On September 24, 2026, a master class titled “Systemic Inflammation and Chronic Pain in Rehabilitation and Palliative Care Pathways: Time for Informed Decisions” was held in a hybrid format. Given the security situation in the capital, most doctors joined the event online. The online broadcast was organized from the conference hall of the Kyiv City Clinical Oncology Center. The event served as an effective interactive platform for specialists in the fields of oncology, oncopsychology, rehabilitation, and palliative care to exchange experiences.
The doctors were welcomed, and the master class was opened by Andriy Kramarenko, director of the Kyiv Municipal Cancer Center, Candidate of Medical Sciences, and a top-level surgical oncologist, and Dmytro Osynskyi, Doctor of Medical Sciences, professor, deputy director for surgical care, and oncology expert at the Kyiv City Health Department.
The event opened with a presentation titled “Practical Aspects of Treating Chronic Pain in Incurable Cancer Patients,” delivered by Oleksiy Kalachov, head of the palliative care department at the Kyiv Municipal Clinical Oncology Center (KMKOC). It is important to note that the treatment of chronic pain in incurable cancer patients is based on the WHO’s three-step analgesic ladder and systemic pharmacotherapy, which is effective in over 80% of cases.
A highlight of the scientific program was the presentation titled “The Palliative Care Pathway for Cancer Patients. Key Guidelines for Psychological Support,” jointly prepared by Oleksiy Borshch, a psychiatrist and lecturer in the Department of Psychology at Bohdan Khmelnytskyi National University of Cherkasy, and Oleksandr Golubnychyi, a psychiatrist and specialist in oncological psychology and palliative care for cancer patients. Psychological support for cancer patients is an important part of treatment that helps them cope with stress, come to terms with their diagnosis, and improve the quality of life for both the patient and their family.
A significant addition to the event’s scientific program was the lecture “Endocrinological Patterns of Tumor Onset and Development,” prepared by Yulia Komisarenko, M.D., Ph.D., Professor, and Chair of the Department of Endocrinology at the O.O. Bogomolets National Medical University, and Serhiy Konovalenko, Ph.D., Serhiy Konovalenko, Ph.D., a researcher in the Department of Tumor Process Monitoring and Therapy Design at the R.E. Kavetsky Institute of Experimental Pathology, Oncology, and Radiology (IEPOR) of the National Academy of Sciences of Ukraine.
The doctors thanked the organizers of the workshop and the event’s medical partner, “Medix Opika,” a provider of mobile palliative care services, for the idea of bringing together the professional expertise of doctors from various specialties and implementing innovative strategies for medical rehabilitation and palliative care aimed at improving the quality of life for cancer patients.
What are the general recommendations for ensuring a comfortable autumn of life for women?
In cases of chronic, incurable diseases, ensuring the patient's quality of life becomes the primary focus. What are the specific features of palliative care for breast cancer bone metastases and progressive osteoporosis?
What recommendations can be given to women for the prevention of osteoporosis?
How common is postmenopausal osteoporosis?
What are the clinical manifestations of bone metastasis?
We know that, in today's world, cancer can be successfully treated if detected at an early stage. Nevertheless, in many cases, the disease progresses and significantly impairs quality of life. In your opinion, which threats associated with a woman's oncological status should be considered critical?
What factors can increase the risk of developing "gynecological" malignant neoplasms?
Ms. Olha, thank you for the opportunity to meet. Statistically, women spend a third of their lives in the postmenopausal period—sometimes referred to as the "autumn of life." What health risks does this stage entail?
Proper nutrition during menopause is a key tool for alleviating hot flashes, stabilizing mood, maintaining bone strength, and managing weight amidst a slowing metabolism. Leading medical organizations, such as the British Dietetic Association (BDA), recommend a diet similar to the Mediterranean style during this period. It is based on a high intake of vegetables, whole grains, high-quality protein, and healthy fats. To ensure the body receives essential nutrients during this time of hormonal transition, it is important to consume foods rich in calcium and vitamin D. Good options include low-fat dairy products such as plain yogurt, kefir, and cottage cheese. Green leafy vegetables—like broccoli, kale, and spinach—are also beneficial. Recommended fish include sardines, salmon, trout, and herring, all of which are sources of Omega-3 fatty acids.
