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"ABSTRAKKanker payudara merupakan jenis kanker terbanyak di antara wanita di dunia maupun Indonesia. Di Indonesia, khususnya di Rumah Sakit Kanker “Dharmais” (RSKD) Jakarta angka kasus meningkat ditiap periode waktu dari angka 21,46% di tahun 1993-1997 meningkat hingga 40,58% di tahun 2003-2007. Dalam menangani penyakit ini, terdapat modalitas terapi kanker di antaranya adalah operasi, radiasi, kemoterapi ataupun kombinasi dari ketiganya. Namun, modalitas terapi tersebut menimbulkan efek samping yang tidak sedikit pada pasien, khususnya kemoterapi. Kondisi ini dapat mempengaruhi kualitas hidup pasien. Akibat dari kondisi tersebut, banyak pasien kanker yang menggunakan terapi komplementer-alternatif (CAM) untuk mengurangi gejala efek samping yang dialaminya. Tujuan penelitian ini adalah untuk mengetahui manfaat CAM terhadap kualitas hidup pasien kanker payudara yang menjalani kemoterapi sebagai terapi pendukung di RSKD. Penelitian ini dilakukan dengan melakukan wawancara terhadap 152 pasien kanker payudara yang menjalani kemoterapi dan verifikasi data rekam medis. Metode penelitian menggunakan disain studi analitik potong lintang. Dari hasil penelitian didapatkan bahwa penggunaan CAM tidak berhubungan bermakna secara statistik (p value >0,05) terhadap kualitas hidup pasien kanker payudara setelah dikontrol variabel lain. Berdasarkan analisis stratifikasi didapatkan hubungan yang signifikan (p value <0,05), di mana pada kelompok responden yang menggunakan CAM non-herbal selama 1-6 bulan memiliki peluang 6,75 kali (95% CI:1,12-40,56) untuk memiliki kualitas hidup baik dibandingkan dengan responden yang menggunakan jenis CAM herbal selama 1-6 bulan. Perlunya penelitian lebih lanjut dengan desain prospektif dan sampel yang lebih besar.

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ABSTRACTBreast Cancer is the most type of cancer among women in the world and in Indonesia. In Indonesia, especially in “Dharmais” Cancer Hospital (RSKD) Jakarta increased number of cases in each periode of time from 21,46% in 1993-1997 to 40,58% in 2003-2007. In dealing with this disease, there is a cancer therapeutic modalities which are surgery, radiation, chemoterapy or a combination of all three. However, the reality these therapies have side effects that are not small in patients, particularly chemoterapy. This condition can affect the patient’s quality of life. The result of these conditions, many cancer patients use Complementar-Alternative Medicine (CAM) to alleviate the symptoms of the side effects they experienced. The porpose of this study was to determine the benefits of CAM to the quality of life of breast cancer patients who are undergoing chemoterapy as supportive therapy in RSKD. This study is a cross sectional analytic that conducted through interviews of 152 breast cancer patients who are chemoterapy and then verifying medical records. The result found that CAM use was not statistically significantly related to the quality of life of breast cancer patients after controlling for other variables. Based on stratification analysis found a significant relationship in which the respondents who use non-herbal types for 1-6 months had 6,75 times (95% CI: 1,12-40-56) the chance to have a good quality of life compared with respondents who used herbal types for 1-6 months. Need to do further research with a larger sample and prospective design."

"Kanker payudara adalah karsinoma atau keganasan pada beberapa morfologi sekaligus, dan salah satu terapi yang diberikan adalah kemoterapi. Kemoterapi yang dilakukan membutuhkan berbagai strategi keperawatan untuk membantu mengatasi berbagai efek yang ditimbulkannya termasuk dukungan keluarga. Maka tujuan penelitian ini adalah mengeksplorasi lebih mendalam tentang harapan pada pasien kanker payudara yang mendapat kemoterapi tentang dukungan keluarga. Selanjutnya penelitian dilakukan pada 5 partisipan dan menemukan 4 tema seperti : harapan untuk dapat melanjutkan normal dalam keluarga, harapan peningkatan pemahaman keluarga tentang dampak penyakit akibat kemoterapi dan perawatannya, harapan untuk di hargai, didengarkan dan ditemani, harapan untuk dibantu menyelesaikan masalah yang dihadapi akibat sakit oleh keluarga.

