Ukudla okunomsoco / Ukudla Komdlavuza Webele weMetastatic

Amaphuzu avelele

Umdlavuza webele we-Metastatic ngumdlavuza othuthukile osudlulele kwezinye izitho zomzimba ngale kwezicubu zebele, futhi unesibikezelo esibi kakhulu. Ukwelashwa kwe-neastasm ebabayo ye-metastatic isiya ekwenzeni kube ngokwakho okwenziwe ngezimpawu zomdlavuza. Izincomo zokudla okunomuntu ofanayo (ukudla nokondla) okususelwa kuzimpawu zomdlavuza nokwelashwa kuyashoda futhi kuyadingeka kakhulu ukuthuthukisa amathuba okuphumelela nekhwalithi yempilo yesiguli esinomdlavuza. Le bhulogi igcizelela izidingo, izikhala kanye nezibonelo zokudla okunomsoco / ukudla (ukudla nokondla) komdlavuza webele we-metastatic.

Izisekelo Zomdlavuza Webele

Umdlavuza webele wumdlavuza otholakala kakhulu futhi ungenye yezimbangela zokufa kwabantu okuhlobene nomdlavuza kubantu besifazane emhlabeni jikelele. Enye yama-subtypes avame kakhulu omdlavuza webele ukuncika kwe-hormone yezocansi, i-estrogen (ER) ne-progesterone (PR) yokwamukela okuhle ne-human epidermal growth factor 2 (ERBB2, ebizwa nangokuthi i-HER2) engeyinhle - (I-ER + / PR + / HER2- uhlobo olungaphansi). Uhlobo oluncane lwe-hormone lomdlavuza webele lunokubikezela okuhle ngesilinganiso seminyaka emihlanu kakhulu sokusinda se-5-94% (I-Waks ne-Winer, i-JAMA, 2019). Ezinye izinhlobo zebele umdlavuza i-hormone receptor negative, i-HER2 i-positive subtype kanye ne-triple negative breast cancer (TNBC) subtype ethi ER, PR kanye ne-HER2 negative. I-TNBC subtype inesimo esibi kakhulu sokubikezela kanye namathuba aphezulu okudlulela esigabeni sesifo esiye sakhula futhi sasakazekela kwezinye izingxenye zomzimba.

I-Metastatic Breast Cancer ingumdlavuza osezingeni eliphezulu kakhulu, wesigaba IV osabalalele kwezinye izingxenye zomzimba (imvamisa amathambo, amaphaphu, isibindi noma ubuchopho). Kukhona kuphela u-6% wabesifazane okutholakala ukuthi bane-neastasm ebabayo ye-metastatic ekuqaleni kokuxilongwa. Iningi lamanye amacala we-neoplasm ebulalayo noma ye-metastatic ibele lapho umdlavuza ubuyele emuva esigulini ngemuva kokuqeda ukwelashwa kwangaphambilini nokuba sesikhathini iminyaka eminingi. Umdlavuza webele we-Metastatic, ovame kakhulu kwabesifazane kodwa futhi otholakala kumaphesenti amancane wamadoda, unesimo esibi kakhulu sokusinda kweminyaka engu-5 esingaphansi kuka-30% njengedatha evela ku-American Cancer Society Publication (Cancer Facts and Figures, 2019 ). Ukusinda okuphelele okuphakathi kwe-metastatic TNBC kungunyaka owodwa kuphela uma kuqhathaniswa neminyaka emi-1 kwamanye ama-subtypes amabili. (I-Waks AG ne-Winer EP, JAMA 2019)

Izinketho Zokwelapha I-Metastatic Breast Cancer

Umdlavuza webele we-Metastatic welashwa ngezinhlobo eziningi zokwelashwa ezibandakanya amakilasi ahlukene we-chemotherapy, i-immunotherapy, ukwelashwa okuqondisiwe, ukwelashwa kwamahomoni kanye ukwelashwa kwemisebe ongakhetha kukho, ngenqubo yokulinga nephutha, ngoba alukho umuthi ochaziwe walo mdlavuza. Ukhetho lokwelashwa luncike ezicini zamangqamuzana amaseli omdlavuza webele wangaphambilini, ukwelashwa komdlavuza webele owedlule, isimo somtholampilo sesiguli nokuthi umdlavuza usabalale kuphi. 

Uma umdlavuza webele ususabalele emathanjeni, khona-ke kanye nokwelashwa kwe-endocrine, chemotherapy noma ukwelashwa okuhlosiwe, isiguli sibuye siphathwe ngama-ejenti wokuguqula amathambo njenge-bisphosphonates. Lokhu kusiza ngokunakekelwa okunciphisayo kepha akubonisanga ukuthuthukisa ukusinda okuphelele.  

Uma umdlavuza webele we-hormone omuhle usudlulele esigabeni se-metastatic isigaba IV, iziguli ziphathwa ngokwelashwa okwandisiwe kwe-endocrine ngama-ejenti alinganisa noma avimbela ama-estrogen receptors, noma avimbela ukukhiqizwa kwe-estrogen emzimbeni. Ukwelashwa kwe-endocrine, uma kungasebenzi, kusetshenziswa kuhlanganiswa nezinye izidakamizwa ze-chemotherapy noma izidakamizwa eziqondisiwe ezifana ne-cell cycle kinase inhibitors noma izidakamizwa ezibhekise izindawo ezithile zokutshengisa zangaphakathi, ngokuya ngezici zamangqamuzana nezomdlavuza.

Ukuze uthole i-hormone negative, i-HER2 positive, umdlavuza webele we-metastatic, inketho yokwelashwa esemqoka yimithi elwa namagciwane i-HER2 noma ama-molecule ama-inhibitors amancane. Lokhu kuhlanganiswe nezinye izidakamizwa zamakhemikhali.

Kodwa-ke, kumdlavuza we-TNBC we-metastatic onesibikezelo esibi kakhulu, azikho izinketho zokwelashwa ezichaziwe. Kususelwa ebukhoneni bokunye ukuguqulwa okuyinhloko kule nhlobo encane yomdlavuza. Uma kunomdlavuza we-BRCA mutant, uphathwa ngama-poly-ADP ribose (PARP) inhibitors. Uma lawa mdlavuza enezindawo zokuhlola izivikeli mzimba, angalashwa ngemithi yokuvikela amasosha omzimba njengama-immune checkpoint inhibitors. Okunye, lezi ziguli ziphathwa ngezindlela ezinolaka kakhulu zamakhemikhali njengezidakamizwa ze-platinum (i-Cisplatin, i-Carboplatin), i-adriamycin (i-Doxorubicin), izidakamizwa zetekisi (i-Paclitaxel), i-topoisomerase inhibitors (i-Irinotecan, i-Etoposide) kanye nezimvume ezahlukahlukene nezinhlanganisela zazo, ukulawula ukubhebhetheka kwalesi sifo. Inhlanganisela yamakhemikhali asetshenziselwa ukwelashwa komdlavuza webele we-metastatic nokho inobuthi obukhulu kakhulu futhi inomthelela omubi kakhulu kwikhwalithi yempilo yeziguli.

Isidingo Sezincomo Zomuntu Uqobo Ezenzelwe Iziguli Ezinomdlavuza

Ukuxilongwa komdlavuza kukodwa kungumcimbi oguqula impilo ohlotshaniswa nokukhathazeka kohambo lokwelashwa oluzayo nokwesaba ukungaqiniseki komphumela. Ngemuva kokutholakala ukuthi zinomdlavuza, iziguli zikhuthazekile ukwenza ushintsho endleleni yokuphila ezikholelwa ukuthi zizothuthukisa impilo yazo nokuphila kwazo, zinciphise ingozi yokuphindeka, futhi banciphise imiphumela engemihle yokwelashwa ngamakhemikhali abo. Imvamisa, baqala ukusebenzisa izithasiselo zokudla ngokungahleliwe, kanye nemithi yabo yokwelapha ngamakhemikhali, ukusiza ukunciphisa imiphumela emibi kakhulu nokwenza ngcono impilo yabo nokuphila kwabo. Kunemibiko ye-67-87% yeziguli ezinomdlavuza ezisebenzisa izithako zokudla ngemuva kokuxilongwa. (UVelicer CM et al, J Clin. I-Oncol., 2008)  