Walnuts, flaxseeds, and chia seeds are also excellent additions, as are whole grains like oats, buckwheat, and quinoa, which help prevent sharp spikes in blood glucose levels. Aim to consume at least 400–500 grams of colorful vegetables and berries daily.
To prevent blood pressure fluctuations, headaches, and autonomic disturbances, ensure your home environment has fresh air. For instance, ventilate your room before going to bed and keep a fan or cool water nearby. Try to put away your gadgets an hour before bedtime and avoid consuming stimulating drinks in the afternoon. And, of course, stay physically active—moderate aerobic activities such as brisk walking, swimming, or dancing lower levels of the stress hormone cortisol and strengthen the heart. Practice yoga, breathing meditations, or tai chi; this stabilizes the nervous system and helps you cope better with mood swings.
In accordance with WHO guidelines followed by gynecologic oncologists, pain management is the primary focus. Modern analgesics are used to control both constant and nighttime pain. To strengthen bone tissue and reduce the risk of fractures and blood calcium levels, specific medications—such as bisphosphonates or denosumab—are prescribed.
Palliative care for osteoporosis aims to alleviate chronic pain, improve the patient's mobility, and prevent further fractures, thereby ensuring the best possible quality of life. Since osteoporosis is a systemic and progressive disease, patients in the advanced stages—particularly following vertebral compression fractures or femoral neck fractures—require comprehensive care. Effective pain management remains a priority, as the back and joint pain resulting from bone deterioration is profoundly debilitating for the patient. Preventing falls and injuries—essentially creating a safe environment—is crucial; in cases of severe osteoporosis, even a minor jolt or a fall from a standing height can lead to serious fractures.
The work of the palliative care team necessarily includes modifying the living environment: removing rugs, installing bathroom grab bars, and ensuring adequate lighting. Maintaining mobility and facilitating physical rehabilitation involves providing assistive devices such as walkers, crutches, and orthopedic braces.
The best way to prevent osteoporosis is through a balanced diet rich in calcium and vitamin D, combined with regular physical activity. Osteoporosis is a condition in which bones become fragile and prone to fracture. According to Ministry of Health guidelines, simple preventive measures can help protect bone health. First, maintain a balanced diet: consume foods rich in calcium and vitamin D, such as milk, hard cheese, yogurt, fish, leafy greens, and broccoli. Moderate sun exposure is beneficial; spending time outdoors allows your body to produce vitamin D naturally. Do not overlook physical activity: stay active every day—whether by walking, doing exercises, or swimming—as physical exertion strengthens both bones and muscles. Basic household safety is also crucial for preventing injuries associated with osteoporosis: avoid falls, ensure your home is well-lit, and wear comfortable footwear.
This is a true modern-day epidemic. Postmenopausal osteoporosis is one of the most significant medical and social issues worldwide, as the sharp decline in estrogen levels following menopause leads to accelerated bone loss. According to data from leading medical organizations, including the International Osteoporosis Foundation (IOF), the statistics regarding the condition are as follows:
One in three women over the age of 50 will experience an osteoporotic fracture during her lifetime. Osteoporosis is diagnosed in approximately 10% of women aged 60, 20% of women aged 70, and 40% of women aged 80. In the first 5–7 years following the onset of menopause, a woman may lose up to 20% of her bone mass due to estrogen deficiency. In Ukraine, approximately 7 million postmenopausal women are at an increased risk of developing osteoporosis. About 2 million women in Ukraine have already been diagnosed with the condition. Statistics indicate that the incidence of the most dangerous complication of osteoporosis—hip fractures—among Ukrainian women aged 50 and older is approximately 255.5 cases per 100,000 population annually.
Pain at the site of the lesion. A characteristic feature is the intensification of pain at night or during movement. Pathological fractures are the most serious complication of bone metastases. Due to the weakening of the bone structure, a rib or femur can fracture under minor stress or an unusual movement. It is also important to remember that osteoporosis is quite common in postmenopausal women and significantly increases the risk of pathological fractures.
Naturally, there is a risk of metastasis. The fact is that, for instance, in breast cancer, the skeletal system is the most common site of metastasis. Bone metastases occur in 65–80% of patients with advanced breast cancer. Among patients with lymph node involvement, the risk of developing bone metastases is approximately 15% at two years and up to 41% at ten years. It is worth noting that 50–70% of cases involving the skeleton are multifocal. The spine, ribs, pelvic bones, skull, and long bones are most frequently affected.
