Patient Pathways: Ovarian Cancer

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Ovarian cancer

Due to often late detection, ovarian cancer is one of the deadliest gynecological malignancies. One in 70 women will develop ovarian cancer, most often between the ages of 50 and 70.

Due to the complexity of treatment and various therapeutic options that include surgery and hormone therapy, patients with ovarian cancer face numerous challenges. Therefore, it is necessary to ensure comprehensive support measures that include medical care, psychological support, and education to improve the quality of life of patients and facilitate coping with the disease.

Ovarian cancer is divided into 4 categories:

Stage 1 - one or both ovaries/fallopian tubes are affected

Stage 2 - the disease has spread to the uterus and surrounding tissues

Stage 3 - the disease has spread to the abdomen outside the pelvic area

Stage 4 - the disease has spread to distant organs and tissues

Patient pathway

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

1. Diagnostics

The patient presents with symptoms such as abdominal pain and bleeding.

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

Medical history and physical examination: Detailed patient history.

Initial tests: gynecological examination and blood tests (CA-125 test, HE4, inhibin B, and CEA)

Referral to a specialist

Referral to a radiologist and oncologist.

Diagnostic Evaluation

Ultrasound

Transvaginal ultrasound: Uses sound waves to create images of internal organs through a vaginal probe, allowing for detailed visualization of the ovaries.

CT or MRI scanning

CT scan: Provides more detailed images of the abdominal and pelvic region.

MRI scan: Uses magnetic waves to create detailed images of internal organs and tissues.

Biopsy

Needle aspiration biopsy: Taking a tissue sample from the ovary using a needle for further analysis under a microscope.

Laparoscopy

Laparoscopy with biopsy: Minimally invasive surgery that allows the doctor to examine the inside of the abdomen and take tissue samples for analysis.

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 the tumor (TNM system), type of ovarian cancer, and the patient’s overall health.

Treatment options

Surgery: Removal of the ovaries, fallopian tubes, uterus, lymph nodes, and other affected tissues.

Chemotherapy: Uses drugs to kill cancer cells. It can be used before (neoadjuvant) or after (adjuvant) surgery.

Radiation therapy: Less commonly used, but may be an option for certain cases.

Targeted therapy: Drugs that specifically target molecules involved in cancer growth.

Immunotherapy: Uses the patient’s immune system to fight cancer.

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

Follow-up

Intensive care unit, regular check-ups with physical examinations

Periodic imaging tests (ultrasound, CT or MRI) to monitor for recurrence

Regular checkups: After treatment is complete, it is important to monitor your health regularly for possible recurrence or side effects of treatment. Checkups usually include:

Physical exams: Regular checkups with an oncologist.

Blood tests: Checking CA-125 levels and other tumor markers.

Imaging tests: Occasional CT, MRI, or ultrasound to check the condition of internal organs.

Symptom review: Monitoring and recording new or changing symptoms that may indicate a recurrence of the disease.

Rehabilitation

Physiotherapy: Exercise and physical activity programs to regain strength and improve overall health.

Nutritional counseling: Help in maintaining a healthy diet that supports recovery and reduces the risk of recurrence.

Psychological support: Individual or group therapy to cope with the emotional consequences of diagnosis and treatment of cancer.

Social support: Involvement in support groups for cancer patients, such as the Croatian League Against Cancer or similar organizations.

Survival

Survival after ovarian cancer depends on a number of factors, including the stage of the disease at diagnosis, response to treatment, and the patient’s overall health. Survival is usually expressed as a five-year survival rate, which varies depending on the stage:

Early stage: When cancer is detected at an early stage, the five-year survival rate can be greater than 90%.

Locally advanced stage: At this stage, the five-year survival rate is lower, but still significant with appropriate treatment.

Metastatic stage: When cancer has spread to other parts of the body, the five-year survival rate is lower but may vary depending on the effectiveness of treatment and the patient’s overall health.

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.

Challenges faced by ovarian cancer patients during their treatment journey

Challenges during diagnositc evaluation

A diagnosis of ovarian cancer can be a stressful and challenging time for patients. Support during this phase can significantly improve the patient’s emotional and physical state. Patients with ovarian cancer face various difficulties during diagnosis, such as physical, psychological, financial and professional burdens and lack of information.

Physical challenges

Symptoms of the disease: bleeding and abdominal pain, which can cause discomfort and anxiety.

Psychological challenges

Fear of a cancer diagnosis, uncertainty about treatment: fear of possible complications and side effects of treatment. The process of emotional acceptance of 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: a sense of isolation 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. 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 the 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: Difficulty eating due to nausea, loss of appetite, or problems with swallowing.

Changes in weight: weight gain or loss due to hormonal changes.

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

Anemia: Decreased number of red blood cells, which can cause fatigue and weakness.

Infections: A decrease in white blood cells increases 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 the disease, treatment, side effects and uncertainty of the outcome, anxiety related to regular check-ups 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 scars or weight changes.

