GOMEL REGIONAL CLINICAL
ONCOLOGICAL DISPENSARY

The department was opened in 1991. Initially, the bed capacity is 40 beds. The chemotherapy department is deployed to 50 beds on the basis of Building №1 of GOKOD at Gomel, ul. Tsiolkovsky, 119 a.

From 1991 to 1993, the department was headed by Ph.D. Derbeneva LI

From 1993 to 1997 - Snigur Anna Leonidovna, the first category on oncology.

From 1997 to 2014 - Savchenko Irina Viktorovna, the highest category in oncology.

Currently - Borsuk Olga Alexandrovna, the first category on oncology.

Branch staff:

Borsuk Olga Alexandrovna
Borsuk Olga AlexandrovnaHead of the department
The doctor of the first qualification category. In the department since 2002.
Zaletilo Tatiana Eduardovna
Zaletilo Tatiana EduardovnaDoctor-oncologist of the first qualification category
In the department since 1998.
Sergeeva Tatyana Vasilievna
Sergeeva Tatyana VasilievnaDoctor-oncologist
In the department since 2005.
Pulkina Svetlana Sergeevna
Pulkina Svetlana SergeevnaDoctor-oncologist
In the department since 2014.

All the doctors passed specialization on the basis of NIIOiMR in Minsk.

Doctors of the department own a number of diagnostic and therapeutic manipulations - pleural and sternal punctures, laparacentesis.

The main activity of the chemotherapy department is the selection and conduct of chemotherapy, hormone therapy and targeted therapy in patients with malignant tumors, both as part of complex treatment, and as an independent treatment.

Chemotherapy is a method of treating cancer with the help of medications. Before the appointment of this procedure, the human body is subjected to a thorough and thorough examination to assess its general condition and determine the operability of the organs. The attending physician should take into account all the characteristics of the patient's organism, while any chronic diseases or age are not grounds for refusing treatment with the drugs.

Chemopreparations can partially or completely destroy malignant formation, contain growth and division of cancer cells, affecting their membranes or destroying their structure. There are medicinal substances that not only fight with malignant cells, but also increase the body's protective reserves, that is, they help in the work of immunity.

In the last 10 years so-called "target chemotherapy" (from English "target" - goal) is developing rapidly, based on the principles of very precise and selective influence on the fine molecular mechanisms of metabolism, reproduction and migration of tumor cells. These mechanisms in cancerous and healthy cells sometimes differ very significantly. In such cases, targeted chemotherapy based on a deep understanding of the molecular mechanisms of the development of a particular tumor and the introduction of certain drugs that are able to selectively block the corresponding processes in tumor cells, but at the same time have little effect on the metabolism of the healthy. Targeted chemotherapy allows a greater degree of impact on tumor cells, with a minimum of side effects. Now target therapy is widely used for chemotherapy of breast, liver, intestines, uterus and ovaries and many other cancers.

In modern medicine, for the treatment of tumoral diseases, as a rule, the administration of several drugs is prescribed. Properly selected complex of drugs in the vast majority of diseases more powerfully affects the tumor. What kind of complex of drugs is needed for a specific patient, an experienced oncologist should prescribe. The decision depends on the type of malignant formation, the extent of the spread and the location of it, as well as on the general condition of the patient.

There are such kinds of cancer that can be cured only with the help of chemotherapy. However, for most types of cancers this is not possible and in these cases, medications are prescribed to alleviate symptoms and to control the development and content of the disease.

Conducting chemotherapy can be applied depending on the stage and type of disease for obtaining the following results:

  • Complete destruction of malignant neoplasm;
  • Reducing the size of the tumor and obtaining the necessary conditions for surgical intervention;
  • Slowing the growth of tumor cells and destroying a tumor that can metastasize to other organs and tissues of the body;
  • Destruction of malignant cells that were not surgically removed.

As a rule, chemotherapy is prescribed in conjunction with radiotherapy and surgical intervention. Some patients receive it before surgery to reduce the size of the tumor, others - on the contrary after radiation therapy or surgery, to destroy the remaining cancer cells. In some cases, the use of chemotherapy is the only cancer treatment method ..

Most often, the drugs are administered intravenously. It happens that the chemo-composition is injected through the catheter into the artery or vein for several days continuously.

The duration of the procedure depends on the type of cancer, the drugs used, the purpose of treatment, the response of the patient's body. The time of taking the drug and the number of courses should be prescribed exclusively by an experienced oncologist.

In our department, chemotherapy is performed in adjuvant (postoperative) and neoadjuvant (pre-operative) regimens, therapeutic chemotherapy of tumors of the following localizations: mammary gland, stomach, intestine, pancreas, bladder, prostate, lymphoid tissue (all types of lymphomas), sarcomas of bones and Soft tissues, melanoma, head and neck tumors, bone metastases by the introduction of zoledronic acid, tumors from an unidentified source.

CONSULTING - BY PRELIMINARY RECORDING BY TELEPHONES:

+375 (232) 234292, +375 (44) 5445153.

Patients who are not citizens of the Republic of Belarus can be treated on a paid basis.

The cost of one course of polychemotherapy ranges from 40 to 2000 US dollars (with targeted therapy).

Useful articles:

The diagnosis is not a verdict! The diagnosis is not a verdict!

Modern oncology is one of the most rapidly developing medical disciplines in the world. The introduction of innovative technologies for the diagnosis and treatment of tumors takes us further away from the times when the oncological diagnosis was perceived as a sentence.

The global problem is facing oncologists and scientists - this is the achievement of timely detection of the disease in the early stages, i.e. At the level of micrometastases. Over the past decades, a lot of effective methods of diagnosis and treatment have been developed, and drugs have appeared that act on the tumor itself. Patients who received help in the early stages of the disease continue to lead an active life ten, twenty years, during which it is not necessary to recall the need for further treatment.

So why develop a tumor? There are a lot of reasons for this - the influence of environmental factors, heredity, high probability of viral and parasitic infection, exposure to occupational carcinogens at work, smoking in its various forms and neglect in the treatment of chronic diseases. Chronic diseases, regardless of their etiology, affect the immune system. Failures in the work of the protective barrier of the organism create a favorable ground for the development of various oncological diseases.

Regardless of the condition of the human body, early diagnosis of any disease is the leading and indispensable component of our well-being. Like a healthy lifestyle, understanding the need for regular visits to your doctor and periodic medical examinations at work and at your place of residence has become an integral part of modern thinking. This is the primary prevention of diseases, including malignant diseases.

What to do if the diagnosis of cancer, and you do not have anyone to turn to for help and advice, you are left alone with the problem? First of all, you need to call a specialist psychologist and get professional advice from him. You, most likely, still do not know much about your diagnosis, and the doctor's first forecast is not yet a reason for feeling doomed.

Cancer is a disease that can be treated, and your desire to fight cancer is half the victory that the doctor shares with you. In Russia, about 150,000 people are cured of cancer every year, and with the use of new chemotherapy and radiation treatments, the number of healed compatriots will increase steadily.

Our cancer portal fulfills its informational and educational mission in the lives of those people who have been overtaken by a formidable disease: we will help you understand yourself, understand that the chance of a cure depends not only on the doctors, but also on your attitude towards the situation. Like any difficult circumstances in life, the risk that has arisen for your health requires you to concentrate efforts and active, well-planned actions.

Let's start together the way from the solution of the problem to the successful cure of the disease.

How to cope with your mental state?

A person's severe reaction to a diagnosis or a physician's forecast is natural. Each of us understands that health is the foundation of all life plans and opportunities, so it's not surprising that we take seriously when there is a risk of the disease. But such a reaction, additional anxiety, our heavy thoughts and feelings become an additional factor of this risk, create unnecessary barriers in the fight against the disease. It is unrealistic to give advice for all occasions, each specific situation is unique, and it is necessary to select the only solution to it. This is always easier to do with the support of specialists.

Doctors well know: the problem of the psychological state of an oncological patient is that "trifle", on which the result of treatment often depends. It is necessary to be especially attentive to the psychological component of the disease. If the doctor constantly monitors your physical condition and has the opportunity to check your observations objectively, then your inner, mental state is available to him much less and you should closely follow him.

It may also be that even if you follow all our advice, you will still experience psychological difficulties and it will be difficult for you to cope with the situation. These can be both reactions to the circumstances of your illness, to which you could not prepare or accept them, and conditions that seem to have little connection with the real situation.

Yearning, anxiety, inner tension and anxiety, or, on the contrary, apathy, inhibition, lethargy, unwillingness to do anything, uncontrollable irritation are all symptoms of mental distress. If you have a feeling that you can not cope with your emotional state or these symptoms do not go away within a few weeks, you should pay special attention to them.

The causes of the depressive state can be very different, but first of all you should change the current situation of mental discomfort, and only then think what has led to it. Depression is not a weakness, not a lack of emotional balance or fatigue. This is an independent disease that depletes the strength of the body and disrupts the normal course of many processes. She has her symptoms.

Perhaps you celebrate:

  1. Increased fatigue throughout the day, not related to the volume of work performed and not passing after rest;
  2. Constant drowsiness, or, on the contrary, insomnia, if you wake up early, can not fall asleep or repeatedly wake up in the middle of the night;
  3. Lack of appetite, loss of taste of food or ordinary pleasure from eating;
  4. Trouble concentrating, it's hard for you to focus on anything;
  5. If you constantly worry, worry for no apparent reason;
  6. Constantly feel that you do not need anyone, that all of you are abandoned and do not pay attention to you;
  7. If you experience unexplained discouragement or longing and all your future is presented to you exclusively in black;
  8. If you lose weight quickly, it is not necessarily related to your disease, but it is quite possibly one of the signs of depression.

If all this happens to you, then, perhaps, you should take this seriously and apply for qualified advice to specialists.

Do not perceive the need for such treatment as some kind of flaw, do not hesitate to share your problem, specialists in this field exist to help you. You have enough reasons for real anxiety, and do not increase them due to constantly bad mood or anxiety.

Remember: you need to concentrate now all forces on your treatment, and your mental state will largely determine the effectiveness of the basic treatment.

Care for cancer patients

The peculiarity of caring for patients with malignant neoplasms is the need for a special psychological approach. It is necessary to remember at all stages of service that oncological patients have a very labile, vulnerable psyche. When caring for cancer patients, regular monitoring of their condition (weighing, measuring body temperature, nutrition and physiological functions, feeling and mood, etc.) is very important, maintaining a special diary by the patient or his relatives, as any changes may be a sign of improvement Condition or progression of the disease. The keeping of a diary disciplines both the patient himself and all members of his family. The diary can be of invaluable help to the doctor of the oncological dispensary during the next examination or patronage service.

In each case, specialists of the oncological service teach the patient and relatives the hygienic measures, the correct diet, which has its own peculiarities in different forms of the disease and methods of treatment. In some cases, especially after surgical treatment, specialized care is required, carried out by a nurse oncology dispensary (patronage) or a specially trained relative.

In all cases, the main thing in caring for cancer patients is strict adherence to the recommendations of an oncologist doctor and a benevolent attitude to the patient from the surrounding and, first of all, relatives. It is necessary to take measures against attempts of the patient to be treated with znacharian means, which can lead to the most unforeseen complications.

 

New methods to increase the effectiveness of chemotherapy New methods to increase the effectiveness of chemotherapy

The pharmacological market for chemotherapeutic agents is growing every year, new generations of antitumor drugs are being developed, highly selective inhibitors of signal transduction and angiogenesis appear, which undoubtedly should have increased the life expectancy of cancer patients. Unfortunately, this does not happen, and if there is, then to an insignificant extent.

Some progress has now been made with the development of monoclonal antibodies (bevacizumab, cetuximab and trastuzumab) that, in combination with chemotherapy, extend the lives of patients with disseminated colorectal cancer and increase the overall survival of patients with metastatic breast cancer (Her2 / neu-positive).

In addition, to date, inhibitors of signal transduction (gefitinib, erlotinib, imatinib mesilate, sorafenib, sunitinib, etc.) are actively studied, new modes of cytostatic administration (metronome therapy, dose-dense therapy), which probably will increase the overall Survival of patients with advanced cancer.

Among the reasons for the low effectiveness of drug treatment of disseminated solid tumors, we can distinguish:

  • Features of tumor growth kinetics;
  • Existing and acquired drug resistance of cells;
  • Properties of the physiological microenvironment of tumor cells;
  • Repopulation of the neoplasm.

Kinetics of tumor growth

The most famous concepts of the growth kinetics of malignant growths are exponential growth models, Gompertz, Speer-Retsky

For the first time Skipper-Schabel-Wilcox formulated the hypothesis that when a certain cytostatic regimen is prescribed, the fraction of cell death of exponentially growing tumors characterized by a homogeneous sensitivity to cytostatics is always constant (log-kill), regardless of the initial volume of the cell population.