Studies have shown that excess body weight raises blood levels of insulin and estrogens, thereby increasing the risk of cancer. Consequently, specialists recommend gradual, controlled weight loss, which helps significantly lower these levels. Furthermore, the body's natural defenses weaken with age; at some point, the immune system may fail to cope with a dangerous cell that exhibits signs of atypia and initiates a malignant process. Heredity also plays a significant role in tumor development: the presence of such diseases in close relatives increases the risk.
First of all, unfortunately, the risk of developing certain types of cancer—particularly breast and uterine cancer—increases significantly during the postmenopausal period due to age-related changes and hormonal fluctuations. Breast cancer is most frequently diagnosed in older women and during postmenopause. The risk of endometrial cancer rises after menstruation ceases, especially in the presence of excess weight or hormonal imbalances. There is also an increased likelihood of developing cervical and vulvar cancer during this time. Therefore, regular gynecological check-ups remain essential.
Thank you for your expert opinion and valuable advice. As a memento of our meeting, please accept this painting I created myself. It depicts baobabs—a symbol of longevity. Even on a tree that appears withered, there is a flowering branch, symbolizing hope in the most difficult situations.
The Association Visits Renowned Endocrinologist Yulia Komisarenko
Metabolic disorders—specifically metabolic syndrome (MS)—are being called the "endocrinological epidemic" of the 21st century. MS increases the risk of developing type 2 diabetes fivefold. The issue is that, in the vast majority of cases, type 2 diabetes (T2D) develops over years without pronounced symptoms. A gradual rise in glucose levels silently damages blood vessels and nerve endings. This can lead to vascular, vision, or kidney problems even before a person is diagnosed.
To discuss key challenges in the field of diabetology, Serhiy Konovalenko, Chairman of the Board of the NGO "Association for Sustainable Development of Healthcare and Palliative Care," met with Professor Yuliia Komisarenko, MD, Head of the Department of Endocrinology at Bogomolets National Medical University.
Overweight individuals know all too well how difficult it can sometimes be to follow appropriate recommendations. Are there, perhaps, pharmacological approaches to preventing diabetes?
Are preventive strategies for diabetes currently being considered, particularly for individuals with metabolic syndrome and high risk?
What are the specific features of palliative care for patients with diabetes?
What complications does type 2 diabetes pose a risk of?
What diagnostic pathway for detecting diabetes do endocrinology specialists map out today?
What can be said about the prevalence of diabetes in Ukraine and worldwide?
What are the risk factors for the progression of metabolic syndrome to type 2 diabetes?
Yuliia Ihorivna, thank you for agreeing to meet with us amidst your busy schedule preparing for the new academic year. How would you define metabolic syndrome today?
– Indeed, despite the proven effectiveness of lifestyle modification, maintaining body weight—even at the upper limits of the normal range—and controlling metabolic parameters solely through non-pharmacological interventions remains challenging, even for the most motivated patients. In light of this, the latest ADA guidelines state that pharmacotherapy may be considered an additional preventive tool for individuals at high risk of developing type 2 diabetes. Among all the pharmacological agents studied, metformin possesses the most compelling and consistent body of evidence regarding the prevention of the progression from prediabetes to type 2 diabetes. Importantly, the preventive effect of metformin is sustained over the long term and integrates effectively with lifestyle modification programs.
– Yes. It is challenging but achievable. According to the guidelines of the European Association for the Study of Diabetes (EASD), it is possible at a certain stage to reach optimal glycemic levels and improve one's lipid profile solely through lifestyle changes. Recommendations include limiting the intake of carbohydrates and animal fats while increasing dietary fiber and lean, healthy proteins—an eating pattern commonly known as the "Mediterranean diet." Additionally, daily moderate physical activity is advised, such as walking twice a day for a combined total of at least 10,000 steps; Nordic walking, performed at a controlled intensity, is particularly beneficial.
