Editing Patient Pathways: Lymphoma

<span id="lymphoma"></span>
= Lymphoma =

Lymphoma is the most common blood cancer and the third most common cancer in children. Millions of people worldwide are currently living with lymphoma, but many people are still unaware of lymphoma and that it is a life-threatening form of cancer.

Lymphoma is a cancer of lymphocytes, white blood cells that help fight infection, and occurs when abnormal lymphocytes grow uncontrollably and collect in lymph nodes or other parts of the body. Lymphocytes are found in a fluid called lymph, which travels through our bodies in the lymphatic system.

The lymphatic system is a network of vessels, nodes, and organs such as the spleen and thymus that are part of our immune system. Lymphocytes often gather in lymph nodes - most commonly in the armpits, neck, or groin - to fight infection, but can also be found in almost any part of the body.

There are two main types of lymphoma: Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL), with NHL being by far the most common. This categorization is based on the name of the physician, Dr. Thomas Hodgkin, who first described what was then termed Hodgkin’s disease in the early nineteenth century.

Lymphomas can affect the lymph nodes, spleen, bone marrow and other parts of the body. Given the diversity and complexity of different subtypes, it is important for people diagnosed with lymphoma to know and understand their specific subtype, including its low- or high-grade.

Knowing the specific subtype helps people better understand their disease (including its diagnosis, prognosis and treatment plan) and access tailored information and support.

'''Subtypes of lymphoma'''

There are more than 80 subtypes of lymphoma, with different diagnostic assessments, different treatment protocols and different outcomes. It is very important that a lymphoma specialist (hematologist) diagnoses the correct subtype of lymphoma. This ensures that patients receive the right treatment at the right time for the right subtype.

According to the latest data, the prevalence of lymphoma in Croatia is constantly increasing. Non-Hodgkin lymphoma is much more common, while Hodgkin lymphoma accounts for a smaller percentage of cases. The exact number of patients varies, but several hundred new cases of lymphoma are diagnosed in Croatia each year.

<span id="patient-pathways"></span>
= Patient Pathways =

Developing a comprehensive lymphoma treatment plan involves steps from initial presentation and diagnosis to treatment and follow-up. Below is a detailed plan:

<span id="diagnostic"></span>
== 1. Diagnostic ==

The patient presents with symptoms of frequent infections, chills, fever or shivering, fatigue, weakness and malaise, loss of appetite, swollen lymph nodes, and bone pain.

Consultation with a General Practitioner (GP): The patient visits their GP.

Medical history and physical examination: Detailed medical history of the patient.

Initial tests: pelvic exam, pap smear, HPV testing

'''Referral to a specialist'''

Referral to a radiologist and oncologist

'''Diagnostic evaluation'''

* Physical examination
* Blood tests
* Lymph node biopsy
* Imaging studies (CT, PET/CT)
* Computed tomography (CT)
* Magnetic resonance imaging (MRI)
* Positron emission tomography (PET)
* Bone marrow biopsy
* Lumbar puncture

<span id="treatment"></span>
== 2. Treatment ==

'''Multidisciplinary Team (MDT) Meeting'''

'''MDT discussion:''' Review of diagnostic findings with specialists including endocrinologists, surgeons, oncologists, radiologists and pathologists. '''Treatment plan development:''' Based on the stage of lymphoma and the patient’s overall health.

'''Treatment options'''

* Chemotherapy
* Radiotherapy
* Immunotherapy
* Targeted therapy
* Stem cell transplantation

<span id="after-treatment-follow-up-rehabilitation-and-survivorship"></span>
== 3. After treatment: follow-up, rehabilitation and survivorship ==

'''Follow-up'''

'''Follow-up Examinations and Tests'''

'''Regular Checkups:''' After treatment, patients will have regular checkups to monitor their response to treatment and to detect any possible recurrence or side effects.

'''Laboratory Tests:''' Regular blood tests to monitor blood counts, liver and kidney function, and other relevant markers.

'''Imaging Tests:''' Use of CT scans, PET scans, or MRI to monitor the status of lymphoma and to detect potential recurrence or complications.

'''Side Effect Monitoring'''

'''Long-term Side Effects:''' Addressing potential long-term side effects of treatment, such as cardiovascular disease, lung problems, or neurological problems.