Kodwa-ke, izincomo zokudla okunempilo nezokudla kweziguli ezinomdlavuza namuhla azenziwe ngezifiso. Ngaphandle kwentuthuko yama-genomics, i-metabolomics, ama-proteomics athuthukise ukuqonda kwethu ngezimpawu zomdlavuza futhi yanika amandla izindlela zokwelashwa ezinemba, ukuqondiswa kokudla okunomsoco uma kukhona okujwayelekile kakhulu. Umhlahlandlela wokudla okunempilo awususelwe ohlotsheni oluthile lomdlavuza nezici zofuzo zomdlavuza, noma uhlobo lokwelashwa olunikezwa isiguli. Imihlahlandlela ejwayelekile yokudla / yokudla njengoba kunconywe yi-American Cancer Society ifaka: 

• Ukugcina isisindo esinempilo; 
• Ukwamukela indlela yokuphila esebenzayo; 
• Ukusebenzisa ukudla okunempilo ngokugcizelela emithonjeni yezitshalo; futhi 
• Ukunciphisa ukusetshenziswa kotshwala. 

Izinketho zokwelashwa komdlavuza ohlukile zisekelwe ebufakazini futhi zinconywe imihlahlandlela ehlukene yomphakathi womdlavuza njengeNational Comprehensive Cancer Network (NCCN) noma i-American Cancer Society (ACS). Ubufakazi obutholwe izidakamizwa bususelwa ezivivinyweni ezinkulu zomtholampilo ezenziwa ngokungahleliwe (RCTs). Imithi eminingi ibhekiswe kuzici ezithile zomdlavuza zomdlavuza. Ngaphandle kwalokho, kumdlavuza omningi othuthukile onjenge-metastatic TNBC, azikho iziqondiso ezijwayelekile kanye nemithi yokwelashwa eyaziwa ukuthi iyasebenza. Ukwelashwa kwale subtype kusasuselwa kuzindlela zesilingo nephutha.  

Kodwa-ke, abukho ubufakazi obunjalo obususelwa kuzincomo zomuntu siqu zokudla / izincomo zokudla. Kunobuncane bama-RCT wokukhiqiza ubufakazi bokuthuthukisa izincomo zokondleka kanye nemihlahlandlela yokudla ukugcwalisa izinhlobo ezahlukene zomdlavuza kanye nokwelashwa. Leli yigebe elikhulu esinalo njengamanje ekunakekelweni kwethu ngumdlavuza namuhla. Ngaphandle kokwazi okwandayo kokusebenzisana kwezakhi zofuzo, ubunzima bezenzo zomsoco nokusebenzisana kunzima ukubhekana ngokwanele nganoma iyiphi idizayini eyodwa yocwaningo lwe-RCT. (UBlumberg J et al, Umsoco. UMfu, 2010)  

Ngenxa yalo mkhawulo, izinga lobufakazi bokwesekwa komsoco kanye nokuzethemba ekuchazeni izidingo zokudla/ukudla kweziguli ezinomdlavuza lizohlala lihlukile kulokho okudingekayo ekuhlolweni kwezidakamizwa. Ukwengeza, isiqondiso sokudla okunomsoco/ukudla okungafani nokwelashwa kwezidakamizwa kungokwemvelo, kuphephile futhi kuhlotshaniswa nemiphumela engemihle ephansi ukuya kwemincane ezimweni eziningi. Nokho, ukwenza kube ngokwakho izincomo zokudla okunomsoco kumongo othize we umdlavuza uhlobo nokwelashwa okusekelwe ekugqagqeni kwendlela yesayensi kanye nesizathu esisekelwa idatha yokuhlola, nakuba ingafani nobufakazi obusekelwe ku-RCT, inganikeza isiqondiso esingcono ezigulini futhi ithuthukise ukunakekelwa komdlavuza okudidiyelwe.

Njengoba kune-heterogeneity ngisho nasemdlavuzeni nasekwelapheni ama-metastatic malignant neoplasms ohlobo olufanayo lwezicubu, izincomo zokudla okunempilo njengengxenye yokunakekelwa komdlavuza wokuhlanganisa nazo zizodinga ukwenziwa zibe ngezakho. Ukudla okunesondlo okulungile futhi okubaluleke kakhulu ukudla okufanele kukugwebe ezimweni ezithile nangesikhathi sokwelashwa kungasiza ekuthuthukiseni imiphumela.

Izinzuzo Zokudla Okusezingeni Elifanele / Ukudla (Ukudla Nezithasiselo) zeMetastatic Breast Cancer

Njengoba izici zesifo nokwelashwa komdlavuza webele we-metastatic kuhlukahluka kakhulu kususelwa kusiqalo esiyinhloko sesifo, izidingo zokudla okunomsoco / ukudla (ukudla kanye nezengezo) nakho ngeke kube usayizi owodwa olingana konke. Kuzoya ngezici zofuzo zomdlavuza webele we-metastatic kanye nohlobo lokwelashwa olutholwayo. Ngakho-ke izici zofuzo zalesi sifo, ezinye izici ezibalulekile zeziguli ngazinye ngokwesimo somzimba wazo (BMI) ukuhlola amazinga okukhuluphala, izinto zokuphila njengokuvivinya umzimba, ukuphuza utshwala njll. umsoco ongaxhasa futhi osebenze ekuphazamiseni umdlavuza kuzo zonke izigaba zesifo.  

Ukubaluleka kokuhlinzeka ngokuqondiswa kokudla okunomsoco / kokudla okwenzelwe umdlavuza othize kanye nokwelashwa, kweziguli ezine-metastatic breast neoplasms ebulalayo kunganikeza izinzuzo ezilandelayo: (UWallace TC et al, J. wase-Amer. I-Coll. Kwezomsoco., 2019)

1. Thuthukisa amandla nokuzivikela kwesiguli ngaphandle kokuphazamisa ukusebenza kahle kokwelashwa.
2. Siza ngokunciphisa imiphumela emibi yezokwelapha.
3. Siza ekwenzeni ngcono ukusebenza okuqhubekayo kokwelashwa ngokukhetha ukudla nezithasiselo ezingavumelana nendlela yokwenza ukwelashwa okuqhubekayo ngokuguqula izindlela ezifanele, noma ukuvimbela izindlela ezingamelana nokuphikiswa.
4. Gwema ukudla nezithasiselo ezingaphazamisa ukwelashwa okuqhubekayo ngokuhlangana kwezidakamizwa ezinomsoco ezinganciphisa ukusebenza noma zenyuse ubuthi bokwelashwa.

Izibonelo Zokudla Okufanele Umuntu / Ukudla (Ukudla Nezithasiselo) zeMetastatic Breast Cancer

Izincomo zokudla / okunomsoco (ukudla nezithasiselo) zeziguli ezinomdlavuza we-metastatic positive eziqhubeka nokwelashwa okwandisiwe kwe-endocrine njengeTamoxifen kuzohluka kakhulu kwezinye iziguli ezinomdlavuza webele we-metastatic.  

Izibonelo Zokudla / Izithasiselo Okufanele Uzigweme uma ukwelashwa ngama-Estrogen Modulators

Ezigulini ezikuma-modulators e-estrogen, ezinye izibonelo zokudla nezengezo ezizodinga ukukugwema ezingaphazamisa ukwelashwa kwazo kwe-endocrine kanye nomqondo wesayensi kushiwo ngezansi:  

Curcumin 

Curcumin, isithako esisebenzayo esivela ku-curry spice turmeric, siyisengezo semvelo esidumile phakathi kweziguli zomdlavuza nabasindile ngenxa yaso elwa nomdlavuza nezakhiwo ezilwa nokuvuvukala. Ngakho-ke, amathuba eziguli zomdlavuza webele ezithatha iCurcumin ngenkathi ekwelashweni kweTamoxifen ephezulu. 

Isidakamizwa somlomo i-Tamoxifen sihlanganiswa emzimbeni sibe yimetabolites yayo esebenzayo ekhemisi ngokusebenzisa ama-enzyme e-cytochrome P450 esibindi. I-Endoxifen yi-metabolite esebenzayo yomtholampilo ye-Tamoxifen, okungumlamuleli oyinhloko wokusebenza kokwelapha kwe-tamoxifen (UDel Re M et al, Pharmacol Res., 2016). Ucwaningo lomtholampilo olusanda kushicilelwa (i-EudraCT 2016-004008-71 / NTR6149) oluvela e-Erasmus MC Cancer Institute eNetherlands, lukhombise ukuxhumana okungekuhle phakathi kweCurcumin neTamoxifen ezigulini zomdlavuza webele (IHussaarts KGAM et al, Cancers (Basel), 2019). Imiphumela ikhombise ukuthi ukugxilwa kwe-metabolite esebenzayo i-Endoxifen kwehle ngendlela ephawuleka ngokwezibalo lapho iTamoxifen ithathwa kanye nesengezo seCurcumin.  

Izifundo ezinjengalezi azikwazi ukushaywa indiva, nakuba ngenani elincane lesifuba umdlavuza iziguli, futhi unikeze isexwayiso kwabesifazane abasebenzisa i-tamoxifen ukuthi bakhethe izithasiselo zemvelo abazithatha ngokucophelela, ezingaphazamisi ukusebenza komuthi womdlavuza nganoma iyiphi indlela. Ngokusekelwe kulobu bufakazi, i-Curcumin ayibonakali iyisengezo esifanele okufanele sithathwe kanye ne-Tamoxifen. Nokho, lokhu akusho ukuthi i-curcumin njengesinongo nesinongo kuma-curries idinga ukugwenywa ngokuphelele.

I-DIM (diindolylmethane) Supplement  

Esinye isengezo esivamile futhi esisetshenziswa kabanzi phakathi kweziguli ezinomdlavuza webele yi-DIM (diindolylmethane), i-metabolite ye-I3C (Indole-3-carbinol), etholakala imifino cruciferous njenge-broccoli, ukholifulawa, i-kale, iklabishi, amahlumela we-brussel. Lokhu kuduma kwe-DIM kungasuselwa ezifundweni zokwelashwa ezibonise ukuthi ukusetshenziswa okuphezulu kakhulu kwemifino ye-cruciferous ekudleni / ekudleni okunomsoco kuhlotshaniswa kakhulu nengozi ephansi engu-15% yomdlavuza webele. (U-Liu X et al, Isifuba, 2013Kodwa-ke, isifundo somtholampilo esilawulwa ngokungahleliwe, esiyimpumputhe, esilawulwa yi-placebo esivivinye ukusetshenziswa kwe- Isengezo se-DIM kanye neTamoxifen ezigulini zomdlavuza webele, kukhombise ukuthambekela okwethusayo kokuncishiswa kwe-tamoxifen esebenzayo kwe-metabolite, ngaleyo ndlela kube namandla okunciphisa ukusebenza kwe-endocrine therapy. (NCT01391689) (I-Thomson CA, Res yomdlavuza webele. Phatha., 2017).

Njengoba idatha yomtholampilo ikhombisa ukuthambekela kokusebenzisana phakathi kwe-DIM ne-tamoxifen, iziguli zomdlavuza webele ngenkathi zilashwa nge-tamoxifen kufanele zihambisane nokuqapha futhi zigweme ukuthatha isengezo se-DIM. Ukudla okususelwa ekudleni okunotshiswa imifino ye-cruciferous kungahlinzeka ngenzuzo edingekayo ngokuthatha isengezo se-DIM kulo mongo.

Ukudla Okunenzuzo Nokuncanyelwayo Komdlavuza Webele We-Metastatic

Kunokudla okuningi nezithasiselo ezihambisana nemiphumela yokuthuthuka yeziguli ezinomdlavuza webele we-metastatic. Ukuhlaziywa kwe-meta kokucwaninga okuningana okuzoba khona kanye nama-RCT asanda kushicilelwa ngabaphenyi abavela e-Institut Curie eFrance kubike ukuthi ukudla okunamafutha amancane kuhlotshaniswa nokusinda okungcono. Futhi, ukudla obekunothile ama-phytoestrogens kusuka izithelo nemifino, kwehlise ubungozi bokuphindeka komdlavuza. Futhi, ukudla okunempilo nokudla okutshalwe ezitshalweni kuhlotshaniswa nokwenziwa ngcono kokuphila okuphelele kanye nengozi yokufa. (UMaumy L et al, Umdlavuza weBull, 2020)

Ucwaningo olushicilelwe ekuqaleni konyaka luvavanye umthelela wokudla / okunomsoco we-ketogenic ekusindeni kweziguli ezinomdlavuza webele. Bathola ukuthi ukudla okune-ketogenic kanye nokwelashwa ngamakhemikhali okuqhubekayo kuthuthukise ukusinda okuphelele ngaphandle kwemiphumela emibi ezigulini. (Khodabakhshi A, Nutr. Umdlavuza, 2020) Ukudla okune-ketogenic kungukudla okune-carbohydrate eyedlulele okuhlose ukukhuthaza ukwakheka komzimba kwamafutha emizimbeni ye-ketone (kune-carbohydrate ibe yi-glucose) ukuhlinzeka ngomthombo oyinhloko wamandla emzimbeni. Amaseli ajwayelekile emzimbeni wethu angashintshela ekusebenziseni imizimba ye-ketone ukuthola amandla, kepha amangqamuzana omdlavuza awakwazi ukusebenzisa ngempumelelo imizimba ye-ketone ukuthola amandla ngenxa yemetabolism engavamile. Lokhu kwenza amangqamuzana e-tumor abe sengozini kakhulu futhi ngaphezu kwalokho, imizimba ye-ketone inciphisa i-tumor angiogenesis nokuvuvukala ngenkathi kuthuthukisa ukufa kweseli le-tumor. (UWallace TC et al, J. wase-Amer. I-Coll. Kwezomsoco., 2019)

Njengoba izinhloso zokwelashwa ezithile kufanele zifinyelelwe ngokususelwa kuzici zomdlavuza nohlobo lokwelashwa, ukunemba nokudla okwenziwe ngezifiso kufanele kusekelwe ekudleni ngakunye nakwizithasiselo ngezindlela ezisungulwe kahle zesenzo ezingeni lamangqamuzana ngokuya ngomthelela wazo kuzakhi zofuzo futhi izindlela. (I-Reglero C no-Reglero G, ama-Nutrients, 2019)

 Isibonelo, enye indlela yokuvimbela i-metastasis yomdlavuza ukuvimba i-angiogenesis, ukuhluma kwemithambo yegazi emisha, nayo engavimbela ukumelana namakhemikhali. Kukhona ukudla nezithasiselo nge-bioactive silibinin, efana ne-artichoke ne- Thistle ubisi, okukhonjiswe ngokwesayensi ukuvimbela i-angiogenesis. Izincomo zomuntu siqu zokudla / kokudla kwalokhu kudla / izithasiselo kulo mongo womdlavuza webele we-metastatic owenziwa ngamakhemikhali, kungasiza ekwenzeni ngcono ukwelashwa futhi kuvimbele ukuphindeka. (UBinienda A, et al, Ama-Anticancer Agents Med Chem, 2019)