Thus, for many drugs, the effect (the number of dead cells) depends on the dose. However, in the clinical practice of treatment of disseminated solid tumors, this hypothesis does not look so optimistic, since recurrences of the disease are often found. This is probably due to the assumption of exponential growth of all malignant neoplasms, as well as homogeneous sensitivity to cytostatics of tumor cells and recognition of absolute drug resistance.

On the other hand, now the Norton-Simon model, based on the Gompertz kinetics, remains popular. Based on clinical and laboratory data, the authors improved the Skipper-Schabel model. They suggested that the fraction of deaths when injected with the drug is non-log-kill and depends on the phase of the cell cycle.

The effectiveness of many drugs depends on the rate of growth in the existing tumor, i.e. The higher the cytoreduction, the greater the rate of cell growth, and vice versa. Gompertz's kinetics underlies the development of the malignant process: when the tumor size in the plateau phase, growth slows down, and the tumor becomes resistant to cytostatics, with a decrease in size, growth resumes and it quickly reaches its former volume.

Consequently, using the standard approach to cure a patient of a neoplasm that changes its volume according to the Gompertz kinetics, it is practically impossible.

Existing and acquired drug resistance of cells

According to the literature, in 99% the low effectiveness of chemotherapy is the result of existing or acquired drug resistance of tumor cells, which is based on genome instability and heterogeneity of tumor cells, the presence of drug resistance genes (MDR genes) and certain protective molecules (carrier proteins, Enzymes)].

Physiological microenvironment of tumor cells

The physiological microenvironment of the tumor is its stroma. It includes collagen fibers, connective tissue cells, immune system cells, chemokines, cytokines, and vessels. They form an extracellular matrix and define intercellular interactions, intercytial fluid pressure, rate and amount of tissue penetration of the drug, drug distribution in the tumor, drug metabolism.

Repopulation of the neoplasm

Currently, at the base of treatment of patients with disseminated malignant tumors lies the empirical choice of the drug and the titration of the total dose of the drug, i.e. The appointment of a cytotoxic at certain time intervals, depending on its hematological toxicity. On average, this interval is 3-4 weeks.

This does not take into account the properties of tumor cells, which in the interval between cycles of chemotherapy are able to restore their volume, i.e. Regenerate (repopulate). In experimental studies, an increase in the proliferative activity of tumor cells after the administration of chemotherapy compared with the control group was noted.

At present, the following mechanisms underlying the increase in proliferative activity are known:

  • Physiological modification of tumor cells
  • Achieving the fission rate of the corresponding intact volume of tumor cells
  • Increased nutrition of surviving clonogenic cells due to redistribution of blood flow in the tumor
  • Stimulation of residual tumor cells by circulating growth factors
  • Modification of "dormant" tumor cells into clonogenic cells;
  • The presence of potentially lethal damage (Hanh, 1973).

If we assume that there is no increase in the rate of repopulation of the neoplasm after the administration of cytostatics, then the treatment lasted as long as possible without progression of the disease and death of the patient from malignant neoplasm.

Accordingly, it is advisable to influence on:

1. Processes of proliferation and differentiation in tumor cells

- Tyrosine kinase inhibitors;

- dose-dense therapy;

2. Microenvironment of the tumor

- inhibitors of angiogenesis;

- metronome therapy;

- drugs affecting the stroma of the tumor;

3. Combined effects on the tumor and its microenvironment

- "Chemo-Switch" regimen, which includes consecutive administration of chemotherapy in the maximum tolerated doses followed by metronome therapy in combination with inhibitors of signal transduction and angiogenesis.

Tyrosine kinase inhibitors

Signal transmission in eukaryotic cells is carried out by means of special proteins (kinases).

To date, there are more than 90 genes encoding these molecules. At the same time, 58 of them are responsible for 20 families of transmembrane kinases, and 32 for 10 families of non-receptor cytoplasmic proteins.

In normal cells, their activity is very clearly regulated. Tumor transformation leads to disruption of kinase signals due to various genetic damage, determining uncontrolled proliferation and dedifferentiation.

The pharmacological effect on the altered signaling pathway leads in a number of cases to the restoration of the regulation of fission in the cell. In this case, drugs can act on one signal path, as well as several.

Drugs affecting one signal pathway

Erlotinib (OSI-774) and gefitinib (ZD1839) -reduces the interaction of ATP with the tyrosine kinase domain of the epidermal growth factor receptor (EGFR-1).

This type of receptor is expressed in a lung tumor. The objective response in patients with non-small cell lung cancer, who underwent therapy with these drugs, was only 9-18%.

In this erlotinib statistically significantly increased disease-free and overall survival and gefitinib no. A detailed analysis of subgroups of patients in these studies revealed factors that affect the efficacy of EGFR-1 inhibitors.

These include:

  • Absence of smoking in the anamnesis,
  • female,
  • The Mongoloid race,
  • Adenocarcinoma,
  • Presence of a mutation in 18 exon,
  • Bronchioloalveolar carcinoma.

In 2003 gefitinib was approved by the FDA as the third line of therapy for patients with locally advanced and disseminated non-small cell lung cancer (NSCLC) (platinum and docetaxel-resistant).

However, the ISEL study (2005) led to a revision of this position.

In 2004, erlotinib was approved for FDA use in patients with NSCLC as a second-line therapy. Given the overexpression of the epidermal growth factor receptor, clinical studies of the effectiveness of EGFR-1 inhibitors in various solid neoplasms (esophageal cancer, pancreatic cancer, colon cancer, head and neck tumors, stomach cancer, breast cancer, prostate cancer, bladder cancer , Ovarian cancer).

The combination of gemcitabine and erlotinib is standard in North America as the first line of therapy for disseminated pancreatic cancer.

Lapatinib (GW572016) is a reversible inhibitor of EGFR-1 and Her2 / neu. Currently, Phase II-III is being used for NSCLC, esophageal cancer, ovarian cancer, head and neck tumors, prostate cancer, glioblastoma.

Clinical studies of phases II and III demonstrated the efficacy of this drug in patients with locally advanced and metastatic breast cancer, as well as in the presence of metastases in the brain.

Interim analysis of the combination capecitabine and lapatinib versus capecitabine mono-mode demonstrated an increase in the time to progression of the disease by 50% when using the combined regimen.

Imatinib mesylate (STI571) inhibits tyrosine kinase type 3 (ABL, c-KIT, PDGFR).

In one tumor, the drug inhibits one signaling cascade.

The recommended therapeutic dose is 400 mg / day.

Demonstrated efficacy in patients with chronic myeloid leukemia (complete clinical-

Hematological regression in 95%, cytogenetic regression in 60%), gastrointestinal neoplasms (53.7% objective response + 27.9% stabilization for more than 6 months), dermatofibrosarcoma-protuberance (99% objective response).

The effectiveness of imatinib mesylate is currently evaluated in breast cancer, c-KIT-positive germ cell tumors, thyroid cancer, melanoma, prostate cancer

Glands, kidney cancer, small cell lung cancer, ovarian cancer.

Drugs affecting several signaling pathways

Sunitinib (SU11248) is a multitarget tyrosine kinase receptor inhibitor

VEGFR1, VEGFR2, PDGFR, c-KIT, FLT3, CSF-1R, RET, i.e. Has both anti-tumor and anti-angiogenic activity.

In the Phase I study, a dose response of 30 to 75 mg daily was assessed.

The optimal use of this drug is 50 mg / day for 4 weeks, followed by a break of 2 weeks.

In the Phase II study with disseminated kidney cancer, an increase in the time to progression of the disease to 8.7 months was revealed with this drug compared with the placebo group - 2.5 months.

In a phase III study comparing the efficacy of sunitinib and interferon as a first-line therapy in patients with disseminated renal cancer, the median time to progression was 11 months and 5 months, respectively.

An objective response was registered in 31% of the tyrosine kinase inhibitor group and 6% in the interferon group.

The effectiveness of sunitinib has also been demonstrated in patients with gastrointestinal stromal tumors (GIST), resistant to imatinib mesylate therapy.

Sunitinib was approved by the FDA for the treatment of patients with GIST and advanced kidney cancer.

Sorafenib (BAY43-9006) - inhibitor of tyrosine kinase receptors VEGFR2, VEGFR3, FLT3, PDGFR-b, FGFR1, KIT, RET and serine-threonine kinases of the receptors B-raf, Raf-1 / C-raf.

The recommended dose for clinical use is 400 mg / 2 r / day.

Sorafenib was approved by the FDA for the treatment of patients with disseminated kidney cancer. Currently, phase II studies are under way with various solid neoplasms (NSCLC, head and neck tumors, melanoma, hepatocellular carcinoma, prostate cancer, pancreatic cancer, ovarian cancer).

At present, the combination of this agent with bevacizumab is continuing with disseminated breast cancer.

Vitalanib (PTK787) is a multivalent tyrosine kinase inhibitor VEGFR1, VEGFR2, VEGFR3, PDGFR, c-kit, c-Fms.

2 studies were conducted for disseminated colon cancer - CONFIRM-1

(First line of therapy in combination with FOLFOX-4) and CONFIRM-2 (second line in combination with FOLFOX-4).

In the first line of therapy, there was no significant difference in time to progression and overall survival compared with chemotherapy alone.

For the second line there was an increase in the time to progression of the disease when using the combined regime from 4.1 months to 5.5 months.

The overall survival was not different (11.8 and 12.1 months, respectively).

As a monotherapy, the drug is effective in patients with GIST, resistant to imatinib mesylate.

In patients with NSCLC in the second line of therapy, 2% showed partial regression of the tumor, and 56% - stabilization.

As a first-line therapy, the drug demonstrated efficacy in malignant mesothelioma (objective response 11%, time to progression 4.1 months, median overall survival 10 months). With breast cancer is currently in the preclinical test.

Aksitinib (AG-013736) is a potential inhibitor of tyrosine kinases VEGFR, PDGFR, KIT.

In patients with disseminated cytokine-resistant kidney cancer

Demonstrated efficacy in mono mode - 21 patients out of 52 had partial regression of the disease. Currently, this drug is being studied for advanced thyroid cancer, pancreatic cancer, NSCLC, breast cancer.

Trastuzumab (Herceptin) blocking the Her-2 / neu receptor, also belonging to the family of receptors of epidermal growth factor II type.

It is known that the Her-2 / neu receptor is present in normal human breast tissue - an average of 20 000-50 000 receptors on the cell surface, but their number increases to 1,000,000 or more on the surface of cancer cells.

A similar phenomenon occurs in adenocarcinoma of the stomach, lung cancer and breast cancer in about 20-25% of cases.

The increased density of Her-2 / neu receptors induces ligand-induced receptor activation, which initiates mitosis.

Hyperexpression of the Her-2 / neu receptor in the primary tumor is usually accompanied by a high probability of regional metastases and low levels of hormones.

There is evidence that overexpression is more common in protocol than in lobular cancer, and is rarely seen in breast cancer in men and in medullary cancers. It is also known that overexpression is characteristic of Paget's disease, an inflammatory form of breast cancer. Numerous clinical studies have shown the importance of overexpression of the Her-2 / neu receptor as an informative indicator of the unfavorable prognosis of the course of the malignant process.

The use of herceptin in patients with breast cancer, resistant to standard therapy, allowed to register an objective therapeutic effect in 21% of cases

However, the drug proved to be more effective in combination with chemotherapy. With the combination of herceptin and docetaxel in comparison with monotherapy with docetaxel, the objective effect rate was 61% and 55%, and the time to progression was 10.6 and 6.1 months, respectively.

Effects on the microenvironment in tumors and inhibitors of angiogenesis

Currently, various types of medicines are developing, affecting both the regulation points of angiogenesis in the tumor, and, directly, on the vessels.

Among them are monoclonal antibodies, tyrosine kinase inhibitors, soluble receptors, cytotoxic drugs in certain doses, and many others.

COX-2 Inhibitors

Cyclooxygenase -2 plays a major role in the progression of cancer of various localizations.

Under hypoxic conditions, overexpression of this enzyme was noted, which leads to an increase in the formation of prostaglandin 2 (PG2) from arachidonic acid.

This, in turn, contributes to the development of the hypoxic factor (HIP-1-alpha), which binds to the carriers of aromatic hydrocarbons (Arnt), activating the transcription of VEGF.

To date, preclinical and clinical studies of the use of cyclooxygenase-2 inhibitors have been conducted in disseminated solid neoplasms.

When using a combination of irinotecan, capecitabine, celecoxib in patients with metastatic colorectal cancer, partial regression was achieved in 9 of 23, and stabilization in 10 patients.

Vascular-targeting agents

An independent class of anti-angiogenic drugs, which is at the stage of study. The effect develops a few hours after application. These drugs selectively affect endothelial cells in the vessels of the tumor. Among them, the most actively studied inhibitor of microtubules ZD6126, combretastatin A-4 phosphate, AGM 1470.

