Clinical significance of complex rehabilitation among patients with metastatic gastric cancer treated with immunotherapy and with a history of radical surgical treatment

Objective: to evaluate the clinical efficacy of complex rehabilitation for patients with metastatic gastric cancer receiving immunotherapy, who had a history of radical surgery, which resulted in anatomical changes in the gastrointestinal tract. Material and methods. The study involved 169 patients with metastatic gastric cancer who underwent immunotherapy in 3–4 lines. All patients received immunotherapy in a mono-mode with anti-PD-1 drugs (nivolumab, pembrolizumab), in accordance with standard treatment protocols [8]. Patients were randomized into two groups, in the study cohort, an individual rehabilitation complex was added to the standard treatment (n = 68), in the control group (n = 100), treatment was carried out with anti-PD-1 drugs without rehabilitation programs. Results. The efficacy of a comprehensive approach, including individualized programs of nutritional support, physical rehabilitation and physiotherapy, was studied. It was shown that patients who underwent gastrectomy or resection tended to have worse nutritional status before the start of planned 3–4 line immunotherapy, which was assessed by the NRS-2002 scale and using the individual prognostic index PNI. In the group of patients who received comprehensive rehabilitation, improvements in nutritional status, increased physical activity and a decrease in the frequency of side effects were noted, which contributed to a better perception of therapy and improved quality of life. Conclusion. Patients subject to systemic therapy for metastatic disease, with a history of radical surgical treatment of gastric cancer, are a special group for whom early rehabilitation is indicated, including individualized programs of nutritional support, physical rehabilitation and physiotherapy.