clinical syndrome of post-cytostatic metabolic distress, necessitating targeted pathogenetic correction during the post-hospital follow-up stage. Comprehensive metabolic rehabilitation at the outpatient and sanatorium-resort stages should include: energy-supportive and antioxidant therapy using plant-based antihypoxants; regulation of sleep and melatonin synthesis; sanatorium-resort methods for alleviating hypoxia; graduated physical rehabilitation based on a step-by-step training principle; enteral detoxification using dietary fibers and pectins as part of an anti-carcinogenic diet; psychosocial support and readaptation; and objective monitoring of rehabilitation efficacy.

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Bibliography:

1. Van Daele DJ, Langmore SE, Krisciunas GP, Lazarus CL, Pauloski BR, McCulloch TM, et al. The impact of time after radiation treatment on dysphagia in patients with head and neck cancer enrolled in a swallowing therapy program. Head Neck. 2019;41(3):606-614. DOI: https://doi.org/10.1002/hed.25344
2. Smuder AJ. Exercise stimulates beneficial adaptations to diminish doxorubicin-induced cellular toxicity. Am J Physiol Regul Integr Comp Physiol. 2019;317(5):R662-R672. DOI: https://doi.org/10.1152/ajpregu.00161.2019
3. Mokhosoev IM, Astakhov DV, Terentiev AA, Moldogazieva NT. Human Cytochrome P450 Cancer-Related Metabolic Activities and Gene Polymorphisms: A Review. Cells. 2024;13(23):1958. DOI: https://doi.org/10.3390/cells13231958
4. Mohan V, Bruin NM, van de Kamer JB, Sonke JJ, Vogel WV. The increasing potential of nuclear medicine imaging for the evaluation and reduction of normal tissue toxicity from radiation treatments. Eur J Nucl Med Mol Imaging. 2021;48(12):3762-3775. DOI: https://doi.org/10.1007/s00259-021-05284-5
5. Quadflieg K, Grigoletto I, Haesevoets S, Cops D, Ramos EMC, Spruit MA, et al. Effectiveness of Non-pharmacologic Interventions on Device-measured Physical Activity in Adults With Cancer, and Methodology Used for Assessment: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil. 2023;104(12):2123-2146. DOI: https://doi.org/10.1016/j.apmr.2023.04.013
6. Zong Y, Li H, Liao P, Chen L, Pan Y, Zheng Y, et al. Mitochondrial dysfunction: mechanisms and advances in therapy. Signal Transduct Target Ther. 2024;9(1):124. DOI: https://doi.org/10.1038/s41392-024-01839-8
7. Zhang B, Pan C, Feng C, Yan C, Yu Y, Chen Z, et al. Role of mitochondrial reactive oxygen species in homeostasis regulation. Redox Rep. 2022;27(1):45-52. DOI: https://doi.org/10.1080/13510002.2022.2046423
8. Firczuk M, Bajor M, Graczyk-Jarzynka A, Fidyt K, Goral A, Zagozdzon R. Harnessing altered oxidative metabolism in cancer by augmented prooxidant therapy. Cancer Lett. 2020;471:1-11. DOI: https://doi.org/10.1016/j.canlet.2019.11.037
9. Alsulami FJ, Shaheed SU. Role of Natural Antioxidants in Cancer. Cancer Treat Res. 2024;191:95-117. DOI: https://doi.org/10.1007/978-3-031-55622-7_4
10. Chik WI, Zhu L, Fan LL, Yi T, Zhu GY, Gou XJ, et al. Saussurea involucrata: A review of the botany, phytochemistry and ethnopharmacology of a rare traditional herbal medicine. J Ethnopharmacol. 2015;172:44-60. DOI: https://doi.org/10.1016/j.jep.2015.06.033
11. Borrmann K, Troschel FM, Brücksken KA, Espinoza-Sánchez NA, Rezaei M, Eder KM, et al. Antioxidants Hydroxytyrosol and Thioredoxin- Mimetic Peptide CB3 Protect Irradiated Normal Tissue Cells. Antioxidants (Basel). 2024;13(8):961. DOI: https://doi.org/10.3390/antiox13080961