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Breast cancer is carcinoma or malignancy in some morphology as well, and one kinds of treatment that is given is chemotherapy. There were various kinds of nursing strategy to help overcoming various effects that are aroused by the chemotherapy given including family support. Therefore, the purpose of this research was to explore deeper about family support in raising breast cancer patient?s hope which is got chemotherapy. This research is held toward five participants and find four themes i.e. hope to continue normal life in their family, hope to raise family understanding about the impact malady caused by chemotherapy, hope to be appreciated, to be listened and to be accompanied, hope to be helped by their family in overcoming a problem which is faced because of the disease."

"Tujuan: Mengetahui hubungan beban finansial terhadap kualitas hidup pasien kanker yang menjalani terapi radiasi di instalasi radioterapi rumah sakit pusat rujukan nasional Indonesia yang menggunakan JKN.Metode: Desain penelitian deskriptif analitik dengan metode cross sectional. Data diambil dari rekam medis dan kuesioner yang didalamnya terdapat formulir EORTC QLQ-C30 untuk menilai HRQoL, yang diisi melalui wawancara via telepon pada pasien kanker yang telah menjalani radioterapi di IPTOR RSUPN Dr. Cipto Mangunkusumo periode Januari 2022 - Maret 2023. Dilakukan analisis untuk mengidentifikasi dan mengetahui hubungan antara karakteristik sosiodemografi, klinis, dan ekonomi/beban ekonomi, terhadap HRQoL pasien kanker.Hasil: Dari analisis bivariat masing-masing variabel independen, didapatkan untuk global health yang secara statistik memiliki hubungan (p>0,25) antara lain usia (p=0,166), jenis kelamin (p=0,090), stadium (p=0,111), pendapatan bulanan (p=0,114), dan skor COST FACIT (p<0,001). Untuk fungsi fisik, yang berhubungan yaitu KPS (p=0,089), OTT (p=0,048), pendapatan (p=0,146), dan skor COST FACIT (p<0,001). Sedangkan fungsi emosional, berhubungan dengan usia (p=0,081), jenis kelamin (p=0,113), KPS (p=0,119), indikasi radiaisi (p=0,188), OTT (p=0,053), OOP (p=0,021), financial catastrophe (p=0,135), dan skor COST FACIT (p<0,001). Hasil analisis multivariat dengan regresi linier didapatkan hanya skor COST FACIT yang memiliki nilai p<0,05 dari analisisi regresi liniernya untuk global health (p<0,001 b=0.443 R2=18,8%), fungsi fisik (p<0,001 b=0,456 R2=20,1%), dan fungsi emosional (p<0,001 b=0,523 R2=34,6%).Kesimpulan: Toksisitas finansial memilki hubungan yang bermakna dalam menilai HRQoL pasien kanker yang menjalani radioterapi. Pendapatan, OOP, dan financial catastrophe juga dapat dipertimbangkan dan menjadi perhatian dalam mengevaluasi HRQoL dari pasien kanker.

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Objective: To determine the relationship between financial burden and the quality of life of cancer patients undergoing radiation therapy at the radiotherapy installation of the national referral hospital in Indonesia that utilizes the National Health Insurance (JKN).

Methods: A descriptive-analytical research design with a cross-sectional method was employed. Data were obtained from medical records and questionnaires containing the EORTC QLQ-C30 form to assess HRQoL, filled out through telephone interviews with cancer patients who had undergone radiotherapy at IPTOR RSUPN Dr. Cipto Mangunkusumo from January 2022 to March 2023. An analysis was conducted to identify and understand the relationship between sociodemographic, clinical, and economic/economic burden characteristics with the HRQoL of cancer patients.

