Patient Pathways: Myeloma

Myeloma

Multiple myeloma is a relatively rare form of cancer that affects plasma cells. These are types of white blood cells that originate in the bone marrow. The function of plasma cells is to produce antibodies. Antibodies occur naturally in our immune system and help us protect ourselves from infections caused by agents such as bacteria or viruses. When plasma cells grow uncontrollably, they suppress the growth of other bone marrow cells. This can lead to conditions such as anemia, bleeding disorders, infections, and bone lesions. In most cases, there is also an abnormal production of non-functional antibodies called monoclonal protein. In multiple myeloma, a large amount of one type of abnormal antibody is produced, which has no beneficial role in the body.

Myeloma usually affects multiple sites in the body where blood cells are made in the bone marrow, most commonly within the bones of the spine, skull, pelvis, ribs, as well as in the shoulder and hip areas. That is why the disease is called multiple myeloma.

In Croatia, the incidence of multiple myeloma is gradually increasing, reflecting global trends. According to data from the Croatian National Cancer Registry, the annual incidence rate of multiple myeloma is about 4-6 cases per 100,000 inhabitants. This means approximately 200-250 new cases each year. The disease is more common in older adults, with most diagnoses occurring in people aged 65 and over.

Based on the stage, it can be divided into:

Stage I Beta-2-microglobulin in serum <3.5 mg/dl and albumin in serum> 3.5 g/dl

Stage II Not stage I or III

Stage III Definition Serum beta-2-microglobulin > 5.5 mg/l

Patient pathway

Creating a comprehensive plan for myeloma treatment includes steps from initial presentation and diagnosis to treatment and follow-up. Below is a detailed plan:

1. Diagnostics

The patient presents with symptoms of decreased physical fitness, stiffness, fatigue, and less commonly loss of appetite, nausea, vomiting, or weight loss.

Consultation with a general practitioner (GP): The patient visits a general practitioner.

Medical history and physical examination: A detailed history of the patient’s illness.

Initial tests: gynecological examination, Pap test, HPV testing

Referral to a specialist

Referral to a radiologist and oncologist.

Diagnostic evaluation

Physical examination Laboratory tests Hematological and biochemical tests, urine tests Imaging (CT, PET/CT) Computed tomography (CT) Magnetic resonance imaging (MR) Positron emission tomography (PET) Bone marrow biopsy Tests for monoclonal proteins Genetic molecular tests

2. Treatment

Multidisciplinary Team (MDT) meeting

MDT discussion: Review of diagnostic findings with specialists including endocrinologists, surgeons, oncologists, radiologists and pathologists.

Development of a treatment plan: Based on the stage of the myeloma and the patient’s general health.

Treatment options

Chemotherapy: Used to kill or slow the growth of cancer cells. It is usually used in combination with other medications for better results.

Immunotherapy: This method uses the patient’s own immune system to fight cancer. Drugs such as monoclonal antibodies or CAR-T cell therapy may be included in this approach.

Steroid therapy: Steroids such as dexamethasone can help control symptoms and reduce the number of tumor cells.

Biological therapy: This therapy uses substances that come from natural sources or are synthesized in the laboratory to help the body fight cancer. Examples include drugs like bortezomib or lenalidomide.

Stem cell transplantation: This procedure involves replacing damaged or diseased blood cells with healthy stem cells. Transplantation can be autologous (using the patient’s own stem cells) or allogeneic (using donor stem cells).

Radiation: It can be used to treat specific lesions or to control bone pain.

Support and symptomatic treatment: Includes treating symptoms such as pain, anemia, infections, and kidney problems.

3. After treatment: follow-up, rehabilitation and survivorship

Follow-up

Regular checkups: patients will see their oncologist regularly to monitor their response to treatment and to identify any side effects or complications. Checks include physical exams, lab tests, and imaging.

Laboratory tests: Monitoring of blood protein levels, such as beta-2-microglobulin, and urinalysis to assess kidney function and detect any signs of relapse.