Endogenous inhibitors of angiogenesis

Neovastat is an inhibitor of VEGFR1 and metalloproteinases MMP-2, -9, 12. The dose of the drug is studied in the range of 60-240 ml / day. In patients with disseminated renal carcinoma, 2 objective responses were recorded in the 2nd phase of the study (with a dose of 240 ml / day). The median overall survival was 16.3 months.

Bevacizumab (avastin) is a humanized monoclonal antibody with a targeted effect on VEGF.

In animal experiments it has been shown that in addition to blocking the formation of new vessels, anti-VEGF therapy induces apoptosis of endothelial cells, reduces the diameter, density and permeability of existing blood vessels, which leads to the death of tumor cells.

The process of blocking neoangiogenesis and reverse development of tumor-typical immature vessels creates conditions for lowering the vascular permeability, leading to a reduction in interstitial pressure in the tumor, which makes it more accessible for chemotherapeutic drugs.

In addition, a decrease in interstitial pressure helps to reduce foci of hypoxia in the tumor, which increases its sensitivity to radiation therapy.

Anti-VEGF therapy can enhance the apoptosis of tumor cells carrying on their surface receptors of vascular endothelial growth factor and playing the role of proliferation factors. Finally, anti-VEGF therapy has a targeted effect on the effects of the immune system, since it is established that VEGF enhances the adhesion of natural killers to the microvasculature of the tumor and suppresses the maturation of dendritic cells, helping the tumor to avoid immune surveillance.

Currently, the drug is used in combination with cytostatics in the treatment of breast cancer, colorectal cancer, glioblastoma and non-small cell lung cancer (NSCLC).

Drugs activated by hypoxia

This approach of therapy is based on the ability of some drugs to transform into active forms in conditions of hypoxia.

These include - Mitomycin C, E09, SR 4233.

The clinic uses only mitomycin.

Dose-dense therapy

The idea of ​​prescribing chemotherapy at short intervals is to try to slow the repopulation of tumor cells u between cycles of therapy.

This increases the cumulative cell-kill and, accordingly, the therapeutic effects.

The effectiveness of dose-dense therapy is shown in the CALGB 9741 study, in which, irrespective of

Sequential or parallel use of chemotherapy drugs, a statistically significant efficacy of the 2-week regimen compared with the standard 3-week interval was noted: disease-free survival was 85% and 81% (p = 0.01), and 92% and 90% (p = 0.013) , Respectively

In this case, shorter breaks between the cycles of therapy do not increase the toxicity of the treatment.

To date, some randomized trials have shown the advantage of a dose-dense regimen in the form of an increase in disease-free and overall survival in small-cell lung cancer (an objective response was 63%), advanced colon cancer, urothelial cancer (56% objective response, 15 months overall survival) , Ovarian cancer (objective response 65.5%, time to progression 9 months, overall survival 18 months).

Metronomic therapy

Dose-dense concept includes metronome therapy, which is the administration of chemotherapy daily or several times a week, or weekly at low doses for a long time.

In this case, primarily anti-angiogenic, and not cytotoxic, effect of drugs is realized.

Of these known preparations used in metronomic regime: capecitabine, S-1, UFT,

Temozolomide, Vepeside, cyclophosphamide, methotrexate, interferon-alpha, mitomycin C, 5-fluorouracil, vincristine, vinblastine, doxorubicin, mitoxantrone, paclitaxel, tegafur, topotecan, metilmerkaptopurin-6, 9-amino-20 (S) -camptothecin.

The basis of the anti-angiogenic effect is as follows:

1. Direct action:

Suppression of circulating endothelial stem cells;
Antiproliferative effect on endothelial cells.

2. Indirect action:

increase the level of endogenous thrombospondin 1, which leads to apoptosis of CD36-positive endothelial cells, and reduces the mobilization of stem endothelial cells Efficiency metronomic chemotherapy regimen has been demonstrated in many preclinical studies that contributed to a Phase I and II clinical trials of the treatment of metastatic non-small cell lung cancer Ovaries, breast cancer, prostate cancer.

"Chemo-switch" mode

One way to overcome drug resistance is "chemo-switch" regimen.

Its essence lies in the standard applications of cytostatics in combination with the maximum tolerated doses followed by maintenance mode which involves the use of inhibitors for PDFGR destruction of pericytes, metronomic therapy and VEGFR inhibitors.

Thus, the main pathways of development of tumor cells-proliferation and neoangiogenesis-are blocked.

Unfortunately, to date, the results of clinical studies of this method of therapy there.

Conclusion

To date, in order to overcome resistance and improve the effectiveness of drug treatment, on the one hand, new targeted drugs are being developed that target both the proliferation and differentiation processes in tumor cells and the microenvironment in neoplasm; On the other, attempts are made to change the mode of administration of cytostatics.

Clinical studies have demonstrated the effectiveness of new approaches to the therapy of malignant tumors.

However, the data obtained require further study of such treatment strategies.

Sources:

1 Chubenko V.A. Perspective methods of treatment of malignant neoplasms. Practical oncology, T.8 № 4-2007.

2 Popovskaya TN Target therapy in oncology. The use of monoclonal antibodies to growth factor receptors. Mistetstvo Likuvannya No. 1-2006.

 

Prophylaxis of oncological diseases Prophylaxis of oncological diseases

Throughout the 20th century, the main emphasis in the problem of cancer prevention was on reducing morbidity. This is undoubtedly relevant, but not enough. An equally important aspect of cancer prevention is the prevention of mortality from this disease. And at the end of the last century this topic became more relevant than ever. Numerous discoveries of scientists make it possible to understand the mechanisms of tumor formation and, in many cases, fundamentally change the situation in this branch of medicine.

In fact, this should be the main goal of public health. If the reduction in morbidity depends entirely on the integrated solution of public health problems and the implementation of appropriate programs at the state level, the medical aspects of the oncological care to the population have a significant impact on mortality. They include, first of all, timeliness of detection and diagnosis of the disease, timeliness and quality of treatment of cancer patients, as well as their rehabilitation in the process of dynamic dispensary observation. From this short list it can be seen that the prevention of tumors is a multifactorial problem. Attempts to solve it by considering individual particular issues (for example, smoking) do not have a significant effect.

The report of the WHO Committee of 1 April 2004 noted that work on cancer prevention and control is curbed by low priority, which is often given by governments and health ministries, excessive emphasis on treatment and costs associated with it, and Also a significant imbalance between the resources allocated to cancer research and the resources that are allocated to the prevention and control of this disease.

Nevertheless, the structure of oncological care for patients, the system of diagnostics, rehabilitation and prevention - all this complex today has significantly expanded its capabilities and is ready to solve problems of a new level. Everyone should see their capabilities and resources, and the opportunities that health facilities give him to preserve and strengthen their health. In world medicine, we already see examples of countries that radically changed the situation with the prevention of cancer and the provision of high-tech medical care to oncological patients. A sharp decline in morbidity and mortality statistics in these cases is an encouraging sign that Russia can achieve such results.

The effect of smoking on the risk of cancer

The effect of smoking on the risk of malignant tumors has been thoroughly studied. Based on a synthesis of the results of epidemiological and experimental studies, working groups of the International Agency for Research on Cancer (IARC), convened in 1985 and 2002, concluded that tobacco smoking is carcinogenic to humans and leads to cancer of the lip, tongue and other parts of the cavity Mouth, pharynx, esophagus, stomach, pancreas, liver, larynx, trachea, bronchi, bladder, kidney, cervix and myeloid leukemia.

Tobacco contains nicotine, which is recognized by international, medical organizations as a substance that causes drug addiction. Nicotine addiction is included in the international classification of diseases. Nicotine meets the key criteria for drug dependence and is characterized by:

  • Obsessive, irresistible craving for consumption, despite the desire and repeated attempts to refuse:
  • Psychoactive effects that develop when the substance acts on the brain;
  • Behavioral patterns caused by exposure to psychoactive substances, including withdrawal syndrome.

In the composition of tobacco smoke, except nicotine are several tens of toxic and carcinogenic substances, including polycyclic aromatic hydrocarbons (PAH) such as benzo (a) pyrene, aromatic amines (naphthylamine, aminobiphenyl), volatile nitroso, tabakospetsificheskie nitrosamines (TSNA), vinyl chloride, benzene, aldehydes (formaldehyde), phenols, chromium, cadmium, polonium-210 , Free radicals, etc. Some of these substances are contained in the tobacco leaf, while others are formed during its processing and combustion. It should be emphasized that the combustion temperature of tobacco in cigarettes is very high when tightening and much lower between puffs, which defines different concentrations of chemicals in the main and sidestream tobacco smoke. Sidestream, for example, contains more nicotine, benzene, PAH than the main stream.

Most carcinogenic and mutagenic substances are contained in the solid phase of tobacco smoke, which remains on the so-called. Cambridge filter when smoking cigarettes in a smoking car. It is customary to call the resin a solid fraction of tobacco smoke, detained by the Cambridge filter, minus water and nicotine. Depending on the type of cigarettes, the filter they are equipped with, the types of tobacco and its processing, the quality and degree of perforation of the cigarette paper, the content of tar and nicotine in tobacco smoke can be very different. Over the past 20-25 years, there has been a significant decrease in the concentrations of tar and nicotine in cigarette smoke from cigarettes produced in developed countries, incl. And in Russia. In most countries, standards for tar and nicotine have been introduced. For the resin, these standards range from 10-15 mg in a cigarette, and for nicotine, 1-1.3 mg in a cigarette.

The carcinogenicity of tobacco smoke was proved in experiments on laboratory animals. Contact with tobacco smoke causes malignant tumors of the larynx and lungs. However, the difficulty of conducting such experiments with the inhalation of tobacco smoke is obvious in view of the impossibility of simulating the smoking process in animals. In addition, as is known, the life span of laboratory animals, such as mice and rats, is very short, which hinders the setting of long-term experiments simulating a prolonged (20 years or more) process of carcinogenesis in humans.

The etiological relationship between smoking and malignant tumors is shown in many epidemiological studies. The relative risk (RR) associated with smoking is different for tumors of different localizations and depends on the age of smoking initiation, the duration of smoking and the number of cigarettes smoked per day.

The risk of cancer of the oral cavity and pharynx in smokers is increased by 2-3 times in comparison with non-smokers, and in those who smoke more than one pack of cigarettes by the day, the relative risk reaches 10.

The risk of cancer of the larynx and lung in smokers is very high. In most epidemiological cohort studies, the dose dependence between the age of smoking initiation, the duration of smoking, the number of cigarettes smoked per day and the indicator of OP is noted. For example, according to a cohort study of English doctors, lung cancer is 7.9 for smokers, 1-14 cigarettes, 12.7 for smokers, 15-24 cigarettes and 25 for those who smoke more than 25 cigarettes a day. The results of the cohort study of the American cancer society and cohort studies conducted in other countries, prove the important role of the age of the beginning of smoking. The greatest OR of lung cancer was observed in men who started smoking before the age of 15 (15.0). In men who started smoking at the age of 15-19; 20-24 and more than 25 years, the PR was 12.8; 9.7 and 3.2, respectively. It should be noted,

The risk of esophageal cancer is 5 times higher among smokers compared to non-smokers. The risk of gastric cancer in smokers is also increased and equal to 1.3-1.5, with smoking increasing the risk of cancer of both cardiac and other parts of the stomach. Smoking is one of the causes of pancreatic cancer. OR of pancreatic cancer in smokers is increased by 2-3 times. Smoking, most likely, does not affect the risk of colorectal cancer, but in a number of epidemiological studies, an association between smoking and adenomatous polyps of the colon has been identified. There is a relationship between smoking and the risk of cancer of the anus (a tumor that has a squamous or transitional cell structure).

Several epidemiological studies have identified an increased risk of hepatocellular cancer associated with smoking. Most likely, smoking increases the risk of hepatocellular liver cancer in combination with alcohol consumption. In addition, it is shown that smoking increases the risk of liver cancer in persons infected with hepatitis B and C viruses. There were no links between smoking and cholangiocellular cancer, as well as malignant tumors of the gallbladder and bile ducts.

Smoking causes bladder and kidney cancer. The risk of bladder cancer among smokers is increased 5-6 times. The relationship between smoking and risk of kidney cancer is more pronounced for squamous and transitional cell carcinoma than for adenocarcinoma.

The relationship between smoking and cervical cancer and intraepithelial neoplasia has been identified. Given the fact that infection with the human papillomavirus is a proven cause of cervical cancer, smoking is likely to play the role of a promoter of the carcinogenesis process in the cervix, initiated by human papillomavirus. A number of epidemiological studies have shown the relationship of smoking with the PR of myeloid leukemia. In particular, the OR of acute myeloblastic leukemia is 1.5.