Results: From the analysis of each independent variable, it was found that for global health, there is a statistically significant relationship (p>0.25) with age (p=0.166), gender (p=0.090), stage (p=0.111), monthly income (p=0.114), and COST FACIT score (p<0.001). For physical function, the relationship variables are KPS (p=0.089), OTT (p=0.048), income (p=0.146), and COST FACIT score (p<0.001). Meanwhile, emotional function related to age (p=0.081), gender (p=0.113), KPS (p=0.119), radiation indication (p=0.188), OTT (p=0.053), OOP (p=0.021), financial catastrophe (p=0.135), and COST FACIT score (p<0.001). The results of multivariate analysis with linear regression show that only the COST FACIT score has a p-value <0.05 from its linear regression analysis for global health (p<0.001 b=0.443 R2=18.8%), physical function (p<0.001 b=0.456 R2=20.1%), and emotional function (p<0.001 b=0.523 R2=34.6%).

Conclusion: Financial toxicity is significantly related to assessing the HRQoL of cancer patients undergoing radiotherapy. Income, OOP, and financial catastrophe should also be considered and given attention when evaluating the HRQoL of cancer patients."

"[ABSTRAKKanker merupakan faktor penting dalam beban penyakit global saat ini.Kasus baru setiap tahun terus meningkat. Angka kasus kanker payudara di RumahSakit Kanker Dharmais masih menempati urutan pertama dari jenis kanker lain.Informasi mengenai kualitas hidup perempuan dengan kanker payudara menjadisangat penting mengingat masih tingginya angka kasus kanker payudara sertauntuk memberikan dukungan kepada pasien kanker payudara dalamkeberlangsungan hidup jangka panjang. Kualitas hidup pasien kanker payudaratak luput dari faktor karakteristik individu, faktor karakteristik klinis dan faktorlingkungan sosial. Penelitian ini menggunakan desain case series dengan 90sampel diambil secara consecutive sampling. Hasil penelitian menunjukkanbahwa usia, terapi yang sedang dijalani, paparan informasi serta dukungankeluarga berhubungan dengan kualitas hidup pasien kanker payudara. Saran untukRumah Sakit Kanker Dharmais agar lebih meningkatkan penyebaran informasitentang kanker payudara, bagi masyarakat meningkatkan dukungan keluargaterhadap pasien kanker payudara.