Immunological tests: Checking the number and function of plasma cells in the bone marrow to monitor disease progression.

Imaging tests: MRI, CT scans or PET scans can be used to monitor any changes in the bones or to identify new lesions.

Rehabilitation

Physical Rehabilitation: Physical rehabilitation programs can help maintain mobility, strengthen muscles, and reduce pain. Exercises are often tailored to the patient’s condition.

Psychological Support: Psychological help, such as therapy or support groups, can help patients cope with the emotional and mental challenges of the disease.

Nutritional Support: A nutritionist can help create meal plans that support bone health and overall well-being, and help prevent or treat side effects such as loss of appetite or nausea.

Symptom Control: Includes managing pain, anemia, and other symptoms caused by the disease or its treatment.

Survivorship

Monitoring long-term effects: Long-term survival may involve monitoring for any long-term effects of treatment, such as kidney problems, osteoporosis, or cardiovascular problems.

Planning for relapse: In case of recurrence of the disease, it is important to have a plan for re-treatment, which may include changing therapy or additional treatment methods.

Healthy lifestyle: Maintaining a healthy lifestyle, including a balanced diet, regular exercise, and avoiding unhealthy habits, can help maintain overall health and prevent complications.

Support from family and friends: Involving loved ones can provide emotional and practical support, which can significantly improve quality of life.

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 when treatment is no longer an option, for skin and mucous membrane care.

Challenges myeloma cancer patients face during their treatment journey

Challenges during diagnostic evaluation

A myeloma diagnosis can be a stressful and challenging time for patients. Support during this phase can significantly improve the patient’s emotional and physical condition.

Patients with myeloma face various challenges during diagnosis, such as physical, psychological, financial and professional difficulties and lack of information.

Physical challenges

Symptoms of the disease: nausea, vomiting or weight loss make it difficult to perform daily activities and can cause anxiety.

Psychological challenges

Fear of cancer diagnosis, uncertainty about treatment: fear of possible complications and side effects of treatment. The process of emotionally accepting 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 because of the illness and the need for privacy.

Financial and professional challenges

Absence from work: frequent medical check-ups and treatments can cause absence from work, which can affect career and financial stability. The costs of diagnostics and treatment, insufficient health insurance.

Lack of information

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

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

Challenges during treatment

Physical challenges

Lack of energy: constant fatigue and exhaustion due to treatment and hormonal imbalance.

Problems with nutrition: Difficulties with food intake due to nausea, loss of appetite, or swallowing problems. Weight changes: weight gain or loss due to hormonal changes.

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

Anemia: Reduction in the number of red blood cells, which can cause fatigue and weakness.

Infections: Decreased white blood cells increase the risk of infections.

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 check-ups and fear of recurrence. Depression: feelings of hopelessness, loss of interest in everyday activities, isolation. Changes in body self-awareness: discomfort due to physical changes, such as scars or weight changes.

Treatment-related stress: Psychological stress due to intense treatments and their impact on everyday life.

Relationship with 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 exposure to infections during therapy.

Financial and professional challenges

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

Absences from work: frequent medical visits and treatments that require absences from work, which can affect career and financial stability.

High costs of medicines, operations, therapies and other medical services, travel and accommodation costs for patients who have to travel to health care centers. Reduced income due to reduced work capacity or job loss. Ongoing costs associated with long-term follow-up and maintaining health.

Lack of information

The 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.

Ignorance of patient rights.

Lack of information about healthcare providers during treatment.

Challenges during rehabilitation and disease follow-up

Physical challenges

Chronic fatigue: Feeling exhausted that lasts for weeks or months after treatment is complete.

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

Postoperative pain: Pain that lasts after surgery.

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

Insomnia: Difficulty sleeping, which can be caused by stress, pain, or side effects of treatment.

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

Psychological challenges

Fear of recurrence: ongoing fear of cancer recurrence. Anxiety and Depression: psychological stress and emotional problems associated with the experience of cancer. Social isolation: reduced social interaction due to fatigue, anxiety, or other symptoms.

