Substantiation of the use of the hematopoietic stem and progenitor cells in the systemic rehabilitation of oncological patients and neurorehabilitation

Rehabilitation of cancer patients

Rehabilitation of the patients is a complex of the public, healthcare, educational, social and economic measures that aim at the restoration or compensation of the disordered functions of the organism, its adaptation to new disease associated conditions of living, as well as social functions and working capacity.

Full scope rehabilitation of cancer patients must include all types of measures just as in the standard rehabilitation in neurology and neurosurgery. The advances of scientific and technical progress led to the benefits in the therapy of malignant tumors. Along with the increased survival, the number of the patients with the pronounced defects and functional disorders induced by extensive and frequently disabling surgeries have grown. Accordingly, one of the priorities of medical rehabilitation for oncology is improvement of life quality. In contemporary oncology we must estimate the results of the combined and complex therapy not only by the criteria of the survival rates but also according to the special indicants of life quality, which reflect the modern trends of humanistic traditions of medicine. Hence, life quality is the main criteria in the system of rehabilitation of cancer patients.

Medical rehabilitation of cancer patients is performed in medical institutions and its main idea is to recover the lost or weakened functions of the patients as well as in the development of the compensatory mechanisms by the surgical, pharmaceutical and resort therapy.

Rehabilitation of cancer patients is a multi-stage process. Different types of rehabilitation are employed at different stages of the therapy and follow-up permitting return of the patients to their works, families and previous level of social life, or, if that is impossible, acceptable quality of life. As early as possible beginning of the rehabilitation and the rehabilitation continuity lead to the reduced disabilities and associated expenses of the needs of the disabled. According to the evidence of German researchers, the funds spent for the rehabilitation in the first 6 years, compensate ten- or even twentyfold.

In the Russian Federation the medical rehabilitation is organized according to the Edict of the Ministry of Healthcare 1705n, December 29, 2012 On The Order Of Organization Of Medial Rehabilitation

Moreover, the Edict of the Ministry of Healthcare 915n, November 15, 2012 approved The Order Of Healthcare Delivery To The Population In The Sphere Of Oncology (hereinafter referred to as the Order).

According to the Order, the healthcare for oncology is delivered as:

• primary medical care;
• specialized care, including highly technological care involving:
  • prevention and diagnostics of cancer disorders;
  • therapy and rehabilitation of the cancer patients with new specific methods including unique medical technologies.

Healthcare in rehabilitation of the cancer patients is given according to the Appendixes №№ 25–27 to the Edict that specify:

• the rules of the organization of the rehabilitation department of an oncologic dispensary and medical organization that provides healthcare to the patients with oncological disorders;
• recommended personnel standards for the rehabilitation department of an oncologic dispensary and medical organization that provides healthcare to the patients with oncological disorders;
• the equipment standard for the rehabilitation department of an oncologic dispensary and medical organization that provides healthcare to the patients with oncological disorders.

The rehabilitation therapy is in great demand, over 25% of the general number of cancer cases needs in-hospital rehabilitation. For example, for Blokhin NN Cancer Research Medial Center it is about 2500 patients per year. No less that 50% of all cancer cases need rehabilitation as out-patients.

It is practical to have an in-patient rehabilitation department for no less than 50 beds or even a separate rehabilitation center for 150-200 beds in the structure of a cancer center with the capacity of treatment departments for 50 beds each.

However, rehabilitation of cancer patients must not include only physical methods of therapy and therapeutic exercise. After the standard course of chemo- or radiotherapy the cancer patients develop disorders of hemopoiesis and immunopoiesis, dysmetabolic and endocrine disorders of various degree. Hence, the use of the HSCs and HPCs have direct and obligate indications to recover the hemopoiesis and immunopoiesis and must be an obligatory component of the rehabilitation of oncological patients.