12. Skrypnyk I, Maslova G, Lymanets T, Gusachenko I. L-arginine is an effective medication for prevention of endothelial dysfunction, a predictor of anthracycline cardiotoxicity in patients with acute leukemia. Experimental Oncology. 2017;39(4):308-11.
13. Hardeland R. Neurobiology, pathophysiology, and treatment of melatonin deficiency and dysfunction. ScientificWorldJournal. 2012;2012:640389. DOI: https://doi.org/10.1100/2012/640389
14. Makovetska LI, Dyomina EA. Perspektyvy vykorystannya melatoninu u promeneviy terapiyi. Oncology. 2024;26(1):5-21. [in Ukrainian].
15. Nissen ER, Neumann H, Knutzen SM, Henriksen EN, Amidi A, Johansen C, et al. Interventions for insomnia in cancer patients and survivors-a comprehensive systematic review and meta-analysis. JNCI Cancer Spectr. 2024;8(3):pkae041. DOI: https://doi.org/10.1093/jncics/pkae041
16. Schmitz KH, Campbell AM, Stuiver MM, Pinto BM, Schwartz AL, Morris GS, et al. Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer. CA Cancer J Clin. 2019;69(6):468-484. DOI: https://doi.org/10.3322/caac.21579
17. Stout NL, Santa Mina D, Lyons KD, Robb K, Silver JK. A systematic review of rehabilitation and exercise recommendations in oncology guidelines. CA Cancer J Clin. 2021;71(2):149-175. DOI: https://doi.org/10.3322/caac.21639
18. An KY, Min J, Lee DH, Kang DW, Courneya KS, Jeon JY. Exercise Across the Phases of Cancer Survivorship: A Narrative Review. Yonsei Med J. 2024;65(6):315-323. DOI: https://doi.org/10.3349/ymj.2023.0638
19. Yang L, Courneya KS, Friedenreich CM. The Physical Activity and Cancer Control (PACC) framework: update on the evidence, guidelines, and future research priorities. Br J Cancer. 2024;131(6):957-969. DOI: https://doi.org/10.1038/s41416-024-02748-x
20. De Giani A, Oldani M, Forcella M, Lasagni M, Fusi P, Di Gennaro P. Synergistic Antioxidant Effect of Prebiotic Ginseng Berries Extract and Probiotic Strains on Healthy and Tumoral Colorectal Cell Lines. Int J Mol Sci. 2022;24(1):373. DOI: https://doi.org/10.3390/ijms24010373
21. Pascale N, Gu F, Larsen N, Jespersen L, Respondek F. The Potential of Pectins to Modulate the Human Gut Microbiota Evaluated by In Vitro Fermentation: A Systematic Review. Nutrients. 2022;14(17):3629. DOI: https://doi.org/10.3390/nu14173629
22. Gabriel I, Creedy D, Coyne E. A systematic review of psychosocial interventions to improve quality of life of people with cancer and their family caregivers. Nurs Open. 2020;7(5):1299-1312. DOI: https://doi.org/10.1002/nop2.543
23. Giardini A, Pisoni C, Giorgi I, Borelli V, Scoccia E, Majani G. ICF, quality of life, and depression in breast cancer: perceived disability in disease-free women 6 months after mastectomy. Support Care Cancer. 2013;21(9):2453-2460. DOI: https://doi.org/10.1007/s00520-013-1794-7
24. Yu Z, Xu C, Song B, Zhang S, Chen C, Li C, et al. Tissue fibrosis induced by radiotherapy: current understanding of the molecular mechanisms, diagnosis and therapeutic advances. J Transl Med. 2023;21(1):708. DOI: https://doi.org/10.1186/s12967-023-04554-0
25. World Health Organization. Rehabilitation 2030: A Call for Action. Meeting report, 6-7 February 2017. Geneva: WHO; 2020. 54 p.

Publication of the article:

«Bulletin of problems biology and medicine», 2026 Issue 3, 182, 126-132 pages, index UDC 616-066:615.28-08:615.8

DOI:

10.29254/2077-4214-2026-3-182-126-132