APOZ Bulgaria

Training advanced breast cancer patients in Bulgaria to improve adherence to treatment

Information and support gap
Policy and health system gaps


In Bulgaria, breast cancer accounts for over 25% of all new cancer cases among women of all ages and it has the third highest mortality (both sexes, all ages).[1] Due to the complexity, and distressing nature of the diagnosis, patients can struggle to process information regarding their treatment options as consultations with their physicians are often short. Nurses can act as a source of trustworthy information for metastatic breast cancer (MBC) patients embarking on this difficult journey with the disease. To support advanced breast cancer patients in actively participating in their own treatment, the Association of Cancer Patients and Friends (APOZ) launched the ABC Patient Academy. Through nurse’s engagement and patient’s training, the patients benefiting from this programme can make inform decisions and better adhere to their treatment.

Association of Cancer Patients and Friends (APOZ) is a non-profit organisation whose mission is to change the public’s attitude towards cancer and its acceptance of the disease, advocate for patients' rights and work to increase access to quality and affordable treatment. 

Project description

In 2015, APOZ received a SPARC MBC Challenge grant to implement the ABC Patient Academy.

In the first three months of the programme, training materials were produced for the nurses as well as educational materials for the MBC patients in Bulgarian. The Bulgarian Association of Healthcare Professionals in Nursing and the Bulgarian Cancer Society were key collaborators in various project elements. The Bulgarian Cancer Society reviewed the training and educational materials for accuracy and quality, while the Bulgarian Association of Healthcare Professionals in Nursing provided the perspective on the nurse’s role in helping the patient play an active role in their treatment management process.

The nurses trained by APOZ were equipped to provide relevant and accurate information to the MBC patients treated in their respective cancer treatment centres.

The project was promoted through posters in several cancer treatment centres, and a Facebook page was launched and actively promoted to spark discussions on the topic.


APOZ reported successfully trained 95 nurses from 30 cancer centres in Bulgaria, who reached over 450 MBC patients during the first year of the project. On average, nurses provided 40 consultations a month throughout the country. 86% of patients expressed lower levels of anxiety after having interacted with the nurses.

According to the nurses’ evaluation, only 15% of the patients understood the outcome of their disease and the treatment options proposed before entering the programme. By the end of the programme, 81% of patients enrolled reported having a better understanding of their disease and treatment options.

The results of this project demonstrate the important role nurses can play in MBC patient care. In this case, the nurses became trusted informants with whom patients talked openly about their disease, its effects and their condition. The ABC Academy is still live, four years after its launch.


Organisation’s website: APOZ Website (in Bulgarian)

SPARC project’s webpage: ABC Academy  (in Bulgarian)

Training materials: Training materials for nurses

Educational materials: Educative materials for MBC patients

Social media: APOZ Facebook page


[1] GLOBOCAN 2018

(Information from the project description and context is compiled from the SPARC reports)

Last update: 
Monday 28 February 2022
Cancer type: