Kaip padėti onkologiniam ligoniui?

Kaip padėti onkologiniam ligoniui?

Robertas J. ThomasProf. Robertas J. Thomas 

Medicinos daktaras, Karališkojo gydytojų koledžo, Karališkojo radiologijos ir onkologijos koledžo narys, Nacionalinio vėžio tyrimų tinklo Klinikinių tyrimų komiteto narys, Nacionalinio sveikatos tyrimų instituto Klinikinių tyrimų konsultacinio komiteto ir Britų integratyviosios onkologijos draugijos narys, Fizinių pratimų ekspertų konsultacinio komiteto pirmininkas, Amerikos klinikinės onkologijos ir Europos medicininės onkologijos draugijų narys

Balandžio pradžioje Pagalbos onkologiniams ligoniams asociacijos POLA kvietimu Lietuvoje viešėjo žymus Didžiosios Britanijos mokslininkas onkologas Robertas J. Thomas. Profesorius susitiko su Nacionalinio vėžio instituto ir Kauno klinikų vadovais, bendravo su Lietuvos Respublikos sveikatos apsaugos ministru ir aptarė abiem šalims aktualias onkologinių ligonių gydymo bei reabilitacijos problemas. Prof. R. J. Thomas visiškai pritarė sveikatos apsaugos ministro nusistatymui prieš besaikį alkoholio ir cukraus vartojimą, nes abu šie produktai yra vieni pagrindinių kancerogenų.

Nacionaliniame vėžio institute ir Kauno klinikose profesorius skaitė paskaitas medicinos specialistams ir pacientams apie gyvenimo būdo, mitybos ir fizinio aktyvumo įtaką onkologinių ligonių gydymui, jų sveikatai ir gyvenimo kokybei po gydymo.

Prof. R. J. Thomas maloniai sutiko duoti interviu žurnalo „Internistas“ priedui „Onkologija“ ir atsakyti į keletą onkologams, šeimos gydytojams ir jų pacientams rūpimų klausimų.

 

Gerbiamas profesoriau, skaitytojams būtų įdomu sužinoti apie pagrindines jūsų darbo kryptis, ypač apie klinikinius tyrimus, kuriems vadovaujate.

Man didelė garbė būti pakviestam į jūsų gražią šalį. Jau daugiau kaip 30 metų esu praktikuojantis onkologas. Daugiausia specializuojuosi gydydamas krūties, prostatos ir žarnyno vėžį. Konsultuoju ir gydau onkologinėmis ligomis sergančius pacientus Kembridžo universitetinėje Bedfordo ir Adenbruko ligoninėse, dėstau klinikinę onkologiją Kembridžo universiteto studentams, be to, Bedfordšyro ir Koventrio universitetuose dėstau taikomuosius biologijos ir fizinių pratimų mokslus. Esu paskelbęs per 100 recenzuotų mokslinių darbų ir parengęs ne vieną dešimtį Jungtinės Karalystės atsitiktinės imties, kontroliuojamųjų tyrimų, iš jų ir Jungtinės Karalystės nacionalinio vėžio tyrimo tinklo Pomi-T tyrimą, kuriuo pirmąkart pasaulyje įrodėme polifenolių gausaus maisto papildo iš granatų, žaliosios arbatos, ciberžolių ir brokolių antinavikinį poveikį. Parengiau ir pirmąjį Didžiosios Britanijos istorijoje onkologinių ligonių reabilitacijos kursą fizinės mankštos specialistams, kurį patvirtino vyriausybė ir kuris iki šiol plačiai taikomas visoje šalyje. Esu knygos Kaip gyventi susirgus vėžiu. Faktai (angl. Lifestyle after Cancer – the Facts) autorius.

Jau kurį laiką mane, kaip mokslininką, domina gyvenimo būdo ir mitybos įtaka gydant onkologines ligas ir pacientų gyvenimo kokybei pasibaigus gydymui. Kembridžo universitete su Bedfordšyro ir Koventrio universitetais esame įkūrę klinikinių tyrimų grupę, kuriai ir vadovauju. Jau daugiau nei 5 metus atliekame klinikinius tyrimus ir pateikiame faktais paremtus įrodymus, kurios gyvenimo būdo strategijos yra veiksmingos, o kurios nepadeda. Tyrimų išvadas viešiname ne tik medikams, bet ir visuomenei skirtuose žurnaluose, interneto svetainėse Cancernet.co.uk, Keep-healthy.com, supažindiname su jomis pacientų organizacijas, kurios Didžiojoje Britanijoje yra labai aktyvios ir įtakingos, panašiai kaip jūsų POLA. Daugelis tyrimų su konkrečiais ligos atvejais aprašyti ir mano knygoje Kaip gyventi susirgus vėžiu. Faktai.

