Palliative medicine is based on caring for the patient’s subjective state; care for the patient; the ability to control all the symptoms of the patient’s illness and pain in the first place. The principles of palliative medicine are aimed at maintaining the quality of life. In this case, the goal of curing the patient is missing. The philosophy of hospice care is based on the understanding and acceptance of death as a natural process that cannot be accelerated, but which can be entered without losing the level of quality of life. The article highlights the peculiarities of palliative care requiring the synthesis of skills of various medical specialties. Therefore, the emergence of palliative medicine specialists as well as the specialty itself is one of the positive moments in oncological practice. The main problems for a cancer patient begin at the stage of transition from specialized to palliative care. Moreover, the perception of the disease does not always correspond to reality, as the doctors do not always provide complete information and, accordingly, the information from relatives is also confused and sparing. In the end, only a small proportion of patients are able to really and fully assess the situation, which concerns both the course of the disease and its future prospects. The irreversibility of the approaching death generates a lot of psychological reactions. One of the main negative factors at this stage of life for a patient is the impossibility of continuing observation and treatment at his oncologist; the need to find another doctor and ultimately the awareness of the need for medical care in the only possible place for him/her – the palliative or hospice ward. In this case, the purpose of palliative medicine is not limited to providing only symptomatic relief. In oncology, there are concepts of palliative radiation and drug treatment, which, unfortunately, are not carried out in modern palliative departments and hospices. The author suggests creating palliative care departments and hospices on the basis of existing oncological institutions as one of the promising developments in the care of patients with terminal stages of malignant diseases. The article discusses the principles of care for cancer patients in the departments of palliative medicine; principles of building relationships between the medical staff, the patient and his/her relatives. The stages of changes in the psychological reactions of patients from the moment they entered the department and in the process of staying in it, were traced in details. The need for development, improvement and further implementation of palliative care and hospice departments into practical medicine has been convincingly proven. In practice it will help to maintain an adequate level of quality of life for patients with malignant tumors.

Keywords: cancer patient, palliative care, hospice, quality of life

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1. Meditsinskaya reabilitatsiya [Medical rehabilitation]. Kniga 1. Pod red akademika RAMN VM Bogolyubova. M: BINOM; 2010. 416 p. [Russian]
2. Balabukha OS. Kachestvo zhizni kak osnova programm reabilitatsii onkologicheskikh bolnykh [Quality of life as the basis for cancer rehabilitation programs]. Mezhdunarodnyy meditsinskiy zhurnal. 2015; 4: 11-3. [Russian]
3. Volodin BYu. Vozmozhnosti psikhoterapii v onkologicheskoy klinike [Possibilities of psychotherapy in the oncology clinic]. Rossiyskiy onkologicheskiy zhurnal. 2013; 1: 43-5. [Russian]
4. Materyaly mezhdunarodnogo kongressa «Reabylytatsyya y sanatorno-kurortnoe lechenye 2012» [Materials of the international congress "Rehabilitation and spa treatment 2012"]. M; 2012: 42. [Russian]
5. Sydorchuk TA. Tekhnologyy povyshenyya kachestva zhyzny onkologycheskykh bolnykh [Technologies for improving the quality of life of cancer patients]. Tekhnologyy psykhologycheskoy y sotsyalnoy raboty v uslovyyakh megapolysa: materyaly mezhdunarodnoy nauchno-praktycheskoy konferentsyy. SPb; 2012: 77-81. [Russian]