– Palliative care for severe or advanced-stage diabetes focuses on pain relief, maintaining comfort, and improving the patient's quality of life; at this stage, strict blood sugar control is no longer the primary goal, and symptom relief becomes the priority. In other words, the context of palliative care entails a fundamental shift in therapeutic priorities. The key objective is no longer achieving the glycemic targets standard for the early stages of diabetes management, but rather ensuring the patient's maximum physical and psychological comfort. The main areas of focus include reducing pain and the intensity of other symptoms—specifically, selecting safe analgesics and medications to improve well-being. Other aspects include nutrition that prioritizes comfort—offering food that is enjoyable and easily digestible, without rigid dietary restrictions—as well as hygiene and preventive measures, such as regular body care and repositioning bedridden patients. Educating family members is also crucial; this involves instructing loved ones on daily care routines and how to recognize signs of dangerous conditions.
– Diabetes damages blood vessels and nerves. Major complications include heart attacks, strokes, vision loss due to retinopathy, kidney failure, nerve damage (neuropathy), and diabetic foot syndrome, which can lead to wounds and amputations. Diabetes complications such as retinopathy, nephropathy, diabetic foot syndrome (DFS), and polyneuropathy are leading causes of disability among patients with diabetes. As a chronic, progressive disease, diabetes is a risk factor for cardiovascular diseases and their complications. The presence of diabetes increases the risk of ischemic heart disease (IHD) by two- to fourfold—a risk that rises with the duration of the disease—and more than half of patients already suffer from IHD at the time their type 2 diabetes is diagnosed. According to the literature, type 2 diabetes leads to cardiac autonomic neuropathy (CAN), a condition that is highly prevalent yet frequently undiagnosed in diabetic patients. All examined patients with type 2 diabetes and CAN exhibited myocardial structural changes in the form of concentric remodeling and concentric hypertrophy.
– Diabetes mellitus is diagnosed based on fasting plasma glucose levels or, if necessary, by considering the plasma glucose level two hours after an oral 75-gram glucose tolerance test. Glycated hemoglobin (HbA1c) serves as an additional diagnostic marker. These same tests can be used to identify individuals with prediabetes. The American Diabetes Association (ADA) proposes the following diagnostic criteria for prediabetes: fasting blood glucose level of 5.6–6.9 mmol/L; postprandial glucose level two hours after a 75 g oral glucose test of 7.8–11.0 mmol/L; and glycated hemoglobin (HbA1c) level of 5.7–6.4%. Since 2022, the ADA has recommended screening for all individuals aged 35 and older; if test results are normal, repeat screening is advisable at intervals of at least three years. Overweight or obese adults with one or more additional risk factors should undergo testing for prediabetes and/or type 2 diabetes regardless of age. If a screening test is positive, the diagnosis of diabetes should be confirmed based on ADA criteria: fasting blood glucose level ≥ 7.0 mmol/L or the two-hour postprandial glucose level. ≥ 11.1 mmol/L after a 75 g oral glucose tolerance test, or a glycated hemoglobin (HbA1c) level ≥ 6.5%.
– The reality today is that diabetes poses a serious global challenge to human health and well-being. In 2021, the global prevalence of diabetes among people aged 20–79 was estimated at 10.5%, representing over 500 million individuals worldwide. Projections indicate that the total number of people with diabetes will rise to 700 million by 2040. Currently, more than 1.3 million people in Ukraine are officially registered with diabetes; approximately 190,000 have type 1 diabetes, while over 1.26 million have type 2 diabetes. However, the actual number of cases may be significantly higher, as many people remain undiagnosed.
– Since metabolic syndrome is essentially a precursor to type 2 diabetes, it is best to consider the general risk factors for developing diabetes in this context. Endocrinologists have currently agreed upon a list of factors that, to varying degrees, create conditions conducive to the disease's development. These primarily include individuals who are overweight (BMI ≥ 25 kg/m²), suffer from arterial hypertension (> 130/80 mmHg), and have low-density lipoprotein (LDL) cholesterol levels > 0.91 mmol/L or triglyceride levels > 1.7 mmol/L. Also included are individuals with atherosclerosis, gout, and hyperuricemia; women with a history of gestational diabetes; and individuals with chronic liver, kidney, or cardiovascular diseases, as well as patients on long-term therapy with diabetogenic drugs such as synthetic estrogens, diuretics, and corticosteroids.