Cancer of the body of the uterus is the only form of cancer, the risk of which for women who smoke is reduced. This observation is confirmed in several case-control studies. The relative risk of endometrial cancer in smokers is 0.4-0.8. The protective effect of smoking against cancer of this localization can most likely be explained by the hormonal mechanism, namely, reduction (inhibition) of the production of estrogens. In addition, it is known that men who smoke menopause occur 2-3 years earlier than non-smokers. Smoking, most likely, does not affect the development of ovarian cancer. At the same time, the relationship between smoking and the risk of vulvar cancer is shown. The effect of smoking on the risk of breast cancer has been studied in many epidemiological studies, the results of which indicate that smoking, most likely, Does not affect the risk of developing breast cancer. Prostate cancer also refers to forms of cancer, the risk of developing which smoking, apparently, does not affect.

Attributive risk (AR), i.e. The percentage of all cancers etiologically related to smoking is different for different forms of malignant tumors. Thus, according to the most conservative estimates, the immediate cause of 87-91% of lung cancer in men and 57-86% in women is cigarette smoking. Between 43 and 60% of cancers of the mouth, esophagus and larynx are caused by smoking or smoking in combination with excessive consumption of alcoholic beverages. A significant percentage of tumors of the bladder and pancreas and a small part of cancer of the kidney, stomach, cervix and myeloid leukemia are causally related to smoking. Smoking cigarettes is the cause of 25-30% of all malignant tumors.

Despite the widespread belief that cigar smoking is not carcinogenic, convincing epidemiological data have been obtained that smoking cigars increases the risk of cancer of the oral cavity, pharynx, larynx, lung, esophagus and pancreas, and the carcinogenic effect of cigars on the oral cavity, pharynx and larynx is similar Effect of cigarettes. The risk of lung cancer among cigar smokers is somewhat lower, but it can reach high rates for those who are deeply drawn out. The relative risk of malignant tumors in smokers depends on the duration of smoking, the number of cigarettes smoked per day, and whether cigarette smoking is combined with smoking cigarettes or a tube. Cigar smoke contains almost all the same toxic and carcinogenic substances as tobacco smoke from cigarettes. However, it contains more nicotine and TSNA. In addition, the pH of the cigar smoke is higher, Than cigarette smoke, which is an obstacle, albeit relative, to its inhalation. Nicotine and other substances are absorbed through the mucous membrane of the oral cavity, and if the smoker is tightened, then through the mucous membrane of the bronchi.

Based on several dozens of epidemiological studies, the IARC working group (2003) concluded that passive smoking is also carcinogenic, the lung cancer in non-smokers in non-smokers whose husbands smoke is 1.3-1.7 according to various studies. The US Environmental Protection Agency concluded that passive smoking causes 3,000 deaths from lung cancer per year and increases the risk of lung cancer by 30%.

In addition to smoking, other forms of tobacco consumption are known. In India, tobacco and its various mixtures (for example, a mixture of tobacco with lime or a powder of crushed shells wrapped in a betel leaf) is laid on the cheek or under the tongue or chewed. In Central Asia, we are distributed, which consists of a mixture of tobacco with lime and ash. We are also laid under the tongue or on the cheek. In Sweden, a tobacco snack product is also distributed, which is also intended for oral consumption. In addition, there are snuffs.

Unlike tobacco smoke, the above types of tobacco products do not contain carcinogens, which are formed as a result of burning tobacco at high temperatures. However, their composition includes TSNA, such as N-nitrosonoricotine (NNN), 4-methylnitrosamino-1- (3-pyridyl) -1-butanone (NNK), which have been shown to be carcinogenic. Epidemiological studies have shown that consumption of oral forms of tobacco products increases the risk of cancer of the oral cavity and pharynx. In addition, there was a correlation between the consumption of oral forms of tobacco and the presence of leukoplakia, pathological formations of the oral mucosa, which usually precede the development of cancer.

The IARC Working Group convened in 1984, based on an analysis of experimental and epidemiological data, concluded that oral forms of tobacco products are carcinogenic to humans.

Thus, tobacco is the most important cause of malignant tumors.

Reducing the incidence of smoking among people in some developed countries, such as the US and the UK, has already reduced the incidence and mortality of lung cancer and other forms of cancer that are etiologically related to smoking.

In addition to malignant tumors, smoking is the main cause of chronic obstructive pulmonary diseases and one of the most important causes of myocardial infarction and cerebral stroke. Every second smoker dies of smoking-related causes. The mortality of smokers in middle age (35-69 years) is 3 times higher than that of non-smokers, and their life expectancy is 20-25 years lower than non-smokers.

Quitting smoking even in middle age leads to a reduction in the risk of dying from cancer and other causes related to smoking. For example, if the cumulative risk of death from lung cancer (up to 70 years) for men who have smoked their whole life is 16%, then among those who quit smoking at 60, this figure is 11%. The cumulative risk of dying from lung cancer is reduced to 5 and 3% among those who quit smoking at 50 and 40 years, respectively.

The main direction of cancer prevention is the fight against smoking. In all known national and international cancer prevention programs, smoking control is given paramount importance.

Food

Diet for prevention of cancer

Diet for the prevention of cancer mainly consists of fruits and vegetables. Meat should be a little, not more than eighty grams a day, mostly boiled, baked or stewed. This is the main conclusion of the report of the World Cancer Research Foundation, published in London, on the relationship between nutrition and cancer. The document emphasizes that a proper diet combined with high physical activity can prevent at least twenty percent of lung cancer, one-third of breast cancers and two-thirds of the large intestine. If you refuse to smoke, the overall probability of cancer will drop by 60-70 percent.

Features of food

Nutrition plays an important role in the etiology of malignant tumors. It is known that the incidence and mortality from malignant tumors varies significantly in different geographical regions. For example, the incidence of stomach cancer is very high in Japan, Korea, China and is low in North America. At the same time, the incidence of malignant tumors of the colon, breast, and prostate is low in the countries of South-East Asia and is high in North America and Western Europe.

Studies of migrants from South-East Asia in the United States showed that the Japanese and Chinese living in the United States, in the first generation, the incidence of stomach cancer decreased and the incidence of colon cancer increased.

Studies of migrants suggested that the geographical variability in the incidence of malignant tumors is due to certain environmental factors and lifestyle, rather than population genetic characteristics. Therefore, a hypothesis was formulated on the role of nutrition in the etiology of malignant tumors. Observations of some religious groups, in particular Seventh-day Adventists, who adhere to a special diet that does not include meat products, have shown that the incidence of cancer of the colon, breast, uterine body and prostate is much lower than that of the rest of the population, Living next to them.

The relationship between nutritional characteristics and the incidence of malignant tumors was first shown in correlation studies. It was found that the consumption of fats (especially animals), meat and milk per capita and the number of calories consumed positively correlates with the incidence of colon, breast, uterine and prostate cancer.

Experimental studies have shown that limiting the consumption of calories, as well as saturated fats of animal origin, inhibits the process of carcinogenesis induced by chemical carcinogens. In some experimental studies, a reduction in fat intake without a corresponding reduction in calorie intake also led to a decrease in the number of induced tumors and an elongation of the latent period of their development, i.e. Inhibiting the process of carcinogenesis. Inhibition of the process of carcinogenesis induced by chemical carcinogens, as a result of the restriction of energy consumption and animal fats, was noted for malignant tumors of the mammary gland and large intestine, as well as lung, skin and some non-epithelial tumors. It should be noted that, as in the experiment, Both in epidemiological studies it is very difficult to completely distinguish between the effect of calorie intake and fat intake, Animal fat is the most energy-intensive component of nutrition and the main source of calories.

The mechanism of tumor growth inhibition associated with the restriction of calories consumed can be explained by a decrease in cell proliferation and stimulation of apoptosis, increased DNA repair, a decrease in the formation of free radicals and, accordingly, damage to cells, a change in the hormonal profile, in particular a decrease in the level of both total and free estradiol And testosterone.

Markers of energy consumption in childhood and adulthood are growth (growth rate), body weight, and the level of physical activity. In women, the age of the onset of menstruation is also a very important marker of calories consumed in childhood. Epidemiological studies have shown that all of these characteristics affect the risk of developing cancer.

The mechanism of the carcinogenic effect of fats is associated with their effect on the processes of synthesis and metabolism of steroid sex hormones such as estradiol and testosterone. Fatty acids, especially saturated, inhibit the binding of estradiol to blood plasma proteins, which is the reason for the high concentration of free circulating estradiol in the blood. It was shown that a decrease in fat intake leads to a decrease in levels of estrone and estradiol in women of childbearing age. In women in menopause, a decrease in fat intake from 40 to 20% resulted in a marked (by 17%) decrease in the concentration in the blood plasma of total estradiol. Consumption of fats also affects the concentration of the male sex hormone testosterone. It is shown that the concentration in the blood of testosterone significantly correlates with the consumption of fats. For example, The concentration in the blood of testosterone is much higher in African-Americans than Africans living in Africa. The latter is much lower and the consumption of fat. At the same time, the incidence of prostate cancer is much higher among African-Americans. A study of the hormonal profile of patients with prostate cancer and a control group in countries with a low and high incidence of prostate cancer in Japan and the Netherlands showed that both fat intake and testosterone concentration in the blood are significantly higher among the Dutch.

The mechanism of action of fats on the process of carcinogenesis in the colon is associated with their effect on the metabolism of intestinal flora and the concentration of secondary fatty acids, which contribute to carcinogenesis in laboratory animals. In addition, fats stimulate the formation in the colon of fecapentanes - substances that have a mutagenic effect, and most likely play an important role in the process of carcinogenesis in this organ. As a result of processing fats in the intestine, fecal sterols are formed, some of which play a key role in the proliferation of colonic epithelium. It has been shown that people with a high intake of fats have a high concentration of secondary fatty acids - fecapentanes, a more pronounced metabolism of the intestinal flora, as well as the process of lipid conversion into mutagenic fecal sterols.

The relationship between the consumption of animal fats and the risk of colon, breast, and prostate cancer has been shown in many analytical epidemiological studies. In most works published before the mid-80's. XX century, it was revealed that the risk of colon cancer, breast cancer, prostate cancer is increased in people with high consumption of animal fats and meat. However, the analytical epidemiological studies of subsequent years, which used more accurate methods for estimating the consumption of fats and other nutrients and improved methods of statistical analysis, questioned this claim.

The cohort study of American nurses, which included 90,000 participants, did not reveal an increased risk of breast cancer in the group of women with high fat intake in general, and in particular saturated fatty acids and cholesterol. However, a meta-analysis of 12 case-control studies showed a small but statistically significant increase in the risk of breast cancer associated with high indicators of fat intake in general and saturated fats in particular. Thus, the role of fat consumption in the etiology of breast cancer remains unclear.

It is suggested that in studies in which such a relationship is identified, most likely, it was not possible to separate the effect of energy consumption from the effect of fat consumption. As already mentioned above, fat is the most energy intensive nutrient and most of the calories consumed by man (more than 40%), especially in developed countries, are represented by fats.

As for the epidemiological studies of colon cancer, most of them show a link between the consumption of fats, especially saturated, as well as meat with the risk of developing cancer of this organ. For example, in the already mentioned cohort study of American nurses, a statistically significant increase in the risk of colon cancer in women with high intake of animal fats, beef, pork, lamb and sausages was detected. In this and other American cohort study of health workers it was shown that the risk of cancer and adenomatous polyps of the colon depends on the ratio of meat consumption to poultry and fish consumption, i.е. The higher the consumption of meat compared to the consumption of poultry and fish, the higher the risk of cancer of this organ.

Carbohydrates along with fats are an important source of calories. In developing countries, carbohydrates account for 70% or more of energy consumed. In developed countries, the proportion of carbohydrates in the diet is reduced due to increased consumption of fat. In food, carbohydrates are presented in the form of starch, sugars and other polysaccharides, most of which is the so-called fiber. The main source of starch are cereals (bread), cereals, potatoes, peas, beans. Fiber is an integral component of plant foods, vegetables, fruits and unrefined (uncooked) cereals.

The hypothesis of the protective role of cellulose was formulated by the English physician Burkitt on the basis of observations in Africa, where the incidence of colon cancer is low, and the consumption of foods high in fiber is high. It is assumed that people who consume a lot of fiber, increased the amount of stool, which leads to a decrease in the colon of carcinogenic substances.

Clinical metabolic studies have shown that adding to the daily ration of 10-13 g of cellulose or grain of wheat (wheat bran) significantly reduces the concentration in the stool of secondary bile acids, their metabolic and mutagenic activity.

