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Patients who underwent radical antitumor treatment for ovarian cancer, borderline ovarian tumors, often experience a severe range of morphofunctional and psychological disorders. Frequent complications are postovariectomy syndrome, sexual dysfunction, anxiety and depression, and chronic pelvic pain, which reduces the overall quality of life. Numerous studies show that for this category of patients, the preservation of labor activity and social significance is an extremely important aspect. This dictates the need to organize rehabilitation measures that significantly increase the quality of life of oncogynecological patients and contribute to the restoration of their professional and social functioning.

Background. Radical treatment of malignant neoplasms (MNs) of female reproductive system often has serious consequences. Chronic pain syndrome, distress, anxiety and depression, decreased self-esteem, sexual dysfunction and social maladjustment reduce quality of life (QoL) and require psychotherapeutic support.Objective: to create an algorithm for the provision of comprehensive psychotherapeutic support during rehabilitation following the treatment of reproductive system MNs and to evaluate its effect on QoL indicators in women with neuropsychiatric disorders.Material and methods. The algorithm for the provision of comprehensive psychotherapeutic support included clinical interview, cognitive behavioral therapy, visualization, audio therapy, art therapy, group and individual psychotherapy, family psychotherapy, image therapy. The QoL indicators were determined by questionnaires using the Functional Assessment of Cancer Therapy – General (FACT-G) with nosology-specific extensions (subscales of physical well-being, social/family well-being, emotional wellbeing and functional well-being), Hospital Anxiety and Depression Scale (HADS), Kupperman–Uvarova Modified Menopausal Index (MMI). The follow-up period was 1 year after radical surgical treatment of reproductive system MNs in different localizations. The main group received the algorithm for the provision of comprehensive psychotherapeutic support as part of active medical rehabilitation, the comparison group received basic rehabilitation.Results. The study included 47 women with vulvar cancer (VC): active rehabilitation group (VC-1) – 24 patients and basic rehabilitation group (VC-2) – 23 patients; 61 women with endometrial cancer (EC): active rehabilitation group (EC-1) – 29 patients and basic rehabilitation group (EC-2) – 32 patients; 103 women with cervical cancer (CC): active rehabilitation group (CC-1) – 51 patients and basic rehabilitation group (CC-2) – 52 patients; 62 women with stages I–II ovarian cancer (OC) and low malignant potential tumor (LMPT): active rehabilitation group (LMPT-1) – 29 patients and basic rehabilitation group (LMPT-2) – 33 patients. Differences in physical, social/family and functional well-being (FACT-G) were significant from the 6th month and in emotional well-being – by the end of follow-up. Neurovegetative and psycho-emotional disorders, as assessed by Kupperman–Uvarova MMI, showed significant positive dynamics in women who received the algorithm for the provision of comprehensive psychotherapeutic support, in contrast to the comparison group, where these indicators remained without significant dynamics or worsened by the end of the follow-up period. The HADS scores during psychotherapeutic support decreased to normal values at the 6–12th months of follow-up, while those who received the basic rehabilitation continued to have subclinical anxiety and depression.Conclusion. The developed algorithm for psychotherapeutic support as part of active medical rehabilitation of women who underwent radical treatment for reproductive system MNs (VC, EC, CC, OC, and LMPT) has demonstrated its effectiveness, justifuing its implementation in clinical practice.

The influence of epigenetic processes on the development of malignant diseases, including gynaecological cancers, is now beyond doubt. DNA methylation, histone modification and post-transcriptional regulation by microRNAs lead to changes in the activity of various genes, contributing to female genital cancers (cervix, endometrium, ovarian). It should be noted that disruptions in gene expression do not only occur in malignant cells, but also in the tumour microenvironment, resulting in disease progression and relapse. However, “epigenetic markers” of carcinogenesis can be useful in the treatment and rehabilitation of patients, making a personalized approach possible.