Financial and professional challenges

Return to work: Difficulties returning to work due to physical and emotional limitations. Long-term financial burden associated with ongoing medical expenses.

Difficulties during palliative care

The difficulties faced by patients with myeloma 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 of patients and their families is often significant. Family caregivers often face high levels of stress and emotional distress. Cultural and ethical issues: reluctance to discuss end-of-life issues can hinder 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 costs of care can be a significant burden for families, especially given 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 among 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 financial burdens, 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.

Challenges patients face after completing myeloma treatment

Physical challenges

After completing treatment, survivors may experience long-term side effects, such as skin problems, cardiovascular problems, and urinary 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 is complete. Their support remains crucial, but adjustments may be needed to accommodate new circumstances and reduced care intensity.

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 the risk of cancer recurrence.

Financial and professional challenges

Return 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 support cancer survivors returning to work.

Coordination of health care

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

Patients with myeloma face various challenges during their diagnostic, treatment and rehabilitation journey, including physical, psychological, financial and professional difficulties, lack of information, and coordination of health care.

Providing comprehensive support that includes medical care, psychological support, education and social services can significantly improve quality of life and treatment outcomes for these patients.

Supportive care for myeloma patients

A coordinated multidisciplinary approach to providing supportive care in healthcare settings is essential to helping patients throughout their treatment journey. Such an approach significantly improves the quality of life of patients with myeloma, helping them to cope more easily with the difficulties that the disease and treatment bring. Civil society organizations, such as patient associations and cancer charities, can play a key role in informing patients about such supportive activities. Likewise, associations can organize and provide, with the help of experts, part of the necessary support to patients in order to reduce physical, psychological, financial and professional difficulties, lack of verified and understandable information, and strengthening the coordination of healthcare not only within the health system but also through activities aimed at actively involving patients in the development of better national health guidelines and policies.

Support activities provided by institutions health care

Supportive care for physical challenges

Supportive care for myeloma patients within the healthcare system includes a wide range of services aimed at improving the overall quality of life of patients. In addition to medical care, which includes regular monitoring through blood tests, ultrasound, MRI or CT scans, and monitoring by specialist doctors, for optimal management of physical difficulties, patients should have access to a multidisciplinary team of specialists.

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

Oncologist: overall treatment management

Dietitian: nutrition counseling and weight management.

Physiotherapist: pain management and improved mobility.

Psychologist: helps with emotional issues

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

Supportive care for psychological challenges

Cancer patients and their families almost inevitably face numerous psychological difficulties throughout the entire therapeutic journey. Professional psychological help in the form of individual counseling, group therapy, counseling with a partner and family counseling is a key part of support for oncology patients. Also, a psychiatrist can recommend psychopharmacotherapy as a support for patients.

Supportive care for providing 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.

Right to a second medical opinion: guaranteed by the Patient Rights Protection Act. The patient always has the right to seek a second medical opinion on their state of health. Every healthcare professional with a high level of professional qualifications and appropriate specialization who was not involved in the direct provision of a certain type of healthcare service to the patient is obliged to give a second medical opinion to the patient at the patient’s verbal or written request. Apart from the patient, the doctor is the one who can initiate the procedure of seeking a second opinion. In the case of diagnosis of a rare disease, inability to find (adequate) therapy, inadequate technological equipment of the healthcare institution that prevents or makes it difficult to establish a diagnosis or the course of therapy, doctors often seek help and confirmation from their colleagues from other institutions for the purpose of the highest quality approach to each patient.

Supportive care provided by associations

Supportive care for physical challenges

Support related to side effects of treatment: organizing workshops and informative activities that educate patients on ways to manage side effects. Providing brochures and online resources with practical advice.

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

Support related to metabolic disorders, eating problems and lack of energy: connecting patients with nutritionists and endocrinologists through organized events and online consultations for personalizing the patient’s dietary plan and collaborating with fitness and nutrition experts for personalized recommendations for moderate exercise. Organizing practical workshops for proper nutrition, creating educational materials.