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ABSTRACTCancer is an important factor in the current global disease burden. New cases eachyear continues to increase. The numbers of breast cancer cases in the DharmaisHospital Cancer still ranks first than other types of cancer. Information on thequality of life of women with breast cancer becomes very important consideringthe high number of cases of breast cancer and to provide support to breast cancerpatients in the long-term survival. The quality of life of breast cancer patientslitely dependent the individual characteristic, clinical characteristics and socialenvironmental factors. This study used a case series design with 90 samplesemployed consecutive sampling. The results showed that age, the therapy beingundertaken, breast cancer exposure information as well as family support relatedto the quality of life of the breast cancer patients. Suggestions one made to theDharmais Cancer Hospital to further improve the dissemination of informationabout breast cancer, in the family to increase family support for breast cancerpatients.;Cancer is an important factor in the current global disease burden. New cases eachyear continues to increase. The numbers of breast cancer cases in the DharmaisHospital Cancer still ranks first than other types of cancer. Information on thequality of life of women with breast cancer becomes very important consideringthe high number of cases of breast cancer and to provide support to breast cancerpatients in the long-term survival. The quality of life of breast cancer patientslitely dependent the individual characteristic, clinical characteristics and socialenvironmental factors. This study used a case series design with 90 samplesemployed consecutive sampling. The results showed that age, the therapy beingundertaken, breast cancer exposure information as well as family support relatedto the quality of life of the breast cancer patients. Suggestions one made to theDharmais Cancer Hospital to further improve the dissemination of informationabout breast cancer, in the family to increase family support for breast cancerpatients.;Cancer is an important factor in the current global disease burden. New cases eachyear continues to increase. The numbers of breast cancer cases in the DharmaisHospital Cancer still ranks first than other types of cancer. Information on thequality of life of women with breast cancer becomes very important consideringthe high number of cases of breast cancer and to provide support to breast cancerpatients in the long-term survival. The quality of life of breast cancer patientslitely dependent the individual characteristic, clinical characteristics and socialenvironmental factors. This study used a case series design with 90 samplesemployed consecutive sampling. The results showed that age, the therapy beingundertaken, breast cancer exposure information as well as family support relatedto the quality of life of the breast cancer patients. Suggestions one made to theDharmais Cancer Hospital to further improve the dissemination of informationabout breast cancer, in the family to increase family support for breast cancerpatients.;Cancer is an important factor in the current global disease burden. New cases eachyear continues to increase. The numbers of breast cancer cases in the DharmaisHospital Cancer still ranks first than other types of cancer. Information on thequality of life of women with breast cancer becomes very important consideringthe high number of cases of breast cancer and to provide support to breast cancerpatients in the long-term survival. The quality of life of breast cancer patientslitely dependent the individual characteristic, clinical characteristics and socialenvironmental factors. This study used a case series design with 90 samplesemployed consecutive sampling. The results showed that age, the therapy beingundertaken, breast cancer exposure information as well as family support relatedto the quality of life of the breast cancer patients. Suggestions one made to theDharmais Cancer Hospital to further improve the dissemination of informationabout breast cancer, in the family to increase family support for breast cancerpatients., Cancer is an important factor in the current global disease burden. New cases eachyear continues to increase. The numbers of breast cancer cases in the DharmaisHospital Cancer still ranks first than other types of cancer. Information on thequality of life of women with breast cancer becomes very important consideringthe high number of cases of breast cancer and to provide support to breast cancerpatients in the long-term survival. The quality of life of breast cancer patientslitely dependent the individual characteristic, clinical characteristics and socialenvironmental factors. This study used a case series design with 90 samplesemployed consecutive sampling. The results showed that age, the therapy beingundertaken, breast cancer exposure information as well as family support relatedto the quality of life of the breast cancer patients. Suggestions one made to theDharmais Cancer Hospital to further improve the dissemination of informationabout breast cancer, in the family to increase family support for breast cancerpatients.]"

"ABSTRAKKanker payudara merupakan kanker yang menduduki urutan terbanyak nomor dua di Indonesia. Untuk mengatasi kanker payudara menggunakan terapi konvensional dan terapi komplementer. Studi kualitatif fenomenologi dilakukan untuk menggali berbagai pengalaman klien dengan kanker payudara yang telah menggunakan terapi komplementer. Partisipan dipilih dengan kriteria tertentu menggunakan metode purposif. Jumlah partisipan delapan. Data dikumpulkan melalui wawancara mendalam sebanyak 2 kali yang dilengkapi dengan catatan lapangan. Wawancara direkam kemudian dibuat transkrip. Penelitian ini mengidentifikasi dua jenis terapi komplementer yang digunakan oleh partisipan yaitu terapi herbal dan terapi spiritual. Tema-tema tersebut adalah (1) berbagai motivasi yang menggambarkan alasan menggunakan terapi komplementer, (2) Berbagai persepsi dalam menggunakan terapi komplementer, (3) berbagai manfaat yang dirasakan setelah menggunakan terapi koplementer, (4) pelayanan kesehatan yang sudah diterima, (5) kebutuhan pelayanan kesehatan yang diharapkan klien kanker payudara dalam menggunakan terapi komplementer. Hasil penelitian ini memperlihatkan bahwa motivasi menggunakan terapi komplementer adalah untuk ingin cepat sehat, persepsi tentang penggunaan terapi komplementer bahwa terapi komplementer sebagai pelengkap terapi medis dan sebagai pengobatan tradisional, manfaat terapi komplementer adalah untuk meningkatkan stamina; pelayanan kesehatan yang sudah diterima adalah memuaskan dan pelayanan kesehatan yang diharapkan adalah informasi tentang penggunaan terapi komplementer di Rumah Sakit Kanker Dharmais.

