The role of a family physician in comprehensive care of patients during cancer treatment

Obzirom na značajan teret bolesti koji proizlazi iz prirode malignih bolesti, modaliteta liječenja te njihovog utjecaja na socijalno i radno funkcioniranje i kvalitetu života bolesnika, suvremeno zbrinjavanje malignih bolesti podrazumijeva model integrirane skrbi koji uključuje temeljnu skrb liječnika primarne zdravstvene zaštite uz primjereno upućivanje, liječenje i praćenje u specijalističko-konzilijarnoj skrbi. U ovome radu stavljen je naglasak na proces aktivnog onkološkog liječenja u okviru kojeg su prikazane temeljne terapijske opcije te osvrt na ulogu obiteljskog liječnika tijekom procesa liječenja, uključujući zbrinjavanje najčešćih nuspojava u obiteljskoj medicini prouzrokovanih pojedinim modalitetima onkološkog liječenja. Osim primarne i sekundarne prevencije malignih bolesti, koje se danas uspješno provode na razini primarne zdravstvene zaštite, bitna uloga obiteljskog liječnika jest i u tercijarnoj prevenciji koja uključuje zaustavljanje progresije bolesti i primjereno zbrinjavanje simptoma. Time optimalni oblik skrbi za onkološke pacijente predstavlja model integrirane skrbi koji uključuje dostupnu, kontinuiranu i sveobuhvatnu skrb u obiteljskoj medicini, uz primjerenu koordinaciju i suradnju sa specijalistima onkoloških struka, uz uvažavanje pacijentovih izbora i pružanje emocionalne potpore.Given the significant burden of disease arising from the complexity of malignant diseases, treatment modalities and their impact on social functioning and quality of life of patients, modern care of malignant diseases implies a model of integrated care that includes basic care of primary care physicians with appropriate referral, treatment and monitoring in specialist-consultative care. This paper emphasizes the process of active oncology treatment and presents the basic therapeutic options and a review of the role of the primary care physicians during the treatment process, including the management of the most common side effects in family medicine caused by certain modalities of oncology treatment. In addition to primary and secondary prevention of malignant diseases, which are now successfully implemented at the level of primary health care, an important role of the primary care physicians is in tertiary prevention, which includes stopping the progression of the disease and appropriate symptoms management. Thus, the optimal form of care for oncology patients is a model of integrated care that includes accessible, continuous and comprehensive care in family medicine, with appropriate coordination and cooperation with oncology specialists while respecting the patient's choices and providing emotional support

Serological Response to SARS-CoV-2 Vaccine in Hemodialyzed Patients and the Association with Later COVID-19 Positivity

Background: The effectiveness of the COVID-19 vaccine may differ in hemodialysis patients. The aim of this prospective multicenter study was to determine the degree of serological response to the SARS-CoV-2 vaccine in the population of dialysis patients and its association with later SARS-CoV-2 infections. Methods: A blood sample was taken for the determination of COVID-19 serological status (IgG antibodies) in 706 dialysis patients 16 weeks after vaccination with the second dose (Pfizer-BioNTech). Results: Only 314 (44.5%) hemodialyzed patients had a satisfactory response to the COVID-19 vaccine. Eighty-two patients (11.6%) had a borderline response, while 310 patients (43.9%) had an unsatisfactory (negative) post-vaccinal antibody titer. A longer dialysis vintage had an increased odds ratio (OR) of 1.01 for the occurrence of COVID-19 positivity after vaccination. In the group of subsequently positive patients, 28 patients (13.6%) died from complications of COVID-19. We have found differences in mean survival time between patients with and without appropriate responses to vaccination in favor of patients with a satisfactory serological response. Conclusions: The results showed that the dialysis population will not have the same serological response to the vaccine as the general population. The majority of dialysis patients did not develop a severe clinical picture or die at the time of positivity for COVID-19