'''Plan Adjustments:''' Adjusting treatment plans or therapies to manage side effects and maintain quality of life.

'''Psychological Assessment'''

'''Mental Health:''' Regular assessment of mental health, including anxiety and depression, and providing necessary psychological support.

'''Rehabilitation'''

'''Physical Rehabilitation'''

'''Exercise and Therapy:''' Customized exercise programs to improve physical strength, flexibility and functional capacity, including physical therapy if needed.

'''Fatigue Management:''' Strategies to manage fatigue and improve energy levels.

'''Nutritional Support'''

'''Nutrition Planning:''' Counseling on a balanced diet that can aid in recovery and improve overall health.

'''Weight Monitoring:''' Regularly monitoring weight and nutritional needs, especially if appetite or digestive problems are present.

'''Rehabilitation of Social Functioning'''

'''Return-to-Work Support:''' Assistance in returning to work or modifying the work environment as needed.

'''Social Integration:''' Activities to help integrate into the community and rebuild social contacts.

'''Organ Function Monitoring'''

'''Health Services'''

'''Ongoing Medical Care:''' Ensuring ongoing medical care to monitor and treat any new or residual health problems.

'''Survivorship'''

'''Monitoring long-term outcomes'''

'''Health Monitoring:''' Long-term follow-up for early detection and treatment of any problems that may arise after completion of primary treatment.

'''Preventive Measures:''' Implementing preventive measures to reduce the risk of other diseases or complications related to treatment.

'''Support for Survivors'''

'''Support Groups:''' Participating in support groups for survivors to share experiences and receive emotional support.

'''Counseling and Education:''' Education on the long-term effects of treatment and available support resources.

'''Adjusting to a New Life'''

'''Mental and Emotional Adjustment:''' Working on emotional adjustment to life after treatment, including working on self-confidence and a positive self-image.

'''Improving Quality of Life:''' Focusing on improving quality of life through activities that bring satisfaction and meaning.

'''Monitoring the risk of recurrence'''

'''Regular Checkups:''' Scheduling regular checkups and tests to detect possible recurrence early.

'''Risk Management:''' Developing strategies to manage the risk of recurrence.

<span id="palliative-care-if-applicable"></span>
== 4. Palliative Care (if applicable) ==

'''Palliative treatments:''' To relieve symptoms and improve quality of life in advanced cancer.

'''Pain management:''' Medications, nerve blocks.

'''Symptom control:''' Management of shortness of breath, pain, etc.

'''Hospice care:''' For end-of-life care if curative treatment is no longer an option. Skin and mucous membrane care.

<span id="challenges-faced-by-lymphoma-patients-during-their-treatment-journey"></span>
= Challenges faced by lymphoma patients during their treatment journey =

<span id="challenges-during-diagnostic-evaluation"></span>
== Challenges during diagnostic evaluation ==

A cancer diagnosis can be a stressful and challenging time for patients. Support during this phase can significantly improve a patient’s emotional and physical well-being. Cancer patients face a variety of challenges during diagnosis, including physical, psychological, financial and professional challenges, and lack of information.

'''Physical Challenges'''

Symptoms of the disease that can cause discomfort and anxiety, problems with urination

'''Psychological Challenges'''

'''Fear of a cancer diagnosis, uncertainty about treatment:''' fear of possible complications and side effects of treatment.

The process of emotionally coming to terms with a cancer diagnosis can be very stressful and challenging. The patient needs emotional support, which puts pressure on family and friends to provide support.

'''Social isolation:''' Feeling isolated due to illness and the need for privacy.

'''Financial and professional challenges'''

'''Absence from work:''' Frequent medical checkups and treatments can cause absence from work, which can affect career and financial stability. Costs of diagnosis and treatment, insufficient health insurance.

'''Lack of information'''

Patients often have difficulty finding reliable and understandable information about their illness, diagnostic procedures, treatment options, and their rights.

'''Insufficiently clear communication with physicians:''' The complexity of medical terminology and lack of time during consultations can make it difficult to fully understand the diagnosis and treatment options.

<span id="challenges-during-treatment"></span>
== Challenges during treatment ==

'''Physical challenges'''

'''Lack of energy:''' Constant fatigue and exhaustion due to treatment and hormonal imbalances.

'''Eating problems:''' Difficulty eating due to nausea, loss of appetite or difficulty swallowing. Weight changes: weight gain or loss due to hormonal changes.

