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Aim: to assess an effectiveness of medical rehabilitation after radical surgical treatment of endometrial cancer (EC). Materials and Methods. Post-surgery EC patients were stratified into two groups: the main group included 29 women who underwent the proposed program of complex "active" medical rehabilitation, the comparison group – 32 patients treated in accordance with the approved clinical guidelines. Body mass index (BMI), waist and hip measurements, atherogenic index, serum glucose, leptin, tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) levels were analyzed at week 1, as well as 3, 6 and 12 months later. Results. Significant inter-group differences were observed 6 and 12 months later during the follow-up. Starting from 6 months after EC surgical treatment, in the main group BMI decreased reaching 31.14, whereas in the comparison group, it increased up to 35.07 (p < 0.05). Differences in waist and hip measurements became significant by month 6 and 12, respectively, after the onset. The glucose level in the main and comparison group 6 months later was 6.16 ± 0.24 mmol/l and 6.16 ± 0.33 mmol/l, respectively; in the main group it decreased to the norm at month 12 comprising 5.09 ± 0.30 mmol/l, whereas in the comparison group it was higher than normal range reaching up to 5.87 ± 0.27 mmol/l (p < 0. 05). The decrease in the atherogenic index in the main vs. comparison group, which plateaued, became significant at month 6 and 12, respectively. A decrease in serum leptin, TNF-α and IL-6 level was found in the main group, but not in the comparison group. Conclusion. For the first time, a phenomenon of dynamically decreased level of serum pro-inflammatory markers was established during the complex "active" medical rehabilitation of women after radical surgical EC treatment. In addition to the previously verified improvement in the quality of life based on subjective questionnaires and scales, the effectiveness of the proposed medical rehabilitation program for such patients was confirmed by objective methods. This rehabilitation program can be recommended to all EC females in the recovery period after surgical treatment.

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.

Introduction. Radical surgery for recurrent atypical endometrial hyperplasia (AEH) allows to fully assess pathological changes of the endometrium, a risk of concomitant cancer, and provides insight into proposing a definitive therapy. However, after ovariohysterectomy, young women develop postovariectomy syndrome (POES) and psychosexual disorders profoundly decreasing quality of life (QoL) that requires rehabilitation measures.Aim: to conduct a comparative analysis of QoL in patients with recurrent AEH after hysterectomy with bilateral salpingooophorectomy based on the management tactics in the rehabilitation period.Materials and Methods. In the second part of the prospective randomized comparative study, 58 women diagnosed with recurrent AEH (mean patient age 44.25 ± 3.40 years) underwent a one-year-follow-up, divided into 2 groups according to the management tactics in the rehabilitation period: group 1 – 27 patients with "active" rehabilitation according to the complex rehabilitation and therapeutic protocol proposed by our research group; group 2 – 31 patients with "passive" rehabilitation. To assess the overall QoL, a questionnaire the Functional Assessment of Cancer Therapy for Patients with Endometrial Cancer (FACT-En) was used, analyzing a level of anxiety and depressive disorders with the Hospital Anxiety and Depression Scale (HADS) as well as manifestations of surgical menopause using Kupperman–Uvarova modified menopausal index (MMI) and sexual function – with the Female Sexual Function Index (FSFI) on day 3–7 as well as 3, 6, 12 months after surgical treatment.Results. It was found that inter-group difference was significant in the FACT-En questionnaire observed as early as by 3 months of the study, whereas by 12 months the QoL score in the "active" rehabilitation group increased by 39.36 points based on the FACT-En questionnaire, but only by 17.38 points in the "passive" rehabilitation cohort (p < 0.001). Analyzing Kupperman–Uvarova MMI, the degree of manifested surgical menopause decreased over time in both groups. However, as early as 6 and 12 months after onset, “active” rehabilitation was featured with surgical menopause parameters corresponding to a mild course, whereas “passive” rehabilitation was associated with moderate severity (p < 0.001). Over the entire follow-up period, "active" rehabilitation group was shown to have anxiety parameters decreased from 10.77 ± 2.36 score (subclinical anxiety) to 4.55 ± 1.50 score (normal range), whereas at 6 and 12 months of follow-up the "passive" rehabilitation group was found to have anxiety parameters corresponding to subclinical manifestations. Over time, sexual function improved in both groups, however, the parameters in the "active" vs. "passive" rehabilitation group were significantly higher as early as 3 months after the onset, with similar pattern observed at 6 and 12 months (p < 0.05).Conclusion. The set of rehabilitation measures proposed by us improves psycho-emotional state, corrects POES manifestations, improves sexual function of AEH patients, thereby increasing overall QoL. This is comparable to the results of medical rehabilitation of women after radical treatment with endometrial cancer.