– According to leading global endocrinology and diabetology associations, metabolic syndrome (MS) is defined as a cluster of interrelated metabolic disorders and conditions, including abdominal obesity, high blood pressure, cardiovascular abnormalities, elevated blood sugar levels, and disturbances in lipid and uric acid metabolism. Collectively, these factors significantly increase the risk of heart disease, stroke, and type 2 diabetes. At the core of MS lies insulin resistance—a condition in which the body's cells become less sensitive to insulin. Consequently, the pancreas produces even more insulin, triggering a disruption in fat and carbohydrate metabolism.
Marta Matiushko, Head of the Health Department of the Lviv City Council;
Iryna Kmit, Head of the Postgraduate Education and Organizational Support Division of the Lviv Regional State Administration;
Nataliia Ivanchenko, Director General of the Lviv Regional Center for Disease Control and Prevention of the Ministry of Health of Ukraine.
During the visit, meetings were held with:
At a meeting with Iryna Kmit, Head of the Postgraduate Education and Organizational Support Department at the Lviv Regional State Administration.
Meeting with Marta Matiushko, Head of the Health Department of the Lviv City Council
The focus of the discussions is the individual and their needs at various stages of life and treatment. Today, the Ukrainian healthcare system faces challenges that require not only immediate solutions but also a systemic vision for the years ahead. The war has significantly increased the need for comprehensive rehabilitation, long-term care, psychological support, and quality palliative care. At the same time, these areas must not develop in isolation but rather as interconnected components of a modern healthcare system. That is why significant attention during the meetings was devoted to developing the palliative care system—focusing on its accessibility, quality, and orientation toward the needs of patients and their families.
For us, palliative care is primarily about quality of life and human dignity. It is about the opportunity to receive proper pain relief and symptom management, professional care, and psychological and social support. It is also crucial that such care is available not only in large specialized facilities but is brought as close as possible to the individual and their community.
Rehabilitation is another key area. Today, a vast number of Ukrainians require it: military personnel and veterans, people recovering from injuries and complex surgeries, patients with chronic illnesses, and anyone needing to restore lost functions and return to a life that is as active and independent as possible.
Discussions also covered the need to strengthen cooperation between different levels of medical care, develop multidisciplinary teams, facilitate the exchange of practical experience among specialists, and implement modern approaches to organizing care. After all, a high-quality system is not merely a collection of isolated services and facilities. It is a seamless continuum of care for the individual, where prevention, treatment, rehabilitation, long-term care, and palliative care complement one another.
A key outcome of the meetings in Lviv was a shared understanding of the need for continued cooperation. We agreed to foster partnerships, exchange expertise and practical experience, and collaborate on initiatives regarding palliative care, rehabilitation, and other vital areas of healthcare. One practical tool for this collaboration will be the organization of joint educational events for healthcare professionals, including those within the framework of Continuous Professional Development (CPD). However, education here is not an end in itself, but a means to disseminate modern practices and gradually improve the quality of care directly at the local level.
We sincerely thank Marta Matiushko, Iryna Kmit, and Nataliia Ivanchenko for the warm welcome, the professional and substantive discussions, their openness to new ideas, and their readiness to join forces.Such meetings reaffirm a simple truth: systemic change begins with dialogue, partnership, and people willing to take responsibility and work together.We return from Lviv with fresh ideas and concrete plans. Ahead lie joint projects, expert consultations, and practical steps toward developing palliative care, rehabilitation, and a people-centered healthcare system in Ukraine.
At a meeting with Iryna Kmit, Head of the Postgraduate Education and Organizational Support Department at the Lviv Regional State Administration.
Last week, Serhiy Konovalenko, Head of the Association for Sustainable Healthcare and Palliative Care, paid a working visit to Lviv. It was a trip marked by several busy days, important professional meetings, candid discussions about the needs of the healthcare system, and—most valuably—a shared vision for the direction of future work.
The Association’s conference in Cherkasy was held with the support of Medix Opika.
On July 23, with the support of the Cherkasy Regional State Administration and the Cherkasy City Council, an interdisciplinary conference titled "The Oncology Patient. Chronic Pain: From Supportive Therapy to Palliative Care" was held at the regional clinical hospital.
It is important to understand that chronic pain management is a comprehensive, multifactorial approach encompassing pharmacological therapy, physical rehabilitation, and psychological support. The primary goal of these therapeutic measures is not only to reduce pain intensity and improve mobility but also to enhance the patient's quality of life.