Stress from treatment: Psychological stress due to intense 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 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 centers. Reduced income due to reduced work capacity or job loss. Ongoing costs associated with long-term monitoring and health maintenance.

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 monitoring

Physical challenges

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

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

Postoperative pain: Pain that lasts after surgery.

Chronic pain: Pain that occurs due to damage to nerves or other tissues 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 the quality of sleep.

Swelling: Usually in the arms or legs, caused by the removal of lymph nodes or radiation.

Psychological challenges

Fear of recurrence: continued fear of cancer coming back.

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

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

Challenges during palliative care

The difficulties faced by patients with ovarian cancer in Croatia and their families during palliative care are multifaceted and include several key aspects:

Limited access to palliative care: There is a significant gap between the demand for palliative care and available resources. Insufficient capacities of specialized palliative care providers.

Psychological challenges

The psychosocial and emotional burden of patients and their families is often great. Family caregivers often experience 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 making decisions and providing care can also create additional stress for families and healthcare professionals.

Financial challenges

The cost of care can be a significant burden on families, especially considering the long-term nature of palliative care. Financial pressure can further exacerbate the stress experienced by patients and their families, affecting their overall well-being and quality of life. Challenges with care coordination: Effective palliative care requires coordination among various healthcare providers. In Croatia, there are challenges related to the coordination of care 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 ovarian cancer treatment

Physical challenges

After treatment is complete, 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 their daily routines and life plans. The role of family members as caregivers often changes after treatment ends. Their support remains crucial, but they may need to adapt to the new circumstances and the 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, in order to improve their quality of life and reduce the risk of cancer 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 when they return to work.

Coordination of healthcare

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 scans, such as ultrasound, depending on the risk of cancer recurrence. Patients with ovarian cancer face various challenges during their diagnostic, therapeutic and rehabilitation journey, including physical, psychological, financial and professional burdens, lack of information, and coordination of healthcare. Providing comprehensive support that includes medical care, psychological support, education, and social services can significantly improve the quality of life and treatment outcomes for these patients.

Supportive activities for patients with ovarian cancer

A coordinated multidisciplinary approach to providing supportive care in healthcare settings is essential to help patients throughout their treatment journey. Such an approach significantly improves the quality of life of patients with ovarian cancer, helping them to more easily cope 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. Also, associations can organize and provide some of the necessary support to patients in order to reduce physical, psychological, financial and professional burdens, lack of verified and understandable information, and strengthen the coordination of healthcare not only within the health system but also through activities focused on active patient involvement in developing better national health guidelines and policies.

Supportive activities provided by healthcare institutions

Supportive activities for physical challenges

Supportive care for patients with ovarian cancer 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 follow-up by specialist doctors, for optimal management of physical ailments, patients should have access to a multidisciplinary team of experts.

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

Oncologist: complete management of treatment.

Dietitian: advice on diet and weight management.

Physiotherapist: pain management and improvement of mobility.

Psychologist: helps with emotional issues.

Oncology nurses: care for you before, during and after treatment, provide information about the 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 difficulties throughout their treatment 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 oncological patients. Also, a psychiatrist may recommend psychopharmacotherapy as a support for patients.

Supportive activities for providing reliable and understandable information

Informed consent: a signed form is proof that the conversation in which the doctor provides information to the patient 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 unavailable.

Right to a second opinion: guaranteed by the Patient Rights Protection Act. The patient always has the right to seek a second opinion about his state of health. Every healthcare professional of higher 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 opinion to the patient, upon an oral or written request. In addition to the patient, the doctor can also initiate the procedure of seeking a second opinion. In the case of diagnosing 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 providing the highest quality of approach to each patient.

Supportive activities provided by associations

Supportive activities for physical difficulties

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. Organization of counseling centers where patients can get advice from medical professionals and psychologists. Inclusion of medical advisors in support programs.

Support related to metabolic disorders, problems with nutrition and lack of energy: connecting patients with nutritionists and endocrinologists through organized events and online consultations to personalize the patient’s diet plan and cooperation with fitness and nutrition experts for personalized recommendations for moderate exercise. Organization of practical workshops for proper nutrition, creation of educational materials.

Supportive activities for psychological challenges

• Offer of free or subsidized psychological counseling, organization of support groups and telephone lines for psychological support.
• In the case of depressive disorders, support in finding a psychiatrist and therapist, and cooperation of associations with them. Organization of support groups for conversation and exchange of experiences.
• Organization of workshops and therapy groups that focus on body positivity and acceptance of change.
• Providing free courses in meditation, yoga and relaxation techniques. Creating online resources and apps to help manage stress.
• Associations can organize workshops for couples, including counseling with sexual health professionals.
• Organization of family therapy sessions and workshops that include all family members in the support process. Connecting with peer groups and social activities. Organization of 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 workplace adaptation. Providing legal advice and support for talking to employers about workplace adjustments. Organization of workshops on workers’ rights.
• Connecting patients with financial advisors and organizing workshops on managing finances during treatment.
• Providing information on financial support, organizing fundraising campaigns and helping to apply for financial assistance.
• Connecting patients with social workers and providing free financial counseling.