Objective: to evaluate the effectiveness of changes in the legal framework that regulates medical rehabilitation (MR) in the Russian Federation.Material and methods. We analyzed the valid Order of the Ministry of Health of the Russian Federation of June 31, 2020 No. 788n “Organization of medical rehabilitation of adults”, which came into legal power on January 1, 2021. It was proposed for public discussion on the introduction of amendments (project of amendments). The changes proposed in the project were compared with the original text of the document. Besides, other legal documents on the organization of medical rehabilitation were analyzed.Results. Order No. 788n regulates the stages of MR, specifies the formation and realization of an individual plan for a multi-disciplinary rehabilitation team based on the evaluation by Rehabilitation Routing Scale. The document includes in-house protocols of profile inpatient and outpatient departments of medical institutions, standards for doctor’s offices equipment, organization of day-time inpatient department, and regulations for MR centers. The project of amendments contains a variant of involvement of the existing additional Groups 1 and 2 medical divisions for the organization of MR, and limitation for the Stage 2 of MR in inpatient settings, which is now possible only for patients who need 24-hour care.Conclusion. The proposed changes have evolutionary character. A lot of issues in the regulatory framework of MR remain unsolved. It is necessary to improve the state policy for MR and perform further clinical studies of its benefits.

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 evaluate effectiveness of a personalized comprehensive rehabilitation program in patients after surgical treatment of endometrial cancer (EC).Material and Methods. There were enrolled 61 patients of reproductive age (44.46 ± 3.84 years) after radical treatment of endometrioid adenocarcinoma by stratifying subjects into 2 groups: group I – «active» rehabilitation with a comprehensive program of restorative measures (n = 29), group II – «passive» rehabilitation with standard management of the postoperative period in accordance with volume and timeframe determined by clinical recommendations (n = 32). Quality of life (QоL) was determined using the following questionnaires: Functional Assessment of Cancer Therapy for Patients with Endometrial Cancer (FACT-En), Kupperman-Uvarova Modified Menopausal Index (MMI), The Female Sexual Function Index (FSFI), Hospital Anxiety and Depression Scale (HADS). The program was based on four patient visits expected to occur at week 1 as well as 3, 6, 12 months after surgery, respectively.Results. In was found that 12 months post-surgery MMI in group I was decreased from 40.75 ± 5.69 down to 26.45 ± 4.84 score corresponding to mild postovariectomy syndrome (POES), whereas in group II – from 39.62 ± 5.37 to 36.15 ± 4.06 score estimated as moderate POES. In addition, at this time point patients in group I were noted to virtually fully recover sexual function assessed by FSFI (24.93 ± 2.86 score), whereas in group II it was at markedly lower level (13.39 ± 2.55 score; p < 0.001). According to the HADS, all subjects had level exceeding score of 11 at week 1 post-surgery corresponding to clinically significant anxiety and depression. Moreover, 6- and 12-months post-surgery subjects in group I lacked significant symptoms (score < 7 for each parameter), whereas in group II 12-month follow-up demonstrated subclinical level of anxiety and depression. According to the FACT-En, subjects in group I vs. group II revealed markedly higher QoL on visit 4 reaching 141.31 ± 6.45 and 112.84 ± 6.48 score, respectively.Conclusion. The «active» personalized comprehensive rehabilitation program proposed here demonstrated high efficacy in EC patients after radical surgery compared to subjects underwent standard management in rehabilitation period. Use of the program during 12 months post-surgery allowed to minimize negative manifestations related to POES, positively impacted psycho-emotional status, significantly improved sexual function as well as QoL. Organizing comprehensive rehabilitation in post-surgical EC patients should be considered as one of high-priority approaches in public healthcare.

During the past decades, the prevalence of cancer diseases of female reproductive system has been constantly growing. The issue is especially acute in reproductive-age women because of earlier oncological pathology onset. Morpho-functional disorders and aggressive methods of anti-tumor therapy significantly affect the patients’ quality of life, psychological well-being, emotional stability, and family relationship, which leads to a limitation of physiological and social possibilities. Rehabilitation programs for oncological patients target to prevent unwanted sequela of the disease, its therapy, and relapses. Pre-rehabilitation plays a special role. It includes psychological and specialized medical care for the patient during the period from the disease verification to the start of therapy. Timely rehabilitation measures reduce the rate of repeated hospitalizations for side effects of chemotherapy, radiotherapy complications, antitumor therapy, and radical surgical interventions. Rehabilitation as a part of standard therapeutic strategy can reduce pharmacoeconomical burden for the health care system. However, further clinical and pharmacoeconomic studies are required for the implementation of rehabilitation at the level of the health care system.

Hysterectomy currently occupies one of the leading places among obstetric and gynecological surgeries and is one of the highly effective and sometimes the only method of treating various diseases of the female genital organs. Quite often, however, hysterectomy results not only in the elimination of the cause of disease, but also in the development of complications that reduce the quality of life of patients. More and more attention is being paid to neurological complications, which is obviously due to improved diagnostic capabilities, as well as the results of recent research on the pathogenesis and treatment of neurological disorders. Only recently the scientists have begun to think about the true causes of one of the most important neurologic complications of hysterectomy, namely chronic postoperative pain.The review describes in detail the main neurological disorders that develop after hysterectomy: chronic postoperative pain, traumatic neuroma, residual ovarian syndrome as possible causes of chronic pain, mononeuropathies, sexual and sleep disorders, decreased cognitive and motor functions, lower urinary tract and bowel dysfunction. Considerable attention is given to the mechanisms of neurological complications and the relationship between the surgery and emotional disturbances in women.

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.