Prieš susitikimus su klausytojais bendravote su Nacionalinio vėžio instituto ir Kauno klinikų specialistais. Ar Lietuvoje onkologinių ligonių gydymo galimybės ir sąlygos labai skiriasi nuo Didžiosios Britanijos?

Kaune ir Vilniuje turite ne ligonines, o atskirus aukštos klasės ligoninių miestelius, aprūpintus naujausia įranga. Juose dirba daug puikių gydytojų ir mokslininkų. Tokių sąlygų galėtų pavydėti nemaža dalis Didžiosios Britanijos ligoninių. Nustebino ir pradžiugino tai, kad nuo praeitų metų Lietuvos sveikatos mokslų universitete magistrantai gali rinktis naują kursą – gyvensenos mediciną. Manyčiau, kad šiai medicinos šakai priklauso ateitis.

Susitikimuose su medicinos specialistais ir pacientais pateikėte daug faktų apie sveikos mitybos ir aktyvios gyvensenos naudą onkologinių ligonių sveikatai ir gyvenimo kokybei, ypač po stacionarinio gydymo. Mūsų skaitytojams ši informacija taip pat būtų įdomi.

Jungtinėje Karalystėje vėžiu serga 3 mln. Gyventojų. Europos Sąjungoje tokių ligonių yra 15 mln., Jungtinėse Amerikos Valstijose – 18 mln. Vėžinių ligų diagnostika ir gydymo metodai kasmet tobulėja, ligoniai ilgiau gydomi, jiems taikoma vis daugiau ir įvairesnių gydymo būdų. Taigi per 25 metus, kai dirbu onkologu konsultantu, pacientų išgyvenamumas padidėjo nuo 50 proc. iki 84 proc.. Net tais atvejais, kai išsivysto metastazės, žmonės dabar išgyvena 5 metus ir ilgiau. Tačiau nauji gydymo būdai, kad ir hormonų ar biologinė terapija, vėliau neišvengiamai sukelia ir naujų nepageidaujamų simptomų: pykinimą, nuovargį, odos niežulį, didelį kraujo spaudimą, nutukimą, kaulų retėjimą, sąnarių skausmą ar nagų irimą.

Kembridžo universiteto Klinikinių tyrimų grupės tikslas – nustatyti, kurios priemonės gali palengvinti pacientų gyvenimą ir pasidalyti šia informacija su gydytojais, ypač su bendrosios praktikos gydytojais, taip pat ir pacientais. Juk pasibaigus gydymui nuo vėžio pacientas iš klinikų keliauja pas šeimos gydytoją, kuris periodiškai stebi jo sveikatą, tačiau specialių žinių, kaip padėti vienu ar kitu atveju ir kuo žmogus pats sau galėtų padėti, ne visada turi, todėl ir patarti nelabai gali. Kas tada belieka pacientui – konsultuotis su sodo kaimynu, ieškoti informacijos internete ir imtis savigydos, kuri gali ne tik kad nepadėti, bet dar ir pakenkti.

Iš tiesų mūsų tyrimų grupė siekia ne tik gerinti pacientų savijautą, bet ir padėti jiems pakeisti gyvenimo būdą. Manoma, kad apie 50 proc. atvejų vėžį sukelia netinkamas gyvenimo būdas. Net ir susirgus vėžiu, jo eiga labai priklauso nuo pasirinktos gyvensenos. Vėžys kiekvienam pacientui progresuoja labai skirtingai. Ląstelių proliferacija, invazija į įvairius organus, metastazės trunka skirtingą laiką, todėl galima dar daug ką pakeisti, kad šie procesai vyktų lėčiau, pagerėtų imunitetas, DNR atsikūrimo mechanizmai, kad nevyktų daugiau mutacijų. Daug ką gali lemti ir mityba.

Jungtinės Karalystės gyventojai kasmet išleidžia milijonus svarų įvairiems vaistams – nuo kraujo spaudimo, laisvinamiesiems, virškinimui pagerinti ir pan. Manau, kad panaši situacija ir jūsų šalyje. Žmonėms vertėtų pagalvoti apie tai, kad panašių rezultatų būtų galima pasiekti ir vartojant gerokai mažiau vaistų, tereikia tinkamai subalansuoti mitybą ir kasdien aktyviai mankštintis.

Pietų Kalifornijoje neseniai ištirta didelė grupė žmonų. Žiūrėjome, kaip mitybos ir gyvenimo būdo įpročiai veikia sveikatą. Tyrimas parodė, kad aktyviai mankštinantis žmogaus organizme per valandą įvyksta apie 180 biocheminių pakitimų, kurie padeda apsisaugoti nuo kancerogenų ir pataisyti pažeistas ląsteles, taip pat slopina vėžinių ląstelių augimą ir plitimą, skatina jų apoptozę.

Daugiau kaip 50 didelių tyrimų, kurie apėmė per milijoną pacientų, parodė, kad aktyvi mankšta mažina lėtinį uždegimą, didina hormono irisino ir mažina vazoaktyvaus žarnyno polipeptido (VIP) lygį, mažina oksidacinį stresą ir stiprina antioksidacinius kelius. Be to, mankštinantis aktyvinamas imunitetas, reguliuojamas testosterono ir estrogenų lygis, pradeda kristi svoris, pagerėja psichologinė sveikata ir nuotaika. Dar geriau, jeigu pratimai atliekami lauke – kartu su saule žmogus gauna ir vitamino D. Per savaitę mankštinantis po 3–4 val., lėtėja vėžio progresavimas ir net iki 30 proc. sumažėja ligos atkryčio tikimybė. Užtat 5 val. per savaitę prie televizoriaus atkryčio tikimybę padidina net iki 25 proc.

Dažnai pacientai skundžiasi, kad mankštintis jiems trukdo nuovargis ir sąnarių skausmas, bijo, kad šie simptomai nepablogėtų. 33 labai didelių studijų statistiniai duomenys parodė, kad žmonėms, kurie mankštinosi pagal specialią programą, palyginti su tais, kuriems buvo taikomas klasikinis gydymas, palengvėjo sąnarių skausmai, mažiau vargino karščio pylimas, vidurių užkietėjimas, periferinė neuropatija, pradėjo kristi svoris.

Nutukimas – dar viena opi problema. Žinome, kad nutukusiems žmonėms net 50 proc. padidėja rizika susirgti vėžiu, o išgyvenusiems vėžį – 14 proc. didesnė rizika, kad liga gali atsinaujinti. Daugelis pacientų, kuriems taikoma chemoterapija, priauga svorio. Slaugytojai neretai jiems pataria nesukti dėl to galvos, nes vėliau kilogramai nukris savaime. Tačiau tai klaidinga nuomonė. Ir pagalbos pirmiausia reikėtų ieškoti pas dietologą, o po to kreiptis į sporto medicinos specialistą.

Kembridže tyrėme prostatos vėžiu sergančius pacientus. Jiems buvo taikoma spindulinė terapija. Vyrai, kurie gydėsi ir mankštinosi, neturėjo problemų dėl tiesiosios žarnos funkcijų, kai kuriems pasitaisė net įsisenėjusios bėdos.

Treniruotės gydymo metu gal ir atrodo keistai, bet jos padeda. Ne mažiau padeda ir mityba.

 

Gerbiamas profesoriau, moksliniuose straipsniuose ir klinikiniuose tyrimuose labai dažnai minite polifenolius. Papasakokite plačiau apie šias medžiagas ir jų naudą onkologinių ligonių sveikatai.

Polifenoliai yra augalinės cheminės medžiagos, sukurtos pačios gamtos. Vaisiai, daržovės ar prieskoniai, kuriuose gausu polifenolių, gražiai atrodo, maloniai kvepia, yra skanūs. Daugiausia jų vartoja Viduržiemio jūros ir Rytų šalių gyventojai, todėl jie sveikesni ir gyvena ilgiau. Bet ne tik dėl šių savybių polifenoliai mums naudingi.

Kaip rodo daugelis mokslinių tyrimų, mityba, kurioje gausu augalinių polifenolių, padeda mažinti sunkių lėtinių ligų (vėžio, senatvinės demencijos, artrito, širdies ir kraujagyslių ligų, kataraktos ir kt.) išsivystymo riziką. Dėl polifenolių ir kitų augalinių medžiagų trūkumo gali padidėti krūties, kasos, kiaušidžių, odos, prostatos, stemplės ar kitų lokalizacijų vėžio rizika.

Polifenoliai padeda įveikti iš aplinkos ar su maistu patekusius kancerogenus, neutralizuoti laisvuosius radikalus, slopinti uždegiminius procesus ir stimuliuoti imuninę sistemą, gali stabdyti vėžinių ląstelių mitybai būtinų kraujagyslių augimą, slopinti šių ląstelių proliferaciją ir skatinti jų apoptozę, taip pat lėtinti organizmo senėjimą, padėti apsisaugoti nuo žalingų ultravioletinių saulės spindulių ir net palaikyti normalų kraujo spaudimą ar cukraus lygį kraujyje.

Kai kurie augalai, kuriuose gausu polifenolių, pasižymi ir fitoestrogeninėmis savybėmis. Bet tai vaisių ir daržovių estrogenai, juos vartoti naudinga ir saugu. Pavyzdžiui, sojų pupelėse, linų sėmenyse, lęšiuose yra daug izoflavonų, kurie mažina riziką susirgti krūties vėžiu ar atsinaujinti šiai ligai. Tik nereikėtų pamiršti, kad fitoestrogenai naudingi tol, kol jie slypi maisto produktuose, todėl didelės koncentracijos fitoestrogenų papildai nerekomenduotini.

Produktų, kuriuose gausu polifenolių, reikėtų vartoti ne 1–2 kartus per savaitę, bet kasdien. Pavyzdžiui, pietums išsivirti tirštos brokolių sriubos arba pasigaminti daržovių ir vaisių kokteilių. Tik šie produktai turėtų būti švarūs, neužteršti pesticidais ar herbicidais. Galima produktų prisidžiovinti arba džiovintus suberti į vieną kapsulę ir iš karto gauti visą rekomenduojamą polifenolių paros dozę. Bet tai nereiškia, kad viena kapsulė turi pakeisti visą sveiką mitybą ir gyvenseną.

Pastaraisiais metais spaudoje ir internete ganėtinai daug rašoma apie vitaminus ir maisto papildus. Autorių išvados labai prieštaringos, skaitytojų nuomonė taip pat. O ką apie vitaminus ir papildus manote jūs?

Papildai papildams nelygu, kaip ir vitaminai. Vieni papildai yra sintetiniai arba sudaryti iš maisto produktuose esančių vienų ar kitų medžiagų ekstraktų, kituose koncentruoti sveiki maisto produktai ar jų deriniai.

Pirmajai grupei priskiriami mineralai ir vitaminai bei iš augalų išgauti polifenoliai, tokie kaip likopenas, palmitinas ar genisteinas.

Nors keletas tyrimų parodė, kad mineralų ir vitaminų trūkumas organizme gali būti susijęs su didesne vėžio rizika ir dažnesniais atkryčiais, tačiau dauguma gerai organizuotų didelių tyrimų neįrodė jokios vitaminų ir mineralų naudos ar net nustatė, kad jie šiek tiek didino vėžio riziką.

Žinomiausias iš jų yra klinikinis SELECT tyrimas. Jis parodė, kad vyrams, ilgą laiką vartojusiems vitamino E derinį su selenu, padidėjo rizika susirgti prostatos vėžiu.

CARET studija nustatė, kad ilgalaikis beta karoteno ir retinolio papildų vartojimas padidino plaučių vėžio riziką.

Sveikatos apsaugos specialistų stebėjimo tyrimas, kuris apėmė 51 529 vyrus ir truko 15 metų, parodė, kad ilgalaikis cinko papildų vartojimas arba vartojimas didesnėmis nei 100 mg/d. dozėmis net 2 kartus padidino prostatos vėžio riziką, todėl šio papildo vyrams geriau nerekomenduoti, nebent būtų nustatytas cinko trūkumas.

Jungtinės Karalystės artrito tyrimų organizacijos (angl. Arthritis Research UK) paskelbtoje ataskaitoje teigiama, kad net 13 atsitiktinės imties, kontroliuojamųjų tyrimų, kuriais siekiama nustatyti gliukozamino naudą, taip pat 22 tyrimai, skirti chondroitino ir 17 – žuvų taukų poveikiui, atskleidė, kad šių papildų nauda sąnariams abejotina. Tiesa, tyrimai parodė, kad žuvų taukai turėjo poveikį reumatoidiniam artritui, bet ne osteoartritui.

Dar keletas didesnių atsitiktinės imties studijų, kurioms vadovavo Nacionalinis vėžio institutas, tyrė genisteino, daidzeino ar kitų izoflavonų poveikį prostatos gerybinei hiperplazijai ir prostatos vėžiui, tačiau jokios šių papildų naudos nei PSA dinamikai, nei sveikatai nenustatė.

VITAL studija taip pat nenustatė nei gulsčiųjų serenojų (sabalpalmių) vaisių ekstrakto, nei genisteino ar likopeno poveikio prostatos vėžiui ar gerybiniam prostatos išvešėjimui.

Panašiai nutiko ir su likopenu: 2 atsitiktinės imties, kontroliuojamieji prostatos vėžio tyrimai nenustatė likopeno pranašumo, palyginti su placebu.

Australų atliktas tyrimas parodė, kad beta karoteno ir vitamino E papildų vartojantiems asmenims dažniau susiformuodavo naujų odos vėžio darinių. Tiesa, ir tiems asmenims, kurių mityboje trūko polifenolių, nustatyta didelė odos vėžio rizika.

Tokį U formos pasiskirstymą nustatė ir EPIC tyrimas. Mokslininkai pastebėjo, kad asmenims, kuriems trūko foliatų, ir tiems, kuriems jų buvo per daug, vėžys išsivystė dažniau.

Šis fenomenas paskatino įvairias organizacijas, pavyzdžiui, Jungtinės Karalystės nacionalinį vėžio institutą, paskelbti viešą pranešimą, kad nederėtų ilgą laiką be pertraukų vartoti vitaminų ar mineralų, nebent jų reikėtų vitaminų trūkumui kompensuoti.

Visai kitaip su papildais, sudarytais iš viso maisto produkto ar kelių produktų. Jų neperdozuosi, jų nesikaupia organizme ir yra saugūs vartoti. Moksliniai tyrimai taip pat teikia vilčių.

Mūsų atliktas Jungtinės Karalystės nacionalinio vėžio tyrimo tinklo Pomi-T tyrimas parodė, kad polifenolių gausus maisto papildas, sudarytas iš brokolių, ciberžolių, granatų ir žaliosios arbatos ekstrakto, efektyviai slopino ne tik PSA, bet ir prostatos navikų augimą.

Didelis kohortinis VITAL tyrimas nustatė, kad vynuogių sėklų ekstraktas mažino prostatos vėžio riziką.

Luizianos universiteto atliktas tyrimas parodė, kad arbatos ekstraktas prostatos vėžiu sergantiems vyrams gerokai sumažino kai kurių naviko augimą skatinančių veiksnių ir PSA augimą.

Kalifornijos universiteto atliktas antrosios fazės klinikinis tyrimas nustatė, kad prostatos vėžiu sergantiems vyrams, kurie kasdien gėrė granatų sulčių, reikšmingai pailgėjo PSA dvigubėjimo laikas ir pagerėjo organizmo atsakas į oksidacinį stresą. Du vėlesni Jungtinėse Amerikos Valstijose ir Italijoje atlikti antrosios fazės tyrimai nustatė panašų granatų sėklų ekstrakto poveikį PSA.

Papildų, kuriuose gausu polifenolių, pasirinkimas kol kas nėra didelis. Ne visi polifenoliai turi antivėžinių savybių, o tie, kurie jų turi, greičiausiai teikia skirtingą naudą, kai yra vartojami skirtingų žmonių skirtingais deriniais.

Amerikos klinikinės onkologijos draugijos konferencijoje 2013 metais pristatėte garsųjį Jungtinės Karalystės nacionalinio vėžio tyrimo tinklo Pomi-T tyrimą. Apie jį tada plačiai kalbėjo, o ir šiandien aktyviai domisi daugelio šalių onkologiniai ligoniai. Papasakokite, kaip kilo sumanymas papildomam vėžio gydymui naudoti maisto papildą iš koncentruotų augalinių produktų.

Tai buvo ne spontaniška idėja, o ilgo komandinio darbo rezultatas.

Jungtinės Karalystės nacionalinis papildomo gydymo ir gyvenimo būdo klinikinių tyrimų komitetas jau kurų laiką aiškinosi, kaip polifenoliai kovoja su vėžiu ir kuo jie gali būti naudingi mūsų sveikatai. Buvau pakviestas prisijungti prie šio komiteto. Dirbome 18 mėnesių, perskaitėme daugybę mokslinių darbų, ištyrėme daugybę vaisių, daržovių, prieskonių, grybų ir atrinkome tuos, kurie turėjo daugiausia antivėžinių savybių, kuriuose polifenolių buvo daugiausia. Rinkdamiesi žiūrėjome, kad tai būtų skirtingų rūšių produktai (vaisiai, daržovės, prieskoniai, arbatmedžių lapai) ir juose būtų skirtingomis savybėmis pasižyminčių polifenolių, kad produktuose nebūtų pavojingų alergenų ir fitoestrogenų. Geriausiai šiuos kriterijus atitiko žalioji arbata, ciberžolės, granatai ir brokoliai. Žinoma, produktų, pasižyminčių panašiomis savybėmis, yra gerokai daugiau, tik visko iš karto neaprėpsi ir nesuderinsi. Atrinktieji produktai buvo perdirbti į sausąjį koncentratą ir iš jo pagamintos maisto papildo tabletės.

Žaliajai arbatai daugiausia antivėžinių savybių suteikia epigalokatechino galatas. Arbata slopina ornitino dekarboksilazę – fermentą, kuris padeda vėžinėms ląstelėms išvengti apoptozės, slopina krūties ir prostatos vėžio ląstelių proliferaciją bei angiogenezę.

Dažinė ciberžolė, kurios pagrindinė veiklioji medžiaga kurkuminas, slopina prostatos vėžio ląstelių gyvavimo ciklą: lėtina jų augimą, skatina apoptozę, neleidžia joms peraugti ar išplisti į gretimus ir tolesnius organus. Kurkuminas slopina endotelio augimo faktoriaus receptoriams svarbaus fermento tirozinkinazės aktyvumą, pasižymi nuo fermento ciklooksigenazės-1 (COX-1) priklausomu antiuždegiminiu poveikiu ir lėtina krūties vėžio vystymuisi svarbių kamieninių ląstelių augimą, nepakenkdamas sveikoms krūtų audinio ląstelėms.

Granatuose gausu elago rūgšties. Ši rūgštis slopina vėžinių ląstelių dalijimąsi ir sukelia jų žūtį apoptozės būdu. Granatų veikliosios medžiagos didina ląstelių adheziją ir slopina jų migraciją, o šie procesai yra tiesiogiai susiję su metastazėmis.

Brokoliuose ypač gausu biologiškai aktyvių medžiagų – sulforafano, liuteino, kvercetino, kemferolio glikozidų, beta karoteno, indol-3 karbinolo ir dar kitų gliukozinolatų. Brokoliai padeda įveikti oksidacinį stresą, aktyvina imuninę sistemą, slopina uždegiminius procesus, slopina vėžio ląstelių augimą ir skatina jų apoptozę. Reguliariai vartojant brokolių, slopinami genai, kurie daro įtaką naviko augimui, kartu aktyvinami genai, susiję su vėžinio proceso slopinimu. Toks brokolių poveikis dažnai pasireiškia žmonėms, kurie turi pakitusį fermento glutationo S-transferazės geną (50 proc. pasaulio populiacijos). Jungtinių Amerikos Valstijų mokslininkai pateikė įrodymų, kad sulforafanas ne tik trukdo formuotis krūties vėžiui, bet ir prisideda prie jo gydymo: dėl sulforafano poveikio navikuose gerokai sumažėja kamieninių vėžinių ląstelių, o išlikusios ląstelės jau neaugina naujų navikų.

Būtent šie tyrimai mums ir padėjo sudaryti programą, kaip kovoti su vėžiu ir mažinti ligos atkryčio riziką. Ištyrę pasirinktus 4 maisto produktus, iš jų sukūrėme papildą, gausų skirtingų polifenolių ir kitų medžiagų, kurios veikia skirtingus naviko vystymosi etapus ir taikinius.

Jungtinės Karalystės nacionalinio vėžio tyrimo tinklo Pomi-T tyrimas tikriausiai buvo vienintelis toks pasaulyje, kuriuo siekta nustatyti 4 maisto produktų poveikį prostatos vėžiu sergančių vyrų PSA progresavimui. Ar tikėjotės tokių gerų tyrimo rezultatų?

Jeigu nebūtume tikėję, tyrimo nebūtume rengę.

Jungtinės Karalystės nacionalinio vėžio tyrimo tinklo Pomi-T tyrimui (toliau – Pomi-T tyrimas) pritarė Jungtinės Karalystės nacionalinis etikos komitetas. Atsitiktinės imties, dvigubai aklą, placebu kontroliuojamą II fazės klinikinį tyrimą recenzavo Jungtinės Karalystės nacionalinio vėžio tyrimų instituto Papildomų gydymo metodų tyrimo komitetas ir oficialiai patvirtino Jungtinės Karalystės nacionalinis vėžio tyrimų tinklas.

Pomi-T tyrimui rinkomės prostatos vėžiu sergančius vyrus. Kodėl būtent juos? Prostatos vėžiu sergantys vyrai, kurių ligai taikoma aktyvaus stebėjimo arba budraus laukimo taktika, yra ideali kohorta įvertinti intervenciją, nes jų kraujo serume randamas ligai būdingas žymuo PSA. Be to, esant ligos atkryčiui, gydymo pradžioje medicininės intervencijos dažnai nerekomenduojamos.

Pomi-T tyrimas apėmė 203 savanorius vyrus, sergančius neišplitusiu prostatos vėžiu. Vyrų amžius – 53–89 metai (vidurkis – 74 metai). Iki tyrimo pradžios 59 proc. vyrų nebuvo skirtas joks gydymas, išskyrus aktyvų stebėjimą; 41 proc. vyrų po ankstesnių radikalų intervencijų PSA lygiui vėl pradėjus didėti, buvo taikoma budraus laukimo taktika.

Visi vyrai akluoju būdu buvo paskirstyti į 2 grupes: viena grupė 6 mėnesius 2 k./d. vartojo tabletes iš granatų, žaliosios arbatos, ciberžolių ir brokolių, kita – placebą. Tyrimo pradžioje tarp abiejų grupių nebuvo nustatyta reikšmingų skirtumų pagal Glisono skalę, kūno masės indeksą ar gydymo kategoriją. Siekiant nustatyti PSA pokyčius, vyrams PSA lygis buvo matuojamas tyrimo pradžioje, po 3 ir po 6 mėnesių.

Pasibaigus tyrimui, placebo grupėje PSA lygis vidutiniškai padidėjo 78,5 proc. o maisto papildo grupėje – tik 14,7 proc. Net 63,8 proc. skirtumas buvo ne tik reikšmingas, jis viršijo mūsų lūkesčius.

Tikrai džiaugėmės, kad tyrimo pabaigoje 46 proc. maisto papildą vartojusių vyrų buvo nustatytas sumažėjęs ar pastovus PSA lygis, o placebo grupėje tik 14 proc. Taigi galima sakyti, kad beveik pusei vyrų, vartojusių tabletes iš brokolių, ciberžolių, granatų ir žaliosios arbatos, vėžys nustojo augti ar net regresavo.

Be to, tik 8,2 proc. maisto papildo grupės vyrų, kuriems buvo taikoma aktyvaus stebėjimo arba budraus laukimo taktika, prireikė agresyvesnio gydymo, o ir PSA lygis jiems didėjo lėčiau nei placebo grupei, kurioje keisti gydymo planą turėjo net 27,7 proc. vyrų. Kitaip tariant, papildas iš 4 maisto produktų padėjo vyrams išvengti skausmingų, brangių ir invazinių procedūrų, tokių kaip chemoterapija, spindulinė terapija ar net kastracija, arba jas atitolino.

Dar vienas geras dalykas – naujasis maisto papildas beveik nesukėlė nepageidaujamo poveikio, nebent dujų kaupimąsi (3,6 proc.), pilvo pūtimą (3 proc.) ar šiek tiek laisvesnius vidurius (7,5 proc.). Bet panašių simptomų pasireiškė ir placebo grupės vyrams.

Pomi-T tyrimo rezultatus 2013 metais pristatėme Amerikos klinikinės onkologijos draugijos (angl. ASCO) metinėje konferencijoje Čikagoje ir publikavome medicinos žurnale Prostate Cancer and Prostatic Diseases. Žinoma, paskelbėme ir savo interneto svetainėse, kad gydytojai ir pacientai turėtų tyrimais pagrįstų įrodymų – maisto produktai padeda.

Labai greitai sulaukėme ne tik sveikinimų, bet ir klausimų: gal tai tik trumpalaikis cheminis poveikis, gal naujasis maisto papildas neturi jokio poveikio navikui?

Mūsų tyrimų grupė ryžosi dar vienam žingsniui – Pomi-T klinikiniam tyrimui sukurtų tablečių efektyvumą 2015 metais patikrinome magnetinio rezonanso tomografijos (MRT) tyrimu. Jame dalyvavo 138 lokaliu prostatos vėžiu sergantys vyrai, 102 iš jų vartojo maisto papildą. Visiems vyrams atlikta ne mažiau kaip po 2 MRT ir PSA tyrimus.

Palyginę vyrų kelerių metų PSA tyrimus su MRT nuotraukomis bei kiekvieno vyro PSA ir MRT tyrimus, priėjome prie išvados, kad PSA dinamika 100 proc. atitiko MRT nuotraukose matomus naviko pokyčius. Be to, navikas sparčiau traukėsi arba ilgiau išliko stabilus tiems pacientams, kurie vartojo maisto papildą ir paisė mūsų parengtų sveikos gyvensenos rekomendacijų.

Ši studija dar kartą patvirtino, kad ir nacionaliniame Pomi-T tyrime maisto papildo tabletės paveikė ne tik PSA, bet ir patį naviką.