Ngokufanayo, ezinye izici ezibalulekile zomdlavuza nokwelashwa kungahlaziywa ukuthola ukudla okulungile ngokwesayensi kanye nezithasiselo zokwakheka kokudla okwenzelwe wena kweziguli ezinomdlavuza ukufanisa uhlobo lomdlavuza wazo njengomdlavuza webele we-metastatic nokwelashwa.

Isiphetho

Njengoba izincomo zokwelashwa ziqhubekela ekwenziweni komuntu siqu okusekelwe ku-cancer genomics kanye nezici zomdlavuza wamangqamuzana esiguli ngasinye, ukunakekelwa komdlavuza odidiyelwe nakho kudinga ukuqhubekela ekondlekeni/ukudla okusekelayo okusekelwe esiteji kanye nohlobo umdlavuza kanye nokwelashwa. Lena indawo engakasetshenziswa kakhulu engasiza kakhulu ekwenzeni ngcono imiphumela kanye nezinga lempilo yeziguli ezinomdlavuza webele we-metastatic. Uma unempilo enhle, ukudla kwemvelo nezithako akulimazi. Kodwa, lapho umongo ungumdlavuza lapho umzimba usuvele ubhekene nokuphazamiseka kwangaphakathi kwe-metabolism kanye nokuzivikela komzimba ngenxa yesifo kanye nokwelashwa okuqhubekayo, ngisho nokudla kwemvelo, uma ayikhethiwe kahle, unamandla okulimaza. Ngakho-ke, ukondla okwenzelwe wena okususelwa kunkomba yomdlavuza (njengomdlavuza webele) nohlobo lokwelashwa kungasekela imiphumela eyenziwe ngcono nokuba sesimeni kwesiguli.

Ukudla okudlayo nokuthi yikuphi okunezelayo okwenzayo yisinqumo osithathayo. Isinqumo sakho kufanele sifake ukucutshungulwa kwezakhi zofuzo zomdlavuza, okuwumdlavuza, ukwelashwa okuqhubekayo kanye nezithasiselo, noma yikuphi ukungezwani komzimba, imininingwane yokuphila, isisindo, ubude nemikhuba.

Ukuhlelela okunomsoco komdlavuza kusuka ku-addon akususelwa ekusesheni kwe-inthanethi. Kwenzela wena ukuthathela izinqumo ngokuya ngesayensi yamangqamuzana eyenziwe ososayensi bethu nonjiniyela be-software. Kungakhathalekile ukuthi ngabe uyakukhathalela ukuqonda okuyisisekelo kwamakhemikhali amakhemikhali noma cha - wokuhlelela umsoco ukuhlela lokho kudinga ukuqonda.

Qalisa MANJE ngokuhlela kwakho okunomsoco ngokuphendula imibuzo egameni lomdlavuza, ukuguquka kwezakhi zofuzo, ukwelashwa okuqhubekayo kanye nezithasiselo, noma yikuphi ukungezwani komzimba, imikhuba, indlela yokuphila, iqembu lobudala nobulili.

Iziguli ezinomdlavuza ngokuvamile kufanele zibhekane nokuhlukile imiphumela emibi ye-chemotherapy okuthinta ikhwalithi yempilo yabo futhi babheke ezinye izindlela zokwelapha umdlavuza. Ukuthatha ukudla okunomsoco nezithasiselo ezisuselwa ekucabangeni kwesayensi (ukugwema ukuqagela nokukhetha okungahleliwe) yikhambi elingcono kakhulu lemvelo lomdlavuza nokwelashwa okuhlobene side-effectts.

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