Optimization of cooperation between neurologists and general practitioners: improving the quality of care and treatment outcomes for patients with cancer

between neurologists and general practitioners: improving the quality of care and treatment outcomes for patients with cancer. Cardiometry; Issue No. 33; November 2024; p. 58-62; DOI: 10.18137/cardiometry.2024.33.5862; Available from:

Chemotherapy, which is an integral part of cancer treatment, can lead to various neurological complications that significantly affect the quality of life of patients. These complications cover a range of disorders affecting both the central and peripheral nervous systems.

Peripheral neuropathy is one of the most common neurological complications after chemotherapy, characterized by numbness, tingling and pain in the extremities. This condition affects the peripheral nerves of the body, which often leads to sensorimotor deficiency, which can complicate daily activities [1].

Complications from the central nervous system include encephalopathy and cerebellar syndrome. Encephalopathy is manifested by symptoms such as confusion, hallucinations and drowsiness, which reflects a general dysfunction of the brain. In addition, this dysfunction is sometimes associated with a “chemical brain,” a condition characterized by cognitive impairments that patients undergoing chemotherapy may experience, including memory problems and difficulty concentrating. On the other hand, cerebellar syndrome is characterized by ataxia, nystagmus and dysarthria, which indicates damage to the cerebellum, the part responsible for coordination of movements [2].

Seizures and strokes are severe but less common complications that pose significant health risks. Seizures can occur as an acute reaction to certain chemotherapeutic agents, which requires immediate treatment. A stroke, which can be ischemic or hemorrhagic, is a critical condition requiring immediate medical intervention [3].

Other potential complications are myelopathy and aseptic meningitis. Myelopathy involves spinal cord dysfunction leading to disorders of the motor, sensory and autonomic systems. Aseptic meningitis is manifested by symptoms such as headache, neck stiffness and fever, which indicates inflammation of the protective membranes covering the brain and spinal cord [4].

In patients suffering from neurological complications after chemotherapy, the reversibility of these conditions varies significantly depending on the type of complication and its severity. For example, peripheral neuropathy may improve over time, especially if it is detected at an early stage and if the chemotherapeutic agent causing the disease is discontinued or modified. However, recovery is not guaranteed, and some patients may experience long-term or irreversible consequences [5].

Functional medicine’s approach to neurological care, especially for those experiencing the effects of chemotherapy, embraces a holistic approach, recognizing each patient as a person with a unique health history. This method goes beyond the traditional treatment of symptoms, delving into the root causes of neurological complications. He emphasizes the importance of understanding the patient’s lifestyle, environmental influences, and genetic predisposition.

Creating a personalized treatment plan is central to this approach, ensuring that interventions are tailored to the specific needs of each patient. This may include diet changes, stress management techniques, and targeted supplements, along with traditional medical treatments. By focusing on the individual as a whole, and not just on the symptoms, functional medicine seeks to optimize neurological health and improve overall well-being, offering a pathway not only to treatment, but also to the potential reversal of neurological complications after chemotherapy. This patient-centered care model focuses on the partnership between the practitioner and the patient, empowering people on the path to healing and improving their quality of life.

The purpose of the work is to consider the features of the work of neurologists and general practitioners in order to improve the recovery process.

MATERIALS AND METHODS

Functional medicine testing plays an important role in identifying the underlying imbalance or deficiencies that may contribute to the development of neurological symptoms in patients after chemotherapy. This testing approach aims to understand the root causes of health problems, which allows you to develop a more personalized and effective treatment plan. In addition, this approach allows specialists of different profiles to conduct a full assessment of the condition of patients and build the most effective treatment plan.

The trace element test conducted by SpectraCell Laboratories helps to determine the levels of specific vitamins, minerals and antioxidants in patients after chemotherapy. Understanding these levels allows for targeted dietary interventions aimed at maintaining nerve health and repair, directly eliminating potential sources of neurological symptoms. This test can be considered by both a neurologist and a general practitioner in order to make a treatment plan more appropriate for the patient’s age and weight.

Toxic metals in urine – A 24-hour analysis according to a doctor is useful for assessing the effects of heavy metals, which may affect neurological symptoms in patients undergoing chemotherapy. This will help to alleviate the general condition of the patient, since it is not uncommon after full treatment, the patient may face negative consequences and complications. Identifying and eliminating heavy metal toxicity can help reduce the neurological side effects associated with chemotherapy.