Supportive activities for providing reliable and understandable information necessary for informed participation in the treatment process

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

Supportive activities regarding patient rights

Information on rights and social assistance options is provided. 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 assocations

Civil society organizations and patient associations play a vital role in providing support to patients with ovarian cancer. These groups often offer a peer support system 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 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 political stakeholders about the needs of patients, and informing patients about their rights.

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

Association “Oncology”

Address: Šenoina 7, 10 000 Zagreb

Phone: +385 1 4624558

Website: udruga-onkologija.hr

Association “ALL for HER”

Address: Dr. Franje Tuđmana 4, 10 000 Zagreb

Phone: +385 1 4824275

Website: svezanju.hr

Croatian Parliament of Health

Address: Zvonimirova 32, 10 000 Zagreb

Phone: +385 1 3881 484

Website: hzz.hr

Association “Woman Founder”

Address: Ul. kneza Mislava 9, 10 000 Zagreb

Phone: +385 1 4826666

Website: zena-udruga.hr

Association “Angels”

Address: Branimirova 31, 10 000 Zagreb

Phone: +385 1 4880715

Website: udruga-anjeli.hr

Association “We are not alone”

Address: Ulica grada Vukovara 284, 10 000 Zagreb

Phone: +385 1 6332737

Website: nismosame.hr

Available supportive content for cancer patients

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

ESMO Guide for patients Living with cancer

This Patient Guide on Living with Cancer was 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 during this important time in your life. In this Guide you can find information about support in dealing with the new reality of life, 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 Doc. Dr. sc. Natalija Dedić Plavetić, prim. Dr. med. specialist in internal oncology and, on behalf of patients, psychologist Ljiljana Vukota from the ALL for HER association.

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

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 family members and friends better understand the factors that may influence a personalized approach to cancer prevention, diagnosis and treatment.

This brochure presents current knowledge about the basic principles of personalized medicine, illustrating its application to several types of tumors. Personalized medicine represents the future of cancer treatment, and the role of patients is key to making it a reality in the near future and enabling better treatment of tumors.

As this approach expands and evolves, ESMO is committed to educating patients so they can better understand its key principles and their own contribution to advancing treatment.

The Croatian translation of the Guide was made possible by the Association of Women with and Treated for Cancer ALL 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 and your family, friends and caregivers better understand immune-related side effects and their management. It contains 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 approaches you can take yourself to 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 guide clinicians in the diagnosis, treatment, and follow-up of these events. All ESMO clinical practice guidelines are prepared 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 of Medical Oncology: Doc. Dr. sc. Natalija Dedić Plavetić, representative of the Croatian Thoracic Society: Prof. Dr. sc. Marko Jakopović, representative of the ALL for HER Association of Women with and Treated for Cancer: Ljiljana Vukota.

ESMO Cancer treatment during the Covid-19 pandemic: A guide for patients

The guide contains information about the COVID-19 disease and its symptoms, as well as the measures 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 medical examinations that may be necessary to protect yourself from infection.

The Croatian translation was reviewed by: Prim. Dr. sc. Paula Podolski, President of the Croatian Senological Society, Doc. Dr. sc. Borislav Belev, medical oncologist, National Representative of the Croatian Society of Medical Oncology at ESMO, and Ljiljana Vukota, representative of the ALL 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 a common feature in cancer patients and is a consequence of the presence of the tumor and medical and surgical treatments for cancer.

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 the multimodal treatment of cancer.

Strong evidence shows that nutritional problems should be considered from the time of cancer diagnosis, within the diagnostic and therapeutic pathway, and should run in parallel with anti-cancer treatment. However, worldwide, cancer-related malnutrition is still largely under-recognized, 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.

Directory of associations that offer supportive activities 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, 0995361 386

Email: info@hlpr.hr

Website: https://www.hlpr.hr

Association Institute for Gastroenterological Tumors (Iget)

Activities: counseling, education, campaigns to promote healthy lifestyle habits, connecting patient associations and medical professionals, developing information content for patients

Contact:

Address: Ilica 197, 10000 Zagreb

Phone: +385 955578 587

Email: info@iget.hr

Website: https://iget.hr

Association ALL for HER

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

Contact:

Address: Kneza Mislava 10, 10000 Zagreb

Phone: +38516418765

Email: info@svezanju.hr

Website: http://svezanju.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: http://www.zlpr.hr/liga/o-nama

Croatian Association for the Promotion of Patient Rights

Activities: advising on patient rights and assistance in accessing health services, education and information.

Contact:

Address: Zrinsko Frankopanska 2b, 21000 Split

Phone: +385915027861

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

Association Mammae Osijek

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: +38523627 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: Liga protiv raka Šibeniko-kninske županije

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/

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: Liga protiv raka Vinkovci

Međimurje County

Association County League Against Cancer - 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/