clinvestКачественная клиническая практикаKachestvennaya Klinicheskaya Praktika = Good Clinical Practice2588-05192618-8473ООО «Издательство ОКИ10.37489/2588-0519-GCP-0015FMUEOJclinvest-844Research ArticleПАЛЛИАТИВНАЯ МЕДИЦИНАPALLIATIVE CAREК вопросу о принятии решений в паллиативной медицине на основе изучения непосредственных  причин смерти, механизмов развития фатальных патологических процессов у онкологических больныхTo the issue of decision-making in palliative medicine based on the study of immediate causes of death, mechanisms of fatal pathological processes in cancer patientshttps://orcid.org/0009-0005-2009-3624ВведенскаяЕ. С.VvedenskayaE. S.

Введенская Елена Станиславовна — к. м. н., врач-онколог; член профильной комиссии по паллиативной помощи Минздрава России

Нижний Новгород

Elena S. Vvedenskaya — Cand. Sci. (Med.), oncologistmember of the specialized commission on palliative care of the Ministry of Health of the Russian Federation

Nizhny Novgorod

elenavveden@mail.ruhttps://orcid.org/0009-0008-3922-8324МольковА. М.MolkovA. M.

Мольков Александр Михайлович — анестезиолог-реаниматолог высшей категории, заведующий отделением анестезиологии и реанимации, анестезиолог отделения паллиативной специализированной медицинской помощи; ассистент кафедры анестезиологии, реаниматологии и трансфузиологии

Нижний Новгород

Aleksandr M. Molkov — anesthesiologist-resuscitator of the highest category, head of the department of anesthesiology and resuscitation, anesthesiologist of the department of palliative specialized medical care; assistant of the department of anesthesiology, resuscitation and transfusiology

Nizhny Novgorod

malevich.83@mail.ru ГАУЗ  НО  «"НИИКО"  Нижегородский  областной  клинический  онкологический  диспансер»РоссияResearch Institute of Clinical Oncology «Nizhny Novgorod Regional Clinical Oncology Dispensary»Russian FederationГБУЗ  НО  «Городская  больница  № 28  Московского  района г.  Нижнего  Новгорода»; ФГБОУ ВО  «Приволжский  исследовательский  медицинский  университет»РоссияNizhny Novgorod City Hospital No. 28; Privolzhsky Research Medical UniversityRussian Federation202630032026016577Copyright © Введенская Е.С., Мольков А.М., 20262026Введенская Е.С., Мольков А.М.Vvedenskaya E.S., Molkov A.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.clinvest.ru/jour/article/view/844

Злокачественные новообразования являются одной из основных причин смерти населения во всех странах. Как правило, у онкологических пациентов (ОП) сокращается ожидаемая продолжительность жизни, и летальный исход происходит на фоне диссеминации процесса. Однако более точные причины смерти и ухудшения состояния ОП перед смертью остаются плохо изученными. Недостаток знаний и информации, отсутствие понимания происходящих патологических процессов в организме больного человека затрудняет выбор правильной стратегии для улучшения качества и продления жизни ОП на поздней стадии болезни. Понимание механизмов, лежащих в основе развития фатальных патологических процессов, приводящих к смерти пациентов этой группы, которые направляются в отделения паллиативной специализированной медицинской помощи при ухудшении состояния, даёт нам информацию для проведения/или отказа от проведения/ мероприятий, которые могут продлить жизнь больного, купировать патологические симптомы, или наоборот, не продлевать бессмысленное страдание. В статье кратко рассматриваются непосредственные причины смерти ОП, сложные взаимосвязи между различными патогенетическими механизмами, приводящими к ухудшению состояния и летальному исходу, что поможет врачам лучше ориентироваться в происходящих событиях и выбрать правильную тактику при оказании помощи, также понять, что и у постели сложного ОП медицина как наука и искусство не заканчивается.

Cancer is one of the leading causes of death worldwide. In many cases, cancer patients have reduced life expectancy, and death occurs due to cancer dissemination. However, the precise causes of death and deterioration of cancer patient's condition before death have been poorly studied yet. A lack of knowledge and information, along with a lack of understanding of the pathological processes in a sick person, complicates the selection of appropriate strategies for improving life quality and life extension in advanced cancer patients. Understanding the mechanisms leading to fatal pathological processes and death in this group of patients who are referred to specialized palliative care units when their condition is deteriorating provides us with the information for performing/or refuse from/ interventions that can prolong the patient's life, reduce distress, or, conversely, prevent needless suffering. This article briefly examines the precise causes of death in cancer patients, the complex relationships between various pathogenesis mechanisms leading to condition deterioration and death that will help physicians better navigate the events taking place and choose the right tactics while providing care and realize that yet at the bedside of a patient with advanced disease medicine as science and art never ends.

причины смерти онкологических больныхпатогенез ухудшения состояния при диссеминированном ракепаллиативная помощьсимптоматическая терапияпатогенетические механизмы умиранияпатогенез тягостных симптомовмеханизмы развития кахексииcauses of death in cancer patientspathogenesis of deterioration in advanced cancerpalliative carepathogenesis mechanisms of dyingpathogenesis of distressing symptomsmechanisms of cachexiaReferencesBoire A, Burke K, Cox TR, et al. Why do patients with cancer die? Nat Rev Cancer. 2024; 24(8):578-589. doi: 10.1038/s41568-024-00708-4Boire A, Burke K, Cox TR, et al. Why do patients with cancer die? 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The authors declare that there are no conflicts of interest present.