'''Hair loss (alopecia):''' Chemotherapy can cause temporary hair loss.

'''Anemia:''' A decrease in red blood cell count, which can cause fatigue and weakness.

'''Infections:''' A decrease in white blood cell count increases the risk of infection.

'''Scars:''' Aesthetic and functional consequences of surgical incisions.

'''Skin reactions:''' Rash, itching, and dry skin.

'''Psychological challenges'''

'''Fear and anxiety:''' Fear of illness, treatment, side effects and uncertainty of outcome, anxiety related to regular checkups and fear of recurrence.

'''Depression:''' Feelings of hopelessness, loss of interest in daily activities, isolation.

'''Changes in body image:''' Discomfort due to physical changes, such as scarring or weight changes.

'''Stress from treatment:''' Psychological stress from intensive treatments and their impact on daily life.

'''Relationship with a partner:''' Sexual problems, decreased libido, and emotional distance due to illness.

'''Family Relationships:''' Tensions within the family due to stress, changes in roles and responsibilities.

'''Social Isolation:''' Withdrawal from social activities due to fatigue, discomfort, or fear of contracting infections during therapy.

'''Financial and professional challenges'''

Reduced ability to work due to fatigue, treatment side effects and emotional problems.

'''Absences from work:''' Frequent medical appointments and treatments requiring time off from work, which can affect career and financial stability.

High costs of medications, surgeries, therapies and other medical services, travel and accommodation costs for patients who have to travel to healthcare centers.

Reduced income due to reduced work capacity or job loss.

Ongoing costs associated with long-term follow-up and health maintenance.

'''Lack of information'''

Need to understand complex medical information and make informed decisions. Difficulties in making treatment decisions due to lack of reliable and understandable information or conflicting advice.

Unawareness of patient rights.

Lack of information about healthcare providers during treatment.

<span id="challenges-during-rehabilitation-and-disease-monitoring"></span>
== Challenges during rehabilitation and disease monitoring ==

'''Physical challenges'''

'''Chronic fatigue:''' A feeling of exhaustion that lasts for weeks or months after treatment ends.

'''Muscle weakness:''' Decreased muscle strength due to physical inactivity during treatment.

'''Postoperative pain:''' Pain that persists after surgery.

'''Chronic pain:''' Pain that occurs due to nerve or other tissue damage during treatment.

'''Insomnia:''' Difficulty sleeping, which can be a result of stress, pain, or side effects of treatment.

'''Nightmares and anxiety:''' Problems with emotional stress that affect sleep quality.

'''Psychological challenges'''

'''Fear of recurrence:''' Continuous fear of cancer recurrence. Anxiety and depression: psychological stress and emotional problems associated with the cancer experience.

'''Social isolation:''' Reduced social interaction due to fatigue, anxiety, or other symptoms.

'''Financial and professional challenges'''

'''Returning to work:''' Difficulties returning to work due to physical and emotional limitations.

Long-term financial burden associated with ongoing medical expenses.

<span id="challenges-during-palliative-care"></span>
== Challenges during palliative care ==

Challenges faced by lymphoma patients in Croatia and their families during palliative care are multifaceted and encompass several key aspects:

'''Limited access to palliative care:''' There is a significant gap between the need for palliative care and available resources.

Insufficient capacity of specialized palliative care providers.

'''Psychological challenges'''

The psychosocial and emotional burden on patients and their families is often heavy. Family caregivers often experience high levels of stress and emotional burden. Cultural and ethical issues: reluctance to discuss end-of-life issues can interfere with the provision of effective palliative care.

Ethical challenges in decision-making and care provision can also create additional stress for families and healthcare professionals.

'''Financial challenges'''

The cost of care can be a significant burden on families, especially when considering the long-term nature of palliative care. Economic pressures can further exacerbate the stress experienced by patients and their families, impacting their overall well-being and quality of life.

'''Challenges with care coordination:''' Effective palliative care requires coordination between different healthcare providers. In Croatia, there are challenges related to care coordination between hospitals, palliative care units, and home care services. Addressing these challenges requires a comprehensive approach that includes improving access to palliative care, providing emotional and psychological support to families, addressing the economic burden, and ensuring effective care coordination. In addition, public education and awareness raising about the benefits of palliative care can help reduce cultural and ethical barriers.

