THE IMPACR OF COM[LEX EARLY RAHABILITATION OF BREAST CANCER PATIENTS OF THE QUALITY OF LIFE AND PSUCHOLOGICAL STATE OF PATIENTS


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Abstract

Relevance: due to modern advances in the treatment of breast cancer, the rehabilitation of treated patients has become an urgent problem. To form an individual approach, it is necessary to assess the psychological state of the patient.Objective: to assess the impact of comprehensive rehabilitation of patients suffering from / operated on for breast cancer on the psychological state and quality of life.Methods: the necessary outpatient cards were requested from the archive to conduct the study. A card was filled out for each patient and an entry was created in the table on the rehabilitation measures carried out and the data on the assessment of the psychological state. The main objective of the study is to confirm the impact of rehabilitation on patients with breast cancer by assessing their psychological state and quality of life, taking into account the personality profile.Results: 40 patients were included in the study. The observation period is up to 30 days . In the course of the study, a lower level of anxiety was found in patients with a harmonious type of attitude to the disease, in patients with reconstruction, the level of anxiety was significantly lower (P=0.03).When assessing anxiety on day 10 in patients with LV reconstruction and hypochondriacal type of attitude to the disease, there is a significant decrease in the level of anxiety.Conclusion: the use of rehabilitation in combination with the reconstruction of the LV significantly reduces the level of anxiety, depression in the postoperative period and improves the quality of life

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VI. relevance
Breast cancer is the most common type of cancer in women [1]. Advances in diagnosis, treatment and care have led to an increase in survival, which poses new challenges to achieve optimal rehabilitation. A complicating factor is the need for an individual approach to the rehabilitation of patients receiving treatment for breast cancer. The most common consequences of the disease or treatment are pain, lymphostasis and depression [2]. In addition, there is evidence of a decrease in health-related quality of life and psychosocial consequences associated with a reduction in social contacts and psychological distress, as well as difficulties in resuming work. Consequently, patients may have physical, psychological and social needs for rehabilitation, In this regard, the need for additional research is identified to determine the optimal way to support patients in their new life situation. To optimize rehabilitation, an individual approach is needed that determines the specific needs of each patient
VII.purpose
To assess the impact of comprehensive rehabilitation of patients with breast cancer on the psychological state and quality of life.
VIII.MATERIALS AND METHODS
1. Research plan.To perform this work, a cohort study model was chosen. When organizing the follow-up and analyzing the results, we were guided by the Strobe criterion. To conduct our research, the necessary outpatient cards were requested from the VOCODE archive. For each patient included in the study, an individual card was filled out and an entry was created in the table about the rehabilitation measures carried out and the data of the assessment of the psychological state.
2. Compliance criteria. The study included patients undergoing rehabilitation after radical surgery for breast cancer. The study did not include patients with end-stage breast cancer, since in this condition, surgical intervention is not advisable. Also, male patients with breast cancer were excluded from the study, since the number of these patients is not large and the addition of a statistical group based on gender will not be statistically reliable.
3. Conditions of the event. The study was conducted on the basis of the BOOZ in VOCODE. Search for study participants only among patients undergoing rehabilitation after complex treatment of breast cancer.
4. Duration of the study. We examined patients undergoing rehabilitation during the period from 10.01.2022 to 10.02.2023.
5. Description of the medical intervention. Patients who underwent radical treatment for breast cancer and were admitted to a day hospital for further comprehensive rehabilitation were tested using the TOBOL questionnaire on day 1 in order to determine the patient's attitude to the disease. When interpreting the questionnaire, three leading types of attitudes to the disease were identified among this sample. According to the test results, the patients were divided into three subgroups.Further, against the background of ongoing rehabilitation measures, the propensity to depression and the level of anxiety on the Beck scale were assessed in each subgroup for 3,10,30 days of hospitalization.
6. The main outcome of the study is to confirm the positive impact of the rehabilitation program on patients with breast cancer by assessing their psychological state and quality of life during outpatient rehabilitation and, subsequently, in the conditions of rehabilitation at home, taking into account the individual personality profile.
7. An additional outcome of the study is confirmation of the positive effect of breast reconstruction by an expander during radical surgery on the quality of life and psychological state during the rehabilitation period.
8. Analysis in subgroups: initially, the subjects were divided into two groups: 1 subgroup – patients who underwent radical mastectomy, 2 subgroup - patients who had an expander installed at the same time. At the initial consultation in the rehabilitation department, the TOBOL questionnaire was used to determine the attitude of patients to the disease and, depending on the type of attitude in each group, patients were divided into three subgroups.
9. The method of registering outcomes - the fact of the presence/absence of positive dynamics in assessing the level of anxiety and depression against the background of ongoing rehabilitation measures was checked using a unified Beck questionnaire, carried out 3 times during the entire rehabilitation period.
10. Statistical analysis. Principles for calculating the sample size: the sample size was not previously calculated.Methods of statistical data analysis: Statistical analysis was performed in the STATISTICA 13 program. Quantitative data are presented in the form of M ±SD, where M is the average value, SD is the standard deviation. P<0.05 was taken as the level of statistical significance. Spearman's criterion was used to determine the direction and strength of the connection.
IX. RESULTS
The study included 40 women aged 40 to 65 years who underwent surgery in the oncological department of the BUZ IN VOCOD during 2022 for breast cancer. In 100% of cases, surgical intervention is a Madden mastectomy with expanded lymph node dissection of axillary lymph nodes. In 20% of cases, simultaneous reconstruction with a tissue expander was performed. Leading complications in the postoperative period: lymphostasis 35% of cases, scar deformation of the postoperative suture 23%, brachioplexitis 12%. There is no statistically significant difference in the development of complications in the subgroups depending on the fact of breast reconstruction, however, it should be noted that there are specific complications characteristic only for implant reconstruction: early seroma 20%, hematoma 10%, implant rupture 10%. During the period of 10 -30 days, patients were admitted to a day hospital for the purpose of rehabilitation treatment. Regardless of the presence of complications, patients underwent a complex of rehabilitation measures: physical therapy, hardware mechanotherapy, lymphatic drainage massage.
In both subgroups, on the first day of rehabilitation, all patients were examined using the TOBOL questionnaire, which revealed that in the subgroup of patients without reconstruction, the most common type of attitude to the disease was harmonious (70% of the total number of patients)
Patients with a hypochondriac type of attitude to the disease accounted for 10%. Patients with an egocentric type of attitude to the disease accounted for 20%. In the subgroup with MJ reconstruction: harmonious type 80%, hypochondriac 20%. On day 3, anxiety was assessed on the Beck scale. In the initial comparison of patients with a harmonious type of attitude to the disease, the level of anxiety in patients with reconstruction was significantly lower (P=0.03). When comparing patients with other types of attitudes to the disease, no significant difference was found.When assessing the level of anxiety on day 10 in a subgroup of patients with LV reconstruction and hypochondriacal type of attitude to the disease, there is a significant decrease in the level of anxiety.In the subgroup of patients without reconstruction and with an egocentric type of attitude to the disease by day 10, there is a negative dynamics of the level of anxiety, which, although statistically not reliable, due to a small sample, however, directly correlates with the more frequent development of complications in this subgroup. On the 30th day of the disease, there was no statistically significant difference in the reduction of anxiety levels in both subgroups.
X. DISCUSSION
When analyzing the level of anxiety according to Beck on day 3 in patients with a reconstruction of the LV, a lower initial level of anxiety and depression can be associated with the absence of such a psychological unfavorable fact as awareness of organ amputation. At the same time, a decrease in anxiety on day 10 in patients with reconstructed LV can be associated with a lower level of early complications due to the presence of an implant in the chest tissue. Moreover, against the background of ongoing rehabilitation measures, the level of pain associated with tissue stretching by an expander, according to the literature, sharply decreases just in this period.
In conclusion, it is worth noting that these results, despite a small statistical sample, correlate with the results of other studies, such as the work of Paolucci [1], Muller [2], D. Cuedre [3].
XI. CONCLUSION
The use of rehabilitation measures in combination with simultaneous breast reconstruction significantly reduces the level of anxiety and depression in the postoperative period, improves the quality of life and stimulates patients to systematically implement the recommendations of medical personnel.

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About the authors

Lidia Vladimirovna Ryasnyaskaya

Voronezh State University named after N.N.Burdenko

Author for correspondence.
Email: box-boxfo@mail.ru
ORCID iD: 0000-0002-8021-7298
Russian Federation, Studentskaya str.,Voronezh,394036,Russia

Olga Mikhailovna . Korotkova

Voronezh State University named after N.N.Burdenko

Email: korot1998@mail.ru
ORCID iD: 0000-0002-5412-1508
SPIN-code: 5678-2230
Studentskaya str.,Voronezh,394036,Russia

References

  1. Paolucci T., Saggino A., Tommasi M. The Influence of Rehabilitation on Quality of Life in Breast Cancer Survivors: A Clinical Study. Int J Environ Res Public Health. 2021 Aug 14;18(16):8585. doi: 10.3390/ijerph18168585
  2. Olsson Möller U. , Beck I. , Rydén L. et al. . A comprehensive approach to rehabilitation interventions following breast cancer treatment - a systematic review of systematic reviews. BMC Cancer (2019) 19:472 https://doi.org/10.1186/s12885-019-5648-7
  3. Kudre D. , Chen Z., Richard A. et al. Multidisciplinary Outpatient Cancer Rehabilitation Can Improve Cancer Patients’ Physical and Psychosocial Status—a Systematic Review. Current Oncology Reports (2020) 22: 122 https://doi.org/10.1007/s11912-020-00979-8

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