Most analytical epidemiological studies have confirmed the hypothesis of the protective effect of cellulose. A meta-analysis of 16 case-control studies confirmed the inverse relationship between fiber intake and fiber-rich foods and the risk of colon cancer. A prospective study of American health workers, in which about 10,000 men were under observation, found that fiber intake, the source of which is fruits and vegetables, as well as cereals and cereals, reduces the risk of adenomatous polyps and colon cancer. However, in a cohort study of American nurses, as in a number of other epidemiological studies, it has been shown that only fiber of fruits and vegetables has a protective effect against colon cancer. And this protective effect can also be the result of the action of vitamins,

The protective effect of consumption of vegetables and fruits in the development of malignant tumors in humans is proven for cancer of the oral cavity and pharynx, esophagus, stomach, colon and rectum, lung. The volume of epidemiological scientific evidence is weaker for malignant tumors of the larynx, pancreas, breast and bladder. However, consumption of fruits and vegetables is likely to reduce the risk of developing these tumors. In some epidemiological studies, a decrease in EH due to consumption of fruits and vegetables was noted for tumors of the cervix, endometrium, kidney and prostate. In addition, it is shown that the consumption of vegetables and fruits reduces the risk of all forms of malignant tumors in general. In one cohort study it was shown that in men who ate a lot of green and yellow vegetables, the risk of death from all forms of cancer was 0.3. The onion and garlic have a pronounced protective effect. In a study we conducted in Moscow, it was shown that consuming garlic significantly reduces the risk of stomach cancer. The anti-carcinogenic effect of garlic can be explained by its bactericidal properties, in particular against Helicobacter pylori, whose infection is a known risk factor for developing stomach cancer.

Vegetables and fruits contain active substances, which in an experiment on laboratory animals inhibit the development of tumors. First of all, vitamins C, E, beta-carotene, selenium, which have antioxidant properties, vitamin A, folic acid, as well as phytoestrogens (isoflavinols), flavonoids such as quercetin, indoles, etc., are among them.

Vitamin A plays a central role in cell differentiation, which served as the basis for the hypothesis that vitamin A can be an inhibitor of carcinogenesis. This hypothesis was confirmed in experimental studies. The precursors of vitamin A are carotenoids, which in the experiment turned out to be inhibitors of carcinogenesis, especially on the skin cancer model. Analytical epidemiological studies have confirmed the protective effect of carotenoids and to a lesser extent vitamin A. It should be emphasized that the source of vitamin A is products of animal origin, while carotenoids enter the human body solely with products of plant origin.

In case-control studies and cohort studies evaluating the intake of vitamin A and carotenoids using a questionnaire, as well as a blood test for the content of these vitamins, it was found that a high level of carotenoid intake with food and a high concentration in the blood reduces Risk of lung cancer. Consumption of carotenoids reduces the risk of cancer of the larynx, esophagus, stomach, breast, bladder, cervix.

Vitamin C is an antioxidant and, in addition, inhibits endogenous formation in the stomach of nitrosamines from food-derived amines and nitrites. In a number of case-control studies, the protective effect of vitamin C intake has been noted. People who consume a lot of vitamin C have a reduced risk of developing cancer of the oral cavity, larynx, esophagus, stomach and cervix. As with other vitamins, it remains unclear whether the protective effect of vitamin C or other components of fruits and vegetables, which includes vitamin C. Vitamin E is also a powerful antioxidant. In experimental studies, it was shown that vitamin E inhibits the process of carcinogenesis. The results of epidemiological studies, in which the influence of vitamin E intake on food and its concentration in the blood was studied, Are contradictory. However, it should be noted that in studies that studied the relationship between the concentration of vitamin E in the blood, an inverse relationship was found between the level of vitamin E and the risk of malignant tumors, and especially those that were not causally related to smoking.

Inhibiting the carcinogenesis effect of selenium has been shown by a number of experimental studies. In addition, epidemiological studies have shown an inverse correlation between the level of selenium consumption and the incidence of malignant tumors. Correlation is particularly pronounced for cancer of the colon and breast. The results of analytical epidemiological studies are less convincing. In some prospective studies that examined the concentration of selenium in the blood, a reduction in the risk of malignant tumors of the breast and lungs with an increase in the concentration of selenium in the blood was detected. As for other forms of cancer, epidemiological studies can neither confirm nor disprove the possibility of selenium's protective influence on their development.

Salty, smoked and canned foods may contain various carcinogens. There is reason to believe that nitrosamines, as well as their precursors (nitrates, nitrites) in food are associated with an increased risk of cancer of the esophagus and stomach. An increased risk of stomach cancer is observed among people who consume a lot of salt.

Despite the fact that at present our knowledge is not enough to accurately indicate all components of nutrition that promote the development of cancer or reduce the risk of its development, there is no doubt that an increase in consumption of vegetables, greens and fruits and a decrease in the consumption of fat (especially animal ) Will reduce the incidence of malignant tumors.

Overweight, physical activity

Obesity is one of the most important causes of morbidity and mortality in developed countries and takes second place in importance (after smoking). Obesity and overweight increase the risk of developing diabetes, cardiovascular diseases and cancer. The excess weight is determined by the weight index (VRI). VRI is equal to the weight divided by the squared height. The incidence of obesity is increasing in all developed countries, including Russia.

It is shown that overweight and obesity are the dominant risk factors for endometrial cancer. It was found that the risk of endometrial cancer increases approximately three-fold with an increase in the weight index from 20 to 35. In addition, overweight increases the risk of colon cancer, breast cancer (in menopause), kidneys and adenocarcinomas of the cardiac esophagus and stomach. The risk of colon cancer grows almost linearly with an increase in VRI from 23 to 30. The risk is 1.5-2 times higher in people with VRI exceeding 30, compared to people who have VRIs below 23. The effect of excess VRI over relative risk ( RR) of colon cancer is more pronounced in men than in women. According to a cohort study of 1.2 million people carried out by the American Cancer Society, in men who had VRI greater than 30 kg / m2, compared to men with CRI below 25 kg / m2,

The connection between overweight and breast cancer is shown in more than 100 epidemiological studies. Doubling of the ER is observed in women, in whom VRI exceeds 24 kg / m2. A meta-analysis of cohort studies, in which 340,000 women were included, showed that in women who had more than 28 kg / m2 of VRI, the OR was increased by 30% compared to women with VRIs below 21 kg / m2. Overweight is not a risk factor for breast cancer for young women.

Overweight (VRI more than 30 kg / m2) is associated with a 2-3-fold increase in the risk of kidney cancer. The risk is increased in both men and women. Excess weight has a similar effect on the risk of cancer of the cardiac department of the esophagus and stomach. The relationship between overweight and cancer of the thyroid gland, gall bladder is also shown.

Based on the results of epidemiological studies conducted in Western Europe, it was concluded that overweight and obesity are responsible for 11% of colon cancer, 9% of breast cancer, 39% of endometrial cancer, 37% of adenocarcinomas of the cardiac esophagus, 25% of kidney cancer And 24% of gall bladder cancer.

With regard to physical activity, it is reliably proven that increased physical activity, both professional and related to sports, reduces the risk of developing colon, breast, endometrial and prostate cancer. The higher the physical activity, the lower the risk. Summarizing the results of epidemiological studies has shown that increased physical activity reduces the risk of cancer by 60%.

Thus, an important component of cancer prevention is the control of overweight and exercise. This is especially true of people with sedentary lifestyles, and most in modern society.

Consumption of alcoholic beverages

Excessive consumption of alcoholic beverages increases the risk of cancer of the oral cavity, pharynx, larynx, esophagus, stomach, liver, pancreas, colorectal and rectum. Based on an analysis of available scientific data, the working group of the International Agency for Research on Cancer (ICAR) concluded that alcoholic beverages are carcinogenic to humans.

In the so-called. Ecological or correlation studies, it was shown that alcohol consumption per capita correlates with the mortality from malignant tumors. So, in France, there was a correlation between alcohol consumption, mortality from cirrhosis of the liver and mortality from cancer of the mouth, pharynx, esophagus and stomach. Similar data were obtained in the USA, where a statistically significant correlation was found between alcohol consumption per capita and mortality from gastric, colon and rectal cancer.

In Japan, a correlation study conducted in 46 prefectures revealed a link between alcohol consumption and mortality from tumors in the gastrointestinal tract. In an international study that included 30 countries, a statistically significant correlation was found between consumption of alcoholic beverages per capita and primary liver cancer. Correlation remained reliable after the adjustment for the incidence of hepatitis B. In France, Australia, England and New Zealand, a correlation was observed between the dynamics of alcohol consumption and mortality from cancer of the esophagus, larynx, colorectal and rectum.

The mortality from malignant tumors among representatives of religious groups that abstain from smoking and consumption of alcoholic beverages is significantly lower than among the general population. Studies conducted among Mormons and Seventh-day Adventists living in the US have shown that they are much less likely to develop oral, pharyngeal, esophagus, stomach, colon and rectal cancer.

Analytical epidemiological studies, both prospective and retrospective, have confirmed the role of alcohol consumption in carcinogenesis in humans. A statistically significant increase in the OR of development of cancer of the oral cavity and pharynx was found in all cohort and retrospective epidemiological studies. In some studies, the RR was increased by 10 or more times. Synergy between the carcinogenic effect of smoking and alcohol consumption was noted.

The carcinogenic effect of consumption of alcoholic drinks on the larynx is also proved. Analytical epidemiological studies have shown that OR of laryngeal cancer is significantly increased in men and women consuming excessive amounts of alcoholic beverages. According to various studies, the RR rates range from 15-50, depending on the amount of alcohol consumed. In all epidemiological studies, a synergistic effect of alcohol and smoking on the PR has been identified, and this effect is of a multiplicative nature.

The causal relationship between the consumption of alcoholic beverages and esophageal cancer is revealed in analytical epidemiological studies. In most studies, the OR increased in parallel with the increase in the amount of alcohol consumed and reached 10 or more. Smoking significantly increases the effect of alcohol consumption on the risk of esophageal cancer.

Consumption of alcohol leads to an increased risk of stomach cancer. The influence of alcohol on the process of carcinogenesis in the stomach extends to both the cardiac and other parts of the stomach. In a case-control study conducted in Poland, the non-cardiac cancer of the stomach was significantly elevated in men who drank vodka on an empty stomach.

In a case-control study conducted by us in Moscow, a statistically significant increase in OR of stomach cancer among men and women consuming excessive amounts of alcoholic beverages, and especially vodka, was revealed. The carcinogenic effect of consumption of strong alcoholic beverages is most pronounced for cardia. Smoking increases the carcinogenic effect of alcohol consumption. The result of the interaction of these two factors on the risk of stomach cancer is additive.

The results of analytical epidemiological studies on the impact of alcohol consumption on the risk of colorectal cancer and cancer are controversial. In some case-control studies, there has been an increase in risk due to consumption of strong spirits and beer. However, in most cohort studies and case-control studies, these results are not confirmed.

The relationship between the consumption of alcoholic beverages and primary liver cancer can be considered proven. Excessive consumption of alcohol increases the risk of primary liver cancer by about 1.5-5 times. However, in countries where another important risk factor for primary liver cancer is common is infection with hepatitis B and C viruses, the effect of alcohol consumption on the risk of liver cancer is more pronounced. So, among the cohort of carriers of the surface antigen of the hepatitis B virus, OP associated with the consumption of alcoholic beverages was increased eightfold, which indicates the synergism of the effect of the hepatitis B virus and the consumption of alcoholic beverages on the risk of primary liver cancer.

A positive and statistically significant association between alcohol consumption and breast cancer risk has been identified in more than two dozen cohort and retrospective epidemiological studies. A meta-analysis of 38 epidemiological studies that examined the relationship between alcohol consumption and breast cancer risk showed that breast cancer is 30% higher in women consuming alcohol than in non-drinkers.

In a case-control study conducted by us in Moscow, it was shown that the risk of breast cancer is statistically significantly higher among women drinking alcohol.

Despite the impressive amount of scientific information confirming the carcinogenicity of alcohol consumption for humans, the mechanism of carcinogenic action of alcohol is still not clear.

In experimental studies, ethanol - as such - is not carcinogenic. However, ethanol plays the role of a carcinogenesis promoter in experiments on mice that received benzo (a) pyrene. Most likely, such an effect of alcohol can be explained by its ability to increase the permeability of cell membranes. A similar mechanism of carcinogenic action of alcohol can explain the increased risk of cancer of the oral cavity, pharynx, esophagus, stomach, i.e. Those organs with which alcohol directly comes into contact. However, ethanol, apparently, affects the metabolism of xenobiotics and enhances their damaging effect on DNA.

Based on the results of epidemiological studies in which the quantitative dose-dependent relationship between alcohol consumption and the risk of malignant tumors is noted, it is necessary to limit the consumption of alcoholic beverages.