6. Fetysova NP. Adaptatsyonnaya model bolezny v dynamyke reabylytatsyy onkologycheskykh bolnykh s razlychnoy subektyvnoy otsenkoy prognoza [Adaptive model of the disease in the dynamics of rehabilitation of cancer patients with different subjective assessment of the prognosis]. Vestnyk KRSU. 2016; 8(4): 155-7. [Russian]
7. Cherkasova EA, Krom YL, Novychkova YYu. Medyko-sotsyologycheskoe obosnovanye reabylytatsyy onkologycheskykh bolnykh [Medical and sociological rationale for the rehabilitation of cancer patients]. Sotsyologycheskye nauky. 2013; 2: 10-5. [Russian]
8. Shanazarov NA, Bulekbaeva ShA, Lysovskaya NYu. Vozmozhnosty y problemy sovremennoy reabylytatsyy v onkologyy [Opportunities and problems of modern rehabilitation in oncology]. Fundamental Research. 2015; 1: 1736-40. [Russian]
9. Khasanov RSh. Sovremennye pryntsypy reabylytatsyy onkologycheskykh bolnykh (obzor lyteratury) [Modern principles of rehabilitation of cancer patients (literature review)]. Povolzhskyy onkologycheskyy vestnyk. 2013; 4: 50-5. [Russian]
10. Bodinet C, Freudenstein J. Influence of marketed herbal menopause preparations on MCF-7 cell proliferation. Menopause. 2014; 11(3): 281-4. https://www.ncbi.nlm.nih.gov/pubmed/15167307. https://doi.org/10.1097/01.GME.0000094209.15096.2B
11. Cesario A, Ferri L, Galetta D, Pasqua F, Bonassi S, Clini E, et al. Post-operative respiration rehabilitation after lung resection for non-small cell lung cancer. Lung cancer. 2015; 57(2): 175-80. https://www.ncbi.nlm.nih.gov/pubmed/17442449. https://doi.org/10.1016/j.lungcan.2007.02.017
12. Egebiad M, Nakasone E, Werb Z. Tumors as organs: complex tissues that interface with the entire organism. Dev Cell. 2011; 18(6): 884-901. https://www.ncbi.nlm.nih.gov/pubmed/20627072. https://www.ncbi.nlm.nih.gov/pmc/articles/2905377. https://doi.org/10.1016/j.devcel.2010.05.012
13. Israel I, Edelstein R, Mannoni P, Radot E, Greenspan EM. Plasmapheresis in patients with disseminated cancer. Clinical resalts and correlation with changes in serum protein. The concept of “nonspecific bloking factors”. Cancer. 2014; 40(6): 3146-54. https://www.ncbi.nlm.nih.gov/pubmed/589571. https://doi.org/10.1002/1097-0142(197712)40:6<3146::aid-cncr2820400659>3.0.co;2-n
14. Joensuu H. From molecular bioligy to Lazarus responses. Ann Oncology. 2014; 25(4): iv2. https://doi.org/10.1093/annonc/mdu285.1
15. Lianos G, Mangano A, Cho W. Circulating tumor DNA: new horizonts for improving cancer treatment. Future Oncol. 2015; 11: 545-8. https://doi.org/10.2217/fon.14.250
16. Belaya kniga: Standarty i normy khospisnoy i palliativnoy pomoshchi v Evrope. Chast 1 [White Paper: Standards and norms for hospice and palliative care in Europe. Part 1]. Palliativnaya meditsina i reabilitatsiya. 2016; 1: 24-39. [Russian]
17. Vandeman Dzh. Zhizn posle smerti [Life after death]. Per s angl. M: OOO «Lotest»; 004. 224 p. [Russian]
18. Voronenko YuV, Hubskyi YuH, Tsarenko AV. Pytannya pidhotovky kadriv ta rozvytok naukovykh doslidzhen z paliatyvnoi medytsyny yak peredumova stvorennya suchasnoi systemy paliatyvnoi ta khospisnoi dopomohy v Ukraini [Issues of training and development of palliative medicine research as a prerequisite for the creation of a modern palliative care system in Ukraine]. Mizhnarodnyi zhurnal reabilitatsiyi ta paliatyvnoi medytsyny. 2018; 2(2): 59-66. [Ukrainian]
19. Hubskyi YuH, Khobzey MK. Farmakoterapiya v paliatyvniy ta khospisniy medytsyni. Klinichni, farmatsevtychni ta medyko-pravovi aspekty [Pharmacotherapy in palliative and hospice medicine. Clinical, pharmaceutical and medico-legal aspects]. K: Zdorov’ya; 2018. 352 p. [Ukrainian]
20. Danylov AB, Danylov AB. Upravlenye bolyu. Byopsykhosotsyalnyi podkhody [Pain management. Biopsychosocial approach]. M: AMM PRESS; 2012. 568 p. [Russian]