Supportive care for psychological challenges

Offering free or subsidized psychological counseling, organizing support groups and telephone lines for psychological support. In the case of depressive disorders, support in finding a psychiatrist and therapist, and cooperation between associations and them. Organizing support groups for talking and sharing experiences. Organizing workshops and therapy groups that focus on body positivity and accepting change. Providing free meditation, yoga and relaxation techniques courses. Creating online resources and apps 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 care for financial and professional challenges

Advice on employment rights and workplace adjustments. Providing legal advice and support for talking to employers about workplace adjustments. Organizing workshops on worker rights.

Connecting patients with financial advisors and organizing workshops on managing finances during treatment.

Providing information about financial support, organizing fundraising campaigns, and helping to apply for financial assistance. Connecting patients with social workers and providing free financial counseling.

Supportive care for providing reliable and understandable information needed for informed participation in the treatment process

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

Supportive care for patient rights

Provides information on 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/

Examples of successful supportive activities of croatian associations

Civil society organizations, patient associations play a vital role in providing support to myeloma patients. These groups often offer peer support systems where patients can connect with others going through similar experiences, providing a sense of community and understanding.

They can also organize educational workshops and seminars to inform and educate patients to empower them to actively participate in the treatment process.

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

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

MijelomCRO Association

Address: Ulica kralja Zvonimira 20, 10000 Zagreb

Contact: +385 91 501 0204

Email: info@mijelom.hr

Website: mijelom.hr

Croatian Blood Diseases Society (KROHEM)

Address: Clinic for Hematology, KBC Zagreb, Kišpatićeva 12, 10000 Zagreb

Contact: +385 1 2367342

Website: krohem.hr

Croatian Leukemia and Lymphoma Association (HULL)

Description: An association specialized in providing help and support to people with leukemia and lymphoma. They organize support, information sessions and events.

Address: Preradovićeva 35, 10000 Zagreb

Contact: +38514817690

Website: hull.hr

Available support content for cancer patients

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

ESMO Guide for Patients Living with Cancer

This Guide for Patients Living with Cancer was developed 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 others like you during this important time in your life. In this Guide, you can find information about support in coping with your new reality, life after primary treatment, preventive care, and long-term follow-up. It will also help you keep your personal health record, i.e. plan your healthcare throughout your life with cancer.

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

ESMO Personalized Medicine in Oncology: A Patient Guide

This Patient Guide was initiated by the ESMO Working Group on Personalized Medicine to help patients, their families and friends to better understand the factors that may influence a personalized approach to cancer prevention, diagnosis and treatment.

This brochure presents the current knowledge about the basic principles of personalized medicine, illustrating its application to several types of tumors. Personalized medicine is the future of cancer treatment, and in order for it to become a reality in the near future and enable better cancer therapy, the role of patients is crucial.

In this expanding and developing approach, ESMO is committed to educating patients so they can better understand its key principles and their own contribution to advancing therapy.

The Croatian translation of the Guide was made possible by the Association of Women with 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.

ESMO Side Effects Associated with Immunotherapy and Their Management: A Patient Guide

This guide is designed to help you and your family, friends and carers to better understand the side effects associated with immunotherapy and their management. It contains information on the most common toxicities associated with modern immunotherapies (known as “immune checkpoint inhibitors”), how your oncology team can manage those symptoms, and some things you can do yourself to help reduce their impact. The medical information described in this document is based on ESMO Clinical Practice Guidelines for the management of immunotherapy toxicities, which are designed to support 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: Assoc. Dr. Sc. Natalija Dedić Plavetić, representative of the Croatian Thoracic Society: Prof. Dr. Sc. Marko Jakopović, representative of the Association of Women with Cancer EVERYTHING for HER: Ljiljana Vukota.

ESMO Cancer Treatment During the Covid-19 Pandemic: A Patient Guide

The guide provides information about the COVID-19 disease and its symptoms, as well as the steps you can take to reduce your risk of infection. Also, the guide provides information about the impact of the COVID-19 pandemic on various aspects of cancer treatment, including possible changes to your treatment plan and doctor visits that may be needed to protect yourself from infection.

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

ESPEN practical guideline: Clinical Nutrition in cancer

Malnutrition is common and relevant in cancer patients and results from the presence of the tumor and from anti-cancer medical and surgical treatments.

Malnutrition negatively impacts quality of life and treatment toxicity, and it is estimated that up to 10-20% of cancer patients die from the consequences of malnutrition rather than from the tumor itself. Therefore, nutrition plays a key role in the context of multi-modal cancer treatment.

Strong evidence shows that nutritional issues should be taken into account from the time of cancer diagnosis, within the diagnostic and therapeutic pathway, and should run in parallel to anti-neoplastic treatments. However, worldwide, cancer-related malnutrition is still largely unrecognized, under-diagnosed and undertreated in clinical practice.

These evidence-based guidelines were developed to translate the current best evidence and expert opinion into recommendations for multidisciplinary teams in charge of the identification, prevention and treatment of reversible elements of malnutrition in adult cancer patients.

Directory of associations that offer supportive care to cancer patients

Zagreb

Croatian League Against Cancer

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

Contact:

Address: Ilica 197, 10000 Zagreb

Phone: +385 1 3775 572, 099 536 1386

Email: info@hlpr.hr

Web: https://www.hlpr.hr

Institute for Gastroenterological Tumors Association (Iget)

Activities: counseling, education, campaigns to promote healthy lifestyles, connecting patient associations and healthcare professionals, developing informative content for patients

Contact:

Address: Ilica 197, 10000 Zagreb

Phone: +385 95 557 8587

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: +385 1 641 8765

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 advocating for their interests in front of healthcare institutions.

Education: Organization of workshops and lectures on patients’ rights.

Public Campaigns: Campaigns to raise awareness of patient rights and improve access to health services.

Consulting: 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, as well as campaigns for raising awareness of prostate cancer prevention and early detection. They also organize support groups where patients can share their experiences and receive emotional support and work on campaigns to raise awareness of 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 diseases, organizing workshops, lectures, and distributing educational materials on thyroid disease, counseling and supporting patients during post-treatment rehabilitation, conducting campaigns to raise awareness of thyroid disease and the importance of early detection and treatment. They also have an informative online platform that offers advice on nutrition, treatment, and symptom management.

Contact:

Address: Ulica Frane Petrića 5, 10000 Zagreb

Phone: +385 1 3464 723

Email: udruga.stitnjaca@gmail.com

Web: https://stitnjaca.eu/

Krijesnica Association

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/

Split-Dalmatia County

County League Against Cancer - Split

Offer: Education, support groups, psychological help.

Contact:

Address: Spinčićeva 1, 21000 Split

Phone: 021 556 476

Email: office@zlpr.hr

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

Croatian Association for the Promotion of Patient Rights

Activities: advising on patient rights and assisting with access to healthcare services, education, and providing information.

Contact:

Address: Zrinsko Frankopanska 2b, 21000 Split

Phone: +385 91 502 7861

Email: info@pravapacijenata.hr

Web: https://pravapacijenata.hr/

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/

Osijek-Baranja County

Mammae Osijek Association

Offer: Psychological support, information, support groups.

Contact:

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

Phone: 031 373366, 091/480-1102

Email: klubmammaeos@gmail.com

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

Istria County

League Against Cancer Pula, Stoma Club Pula

Offer: Education, support for patients, 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

Zadar County

League Against Cancer Zadar

Offer: Psychological support, education, information.

Contact:

Address: Veslačka 12, 23000 Zadar

Phone: +385 23 627 783

Email: info@ligaprotivrakazadar.hr

Web: https://ligaprotivrakazadar.hr/

Šibenik-Knin County

League Against Cancer of the 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 Šibenik-Knin County

Varaždin County

Mammae Club Varaždin Association

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/

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

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/