<span id="challenges-patients-face-after-completing-lymphoma-treatment"></span>
== Challenges patients face after completing lymphoma treatment ==

'''Physical challenges'''

After completing treatment, survivors may experience long-term side effects, such as skin problems, cardiovascular problems, and urinary tract problems.

'''Psychological challenges'''

Cancer survivors often experience anxiety and fear of cancer recurrence, which can affect their emotional well-being. They may also face difficulties adjusting after treatment, including changes in daily routines and life plans. The role of family members as caregivers often changes after treatment ends. Their support remains crucial, but may need to be adapted to new circumstances and reduced intensity of care.

'''Lifestyle and prevention:''' Patients are encouraged to adopt healthy lifestyle habits, such as regular exercise, a healthy diet, not smoking and stress management, to improve their quality of life and reduce their risk of recurrence.

'''Financial and professional challenges'''

'''Returning to work:''' Many survivors face challenges returning to work, including fatigue, reduced energy, and physical limitations after treatment.

They need support in adapting to the work environment and managing employer expectations. Employers are often unaware of how to provide support to cancer survivors returning to work.

'''Healthcare coordination'''

'''Regular checkups:''' It is important to continue with regular checkups to monitor for cancer recurrence or treatment side effects. This includes blood tests and imaging scans, such as ultrasound, depending on the risk of recurrence.

Lymphoma patients face a variety of challenges throughout their diagnostic, treatment, and rehabilitation journey, including physical, psychological, financial, and professional challenges, as well as a lack of information and coordination of care. Providing comprehensive support, including medical care, psychological support, education and social services, can significantly improve the quality of life and treatment outcomes for these patients.

<span id="supportive-activities-for-lymphoma-patients"></span>
= Supportive activities for lymphoma patients =

A coordinated multidisciplinary approach to providing supportive care within healthcare settings is essential to help patients throughout their treatment journey. Such an approach significantly improves the quality of life of patients with one of these cancers, helping them to better cope with the challenges that the disease and treatment bring.

Civil society organizations, such as patient associations and cancer advocacy groups, can play a key role in informing patients about such supportive activities. In addition, organizations themselves, with the help of experts, can organize and provide some of the necessary support to patients in order to reduce physical, psychological, financial and professional challenges, lack of verified and understandable information and strengthen the coordination of health care, not only within the health care system but also through activities aimed at actively involving patients in the development of better national health guidelines and policies.

<span id="supportive-activities-provided-by-healthcare-institutions"></span>
== Supportive activities provided by healthcare institutions ==

'''Supportive activities for physical challenges'''

Supportive care for lymphoma patients within the healthcare system encompasses a wide range of services aimed at improving patients’ overall quality of life. In addition to medical care that includes regular monitoring through blood tests, ultrasound, MRI or CT scans, and follow-up with specialist physicians, for optimal management of physical ailments, patients should have access to a multidisciplinary team of professionals.

'''General practitioner:''' Takes care of daily health needs during and after treatment

'''Oncologist:''' Overall management of treatment

'''Dietitian:''' Nutrition counseling and weight management

'''Physiotherapist:''' Pain management and mobility improvement

'''Psychologist:''' Helps with emotional issues

'''Oncology nurses:''' They care for you before, during, and after treatment, provide information about your daily treatment plan, and teach you how to use aids.

'''Supportive activities for psychological challenges'''

Cancer patients and their families almost inevitably face numerous psychological challenges throughout their treatment journey. Professional psychological help in the form of individual counseling, group therapy, partner and family counseling is a crucial part of supporting cancer patients. In addition, a psychiatrist may recommend psychopharmacotherapy to support patients.

'''Supportive activities to provide reliable and understandable information'''

'''Informed consent:''' A signed form is proof that a conversation in which the doctor provides the patient with information about diagnostic and therapeutic procedures, risks, complications and alternative treatments has led to mutual understanding. Detailed but easy-to-understand educational content for patients is essential in this process but often not available.