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ABSTRACTBreast cancer is a type carcinoma which is one of the most cancer in Indonesia (level two). Conventional and complementary therapy are used to treat the carcinoma. Participants selected by given criteria using purposive sampling. The participants were eight. Data collected by two times in-depth interview and completed by field note. The interviews recorded and then transcribed. Researcher identified two kinds of complementary therapy used by participants, herbal and spiritual therapy. Themes emerged from complementary therapy were (1) various motivations described the reason to use complementary therapy, (2) various perceptions in using complementary therapy, (3) various benefits perceived after using complementary therapy, (4) health care received, (5) health care need expected by client with carcinoma mammae in using complementary therapy. The results showed that motivation in using complementary therapy was to achieve health immediately; the perception in using complementary therapy was that complementary therapy as a complement of medical therapy; benefit from complementary therapy was to enhance the stamina; health care received had been satisfied and expected health care need was information about using complementary therapy in Dharmais Cancer Hospital."

"Terapi Paliatif bertujuan untuk meningkatkan kualitas hidup dan mengurangi gejala, namun menambah kompleksitas terapi pasien. Penelitian ini bertujuan untuk menganalisis profil pengobatan dan prevalensi DRPs yang terjadi pada pasien yang menjalani terapi paliatif di RSK 'Dharmais'. Penelitian ini adalah penelitian cross sectional. Data pada penelitian diambil secara prospektif dari data medis pasien bulan maret sampai juni 2011. Karakteristik pasien, 33 orang (68,8%) perempuan, 15 orang (31,3%) laki-laki, dan kasus kanker padat terbesar adalah kasus kanker payudara sebanyak 15 orang (33,3%). Berdasarkan profil pengobatan, 64,6% hanya menjalani satu kali terapi paliatif. Reaksi obat yang tidak diinginkan (ROTD) manifestasi dialami olah 70,1% subyek uji dan 66,2% mengalami ROTD potensial. Lima koma tujuh persen (5,7%) mengalami interaksi dengan signifikansi moderate dan 15,0% terjadi karena pemakaian morphine, dan amitriptyline. Peningkatan risiko kejadian ROTD dipengaruhi oleh (1) usia, bertambahnya usia tidak selalu menyebabkan peningkatan ROTD manifestasi; (2) jenis kelamin, laki-laki akan lebih berisiko mengalami peningkatan ROTD manifestasi; (3) riwayat rejimen kemoterapi kuratif, meningkatkan risiko ROTD manifestasi; (4) penyakit penyerta, meningkatkan risiko ROTD manifestasi dan potensial; (5) jumlah obat; penggunaan > 5 jenis obat dapat meningkatkan risiko ROTD manifestasi dan ROTD potensial. Risiko kejadian interaksi obat dipengaruhi oleh faktor adanya penyakit penyerta dan penggunaan > 5 jenis obat.

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The goal of palliative care is to increase the quality of life and to reduce the symptomps, but its often increace the complexity of patient's therapy. The aim of these research is to analyst the patient's therapy profile and the prevalence of DRPs of patient undergoing the palliative care at 'Dharmais' Hospital National Cancer Center. This reasearch is a cross sectional study. The data of the research is prospectively taken from the patients' medical records start from march to june 2011. The patient characteristic who followed the reasearch are 33 patients (68.8%) women, 15 patient (31.3%) men, and the most solid cancer case are breast cancer, 15 patients (31.3%). Based on therapy profile, 64.6% only had once palliative care. Manifest adverse reaction happen in 70.1% patient of subject and 66.2% subjects get potential adverse reaction. Five point seven percent (5.7%) of drug interaction had moderate signification, 15.0% caused by the morphine, and amitriptyline use. The risk of incident adverse reactions influenced by (1) age, increasing the age not always increase the risk of having the manifest adverse reaction, (2) sex, men will have higher risk of manifest adverse reaction, (3) history of curative chemotherapy regimen, increase the risk of manifest adverse reaction, (4) comorbidities will increase the risk of manifest and potential adverse reaction, (5) the number of drug use, using more than 5 drugs ( > 5 drugs) will increase the risk of manifest and potential adverse reaction. The risk of drug interaction will increase because of the comorbidities and the number of drugs using ( > 5 drugs)."

