R-04. Physical factors in spa rehabilitation of the children with oncohematological disorders

Summary

In recent years, an increase in oncological morbidity in children in St. Petersburg has been registered, associated with an improvement in diagnostics and with the admission of pediatric patients from the Russian regions. More than 70% of children with malignant neoplasms are cured due to highly qualified medical care and usage of modern high-tech methods. Currently, malignant neoplasms have moved from the category of fatal conditions to the category of chronic and curable disorders.

Patients and methods

A system of specialized care has been created and implemented in the Russian Federation, including protocols for managing patients with oncological and hematological diseases. The most important feature of childhood tumors is their high sensitivity to chemotherapy. Mortality of children from malignant neoplasms in the Russian Federation is progressively decreasing. According to 2022 data, 4.000-4.500 cases of childhood oncological diseases are registered in the Russian Federation every year (about 15-17 cases per 10,000 child population).

Results

In 2020-2021, 181 cases of malignant neoplasms in children were registered, 75 children (0-17 years old) were effectively treated. Various common long-term complications in the treated children require special rehabilitation. To treat these patients, the first rehabilitation department for children with oncological diseases was opened in 1998 on the basis of the Solnechnoye multidisciplinary children’s sanatorium. Children aged 2-18 years entering the Oncohematology Department “Mother and Child” may be divided into 4 groups: (1) pediatric patientrs with leukemia receiving maintenance chemotherapy (methotrexate and 6-mercaptopurine) between reinduction courses; (2) children who completed the combined treatment of tumors; (3) patients in complete remission; (4) children without oncological diseases (brothers and sisters of patients who underwent tumor treatment). Patients with leukemias, neoplasms of various localizations, including non-Hodgkin’s lymphomas, Wilms’ tumor, neuroblastomas, sarcomas, lymphogranulomatosis, and CNS tumors predominated. After the end of special treatment, 100% of children in remission are diagnosed with long-term complications of chemoradiotherapy and surgical interventions in the form of dysfunction of vital organs and body systems, exacerbation of comorbidity, cognitive impairment, psychological and social maladaptation, as indicators of a decrease in the quality of life patients. The main objectives of the spa treatment at the sanatorium (SCL) are: antihypoxic measures; treatment of cytopenic syndrome, caused by cytotoxic effects of chemotherapy; correction of dysbiosis; restoration of the immune status; correction of metabolic, vegetative and rhythmological disorders; recovery of motor activity; elimination of cognitive and anxiety-depressive disorders. The basic curative factor is a specific resort environment at the coast of Finnish Gulf, coniferous forest, health paths, therapeutic exercises, hydrocolonotherapy. In addition, differentiated apparatus physiotherapy is successfully administered, including light therapy (photochromotherapy – PCT, supravenous laser blood irradiation), bioacoustic correction, halo- and hypoxic therapy, inhalations, electrotherapy – darsonvalization, electrosleep, transcranial electrical stimulation, magnesium electrophoresis, vascular drugs and vitamins. Rehabilitation measures are carried out in the mentioned groups of patients. 1^st group of children receives health path, physiotherapy exercises, hydrocolonotherapy, inhalation therapy. Group 2 undergoes an extended rehabilitation program depending on the period of remission: halo- and hypoxic therapy, dry and steam-carbonic baths, physical therapy, massage. The patients in the 3^rd group, are, in addition, subjected to showers, therapeutic baths. Local electro-, magneto-, laser therapy, applications of therapeutic mud are also prescribed. Physiotherapy treatment is based on a holistic approach with individualized syndromic therapy. Every year, the department treats and rehabilitates more than 300 children with malignant neoplasms and about 150 children with non-malignant disorders (Group 4). All children receive medical, psychological, speech therapy, pedagogical assistance. No complications from physiotherapy were registered over many years of the department activities.

Conclusion

We report about successful experience of managing children with oncohematological profile 2 to 18 years old at the stage of spa treatment in a multidisciplinary children’s sanatorium. We note a differentiated approach to the volume of care, depending on the nosological groups of patients and the duration of clinical remission, the absence of adverse effects from the treatment measures taken is also mentioned.

Keywords

Children, oncohematological pathology, spa treatment, physical factors.