The second presentation, delivered by psychiatrist Oleksii Borshch, focused on the mental health of cancer patients—spanning the spectrum from the early detection of psychological issues to palliative care.
The most common emotional reactions to a cancer diagnosis are intense fear, anxiety, and depression. Consequently, mental health support facilitates the treatment process and improves quality of life. Well-structured care provided by an onco-psychologist or psychotherapist—professionals who understand the specific nature of the diagnosis—prioritizes open communication, such as discussing feelings with medical staff, family members, or support groups. A patient’s calm and responsible attitude toward grueling treatment often proves lifesaving. During the palliative care stage, when the focus shifts to symptom management, positive interaction—not only with a psychologist but also with loved ones—is crucial.
Olyana Panchenko, an anesthesiologist-intensivist and regional manager for the mobile palliative care provider "Mediks Opika," shared her unique clinical experience in addressing complex practical challenges. A particularly illustrative case involved a patient with a glioblastoma in the frontoparietal region of the brain. Specialists clinically identified a failure of Broca's area; the patient was unable to speak or verbally communicate pain. However, she understood when spoken to—indicating that Wernicke's area was functioning—and could "respond" in other ways, such as by squeezing the doctor's fingers.
In such cases, preventing pulmonary stasis and the formation of atelectasis—complications arising from immobility—is vital. Changing the patient's body position allows lung tissue to expand evenly as the vector of gravitational force shifts, facilitating the physiological clearing of the airways. A semi-seated position with stabilization of the shoulder girdle alleviates shortness of breath by engaging accessory respiratory muscles in addition to the diaphragm.
In his initial presentation, Oleksii Borshch—a psychiatrist and lecturer in the Department of Psychology at Bohdan Khmelnytsky National University of Cherkasy—highlighted the role of social workers in supporting cancer patients and the importance of family communication. He also outlined effective measures to prevent professional burnout among social workers. Given the constantly increasing workload on social services today, the issue of inevitable professional fatigue—exacerbated by the routine nature of daily tasks—has become particularly significant.
Proper, planned prevention of professional burnout among social workers involves psychological self-regulation, clear time management, and regular supervision—a process that entails receiving support and reviewing complex cases with an experienced colleague or psychologist. A healthy team environment—characterized by trust, mutual assistance, and an absence of excessive pressure from management—also plays a crucial role in maintaining motivation.
A scientific and practical highlight of the conference was the lecture "Joint Syndrome. Chronic Pain: From Early Stages to Palliative Patient Management," presented by Taras Omelchenko, MD, a professor in the Department of Traumatology and Orthopedics at Bogomolets National Medical University.
Chronic joint pain is a persistent condition lasting more than three months, most commonly caused by osteoarthritis, rheumatoid arthritis, or gout. Chronic joint pain resulting from wartime injuries and trauma is also frequently encountered. It is important to understand that managing chronic pain requires a comprehensive, multifactorial approach encompassing pharmacological therapy, physical rehabilitation, and psychological support. The primary goal of these therapeutic measures is not only to reduce pain intensity and improve mobility but also to enhance the patient's quality of life.
Taras Omelchenko noted that palliative care in orthopedics constitutes specialized medical care for patients with severe, incurable, or debilitating musculoskeletal diseases and injuries; this care includes chronic pain management, pressure ulcer prevention, and the selection of mobility aids. When caring for bedridden patients, preventing pressure ulcers, contractures, and circulatory disorders is of critical importance.
In closing, Serhiy Konovalenko thanked the event partner—the mobile palliative care provider "MEDIX OPIKA"—for supplying informational materials for physicians, and the leadership of the Cherkasy Regional Clinical Hospital for facilitating the conference.
The series of educational events organized by the NGO "Association for Sustainable Healthcare and Palliative Care Development" will continue on September 17 in Ternopil, at the I. Horbachevsky Ternopil National Medical University.Join us!
Rehabilitation and Palliative Care in Oncology:
Focus on Patient Quality of Life
HIGHLIGHTS
What is the significance of quality of life during the palliative care stage?
We are living in an era of widespread recognition of personalized medicine and innovative HealthTech principles. How can established treatment protocols and a patient's need for personalized approaches coexist in modern oncology? And just how effective can a personalized approach be in the rehabilitation of cancer patients?