'''The right to a second opinion''' is guaranteed by the Patient Rights Act. Patients always have the right to seek a second opinion about their health status. A second opinion must be given to the patient, upon oral or written request, by any health worker with a high level of professional qualifications and appropriate specialization who has not been involved in the direct provision of a particular type of healthcare service to the patient. In addition to the patient, the physician may also initiate the process of seeking a second opinion. In the case of diagnosis of a rare disease, inability to find (adequate) therapy, inadequate technological equipment of the health care institution that prevents or makes it difficult to establish a diagnosis or course of therapy, physicians often seek the help and confirmation of their colleagues from other institutions in order to ensure the highest quality approach to each patient.

<span id="supportive-activities-provided-by-associations"></span>
== Supportive activities provided by associations ==

'''Supportive activities for physical challenges'''

'''Support related to side effects of treatment:''' organizing workshops and educational activities that educate patients on how to manage side effects. Providing brochures and online resources with practical tips.

'''Support related to symptoms of the disease:''' Access to medical professionals for early intervention and treatment of symptoms. Organizing counseling centers where patients can receive advice from medical professionals and psychologists. Including medical advisors in support programs.

'''Support related to metabolic disorders, nutritional problems and lack of energy:''' connecting patients with nutritionists and endocrinologists through organized events and online consultations for personalized dietary plans, and collaborating with fitness and nutrition professionals to provide personalized recommendations for moderate exercise. Organizing practical workshops on proper nutrition, creating educational materials.

'''Supportive activities for psychological challenges'''

Offering free or subsidized psychological counseling, organizing support groups and telephone lines for psychological support. For depressive disorders, support in finding a psychiatrist and therapist, and association cooperation with them. Organizing support groups for talking and sharing experiences.

Organizing workshops and therapy groups that focus on body positivity and embracing change. Providing free courses in meditation, yoga, and relaxation techniques. Creating online resources and applications to support stress management. Associations can organize workshops for couples, including counseling with sexual health professionals. Organizing family therapy sessions and workshops that involve all family members in the support process. Connecting with peer groups and social activities. Organizing social events, online forums and support groups where patients can connect and share their experiences.

'''Supportive activities for financial and professional challenges'''

Advice on labor rights and job adaptation. Providing legal advice and support to talk to employers about job adjustments. Organizing workshops on workers’ rights. Connecting patients with financial advisors and organizing workshops on managing finances during treatment.

Providing information on financial assistance, organizing fundraising campaigns, and assisting with applications for financial assistance.

Connecting patients with social workers and providing free financial counseling.

'''Supportive activities to provide reliable and understandable information needed for informed participation in the treatment process'''

Understanding the disease and treatment: education and informational materials. Organizing educational seminars and workshops with medical professionals. Distribution of brochures and online resources on the disease and treatment.

'''Supportive activities on patient rights'''

Providing information about rights and social assistance options. You can find everything about patient rights at this link of the IGET association - Institute for Gastroenterological Tumors: https://iget.hr/prava-osoba-oboljelih-od-onkoloskih-bolesti/

<span id="examples-of-successful-supportive-activities-of-croatian-associations"></span>
= Examples of successful supportive activities of croatian associations =

Civil society organizations, patient associations, play a vital role in providing support to patients with endometrial, vulvar, vaginal, or cervical cancer. These groups often offer peer support systems where patients can connect with others going through similar experiences, providing a sense of community and mutual understanding. They can also organize educational workshops and seminars to inform and empower patients to be actively involved in the treatment process.

Patient associations are also active in health and social care policy by raising awareness among the public and policy makers about the needs of patients, and informing patients about their rights.

There are a large number of civil society organizations in Croatia that provide support to cancer patients. A larger number of organizations in Croatia are listed in the directory, while we highlight a few here:

'''Croatian Society for the Fight Against Cancer'''

Description: An association that offers help to people with various types of cancer, including lymphomas. They provide information, support, and resources.

Address: Pothodnik 10, 10000 Zagreb

Contact: +385 1 4616666

Website: hrvatsko-drustvo-za-borbu-protiv-raka.hr

'''Association for the help of cancer patients “We are not alone”'''

Address: Trg bana Jelačića 10, 10000 Zagreb

Contact:

Phone: +385 (0)1 46 55 466

E-mail: info@nismosame.hr

Website: www.nismosame.hr

'''Croatian Leukemia and Lymphoma Association (HULL)'''

Description: An association specializing in providing assistance and support to people with leukemia and lymphoma. They organize support, informational sessions, and events.