"Efek samping dari pemberian kemoterapi maupun beban penyakit kanker sering kali meyebabkan gangguan pada semua system dalam tubuh manusia serta masalah psikologis yang akhirnya dapat menyebabkan terjadinya fatigue pada pasien kanker. Tujuan dari penelitian ini adalah untuk mengidentifikasi faktor prediktor yang dapat menyebabkan fatigue. Metode dalam penelitian ini menggunakan analisis korelasi dengan cross sectional, dengan jumlah sampel sebanyak 95. Metode pengambilan sampel dengan menggunakan teknik concecituve samping. Penelitian ini menunjukkan bahwa 72,6% responden adalah perempuan dengan rerata usia 45,54 tahun, rerata kadar Hb 10,881 gr/dl, 38,9% kasus Ca Mammae, 69,5% termasuk stadium lanjut, 30,5% mendapat kemoterapi FAC, 29,5% menjalani kemoterapi lebih dari siklus 4, 55,8% fatigue ringan, 55,8% kategori nyeri sedang-berat, 82,1% kualitas tidur buruk, dan 38,9% termasuk katagori aktif minimal. Hasil penelitian ini menunjukkan bahwa terdapat hubungan yang signifikan (p value 0,05) antara kadar Hb, mual muntah, nyeri, tingkat aktivitas, depresi, dan kualitas tidur dengan fatigue. Analisis berikutnya didapatkan hasil bahwa variabel nyeri merupakan variabel yang berisiko paling besar untuk terjadinya fatigue. Rekomendasi dari penelitian ini adalah pentingnya mengidentifikasi faktor-faktor yang dapat menyebabkan fatigue pada pasien kanker yang menjalan kemoterapi untuk mengurangi risiko kejadian atau semakin parahnya fatigue.

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Side effect of chemotherapy and burden of cancer often cause interference with all the human body systems as well as psycological problems wich eventually can lead to fatigue in cancer patients. The purpose of the study was to identify predictor faktors that can be cause of fatigue. The method of the research applied correlation analysis with cross sectional. There were 95 respondents. Sample was taken by consecutive sampling technique. The research showed that 72,6% female respondents with 45,54 years of age in average, Hb rate 10,881 gr/dl in average, 38,9% Mammae cancer, 69,5% advanced stage, 30,5 % FAC chemotherapy, 29,5% more than 4 cycles of chemotherapy, 55,8% light fatigue, 55,8% moderate-severe pain, 82,1% bad sleep quality, 38,9% moderate nausea and fomiting, 36,8% bordeline anxiety, 62,1% no depression, and 44,2% minimal active.

The analysis showed that there was a significant relation between Hb, depression, physical activity, sleep quality, pain, nausea and vomiting with fatigue lavel of (p< 0,05). Further analysis showed that pain was the greatest risk for the occurence of fatigue. The reseacher recommends that should be to indentifying another factors that can cause fatigue in cancer patient undergoing chemotherapy to reduce risk occurrence and severity of fatigue."