Does a specific patient's rehabilitation program depend on the stage of the disease?
Yuriy Vasylyovych, thank you for making the time. According to open sources, rehabilitation approaches for cancer patients in Ukraine have recently seen significant development. What achievements in the field of cancer rehabilitation can be highlighted today?
– It is decisive. I would say it is life-altering for the patient and their family. We are now coming to understand that palliative care is not merely an integral part of medical assistance but also a realm of possibilities. It is within our power to dispel the myth that this stage represents only a patient’s "final days." We have the capacity—and all the necessary resources—to alleviate a patient's condition, even in the most complex cases.
In my view, a key concept we must foster—through fruitful collaboration with rehabilitation specialists and mobile care teams—is that the palliative stage is not a path toward an inevitable end, but a part of life itself. A palliative patient can and should be well-cared-for, heard, and provided with everything they need; ideally, they can even be happy. And, of course, the careful management of chronic pain plays a decisive role in maintaining an oncology patient's quality of life.
It is crucial to communicate—in an ethically and psychologically sensitive manner—to the patient and their loved ones that curative treatment options have been exhausted and that a transition to palliative care is necessary. Cancer incidence is rising annually, and the number of patients is growing; consequently, there is an urgent need to expand the healthcare system's palliative care capacity.
– The issues raised require special attention. Indeed, evidence-based medicine dictates that an oncologist prescribe treatment in accordance with clinical guidelines. However, every practicing physician acknowledges that while therapy standards exist, there is no such thing as a "standard" patient. The art of clinical reasoning for an oncologist lies in the ability to analyze the patient's medical history, diagnostic test results, and concomitant factors, and to devise a treatment and rehabilitation pathway tailored to the patient's individual characteristics. Statistically, at least 50% of cancer patients require specific recovery programs. The foundation for effective personalized rehabilitation lies in the surgical oncologist's focus on preserving the function of organs affected by the tumor. While the most radical removal of the tumor site is the highest priority, one must always bear in mind the importance of restoring functionality and carefully plan the surgical intervention to minimize impact on surrounding tissues, blood vessels, and nerves whenever possible. Achieving full—or at least partial—restoration of organ function is the key to successful comprehensive rehabilitation and the recovery of the patient's quality of life.
– Yes, and quite significantly so. It is disheartening to admit that even now—in an era of advanced internet access and widespread information regarding the importance of regular medical check-ups and cancer screening—the vast majority of cancer cases are diagnosed at late stages. Naturally, when tumors have reached advanced stages, surgical intervention is more traumatic, and the damaging effects of aggressive chemotherapy regimens are more severe. Consequently, the patient's recovery process is complex, entails a heavier financial burden, and is not always predictable.
– Indeed, the current development of cancer care entails not only therapeutic measures aimed at overcoming the disease but also the mandatory implementation of comprehensive rehabilitation programs. Public and private oncology clinics are continuing to form and coordinate multidisciplinary teams—comprising rehabilitation specialists, oncologists, psychologists, and occupational therapists—thereby creating favorable conditions for the recovery of cancer patients following surgery and grueling chemotherapy. And that is a positive development.
However, I would like to draw attention to another important aspect. The successful rehabilitation of a cancer patient depends primarily on the quality and timeliness of the radical treatment performed. Secondly, chemotherapy and radiation therapy protocols can serve as key reference points when planning the rehabilitation pathway. The fact is that all oncological treatment methods are harsh and traumatic. For instance, the removal of a stomach tumor inevitably leads to digestive disorders due to the loss of the food reservoir and the depletion of enzymes. Common complications in such cases include dumping syndrome—characterized by a sensation of weakness and dizziness after eating—as well as reflux, nausea, and deficiencies in nutrients such as iron and vitamin B12. A complex set of issues arises—problems the patient did not have prior to surgery—that must be addressed.
To discuss the current situation and pressing issues regarding rehabilitation and palliative care in oncology, Serhii Konovalenko, Director of the NGO "Association for Sustainable Healthcare Development and Palliative Care," met with Yurii Dumanskyi—a Corresponding Member of the National Academy of Medical Sciences (NAMS), Doctor of Medical Sciences, Professor, Honored Worker of Science and Technology of Ukraine, and Honorary Chairman of the Board of the National Association of Oncologists of Ukraine.