Address: Preradovićeva 35, 10000 Zagreb

Contact: +38514817690

Website: hull.hr

'''Association of Cancer Patients “Ruža”'''

Description: An association that helps cancer patients by providing various forms of support, including education and treatment information.

Address: Dračevac 21, 21220 Trogir

Contact: +385 91 2145 405

Website: udrugaruza.hr

'''Association “Life Energy”'''

Description: Provides help to people with various diseases, including lymphoma. They focus on patient support and organizing activities.

Address: Obala Kneza Branimira 1, 23000 Zadar

Contact: +385 23 334 174

Website: zivotnaenergija.hr

'''Croatian Association for Help and Support to Cancer Patients (HUPOR)'''

Description: Helps cancer patients through various forms of support and providing information on treatment and resources.

Address: Kolodvorska 7, 47000 Karlovac

Contact: +385 47624 761

Website: hupor.hr

'''Association for Support of Patients with Malignant Diseases “Sjena”'''

Description: An association that provides support to people with malignant diseases, including lymphomas, through various activities and information.

Address: Braće Radić 3, 21000 Split

Contact: +38521332252

Website: udrugasjena.hr

'''Association “Life with a Smile”'''

Description: Provides support to cancer patients, including lymphoma. They focus on emotional and psychological support.

Address: Donje Svetice 24, 10000 Zagreb

Contact: +385 1 2744339

Website: zivotosmisli.hr

Website: iget.hr

<span id="available-supportive-content-for-cancer-patients"></span>
= Available supportive content for cancer patients =

Croatian translation of several Patient Guides was carried out by the Association of Women with and Treated for Cancer EVERYTHING for HER based on the approval of the European Society for Medical Oncology (ESMO).

'''ESMO Patient Guide Living with Cancer'''

This Patient Guide to Living with Cancer has been produced by the European Society for Medical Oncology (ESMO) and the European Cancer Patient Coalition (ECPC) in collaboration with the International Psycho-Oncology Society (IPOS) to help you and those like you at this important time in your life. This Guide will provide you with information on coping with your new reality, life after primary treatment, preventive care and long-term follow-up. It will also help you to keep your own personal health record, i.e. plan your own health care during your life with cancer.

The guide was translated by Dea Ajduković, PhD, and the translation was reviewed by Natalija Dedić Plavetić, PhD, MD, specialist in internal oncology, and Ljiljana Vukota, psychologist, from the EVERYTHING for HER association, on behalf of the patients.

https://www.esmo.org/content/download/131276/2458900/1/ESMO-Vodic-za-Bolesnike-Zivot-s-Rakom.pdf

'''ESMO Personalised Medicine in Oncology: A Patient Guide'''

This patient guide has been initiated by the ESMO Personalised Medicine Working Group to help patients, their family members and friends better understand the factors that can influence a personalised approach to cancer prevention, diagnosis and treatment. This booklet summarises the current knowledge on the main principles of personalised medicine, illustrating its application to several cancer types. Personalised medicine represents the future of cancer treatment, and the patient’s role is crucial in making it a reality in the near future and enabling better treatment of tumours.

The Croatian translation of the Guide was made possible by the Association of Women with and Treated for Cancer EVERYTHING for HER based on the approval of the European Society for Medical Oncology (ESMO). The text of the Croatian translation was reviewed by: Prof. Ljiljana Šerman, Prof. Floriana Bulić-Jakuš and Mrs. Ljiljana Vukota.

https://www.esmo.org/content/download/385655/7486427/1/HR-Personalizirana-Medicina-u-Onkologiji-Vodic-za-Bolesnike.pdf

'''ESMO Immune-Related Side Effects and their Management: A Guide for Patients'''

This guide has been prepared to help you, your family, friends and caregivers better understand immune-related side-effects and how to manage them. It provides information about the most common toxicities associated with modern immunotherapies (known as “immune checkpoint inhibitors”), how your oncology team can manage these symptoms and some steps you can take yourself to help minimize their impact. The medical information described in this document is based on the ESMO Clinical Practice Guidelines for the management of immunotherapy toxicities, which are designed to assist clinicians in the diagnosis, treatment and follow-up of these events. All ESMO Clinical Practice Guidelines are developed and reviewed by leading experts using evidence from the latest clinical trials, scientific research and expert opinion.