Aim: to study the severity of surgical menopause (postovariectomy syndrome), anxiety, depression and sexual function in patients with borderline ovarian tumors (BOTs) after radical treatment, depending on management in the rehabilitation period.Materials and Methods. There were examined 62 women of reproductive age (42.0 ± 4.1 years) after radical treatment of BOTs: Group I - 29 patients were observed during rehabilitation period according to the standards and the National Clinical Guidelines and underwent a 12-month Comprehensive Personalized Rehabilitation Program; Group II - 33 non-participating rehabilitation program patients. The Modified Menopausal Index (MMI) and all related constituent subscales, the level of anxiety and depression according to the HADS (Hospital Anxiety and Depression Scale), as well as sexual function according to the FSFI (Female Sexual Function Index) scale were assessed prior to surgery as well as 1, 6, and 12 months afterwards.Results. All study participants noted significantly aggravated symptoms related to surgical menopause as early as 1 month after treatment: the total MMI increased from 10.9 ± 2.2 score (lacked manifestations of surgical menopause) up to 37.0 ± 6.3 score (moderate manifestations) in Group I and from 10.5 ± 2.0 score (lacked manifestations of surgical menopause) up to 35.8 ± 4.3 score (moderate manifestations) in Group II. By the 12 months, MMI decreased down to 22.2 ± 4.6 score (mild manifestations) in Group I and remained almost unchanged in Group II - 36.9 ± 8.0 (moderate manifestations). In 93.1 % and 81.8 % women from Group I and Group II, respectively, 1 month after antitumor therapy, disorders of the psycho-emotional sphere were observed. In Group I, after 12 months parameters returned to preoperative baseline magnitude, whereas in Group II 87.9 % of patients noted their significant altered values. A twofold decrease in anxiety values according to the HADS was observed in Group I after 12 months of rehabilitation therapy, whereas in Group II, it was also decreased, but to a lower degree. While assessing level of depression, it was found to gradually increase in Group II within the first year after the operation, whereas in Group I it was steadily decreased. Within 1 month after radical treatment of BOTs, a significant decrease in sexual function and the FSFI index was observed in all women of reproductive age (from 23.7 ± 5.5 to 4.0 ± 1.2 score in Group I and from 23.4 ± 5.3 up to 4.0 ± 1.3 score in Group II). After 12 months of comprehensive rehabilitation, sexual function was almost completely recovered in Group I (22.5 ± 5.4 score), whereas in Group II sexual dysfunction was markedly evident (14.9 ± 6.4 score).Conclusion. Comprehensive personalized rehabilitation can reduce the negative symptoms of surgical menopause, normalize the psycho-emotional state, increase sexual function, and hence, improve the quality of life of patients with BOTs of reproductive age after radical treatment.

Aim: to examine intensity of surgical menopause symptoms (postovariectomy syndrome, POES) in patients with borderline ovarian tumors (BOTs) after radical surgery depending on the postoperative period management; to assess a role for “cancer immunotherapy diet”* as a standalone means in correction of surgical menopause symptoms as well as a part of patient-specific rehabilitation program.Materials and Methods. A prospective comparative study was conducted with 62 BOTs female patients aged 30 to 48 (42.0 ± 4.1) years underwent radical surgical treatment, subdivided into 3 groups: group I – “active” rehabilitation (29 subjects underwent 12 month-comprehensive personalized rehabilitation); group II – “passive” rehabilitation (17 women with standard management of the postoperative period in accordance with clinical recommendations); group III – 16 patients followed the one-year “cancer immunotherapy diet” (after being consulted by medical specialist and formulation of individual diet program). Patient data obtained after clinical interview, physical, laboratory and instrumental examinations were assessed at four time points: before surgery (visit 0), after 1, 6 and 12 months (visits 1, 2, 3) after antitumor treatment. In addition, every visit required each patient to fill out the modified Kupperman menopausal index (MMI) questionnaire specifically adapted for BOTs patients. Intensity of neurovegetative, psycho-emotional and metabolic manifestations of surgical menopause symptoms was assessed at various stages of post-surgery period and management strategy during post-surgery period.Results. All BOTs patients one month after radical surgical treatment noted overt signs of surgical menopause. Before surgery, the average MMI score corresponded to normal range – 10.9 (group I), 10.5 (group II), 10.4 (group III), whereas during visit 1 it changed to 37.1, 35.2 and 36.4, respectively evidencing about moderate severity of POES. MMI largely depended on management strategy 6 and 12 months after the onset of therapy: in “active” rehabilitation group it was 27.7 (visit 2) and 22.2 (visit 3), “passive” rehabilitation group – 39.1 (visit 2) and 42.6 (visit 3), “cancer immunotherapy diet” group – 34.1 (visit 2) and 30.8 (visit 3). In addition, distribution of patients based on body mass index (BMI) revealed various types of impaired fat metabolism (IFM) in 59.68 % subjects at visit 0, that increased one month after surgery up to 64.52 %, whereas 6 and 12 months later it decreased down to 62.90 and 61.29 %, respectively. However, end-point results in different groups varied substantially: In particular, at visit 3 in group I 55.17 % (n = 16) subjects had normal BMI, 37.93 % (n = 11) – class I obesity and 6.90 % (n = 2) – class II obesity. The end-point results in group II revealed no patients with normal BMI: 76.47 % (n = 13) and 23.53 % (n = 4) had class I and class II obesity, respectively. Finally, end-point results in group III were at intermediate state: 50.0 % (n = 8) subjects showed normal BMI, whereas 37.5 % (n = 6) and 12.5 % (n = 2) patients demonstrated class I and class II obesity, respectively.Conclusion. Adjuvant therapy of surgical menopause symptoms represents an important component in rehabilitation program for BOTs patients underwent radical surgery. A personalized rehabilitation program demonstrates peak efficacy in correcting surgical menopause symptoms (essential to include “cancer immunotherapy diet” therein). Even isolated administration of diet therapy profoundly reduces intensity of surgical menopause symptoms, thereby improving the quality of woman’s life.