Limiting the consumption of alcoholic beverages is an important area of ​​cancer prevention.

Ultraviolet radiation

Data from experimental and epidemiological studies have shown that UV radiation is carcinogenic to humans and leads to the development of basal cell carcinoma, squamous cell carcinoma and skin melanoma.

UV radiation is an invisible part of the spectrum of sunlight with a wavelength of 100-400 nanometers (nm). The spectrum of UV radiation is conventionally divided into three parts: UV-C with a wavelength of less than 280 nm, or so-called. Herbicide UV rays; UV-A radiation with a wavelength of 330-44 nm, which causes erythema and skin pigmentation in humans and tumors in laboratory animals and UV-B radiation with a wavelength of 280-330 nm. In FW, rays with a wavelength of less than 290 nm are absorbed by the atmosphere, a small fraction of the UV-B radiation reaches the earth. It is this part of the spectrum of UV radiation that is most dangerous. The effect of UV-B radiation on human skin, including carcinogenic, is much stronger than the similar effect of UV-A radiation. The study of the effect of UV rays of different wavelengths on the skin showed that ultraviolet rays with a wavelength of 297 nm are most effective for erythema. With an extension of the wave, the power u, Most likely, the effectiveness of UV rays is reduced. UV-B radiation affects the aging process of the skin. It has been shown that mutations analogous to mutations caused by UV-B radiation in experimental systems are found in most "squamous cell carcinomas of the human skin in the gene of the p53 suppressor." On the other hand, UV-B radiation promotes an increase in the levels of vitamin D and calcium in the body, It is important for the population with inadequate nutrition.

The main component of the atmosphere, which protects us from excessive UV radiation, is ozone (O3). Ozone absorbs UV radiation in the stratosphere, letting only a very small amount of UV-B rays pass to the ground. The disappearance of ozone can lead to an increase in the amount of UV-B radiation reaching the surface of the earth.

Some researchers attribute the current increase in the incidence of squamous cell carcinoma and melanoma of the skin with an increase in the level of UV-B radiation, which was recorded in some regions of the world, namely in Canada and Switzerland. However, the global increase in the level of UV-B radiation has not yet been observed, and the increase in the incidence of malignant skin tumors can most likely be explained by the fact that more people from economically developed countries spend vacations in hot countries.

Malignant skin tumors predominate among the white population, and especially among blue-eyed and gray-eyed blondes and redheads, who are more likely to burn in the sun and who have a tendency to develop freckles. More often, skin tumors are located on open parts of the body.

There is an inverse correlation between the incidence of malignant skin tumors in different regions of the world and the latitude, and a positive correlation with the level of UV radiation. Squamous cell carcinoma of the skin more often affects people who work outdoors and are exposed to prolonged exposure to sunlight, while melanoma of the skin is more common among people working indoors, who, however, are in the habit of sunbathing and burning. The risk of skin cancer is increased in people with skin lesions caused by sunlight (for example, keratosis and elastosis), as well as in individuals with genetic syndromes such as albinism, xeroderma pigment-tozum. The effect of UV radiation on the risk of squamous cell cancer is more pronounced. In the etiology of melanoma, along with solar radiation, a very important role is played by constitutional features in the form of multiple birthmarks,

Considering the important role of UV rays for the prevention of all forms of skin malignant tumors, it is necessary to avoid long exposure to the sun, especially between 12 and 15 hours, when the activity of the most dangerous spectrum of sun rays from the point of view of carcinogenesis is highest. The use of protective creams, while protecting from burns, most likely does not reduce the risk of developing melanoma. In addition, it is not recommended to use tanning beds without appropriate medical indications.

Professional carcinogens

The available epidemiological data, as well as the assessment of professional factors of carcinogenic risk to humans, conducted by IARC, have shown that about 50 chemicals, complex mixtures and factors most commonly found in the workplace increase the risk of developing malignant tumors and are proven carcinogenic to humans and Are included in group 1. Some of them are widely distributed both in highly industrialized countries and in countries with a relatively low level of industrial development. Where it is impossible to identify a specific carcinogenic substance based on available scientific data, it is customary to classify as a carcinogenic production process, where employment leads to an increased risk of developing malignant tumors. Thus, group 1 includes production processes and professions that increase the risk of developing malignant tumors.

In addition, on the basis of experimental and epidemiological studies, several dozen factors have been classified by IARC as possibly carcinogenic (group 2a), and more than 200 substances with which a person touches in production conditions are classified as group 2b, presumably carcinogenic factors, on the basis of experimental studies.

The following are chemical substances and factors, the carcinogenicity of which has been proved for a person (group 1):

  • 4-aminobiphenyl;
  • Azathioprine;
  • asbestos;
  • Aflatoxin;
  • Benzidine;
  • benzene;
  • Beryllium and its compounds;
  • Bis-chloromethyl and chloromethyl esters;
  • N, N-bis (2-chloroethyl) r2: naphthylamine (chloronaphazine);
  • 1,4-butanediol dimethyl sulfonate;
  • Vinyl chloride;
  • mustard gas;
  • Ionizing radiation;
  • Cadmium and its compounds;
  • Silicon (crystalline);
  • Arsenic and its compounds;
  • 2-naphthylamine;
  • Nickel and its compounds;
  • radon;
  • Sulfuric acid (vapors);
  • Talc containing asbestos-like fibers;
  • 2,3,7,8-tetrachlorodibenzo-p-dioxin;
  • UV radiation;
  • Chromium 6-valent and its compounds;
  • Ethylene oxide.

4-Aminobiphenyl, benzidine and 2-naphthylamine increase the risk of developing bladder cancer. In addition, the incidence of bladder cancer is increased among workers employed in the production of certain dyes, including auramine and fuchsin, rubber, as well as in painters (Tables 1 and 2).

Table 1 - Mixtures that have been shown to be carcinogenic to humans (group 1)

Smoking Cancer of the mouth, lips, pharynx, esophagus, pancreas, stomach, liver, larynx, lung, bladder, kidney, cervix, myeloid leukemia 
 Tobacco is non-smoker. Mixture with tobacco  Cancer of the oral cavity, nose, nasal sinuses
 Second hand smoke  Lung cancer
 Alcoholic beverages  Cancer of the mouth, throat, larynx, esophagus, stomach, pancreas, liver
 Coal tar pitch Coal tar. Tar. Soot.  Cancer of the skin, scrotum, lung, bladder
 Mineral oils. Shale oils. Tar.  Cancer of the skin, scrotum, lung
 Salted fish of Chinese cooking  Cancer of the nasopharynx, esophagus, stomach
 Wood dust  Cancer of the cavity and sinuses of the nose

Table 2 - Production processes, carcinogenicity of which is proved for a person (group 1)

 Type of production The substance (factor), which is most likely to be carcinogenic  Malignant tumor
 Aluminum industry  PAHs Lung cancer, bladder cancer
 Auramine production  Auramin Cancer of the bladder
 Coal gasification  PAHs Cancer of the lung, skin, bladder, scrotum
 Extraction of hematite (underground)  Radon Lung cancer
 Isopropyl alcohol production  Diisopropyl sulfate, isopropyl oils Cancer of the nasal sinuses, lungs, larynx
 Coking coal  PAHs Cancer of the lung, kidney, bladder
 Foundry industry  PAH, silicon dust, metal vapor Lung cancer
Furniture industry Wood dust Cancer of the nasal cavity
Painting works Solvents Cancer of the bladder, lung
Shoe industry Benzene Leukemia, lymphoma
Rubber industry

 Aromatic amines, solvents

Cancer of the lung, bladder, stomach, colon, prostate, skin, hemoblastosis
Fuchsina production Fuchsin, ortho-toluidine Cancer of the bladder

The carcinogenicity of the rubber industry is most likely related to the use of 2-naphthylamine in this industry. PR of bladder, kidney and lung cancer is increased in workers engaged in the production process of coal coking and in the aluminum industry. In these industries, carcinogenic effects on humans are provided by polycyclic aromatic hydrocarbons (PAHs). These compounds are also the cause of increased incidence of lung cancer among workers in foundries. It should be noted that the carcinogenicity of the foundry is not limited to the effects of PAH. Casters are also exposed to vapors of chromium, nickel, formaldehyde, and also silica dust. PAHs are most likely the immediate cause of skin cancer (including scrotum) in workers in contact with coal combustion products.

Industrial contact with benzene increases the risk of leukemia. Inhalation of sulfuric acid vapors leads to an increase in the OR of larynx and lung cancer. Increased risk of angiosarcoma of the liver, lung and skin cancer is associated with the extraction and smelting of arsenic. In addition, a powerful carcinogenic effect on the liver is vinyl chloride. Professional contact with vinyl chloride also increases the risk of developing lung cancer, brain tumors and lymphogemopoietic tissue. Industrial contact with asbestos is a direct cause of the development of pleural and peritoneal mesothelioma, as well as lung cancer.

Compounds of beryllium, cadmium and chromium increase the risk of lung cancer. Nickel and its compounds are associated with an increased risk of lung cancer, nose and nasal sinuses. An increased risk of lung cancer among miners mining ore, and in particular radioactive ore, is most likely due to exposure to radon. In addition, miners are exposed to other compounds, for example, silicon dust and arsenic, which are either themselves carcinogenic, or can enhance the carcinogenic effect of other substances.

Workers engaged in the woodworking industry have a significantly increased risk of developing cancer of the nose and nasal sinuses. There are no data on specific carcinogens affecting workers in these industries. Most likely, the dust that occurs in the workplace as a result of the treatment of skin and wood, has an irritating effect on the mucosa and stimulates the proliferation of the epithelium.

Professional skin cancer is described in farmers and fishermen. The risk of skin cancer is increased in workers in contact with coal combustion products and mineral oils used in metal processing.

Professional exposure to various sources of ionizing radiation leads to an increased risk of leukemia, bone tumors, lung cancer, nose and nasal sinuses and skin.

As noted above, there are experimental and epidemiological data regarding many chemicals and industries, indicating that they may be carcinogenic to humans. However, these data are not enough to be attributed to the group of 1 substances or industries, the carcinogenicity of which is proven for humans.

Carcinogenic occupational factors are rarely presented as one specific substance. More often we are dealing with complex mixtures, not all the components of which can be known.

The proportion of cancer cases causally associated with occupational exposure is difficult to estimate, but according to available data, it accounts for up to 5% of all malignant tumors in developed countries. However, this percentage may be higher in regions with developed industry. For example, the incidence of bladder and lung cancer associated with occupational exposure can be very high in regions with developed industry and poor hygiene control.

Malignant neoplasms of professional origin, especially when the cause is established, are more easily preventable. Appropriate hygienic regulations are needed to regulate concentrations in the working area of ​​carcinogenic and toxic substances. Compliance with the rules and instructions for safety is also an important component of professional cancer prevention.

Air pollution

The high level of atmospheric air pollution in cities and the proximity of the place of residence to some industrial enterprises may be associated with an increased risk of lung cancer.

Carcinogens that pollute the air include polycyclic aromatic hydrocarbons (PAHs), chromium, benzene, formaldehyde, asbestos, etc. As an indicator of air pollution PAH adopted benz (a) pyrene (BP). The main sources of atmospheric air pollution are the enterprises of metallurgical, coke chemical, oil refining and aluminum industries, as well as thermal power stations and road transport.

Levels of PAH in the atmospheric air significantly exceed the MPC (1 ng / m3). For example, a metallurgical plant and a coke plant emit more than 2 kilograms of oil per day, and oil refineries more than 3 kilograms.

Concentrations of BP in the emissions of these industries are extremely high for both the work area and for populated areas. Dispersion of emissions abroad of the sanitary protection zone creates an excess of the maximum permissible concentration for coke production by 50 times, for oil refineries - by 20 times. Exceeding the MPC extends up to a distance of 10 km from the enterprises.

Despite the existing uncertainty regarding the effect of air pollution on the risk of malignant tumors, monitoring and monitoring of environmental contamination with carcinogens should be strengthened.

Water pollution

The main most common water pollutants are chemicals that are formed as a result of chlorination of water - chloroform and other trigalomethanes. Morbidity and mortality from cancer of the bladder, colon and rectum are higher among people who consume chlorinated water ,. Such results were obtained in ecological (correlation) studies by the "case-control" method, which were published in the early 80s of the XX century. Further studies in which an attempt was made to study the type of water consumed throughout life by cancer patients and the control group showed that the risk of cancer of the bladder, liver and pancreas was increased in people who for most of their lives consumed chlorinated water from Surface sources, And a dose-dependent relationship between the OP value and the duration of consumption of chlorinated water was noted. The relationship between a prolonged, 60 or more years, the consumption of chlorinated surface water and the risk of developing a malignant tumor is most pronounced for bladder cancer (RR = 2). As for tumors of other localizations, colorectal cancer, liver and pancreas, their connection with the consumption of chlorinated water is less convincing.