Access Med Labs’ comprehensive metabolic panel provides insight into the health of vital organs such as the liver and kidneys, which may be affected by chemotherapy. The assessment of metabolic processes using this test helps to identify any dysfunctions, identify interventions that support organ health, and improve detoxification pathways [6].

In addition, the GI-MAP from Diagnostic Solutions is a valuable tool for studying the microbiome of the gastrointestinal tract and the gut-brain axis. It is worth noting that this category of patients is most often susceptible to disorders of the gastrointestinal tract, therefore a comprehensive approach to treatment is necessary, which will restore the microflora of organs. For post-chemotherapy patients experiencing neurological symptoms, GI-MAP data can help develop strategies to restore intestinal flora balance and address gut-related problems that may affect neurological health.

The inclusion of these tests allows practitioners to adapt their treatment approaches to the individual needs of each patient, contributing to improved neurological health and quality of life. Thanks to the knowledge these tests provide, practitioners can provide care that directly addresses their patients’ unique health problems. These tests allow for a more global assessment of the patient’s condition, enable general practitioners and neurologists to analyze the situation from all sides and come to a common conclusion.

RESULTS

The tests allow you to accurately determine the causes of neurological symptoms and develop an individual treatment plan for each patient, which neurologists and general practitioners can make efforts to. Functional medicine testing includes analysis of the levels of vitamins, minerals, hormones, metabolic processes and other indicators that may be associated with neurological problems. This helps specialists to choose the optimal treatment and improve the quality of life of patients. It is important to test functional medicine regularly to monitor the effectiveness of treatment and adjust the plan if necessary.

DISCUSSION

Dietary strategies with an emphasis on anti-inflammatory foods, antioxidants, and certain nutrients offer a promising approach to improving the neurological health of patients undergoing chemotherapy. Studies show that adopting dietary patterns rich in omega-3 fatty acids, antioxidants, and polyphenols, similar to those found in the Mediterranean diet and the DASH diet [7], can mitigate neuroinflammation and cognitive decline, often associated with chemotherapy. For example, studies, although not specific to cancer patients, highlight the neuroprotective potential of such diets, pointing to their role in suppressing neuroinflammation, which is crucial for patients recovering from neurological complications caused by chemotherapy. Nutritionists, as well as general practitioners, help the neurologist to carry out a complete diagnosis of the patient’s condition. The claimed dietary components can modulate the immune system and alter the neuroinflammatory processes associated with cognitive dysfunction, providing the basis for dietary interventions aimed at neurological recovery. Neurologists and general practitioners play an important role in the combined treatment of oncological diseases, including in the process of assessing the general condition of a patient with diseases such as cancer.

The inclusion of nutrients that promote nerve repair and improve cognitive function can further improve health outcomes. Essential fatty acids, vitamins and minerals play a vital role in the mechanisms of neuronal repair and maintenance of cognitive health. By focusing on foods rich in these nutrients, post-chemotherapy patients can better support their neurological recovery and mitigate the side effects of treatment [8].

In addition, the relationship between gut health and neurological well-being highlights the importance of a holistic dietary approach. Specialists in other fields, in particular nutritionists, therapists, general practitioners and others, allow the neurologist to implement this approach. The gut-brain axis, through which the gut microbiome can significantly affect brain health, suggests that diets that promote a healthy gut may also benefit neurological functions [9].

It is worth noting that one of the main tasks of neurologists and general practitioners in the treatment of oncology is the prevention and treatment of neurological complications such as peripheral neuropathy, metastases in the brain and spinal cord, as well as pain associated with tumor processes.

Lifestyle modifications play a key role in the treatment of neurological symptoms after chemotherapy, with an emphasis on stress management techniques, sleep hygiene and physical activity [10].

The doctor should choose an individual approach to each patient, relying on the assessment of colleagues in other fields. In particular, the general practitioner can give more precise recommendations regarding the physical condition of the patient, as well as provide a number of recommendations regarding the maintenance of the patient’s mental health.

Exercise, in particular, has been recognized as a useful intervention for patients suffering from peripheral neuropathy caused by chemotherapy (CIPN) [11], offering improved control of balance, physical function, and quality of life. Special exercise protocols, including endurance, strength, and sensorimotor training, have shown promising results in improving CIPN symptoms [12] and increasing patient independence and overall well-being.