Aim: to make a comparative evaluation of women with borderline ovarian tumors (BOTs) and surgical menopause (early symptoms) and explore their level of anxiety and depression depending on the age and volume of surgery.Materials and methods. The prospective comparative study included 117 patients, aged 44.3 ± 6.5 years, after surgical treatment of BOTs: 62 women at reproductive age with surgical menopause after radical treatment (group IА), 24 women at reproductive age after organ-preserving surgery (group IВ), 31 women at perimenopausal age after radical treatment (group II). The severity of menopausal syndrome (modified menopausal Kupperman–Uvarova index), anxiety and depression (Hospital Anxiety and Depression Scale, HADS) were determined 29–59 (36.4 ± 5.6) days after surgery.Results. Early symptoms of surgical menopause are found in 98.3 % of patients with BOTs. Reproductive age patients after radical surgery (group IA) had moderate neurovegetative (21.7 ± 4.0 points), mild metabolic (5.8 ± 1.8 points), and moderate psychoemotional disorders (8.9 ± 1.4 points). Young women who underwent organ-saving operations with preservation of at least one ovary (group IB), had normal range the indicators of neurovegetative disorders (8.2 ± 3.1 points), metabolic and psychoemotional disorders were regarded as moderate (2.6 ± 1.6 and 5.9 ± 2.3 points, respectively). Disorders due to surgical menopause (early symptoms) at perimenopausal age females (group II) corresponded to a mild degree: neurovegetative – 15.3 ± 2.7 points; metabolic – 6.0 ± 2.2 points; psychoemotional – 5.7 ± 1.5 points. Our data indicate that patients of group IA had moderate surgical menopause (early symptoms) – 36.4 ± 5.4 points, while in groups IB and II the total values were 16.8 ± 5.4 and 27.0 ± 4.3 points, which corresponds to mild severity. Patients with BOTs (one month after antitumor therapy) had early symptoms of surgical menopause (postovariectomy syndrome). The most typical clinical picture was observed among young women after removal of both ovaries.Conclusion. Surgical menopause affects by somatic and psychological health negatively. This leads to a significant decrease in the quality of life and an increase in the level of disability among patients with gynecological cancer. Therefore, even at the planning treatment, it is necessary to include pre-rehabilitation measures to minimize the negative consequences of cancer therapy.

The article presents updated provisions regarding borderline ovarian tumors in women of reproductive age, including the data on epidemiology, risk factors, clinical aspects, diagnosis, treatment, return of the disease, and women’s reproductive potential.