Pesta Martin, Mrazova Barbara, Kapalla Marko, Kulda Vlastimil, Gkika Eleni, Golubnitschaja Olga
Department of Biology, Faculty of Medicine in Pilsen, Charles University, Plzen, Czech Republic.
F. D, Roosevelt University Hospital, Banska Bystrica, Slovakia.
EPMA J. 2024 Nov 20;15(4):559-571. doi: 10.1007/s13167-024-00386-0. eCollection 2024 Dec.
Breast cancer belongs to the most commonly diagnosed malignancies worldwide, with its increasing incidence paralleled by advances in early diagnostics and effective treatments resulting in significantly improved survival rates. However, breast cancer survivors often experience significantly reduced quality of life linked to the long-term health burden as a consequence of aggressive oncological treatments applied. Their most frequently recorded complains include chronic fatigue, reduced physical activity, disordered sleep, chronification of pain, and severe mental health impairments-all per evidence are associated with compromised mitochondrial health and impaired homeostasis. Self-report of a breast cancer survivor is included in this article to illustrate currently uncovered patient needs. This article highlights mechanisms behind the suboptimal health of breast cancer survivors associated with mitochondrial damage, and introduces a novel, mitochondria-based holistic approach addressing rehabilitation concepts for breast cancer survivors following advanced principles of predictive, preventive and personalised medicine (3PM). By operating via mitochondrial function, the proposed holistic approach triggers systemic effects at molecular, sub/cellular and organismal levels positively affecting energy metabolism, repair mechanisms as well as physical and mental health creating, therefore, highly effective rehabilitation algorithms tailored to an individualised patient profile. The proposed methodology integrates mitochondrial health assessments utilising mitochondrial homeostasis biomarkers in tear fluid as a non-invasive diagnostic tool, tailored nutraceuticals and lifestyle adjustments. The introduced approach aligns with advanced principles of 3PM, offering a holistic and proactive framework for managing persistent post-treatment symptoms of suboptimal health in the cohort of cancer survivors. Furthermore, presented approach is also applicable to pre-habilitation programmes considering needs of other patient cohorts affected by chronic diseases such as CVD and orthopaedic disorders with planned major surgical incisions, who require individually adapted pre- and rehabilitation programmes. Implementing such innovative pre- and rehabilitation strategies may lead to a full recovery, sustainable health conditions and, therefore, facilitating patients' comeback to normal daily activities, family and professional life. Contextually, presented approach is considered a 'proof-of-principle' model for the 3PM-related paradigm shift from reactive medicine to a cost-effective holistic health management in both primary and secondary care benefiting a large spectrum of affected patient cohorts, individuals in suboptimal health conditions as well as society at large.
乳腺癌是全球最常见的诊断恶性肿瘤之一,其发病率不断上升,同时早期诊断和有效治疗的进展使生存率显著提高。然而,由于采用了积极的肿瘤治疗方法,乳腺癌幸存者往往因长期健康负担而经历生活质量显著下降。她们最常记录的抱怨包括慢性疲劳、身体活动减少、睡眠紊乱、疼痛慢性化以及严重的心理健康损害——所有证据都表明这些与线粒体健康受损和体内平衡失调有关。本文收录了一位乳腺癌幸存者的自述,以说明目前尚未被发现的患者需求。本文强调了与线粒体损伤相关的乳腺癌幸存者健康欠佳背后的机制,并引入了一种基于线粒体的全新整体方法,该方法遵循预测、预防和个性化医学(3PM)的先进原则来解决乳腺癌幸存者的康复概念。通过作用于线粒体功能,所提出的整体方法在分子、亚/细胞和机体水平触发全身效应,对能量代谢、修复机制以及身心健康产生积极影响,从而创建针对个体患者情况的高效康复算法。所提出的方法整合了利用泪液中线粒体稳态生物标志物作为非侵入性诊断工具的线粒体健康评估、量身定制的营养保健品和生活方式调整。所引入的方法符合3PM的先进原则,为管理癌症幸存者群体中持续存在的治疗后健康欠佳症状提供了一个整体且积极主动的框架。此外,所提出的方法也适用于考虑到其他受慢性疾病影响的患者群体需求的预康复计划,如患有心血管疾病和需要进行重大手术切口的骨科疾病的患者,他们需要个性化的术前和康复计划。实施这种创新的术前和康复策略可能会带来完全康复、可持续的健康状况,从而促进患者回归正常的日常活动、家庭和职业生活。在此背景下,所提出的方法被认为是3PM相关范式从反应性医学向初级和二级保健中具有成本效益的整体健康管理转变的“原理验证”模型,这将使广泛的受影响患者群体、健康状况欠佳的个体以及整个社会受益。