Moreover, the relationship between psychological factors and neurological health is obvious. That is, stressful experiences have a negative impact on the general condition of the patient. It is believed that stressful experiences and the resulting stress response contribute to cognitive changes in cancer patients.

In the treatment of oncological diseases, a neurologist is obliged to assess the patient’s condition, together with doctors from different practices. This will make it possible to prescribe to the patient a full course of treatment related to physical development, mental development, recovery from chemotherapy and others.

For example, integrative therapy may be needed during treatment, including acupuncture, mas- sage therapy and mindfulness-based stress reduction (MBSR) [13], along with physical and occupational therapy, have shown promising results in maintaining neurological health and treating neuropathy in patients who have undergone chemotherapy.

MBSR, in particular, has been noted for its potential to mitigate cancer-related cognitive impairment and improve quality of life among breast cancer survivors. Research has shown that participation in MBSR programs [14] can lead to significant improvements in cognitive outcomes, suggesting that mindfulness may be an effective strategy to address the psychological and physical challenges faced by cancer survivors.

In addition, the role of acupuncture and massage in the context of infusion chemotherapy has been studied for their ability to alleviate numerous physical and psychological effects, including anxiety, nausea, peripheral neuropathy, fatigue and depression. These therapies provide non-pharmacological pain relief by offering patients and caregivers an active role in their health and recovery processes.

Physical and occupational therapy are an important part of the treatment of neuropathy and the improvement of mobility and function. They offer structured approaches to rehabilitation, focusing on improving the daily functioning and quality of life of patients. Through personalized exercise programs, patients can experience a reduction in neuropathy symptoms and improved physical abilities, which supports a more active and independent lifestyle after chemotherapy.

Research highlights the potential benefits of specific supplements and herbal medicines in the treatment of neurological symptoms after chemotherapy, with particular attention to safety and evidence-based recommendations. Studies involving B vitamins, omega-3 fatty acids and curcumin have shown promising ability to support nerve health and cognitive function in patients undergoing chemotherapy.

Omega-3 fatty acids, known for their anti-inflammatory and neuroprotective properties, have been investigated for their effectiveness in improving cognitive functions in patients undergoing chemotherapy [15]. A clinical study has shown that omega-3 supplements can mitigate cognitive impairment caused by chemotherapy, suggesting a protective role against the neurotoxic effects of chemotherapy.

Curcumin, the active component of turmeric, has been studied for its neuroprotective properties in patients undergoing chemotherapy. Clinical trials show that curcumin supplementation can improve cognitive behavior and neurogenesis, offering a therapeutic approach to counteract neurological deficits caused by chemotherapy.

In addition, the role of B vitamins in nerve health and cognitive support after chemotherapy has been recognized [16]. Studies show that vitamin B supplements can help in the treatment of neurological symptoms associated with chemotherapy, highlighting their importance in post-treatment care.

The collaborative care model, combining the expertise of oncologists, functional medicine specialists and rehabilitation specialists, is crucial for providing comprehensive care to patients after chemotherapy. This interdisciplinary approach ensures that all aspects of the patient’s recovery are taken into account: from the treatment of neurological symptoms to improving overall well-being [17]. Such collaboration contributes to the development of a more holistic treatment plan tailored to the individual needs of the patient, which greatly contributes to improved health outcomes.

Patient education and empowerment are central to this model, emphasizing the importance of patients playing an active role in their recovery process. By being well informed about their health, treatment options, and lifestyle changes, patients can make informed decisions, better adhere to treatment plans, and participate more fully in rehabilitation. Empowering patients on their neurological path to health not only enhances their sense of control, but also has a positive effect on their recovery and quality of life after chemotherapy.

CONCLUSIONS

The integrative approach of functional medicine offers a promising way to address neurological complications after chemotherapy, emphasizing customized care plans tailored to each patient’s unique needs.

Close cooperation between neurologists, oncologists and other specialists is necessary for the successful treatment of patients with oncological diseases. Oncological patients often need complex treatment, and only the combined efforts of specialists in various fields of medicine can provide them with the most effective and safe treatment.

By focusing on the root causes of symptoms, this method contributes not only to the treatment of symptoms, but also to long-term health and well-being. Healthcare providers are encouraged to adopt this ho-

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listic strategy, ensuring that patients receive comprehensive care that takes into account all aspects of their recovery. Ultimately, adopting the principles of functional medicine can significantly improve the quality of life of those who face neurological health problems after chemotherapy.