"Latar Belakang: Kanker payudara merupakan kanker yang paling sering terjadi di dunia dengan insidensi 25,1% dari semua jenis kanker. Pasien kanker payudara yang menjalani radiasi, umumnya tidak memenuhi kriteria malnutrisi pada skrining gizi namun kebanyakan pasien memiliki massa otot yang rendah, sehingga berpotensi mengalami penurunan kapasitas fungsional. Proses keganasan dan radiasi dapat menyebabkan peningkatan IL-6 yang berdampak pada penurunan kadar Hb. Kadar kolesterol LDL yang tinggi juga sering ditemukan pada pasien dengan obes/riwayat obes, peningkatan ini merugikan karena berdampak pada prognosis dan kesintasan pasien. Terapi medik gizi yang adekuat diperlukan pada pasien kanker payudara.Metode: Pasien kanker payudara berusia antara 36-79 tahun. Empat pasien telah menjalani mastektomi dan tiga di antaranya telah dikemoterapi. Pasien memiliki hasil skrining MST ≥2. Pemantauan yang dilakukan meliputi keluhan subjektif, kondisi klinis, tanda vital, pemeriksaan laboratorium, antropometri, komposisi tubuh, kapasitas fungsional dan analisis asupan 24 jam. Keempat pasien mendapatkan edukasi nutrisi, oral nutrition support (ONS), suplementasi vitamin dan mineral serta omega-3.Hasil: Dari hasil pemantauan diketahui bahwa pasien kanker payudara yang mendapatkan terapi medik gizi dapat meningkatkan asupan makanannya, berat badan, massa otot, kekuatan genggam tangan, kadar hemoglobin dan perbaikan kadar kolesterol LDL. Skor ECOG/Karnofsky Performance dari keempat pasien mengalami perbaikan bila dibandingkan dengan pemeriksaan awal.Kesimpulan: Terapi medik gizi dapat memperbaiki outcome klinis, kapasitas fungsional, antropometri, dan laboratorium pada semua pasien dalam serial kasus ini.

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Background: Breast cancer is the most common cancer in the world with an incidency 25.1% of all types of cancer. Generally, breast cancer patients who had undergoing radiation did not meet the criteria for malnutrition based on nutritional screening, but most patient had low muscle mass that reduce functional capacity. Malignancy and radiation cause an increase of IL-6 which result a decrease in Hb levels. High LDL cholesterol levels were also found in obesity or history of obesity which affected the prognostic and survival of breast cacer patient. The patients mostly had skeletal mass decreased. Adequate nutritional therapy is needed for breast cancer patients.Method: The case saries reported breast cancer patients aged between 36-79 years. Three patients had mastectomy and chemotherapy, while the other had only mastectomy. Patients had MST screening ≥ 2. Patiens were examined of subjective complaints, clinical conditions, vital signs, laboratory examination, anthropometry, body composition, functional capacity and 24-hour intake analysis. The four patients received nutritional education, oral nutrition support (ONS), vitamin and mineral supplement and omega-3.Results: Breast cancer patients who got adequate nutritional therapy had increased their food intake, body weight, skeletal mass, handgrip strength, hemoglobin levels and improvement of LDL cholesterol levels. The ECOG/Karnofsky Performance Score of the all patients showed improvement from the initial examination.Conclusion: Medical nutrition therapy improves the outcome, nutritional status, laboratory parameters and body composition in breast cancer patients."

"Kanker payudara adalah kanker dengan prevalensi tertinggi di Indonesia. Dengan prevalensi sebesar 30–50%, nyeri kanker adalah salah satu komplikasi kanker tersering yang dapat menurunkan mutu hidup penderitanya. Nyeri kanker, yang merupakan sejenis nyeri campuran, dapat diakibatkan oleh perjalanan penyakit atau terapi antikanker. Umumnya nyeri kanker ditangani dengan pemberian opioid dengan/tanpa adjuvan. Namun, opioid memiliki efek samping yang bersifat dose-dependent sehingga penggunaannya harus tepat guna agar memaksimalkan manfaatnya sekaligus meminimalisasi risikonya. Studi ini meneliti efek dari pemberian adjuvan gabapentin terhadap intensitas nyeri dan dosis opioid pasien dengan nyeri kanker payudara. Data rekam medis dari 58 pasien dengan nyeri kanker payudara dari dua rumah sakit rujukan di Jakarta diinklusi untuk studi kohort retrospektif ini. Data yang diambil meliputi profil klinis pasien, derajat nyeri, dan dosis opioid. Analisis statistik tidak menemukan adanya perbedaan yang signifikan dalam median intensitas nyeri maupun median dosis opioid antara kelompok pasien dengan nyeri kanker payudara yang menerima adjuvan gabapentin dengan yang tidak. Masih diperlukan penelitian lebih lanjut untuk menentukan peran gabapentin sebagai adjuvan dalam tata laksana nyeri kanker. Penelitian-penelitian selanjutnya disarankan untuk memperbanyak jumlah pasien dan mengendalikan faktor-faktor perancu seperti status opioid dan pemberian adjuvan lain.