Daugelio mokslininkų nuomone, polifenolių antinavikinis ir uždegimo slopinamasis poveikis universalus, todėl Pomi-T tyrime naudotas maisto papildas iš granatų, žaliosios arbatos, ciberžolių ir brokolių turėtų padėti sergant ne tik prostatos, bet ir kitų lokalizacijų vėžiu ar kitomis lėtinėmis ligomis ir, žinoma, siekiant išvengti jų pasikartojimo.

Gal galite išvardyti konkrečių atvejų, kaip brokolių, granatų, ciberžolių ir žaliosios arbatos vartojimas pagerino pacientų sveikatą.

Tokių atvejų yra ne vienas. Beveik visi jie patvirtinti MRT nuotraukomis.

Pavyzdžiui, 69 metų vyrui prostatos vėžys metastazavo. Nors buvo taikoma hormonų ir spindulinė terapija, taksotero infuzijos, tačiau PSA lygis didėjo. Žmogus iš pagrindų pakeitė mitybą, pradėjo aktyviai mankštintis, 6 savaites kasdien valgė brokolių sriubos ir vartojo mūsų sukurtą augalinį papildą. Ir PSA lygis sumažėjo nuo 48 g iki 0,2 g dekalitre.

Arba kitas atvejis: 59 metų moteriai 2008 metais diagnozuotas žarnyno vėžys. Per 2 metus liga išplito į kepenis ir plaučius. Operuoti jos negalėjome. Moteris palyginti gerai jautėsi, todėl chemoterapijos nenorėjo, pradėjo 3 kartus per savaitę aktyviai sportuoti, atsisakė rafinuoto cukraus turinčių produktų ir perdirbtos mėsos gaminių, pradėjo mažiau rūkyti, valgė daug polifenolių turinčių vaisių ir daržovių, kasdien vartojo maisto papildą iš brokolių, granatų, ciberžolių ir žaliosios arbatos. Ir ką jūs manote – po 2 metų metastazės sumažėjo ir sveikata pagerėjo.

Dar vienas ypač sudėtingas atvejis: 48 metų pacientei 2014 metais nustatytos krūties vėžio metastazės į smegenis. Pacientė chemoterapijos atsisakė. Beliko rekomenduoti keisti gyvenimo būdą, mitybą, vartoti daug polifenolių turinčio maisto, papildomai vartoti vitamino D ir Pomi-T tyrimui sukurto papildo, būtinai numesti svorio ir nustoti rūkyti. Moteris sąžiningai laikėsi mūsų rekomendacijų, ir liga nustojo progresuoti.

Paskaitose minėjote dar vieną tyrimą, kuriame tirtas polifenolių turintis nagų balzamas po chemoterapijos. Kokie šio tyrimo rezultatai?

Chemoterapija, ypač taksotero ar taksolo intraveninės infuzijos, o kartais net herceptinas ar net hormoniniai vaistai stipriai pažeidžia nagus. Maždaug 40–70 proc. pacientų chemoterapija sukelia onikolizę: nagai išsausėja, lūžinėja, atkyla nuo nago guolio, paruduoja ar pajuoduoja, iš jų pradeda skirtis skaidraus skysčio, patekus infekcijai pūliuoja. O kur dar skausmas prisilietus prie menkiausio daikto, kaip nusiprausti, eiti į darbą ar gaminti maistą?

Gydytojams kartais atrodo, kad tai tik estetinė problema. Pacientų nuomonė kitokia. Todėl su Nacionalinio vėžio tyrimų instituto Klinikinių tyrimų komitetu ieškojome būdų, kaip palengvinti chemoterapijos sukeltų pažeidimų pobūdį arba jų net išvengti.

Iš alyvuogių aliejaus, kakavos pupelių sviesto, taukmedžių, riešutų sėklų sviesto, šliaužiančiųjų bruknuolių, afrikinių šalavijų ir tikrųjų levandų aliejų bei bičių vaško sukūrėme polifenolių gausų balzamą ir tyrėme jo poveikį pacientams, kuriems taikoma chemoterapija.

 Šio tyrimo rezultatus gegužės mėnesį taip pat pristatysime Amerikos klinikinės onkologijos draugijos konferencijoje.

Gerbiamas profesoriau, dėkojame, kad nepagailėjote pokalbiui tiek daug laiko, ačiū už išsamius atsakymus. Linkime sėkmės ir tikimės, kad dar ne kartą apsilankysite Lietuvoje.

 

Robertas J. Thomas


129 mintys apie “Kaip padėti onkologiniam ligoniui?

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