General Practice Ambulance, Croatia
Title: Supportive Cancer Care: The Role of General Practitioner
Marijan Dintinjana is a member in General Practice Ambulance, Croatia.
Most of the 11 million new cases of cancer annually presents with the clinical picture of disseminated malignant disease.
Th e goal of treating these patients is not to cure, but prolonging life and maintaining quality of life. Malignant disease
is now considered a chronic disease and the range of symptoms that occur during the life of cancer patients is extremely
wide. Th e most common symptoms are pain, infections, respiratory disorders, emesis, anemia, anorexia-cachexia syndrome,
diarrhea, jaundice, and psychosocial problems.
Pain is the most common and most unpleasant distress symptom that occurs in cancer patients. It is defi ned as an
unpleasant sensory and emotional experience that is primarily linked to tissue damage or described in terms of such damage.
Th e pain is usually mixed type (nociceptive pain and neuropatic pain).
As many as 50% of cancer patients will be anemic during their illness. Lower hemoglobin level inevitably implies poorer
treatment outcome. Th e incidence of anemia in malignant disease is variable and depends on the type and stage of malignancy,
chemotherapy regimens and intensity of treatment, infections and surgical interventions.
Fatigue or unusual tiredness syndrome occurs in a large percentage (80-96%) of patients with malignant diseases, but is
not recognized enough and its importanceis underestimated. Treatment options are scarce.
Dyspnea is a bad prognostic sign. Th e etiology is unknown and therefore even treatment is diffi cult. Th ere is still no
defi nitive statement about the therapeutic approach to patients with malignant dyspnea; to what extent and when to use
opioids and oxygen.
Tumor syndrome anorexia-cachexia means loss of appetite, weight loss> 10%, loss of muscle mass and hypoproteinemia.
Th e syndrome occurs from 8-88% of cancer patients depending on the tumor site. Response to chemo/radiotherapy is lower,
side eff ects are more pronounced and survival is shortened. Th e goal of treatment is adequate and timely application of
pharmacotherapy preparations in order to avoid unintended consequences and treatment failure.
In patients with malignant diseases common are respiratory and intra-abdominal infections. Th ey are a refl ection of the
disease itself or as a result of the application of anti-tumor therapy (febrile neutropenia).
From the patient’s point of view nausea and vomiting caused by chemotherapy are the most stressful component of
treatment that may even lead to the rejection of potentially curative treatment.
During the life, cancer patient express average about 10 of this and many other distress symptoms. Th e role of General
Practitioner (GP) is early diagnostic of distress symptomatology, assessment of its intensity and early management. Altough
GP are mostly prescribing the oncologists recommendations, GP are following their patients trough the whole course of their
disease, and therefore are the cornerstone of support of cancer patient and his/hers famillies and caregivers.
Furthermore, cancer destroys all components of life and thus signifi cantly reduces the quality of life of patients. Th is oft en
leads to the occurrence of psychosocial problems which according to some studies are even more frequent compared to the
pain and other physical symptoms. GP is the only doctor who deeply know the patients and familly needs and therefore its
important part of medical care for oncology patients.
Track 2: Organ-Specific Cancers, Cancer Genetics, Drug Development & Diagnostics
Track 4: Tumor Science
Loyola University, USA