The Croatian translation of the guide was reviewed by: representative of the Croatian Society for Internal Oncology: Natalija Dedić Plavetić, MD, PhD; representative of the Croatian Thoracic Society: Marko Jakopović, MD, PhD; representative of the Association of Women with and Treated for Cancer EVERYTHING for HER: Ljiljana Vukota.

'''ESMO Cancer Treatment During the COVID-19 Pandemic: A Guide for Patients'''

The guide provides information on COVID-19 disease and its symptoms, as well as measures you can take to reduce your risk of infection. In addition, the guide provides information on the impact of the COVID-19 pandemic on various aspects of cancer treatment, including possible changes to your treatment plan and medical checkups that may be needed to protect you from infection.

The Croatian translation was reviewed by: Prim. Paula Podolski, MD, PhD, President of the Croatian Senological Society, Borislav Belev, MD, PhD, medical oncologist, National representative of the Croatian Society for Internal Oncology at ESMO and Ljiljana Vukota, representative of the EVERYTHING for HER association.

http://www.svezanju.hr/lijecenje-raka-tijekom-pandemije-covid-19-esmo-vodic-za-bolesnike/

'''ESPEN practical guideline: Clinical Nutrition in cancer'''

Malnutrition is common in cancer patients and is a consequence of the presence of the tumor and medical and surgical cancer treatments.

Malnutrition negatively affects quality of life and treatment toxicity, and it is estimated that 10-20% of cancer patients die from the consequences of malnutrition, not from the tumor itself. Therefore, nutrition plays a key role in multimodal cancer treatment.

Strong evidence shows that nutritional problems should be considered from the time of cancer diagnosis, within the diagnostic and therapeutic pathway, and should be carried out in parallel with antineoplastic treatment. However, worldwide, cancer-related malnutrition remains largely unrecognized, underestimated, and undertreated in clinical practice.

These evidence-based guidelines have been developed to translate the best available evidence and expert opinion into recommendations for multidisciplinary teams responsible for identifying, preventing and treating reversible elements of malnutrition in adult cancer patients.

<span id="directory-of-associations-offering-supportive-activities-to-cancer-patients"></span>
= Directory of associations offering supportive activities to cancer patients =

<span id="zagreb"></span>
== Zagreb ==

'''Croatian League Against Cancer'''

Offer: Psychological support, support groups, education, financial aid.

Contact:

Address: Ilica 197, 10000 Zagreb

Phone: +385 1 3775 572, 099 5361 386

Email: info@hlpr.hr

Web: https://www.hlpr.hr

'''Association Institute for Gastroenterological Tumors (Iget)'''

Activities: Counseling, education, campaigns to promote healthy lifestyles, networking patient associations and medical professionals, developing informative content for patients

Contact:

Address: Ilica 197, 10000 Zagreb

Phone: +385 955578 587

Email: info@iget.hr

Web: https://iget.hr

'''Association EVERYTHING for HER'''

Offer: Psychological support, education, information, support groups.

Contact:

Address: Kneza Mislava 10, 10000 Zagreb

Phone: +38516418765

Email: info@svezanju.hr

Web: http://svezanju.hr

'''Coalition of Associations in Healthcare (KUZ)'''

Patient Rights Advocacy: KUZ is dedicated to protecting patient rights and representing their interests before healthcare institutions.

Education: Organization of workshops and lectures on patient rights.

Public Campaigns: Campaigns to raise awareness about patient rights and better access to healthcare.

Counseling: Providing legal and administrative support to patients.

Contact:

Address: Trpimirova 11, 10000 Zagreb

Phone: +385 1 4572 100

Email: President Ivica Belina: ivica.belina50@gmail.com

Web: https://www.kuz.hr/

'''Croatian Society of Prostate Cancer Patients (HDBRP)'''

Activities: Providing psychological support, counseling and information to patients with prostate cancer and their families, organizing lectures, distributing educational materials, and campaigns to raise awareness about prostate cancer prevention and early detection, organizing support groups where patients can share their experiences and receive emotional support, campaigns to raise awareness about prostate cancer and the importance of regular checkups.

Contact:

Address: Ilica 65/1, 10000 Zagreb

Phone: not listed

Email: info@hdbrp.hr

Web: https://www.hdbrp.hr

'''Association for Thyroid Patients'''

Activities: Providing individual and group psychological support to patients with thyroid disease, organizing workshops, lectures, and distributing educational materials on thyroid disease, counseling and supporting patients in the rehabilitation process after treatment, campaigns to raise awareness about thyroid disease and the importance of early detection and treatment, Information platform that provides advice on diet, treatment and symptom management.