Fluorine can contaminate water. In addition, in the US, and possibly in other countries, fluoride was added to the water for the prevention of caries. Suspicion of the carcinogenicity of fluoride in water arose as a result of a comparison of the high incidence of cancer in US cities where water was fluoridated, with a low incidence in cities where this measure was not applied. However, statistical analysis of the data, taking into account all the factors that could affect the revealed difference in the incidence of malignant tumors, showed that the cause of the difference in incidence between these cities is not the water fluoridation, but a number of socioeconomic and professional factors. In addition, this problem was studied by several scientific committees, incl. And the International Agency for Research on Cancer (IARC, Lyon, France), who concluded that fluoridation of water is not associated with a risk of developing cancer.

The water can contain a number of inorganic and organic toxic and carcinogenic substances, such as beryllium, cadmium, arsenic, chromium and nickel, lead. The most convincing data are obtained in connection with water pollution by inorganic arsenic and skin, bladder, kidney cancer.

The content of nitrates in water can fluctuate between 1 mg / l and 100 mg / l. In most countries of the world, mainly for the prevention of methemaglobulinemia, MPC (40-45 mg / l) was introduced on the content of nitrates in water. Nitrates get into drinking water from many sources and, first of all, from the soil of agricultural land fertilized with nitrogen fertilizers. Nitrates, turning into nitrites and getting into the stomach, interact with amines and form carcinogenic nitrosamines. Some studies have found an increased risk of cancer of the stomach, brain tumors, and lymphogranulomatosis among people who consumed water with a high content of nitrates. At the same time, the professional exposure to high levels of nitrates in the production of nitrogen fertilizers did not lead to an increased risk of malignant tumors.

Carcinogenic hazards to humans may be the contamination of water with some organic substances, for example pesticides, organic solvents used to clean water reservoirs, and many other substances that enter water from landfills, septic tanks, etc. Cases of pollution are described. Water trichloro- and tetrachlorethylene, dichloroethane, which led to an increase in the incidence of cancer of the bladder, esophagus, stomach, breast, and large intestine. In Finland, water contamination with chlorophenol led to an increase in the incidence of non-Hodgkin's lymphoma and soft tissue tumors. An increased incidence of leukemia was detected in the United States among children who consumed water contaminated with dichloro-, trichloro- and tetrachlorethylene.

Along with carcinogenic chemicals, drinking water can be contaminated with asbestos fibers, which enter the water most often from asbestos-cement pipes. The relationship between water pollution by asbestos fibers and the risk of stomach cancer, as well as cancer of the kidney and oral cavity is shown.

Pollution of drinking water may present a certain carcinogenic risk. In this connection, the necessary preventive measure is monitoring of the chemical composition of drinking water and measures for its purification. Despite the carcinogenic risk associated with the chlorination of water, there is as yet no alternative to this method. Chlorination of water should be accompanied by a constant monitoring of the water content of secondary products of chlorination, chloroform and other trihalomethanes.

Effects of radiation in the workplace

The first malignant tumor - skin cancer caused by radiation, was diagnosed in 1902 by roentgenologists. It was further shown that radiologists have a higher risk of leukemia, myeloma, and also most solid tumors. However, the adoption of protective measures significantly reduced the risk of tumors among representatives of this profession.

The risk of developing lung cancer among miners, associated with the high concentration of radioactive gas radon in the mines, was studied in a number of works conducted in Czechoslovakia, the USA, Sweden, China. All these studies show a significant increase in the risk of death from lung cancer. The dose-response curve was strictly linear.

Data on the increased risk of development of malignant tumors among workers of various nuclear installations are inconsistent. Most epidemiological studies based on the observation of these populations did not reveal an increase in morbidity, and in a number of them a "deficit" of the cancer was identified, which can be explained by the so-called. Effect of a "healthy worker". In some studies, an increased risk of leukemia (except chronic lymphoid) and myeloma. At the same time, the risk of lung and prostate cancer is reduced.

The results of the latest studies, which included primary data from workers in various nuclear enterprises in the US and Canada, are more likely to reduce the risk of cancer as a result of the effect of a "healthy worker" than to increase it. It should be emphasized that the dose of radiation received by workers at these enterprises did not exceed 5 cGy (0.05 Gy). The co-operative study, which included US and British data on 76,000 workers at nuclear facilities, showed that only 9 out of 3,976 malignant tumors can be associated with radiation.

The risk of malignant tumors in people living near nuclear facilities

The increase in morbidity and mortality of the enterprise "Mayak", known to be associated with the contamination of the Techa River radioactive releases of the company. Unfortunately, to quantify the degree of cancer risk, which was subjected to this population is likely impossible. At the same time, we have the results of research conducted in different countries around nuclear enterprises. Most of these studies failed to reveal an increase in morbidity and mortality from cancer. In some studies, a slight increase in the incidence of malignant tumors among children was found. However, in most cases, these findings were not confirmed.

Based on research conducted in England, it was suggested that children living in the neighborhood of a nuclear facility in the town of Sellafield increased the incidence of leukemia. Only those children who were born in this town became ill with leukemia. It should be noted that among the workers of the nuclear enterprise in Sellafield there was no excess of the incidence of either malignant tumors in general or leukemia in particular. In addition, based on dosimetry data, it was difficult to assume an increased risk of leukemia. It was suggested that the cause of leukemia in children was most likely the irradiation of the fathers before their conception, i.e. Mutagenic effect of radiation on sex cells. However, further studies did not confirm this hypothesis. It turned out that some of the fathers of children who became ill with leukemia,

 

Prophylaxis of cancer is real! Prophylaxis of cancer is real!

Do not smoke.

If you smoke, try to give up this habit. Refusal to smoke at any age and with any "experience" reduces the risk of lung cancer, oral cavity, mouth, esophagus, stomach, pancreas, bladder, cervix.

Refusal to smoke prevents the development of such formidable diseases as myocardial infarction, cerebral stroke.

Do not smoke in public places, at home, at work

You put your nonsmoking wife or your husband at risk of lung cancer, or just a person nearby.

Try to avoid being overweight, be mobile and physically active

Eat moderately. Limit the consumption of meat and oil and other products that contain animal fats, as well as salty and smoked products. Include in your diet more fruits and vegetables, fish and other seafood. When cooking, use vegetable oils.

Regularly engage in physical education, run, make long walks quick steps. Physical exercises should take at least 40 minutes a day (3.5-4 hours per week).

Drink moderately

If you drink alcoholic beverages, you should limit their consumption. For men, the amount of alcoholic beverages per day should not exceed 50 ml of vodka (or other spirits), 250 ml of dry wine or 500 ml of beer. Women are safe taking half the doses of alcohol. Following these recommendations will reduce the risk of cancer of the oral cavity, pharynx, larynx, esophagus, stomach, liver, breast cancer in women.

Beware of excessive exposure to sunlight or other sources of ultraviolet radiation. Special care should be exercised by people with very light skin, which are prone to burns. Especially dangerous stay in the sun between 12 and 15 hours. Protective creams protect from burns, but not from the development of skin cancer and melanoma. Sunbathing in tanning beds is no less dangerous than under the sun. The statements about the safety of tanning in a solarium are unreasonable.

Strictly follow the safety rules aimed at preventing contact in the workplace with substances and physical factors that cause cancer.

Women aged 18-60 years should participate in the cytological screening of cervical cancer. Screening should be conducted at least once every 3 years.

Women older than 40 years should participate in mammographic screening for breast cancer. Mammography should be performed at least 1 time in 3 years.

Men and women over the age of 50 should take part in the screening of colorectal cancer. It is recommended that a colonoscopy be performed once every 10 years or sigmoidoscopy once every 5 years.

Girls aged 12-14 years are recommended to carry out vaccination against human papillomavirus (HPV). Vaccination does not exclude the need for participation in cytological screening (or screening for the detection of HPV infection).

 

Psychological reactions of the patient to the disease Psychological reactions of the patient to the disease

Reflection of a disease in a person's experiences is usually determined by the concept of an internal picture of the disease (WKB). It was introduced by the national therapist R.A. Luria and is now widely used in medical psychology. This concept, by the definition of a scientist, unites in himself everything that "the patient feels and experiences, the whole mass of his sensations, his general state of health, introspection, his ideas about his illness, about its causes - the whole vast world of the patient, which consists of Very complex combinations of perception and sensation, emotions, affects, conflicts, mental experiences and traumas. "

As a complex structured education, the internal picture of the disease includes several levels: sensitive, emotional, intellectual, strong-willed, rational. WKB is defined not by a nosological unit, but by the personality of a person, it is also individual and dynamic, like the inner world of each of us. At the same time, there are a number of studies that reveal the characteristic features of the experience of patients with their condition.

So, in the basis of the concept of V.D. Mendelevich ("Terminological foundations of phenomenological diagnosis") is the idea that the type of response to a particular disease is determined by two characteristics: the objective severity of the disease (determined by the criterion of lethality and the probability of disability) and the subjective severity of the disease (self assessment of the patient's condition).

The notion of the subjective severity of the disease consists of socio-constitutional characteristics, including the sex, age and profession of the individual. For each age group, there is a register of the severity of the disease - a peculiar distribution of diseases by socio-psychological significance and severity.

So, in adolescence, the most severe psychological reactions can be caused not by diseases that are objectively threatening the health of the body from a medical point of view, and those that change its appearance make it unattractive. This is due to the existence in the adolescent's mind of the basic need - "satisfaction with one's own appearance."

Persons of mature age will react more psychologically to chronic and disabling diseases. "This is connected with the value system and reflects the aspiration of a mature person to satisfy such social needs as the need for well-being, welfare, independence, independence, etc." In this regard, the most intense experiences are associated with cancer diseases. For the elderly and the elderly, the most significant are diseases that can lead to death, loss of work and working capacity.

To the individual psychological characteristics that affect the specificity of the experience of the disease include the features of temperament (with respect to the following criteria: emotionality, tolerance of pain, as a sign of emotionality, and limitation of movement and immobility), as well as features of the character of a person, his personality (ideological attitudes, the level of education).

There is a typology of ways of responding to the disease by the patient. Knowing the type of patient response helps to choose an adequate strategy of interaction with him and his family, use appropriate ways of communication, motivation for treatment.

Types of psychological response to severe medical illness

Typology of response to the disease AE Lichko and N.Ya. Ivanova ("Medico-Psychological Examination of Somatic Patients") includes 13 types of psychological response to the disease, identified on the basis of an assessment of the influence of three factors: the nature of the somatic disease itself, the type of personality in which the most important component determines the type of character accentuation and attitudes Disease in the reference (significant) for the sick group.

In the first block are those types of attitude towards the disease, in which there is no significant violation of adaptation:

Harmonious : for this type of response is characterized by a sober assessment of their condition without a tendency to exaggerate its severity and without reason to see everything in a gloomy light, but without underestimating the severity of the disease. The desire to actively promote the success of treatment in all. Unwillingness to burden others with the hardships of caring for themselves. In the case of an unfavorable prognosis in the sense of disability, the transfer of interests to those areas of life that will remain accessible to the patient. With an unfavorable forecast, attention, cares, interests on the fate of relatives, their business are concentrated.

Ergopathic : characterized by "withdrawal from illness to work." Even with the severity of the illness and suffering, they try to continue to work, no matter what. They work with bitterness, with even greater zeal than before illness, work is given all the time, they try to be treated and undergo research so that it leaves an opportunity for continuing work.

Anosognosic : characteristic is the active rejection of the thought of the disease, of its possible consequences, the denial of the obvious in the manifestation of the disease, attribution to accidental circumstances or other non-serious diseases. Refusal from examination and treatment, the desire to do with their means.

The second block includes the types of response to the disease, characterized by the presence of mental maladaptation:

Alarming : for this type of response, continuous anxiety and suspicion regarding the unfavorable course of the disease, possible complications, ineffectiveness and even the dangers of treatment. Search for new ways of treatment, thirst for additional information about the disease, possible complications, methods of treatment, continuous search for "authorities". Unlike hypochondria, objective data about the disease (the result of analyzes, conclusions of specialists) are more interesting than their own sensations. Therefore, they prefer to listen more to the statements of others than to submit their complaints without end. The mood is above all alarming, oppression - due to this anxiety).

Hypochondriac : characterized by concentration on subjective painful and other unpleasant sensations. The desire to constantly talk about them to others. On their basis, the exaggeration of the real and the search for nonexistent diseases and sufferings. Exaggerated side effect of drugs. The combination of the desire to be treated and the lack of faith in success, the requirements of a thorough examination and fear of harm and painful procedures).

Neurasthenic : behavior is typical of the type of "irritable weakness". Outbreaks of irritation, especially with pain, with discomfort, with treatment failure, adverse survey data. Irritation is often poured out on the first one and ends often with repentance and tears. Intolerance to pain. Impatience. Inability to wait for relief. In the future - remorse for anxiety and incontinence.

Melancholic : characterized by dejection of the disease, lack of faith in recovery, in possible improvement, in the effect of treatment. Active depressive statements down to suicidal thoughts. Pessimistic view of everything around, disbelief in the success of treatment, even with favorable objective data.

Euphoric : characterized by an unreasonably high mood, often faked. Neglect, frivolous attitude towards illness and treatment. Hope that "everything will be all right". The desire to receive from life everything, despite the disease. The ease of violation of the regime, although these violations can adversely affect the course of the disease.

Apathetic : characteristic of a complete indifference to his fate, the outcome of the disease, to the results of treatment. Passive submission to the procedures and treatment with persistent motivation from the outside, loss of interest in everything that previously excited.

Obezivno-phobic : characterized by alarming suspiciousness, first of all concerns fears of not real, but unlikely complications of the disease, failure of treatment, and possible (but little-grounded) failures in life, work, family situation due to illness. Imaginary dangers worry more than real. Signs and rituals become protection from anxiety.

Sensitive : there is an excessive concern about a possible adverse impression that can produce information about your illness on others. Fears that others will be avoided, deemed inferior, disregarded or cautious, to dissolve gossip or unfavorable information about the cause and nature of the disease. Fear of becoming a burden for loved ones due to illness and the disreputability of the relationship on their part in connection with this.

Egocentric : characteristic of "Care in the disease," exposing to loved ones and others their suffering and experiences in order to completely take hold of their attention. The requirement of exceptional care - everyone should forget and abandon everything and take care only of the patient. Conversations surrounding quickly translated "on yourself." In others, also requiring attention and care, see only "competitors" and treat them with hostility. A constant desire to show their special position, their exclusiveness in relation to the disease.

Paranoiac : it is characteristic of the belief that the disease is the result of someone's malicious intent. Extreme suspicion of drugs and procedures. The desire to ascribe possible complications of treatment and side effects of medication to negligence or malicious intent of doctors and staff. Charges and demands for punishments in this regard.

Dysphoric (characteristically melancholy, embittered mood).

Interaction with some of these patients can bring the doctor a pronounced psychological discomfort. But knowing the psychological basis of this type of patient behavior will help the doctor better understand his needs, expectations, fears and emotional responses, optimally organize the process of interaction with him, use certain instruments of influence.

It is important to understand that, even showing complete indifference to the outcome of treatment, the patient most wants to hear the words of hope and needs to strengthen his faith in the best.

Patients constantly worried about their condition need a calm, optimistic and attentive conversation with the doctor, and patients demonstrating the reactions of aggression to others and the doctor - the authoritative confident position of the doctor, which will help to cope with the deepest fear in his life that is hidden in his soul.

Thus, understanding the type of patient's response to the disease will help make the doctor's and patient's union more effective, contributing to the psychological well-being of both participants in the treatment process.

Source: www.oncology.ru.

 

Recommendations for oral care in chemotherapy Recommendations for oral care in chemotherapy

Chemotherapy has a negative effect on the oral mucosa. This is manifested by the development of stomatitis and ulcers. These sores are an open gate for any infection: bacteria, viruses and fungi. With prolonged use of chemotherapy, multiple tooth caries can develop. In the oral cavity many microorganisms, and the mucous membrane is often injured, so against the background of chemotherapy, local infections easily arise.

In order to reduce the manifestation of these complications, you should observe some rules of oral care:

  • Before starting a course of chemotherapy, you should consult your dentist and cure or remove the aching teeth.
  • Acquire a new soft toothbrush (after use, wash the toothbrush thoroughly and store it in a dry place)
  • Brush your teeth after each meal.
  • Use soft pastes that do not irritate the oral mucosa.
  • If the lips are dry, treat them with neutral fat or an oil solution of vitamin A.
  • Patients with removable dentures should take a prosthesis once a day, soak for 30 minutes in an antifungal and antibacterial solution, then rinse thoroughly with water. Do not leave the prosthesis in the mouth during sleep.

If you still have soreness and inflammation of the mucous membrane of the mouth and gums, it is recommended:

  • Eating food is cold or at room temperature.
  • Eat soft foods (mashed potatoes, cereals, scrambled eggs, processed cheese, pasta, bananas, apple puree, etc.).
  • Pre-soak in a liquid of a firm and dry food. Add oil to dry food, a quick sauce or broth.
  • Do not use acidic and irritating foods (tomatoes, oranges, marinades).
  • Do not eat spicy or salty foods.
  • Try to stop smoking.
  • After each meal rinse your mouth.
  • If food causes severe pain in the mouth, sores appear, fever has risen, it is urgent to perform a general blood test and contact a doctor, this may be one of the symptoms of febrile neutropenia, and you need treatment in a specialized hospital.
  • If you have already received chemotherapy, which led to inflammation of the oral mucosa, adhere to these recommendations from the first days of the next course of treatment.
    During chemotherapy, patients often develop immunodeficiency, so dental infection or treatment can have serious consequences. Prevention and periodontal therapy should ideally be performed before the appointment of chemotherapy or after completion. For patients with leukopenia, thrombocytopenia treatment should be delayed.

 

Syndrome of professional burnout Syndrome of professional burnout

Professional burnout is a syndrome that develops against the backdrop of chronic stress and leads to the exhaustion of the emotionally-energetic and personal resources of a working person. Professional burnout arises from the internal accumulation of negative emotions without appropriate "discharge" or "liberation" from them. In 1981, E. Moppoy (A. Morrow) offered a bright emotional image, reflecting, in his opinion, the internal state of an employee experiencing the distress of professional burnout: "The smell of burning psychological wiring."

Doctors-oncologists and average medical staff of oncology departments are people who are highly susceptible to this syndrome. The basis for such a conclusion is both the general reasons inherent in the emergence of "professional burnout" in all categories of workers, as well as specific features related to the nature of their activities.

Common reasons include:

  • Intensive communication with different people, including negative attitudes;
  • Work in a changing environment, clash with unpredictable circumstances;
  • Peculiarities of life in megacities, in conditions of imposed communication and interaction with a large number of strangers in public places, lack of time and resources for special actions to improve one's own health.

For specific reasons, you can include:

  • Problems of a professional nature (career growth) and working conditions (insufficient level of salaries, workplaces, lack of necessary equipment or preparations for the qualitative and successful performance of their work);
  • The inability to help the patient in some cases;
  • Higher lethality than in most other departments;
  • The impact of patients and their loved ones seeking to solve their psychological problems by communicating with a doctor;
  • The tendency of the last time is the threat of appeals of relatives of patients in the event of a lethal outcome with legal claims, claims, complaints.

Professional burnout less relates to people who have the experience of successfully overcoming professional stress and are able to constructively change under stressful conditions. He is also more steadfastly opposed by people who have high self-esteem and self-confidence, their abilities and capabilities. An important distinguishing feature of people who are resistant to professional burnout is their ability to form and maintain positive, optimistic attitudes and values ​​in themselves, as well as other people and life in general.

According to N.V. Samoukina, a leading researcher at the Psychological Institute of the Russian Academy of Education, the symptoms that make up the syndrome of professional burnout can be divided into three groups: psychophysical, socio-psychological and behavioral.

The psychophysical symptoms of professional burnout include such things as:

  • Feeling of constant, not passing fatigue, not only in the evenings, but also in the morning, immediately after sleep (a symptom of chronic fatigue);
  • Feeling of emotional and physical exhaustion;
  • Decrease in susceptibility and reactivity to changes in the external environment (lack of curiosity response to the factor of novelty or fear reaction to a dangerous situation);
  • General asthenia (weakness, decreased activity and energy, worsening of blood biochemistry and hormonal parameters);
  • Frequent causeless headaches; Permanent disorders of the gastrointestinal tract;
  • A sharp loss or a sharp increase in weight;
  • Complete or partial insomnia (fast falling asleep and lack of sleep in the early morning, beginning at 4 am or, conversely, inability to fall asleep at night until 2-3 am and "heavy" waking up in the morning when you need to get up for work);
  • A constant inhibited, drowsy state and a desire to sleep throughout the day;
  • Shortness of breath or breathing problems with physical or emotional stress;
  • A marked decrease in external and internal sensory sensitivity: deterioration of sight, hearing, smell and touch, loss of internal, bodily sensations.

Socially-psychological symptoms of professional burnout include such unpleasant sensations and reactions as:

  • Indifference, boredom, passivity and depression (reduced emotional tone, feeling depressed);
  • Increased irritability to minor, minor events;
  • Frequent nervous "failures" (flashes of unmotivated anger or refusals to communicate, "withdrawal into oneself");
  • A constant experience of negative emotions for which there is no reason in the external situation (feelings of guilt, resentment, suspicion, shame, stiffness);
  • A feeling of unconscious anxiety and heightened anxiety (feeling that "something is wrong");
  • A feeling of hyperopia and a constant sense of fear that "it will not work" or the person "will not cope";
  • General negative attitude towards life and professional perspectives (like "Whatever you try, it will not work anyway").

Behavioral symptoms of professional burnout include the following behaviors and behaviors:

  • The feeling that work is becoming harder and harder, and it is becoming more and more difficult to carry out it;
  • The employee noticeably changes his working schedule of the day (he comes to work early and leaves late or, on the contrary, comes to work late and leaves early);
  • Regardless of the objective need, the employee constantly takes work home, but does not do it at home;
  • The head refuses to make decisions, formulating various reasons for explaining himself and others;
  • Feeling of uselessness, lack of faith in improvement, lower enthusiasm for work, indifference to results;
  • Failure to fulfill important, priority tasks and "getting stuck" on small details, which does not meet the service requirements of spending most of the working time on little-realized or unintelligible execution of automatic and elementary actions.

If you notice these symptoms in yourself and your colleagues, you need to perform a number of actions that protect your psyche from the harmful effects of the syndrome.

First of all, you need rest.

Think about it yourself and explain it to your manager - without such an opportunity you will not be able to fully carry out your work.

Try to take consciously to the situation of the "border": after all, at this time you are crossing an invisible boundary between your private life and professional life. Try to realize this moment on the way to the service and again return to this thought, returning home. Tell yourself that work is not your whole life, and there you perform certain duties and solve important tasks, but when leaving work, you should not carry with you in your soul all the burden of the same problems.

During the working day, the following factors may increase the efficiency of work:

  • Photos of close, memorable places, beautiful landscapes, which you do not just have to place in the workplace, but sometimes you can look at them for a few seconds, as if "leaving" for a more comfortable and pleasant environment;
  • The opportunity during the working day at least 2 times to go out for 5-10 minutes to fresh air;
  • The smell of citrus (it can be from a sachet or another flavor, or maybe just from a mandarin, an orange or a glass of juice that you have not forgotten to hire);
  • Reception of the "white sheet": sit down, close your eyes and imagine a white sheet on which nothing is written, try to keep this picture as long as you can without thinking or imagining other images;
  • Deep breathing, during which, for a few seconds before a new breath, you delay the next movement of the muscles (it is better if you breathe with your "belly").

Also important in the prevention of burnout syndrome have the following methods:

  • Use of "time-outs", which is necessary to ensure mental and physical well-being (rest from work);
  • Definition of short-term and long-term goals (this not only provides feedback indicating that the person is on the right track, but also increases long-term motivation, achieving short-term goals is a success that increases the degree of self-education);
  • Mastering the skills and skills of self-regulation (relaxation, ideomotor acts, definition of goals and positive internal speech contribute to reducing the level of stress leading to burnout);
  • Professional development and self-improvement (one of the ways to prevent burnout syndrome is the exchange of professional information with colleagues, which gives a feeling of a wider world than the one that exists within a separate collective, for this there are different ways - courses of improvement of professional skill, conferences, etc.). ;
  • Avoiding unnecessary competition (there are situations when it can not be avoided, but excessive desire to win causes anxiety, makes a person aggressive, which contributes to the emergence of burnout syndrome);
  • Emotional communication (when a person analyzes his feelings and shares them with others, the probability of burnout is significantly reduced or this process is not so pronounced), except it is important to have friends from other professional spheres in order to be able to distract from their work;
  • Maintaining a good physical shape (do not forget that there is a close relationship between body and mind: poor nutrition, abuse of alcohol, tobacco exacerbate the symptoms of burnout syndrome).

These methods help to remove the momentary tension, the general psychological background of your attitude is in many respects connected for the doctor-oncologist with his philosophical attitude to life, understanding what a person can - and what can not change.

Of course, each situation is unique, and a sense of stress, fatigue, dissatisfaction with oneself and their work is based on a unique set of problems that are unique to each person.

Source: www.oncology.ru.

Gomel regional clinical oncological dispensary

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