Contact:

Address: Ulica Frane Petrića 5, 10000 Zagreb

Phone: +38513464 723

Email: udruga.stitnjaca@gmail.com

Web: https://stitnjaca.eu/

'''Association Krijesnica'''

Offer: Psychological support, legal aid, financial assistance, workshops.

Contact:

Address: Prilaz Gjure Dežalića 50, 10000 Zagreb

Phone: +385 1 3770 477

Email: info@krijesnica.hr

Web: https://krijesnica.hr/

<span id="split-dalmatia-county"></span>
== Split-Dalmatia County ==

'''County League Against Cancer - Split'''

Offer: Education, support groups, psychological support.

Contact:

Address: Spinčićeva 1, 21000 Split

Phone: 021 556 476

Email: office@zlpr.hr

Web: https://www.zlpr.hr/liga/

'''Croatian Association for Patient Rights Promotion'''

Activities: Advising on patient rights and assisting in access to healthcare, education and information

Contact:

Address: Zrinsko Frankopanska 2b, 21000 Split

Phone: +385915027861

Email: info@pravapacijenata.hr

Web: https://pravapacijenata.hr/

<span id="primorje-gorski-kotar-county"></span>
== Primorje-Gorski Kotar County ==

'''Association Nada Rijeka'''

Offer: Psychological support, education, workshops.

Contact:

Address: Milana Smokvine Tvrdog 5/1, 51 000 Rijeka

Phone: 051 371 062, 097 613 9715

Email: klub.nada.rijeka@gmail.com

Web: https://klub-nada-rijeka.hr/

<span id="osijek-baranja-county"></span>
== Osijek-Baranja County ==

'''Association Mammae Osijek'''

Offer: Psychological support, information, support groups.

Contact:

Address: J. Leovića 4 (Health Center “Drava”), 31000 Osijek

Phone: 031 373366, 091/480-1102

Email: klubmammaeos@gmail.com

Web: https://mammae-klub-osijek.hr/

<span id="istria-county"></span>
== Istria County ==

'''League Against Cancer Pula, Stoma Club Pula'''

Offer: Education, patient support, information.

Contact:

Address: Nobileova 1, 52100 Pula

Phone: 052 222 795

Email: liga.protiv.raka@pu.t-com.hr

Web: https://www.ilco.hr/index.php/drustva/pula

<span id="zadar-county"></span>
== Zadar County ==

'''League Against Cancer Zadar'''

Offer: Psychological support, education, information.

Contact:

Address: Veslačka 12, 23000 Zadar

Phone: +38523627 783

Email: info@ligaprotivrakazadar.hr

Web: https://ligaprotivrakazadar.hr/

<span id="šibenik-knin-county"></span>
== Šibenik-Knin County ==

'''League Against Cancer of Šibenik-Knin County'''

Offer: Education, support groups, psychological help.

Contact:

Address: Trg Nikole Tomasea 2, 22000 Šibenik

Phone: 022 218993

Email: liga.sibenik@gmail.com

Find them on Facebook League Against Cancer of Šibenik-Knin County

<span id="varaždin-county"></span>
== Varaždin County ==

'''Association Mammae Club Varaždin'''

Offer: Psychological support, education, workshops.

Contact:

Address: Graberje 33, 42000 Varaždin

Phone: 042/206-900

Email: mammae.klub.varazdin@vz.t-com.hr

Web: https://rakdojke.com/

<span id="vukovar-srijem-county"></span>
== Vukovar-Srijem County ==

'''League Against Cancer Vinkovci'''

Offer: Education, support groups, information.

Contact:

Address:Trg bana Josipa Šokčevića 1, 32100 Vinkovci

Find them on Facebook League Against Cancer Vinkovci

<span id="međimurje-county"></span>
== Međimurje County ==

'''County League Against Cancer Association - Čakovec'''

Offer: Psychological support, education, information.

Contact:

Address: A. Schulteissa 19, 40000 Čakovec

Phone:

Email: liga.protiv.raka.medjimurje@gmail.com

Web: https://www.zlprck.hr/