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Breast cancer is the most prevalent cancer in Indonesia. With a prevalence of 30–50%, cancer pain is a frequent complication of cancer which may lower patient quality of life. Cancer pain, a type of mixed pain, may develop from cancer progression or anticancer therapy. Opioids with/without adjuvants are usually administered to manage cancer pain. However, opioids are associated with dose-dependent side effects. Hence, the administration of opioids should be efficient to maximize benefit and minimize risks. This research studied the effect of adjuvant gabapentin administration on the severity of pain and opioid dose of patients with breast cancer pain. This retrospective cohort study included medical records from 58 patients with breast cancer pain from two tertiary hospital in Jakarta. Patients’ clinical profile, pain severity level, and opioid doses were collected. Statistical analyses did not find a significant difference in median pain severity level and median opioid dose between patients with breast cancer pain who received gabapentin and those who do not. Further research is warranted to determine the role of gabapentin as adjuvant in the management of cancer pain. Future studies should increase the sample size and control confounders such as opioid status and the administration of other adjuvants."

"Latar Belakang: Akhir-akhir ini peristiwa epigenetik turut berperan menjadi penyebab keganasan. Peristiwa epigenetik meliputi metilasi DNA dan modifikasi histon. Gen penekan tumor adalah salah satu golongan gen yang merupakan target utama kcrusakan DNA. Contohnya gen penekan tumor dapat tidak berfungsi karena termutasi, termetilasi dan mengalami LOH (Loss of heterozygosity), gen WRN adalah termasuk gen penekan tumor. Gen WRN termutasi pada penyakit Werner Syndrome, gen WRN yang terletak pada kromosom 8p 11.2-12 sering mengalami LOH dan pada lokus genetik ini terdapat pada pasien usia muda kanker payudara, laporan terakhir mcnyatakan bahwa gen WRN dapat mengalami metilasi, semua kejadian pada gen WRN tersebut dapat mengarah ke kanker. Tujuan: Penelitian ini untuk mengetahui karakteristik status gen WRN yang temietilasi pada pasien kanker payudara di Rumah sakit Kanker Dharmais dan hubungan gen WRN yang termetilasi tersebut dengan ekspresi mRNA nya. Desain: Analitik. Metode: Jaringan segar kanker payudara di isolasi sehingga didapat DNA dan RNA. Untuk mengecek kualitas DNA yang didapat dilakukan PCR konvensional dengan primer Interferon-Gamma. Dilanjutkan perlakuan sodium bisuliit, untuk mengkonversi sitosin yang tidak termetilasi menjadi urasil sedangkan sitosin yang termetilasi tetap menjadi sitosin. Primer myod-1 untuk megecek hasil perlakuan sodium bisuliit kemudian dilakukan teknik MSP dengan masing-masing Primer metilasi dan Primer tidak metisi. RNA yang didapatdi reverse rranscripiase menjadi cDNA kemudian di perlakukan bersama cDNA B-actin diperiksa dcngan Real Time PCR. Uji Mann- Whitney U dipakai untuk menguji hubungan antara gen WRN yang termetilasi dengan ekspresi mRNA dan uji Fisher untuk menguji hubungan antara gen WRN yang temietilasi dcngan data klinik meliputi usia penderita, hasil pemeriksaan lmmunohistokimia (ER, PR, IIer2, p53) dan TNM. Hasil: Gen WRN yang termetilasi sebanyak 9 sampel dari 60 sampel (l5%). Ekspresi mRNA yang dapat dinilai datanya sebanyak 49 sampel dari 60 sampel (8 I ,67%) dan Rasio ekspresi WRN terhadap B-actin sekitar 0,00 hingga 27,75. Kesimpulan: Tidak ada hubungan antara gen WRN yang tcrmetilasi dengan ekspresi mRNA dengan P = 0,61 dan tidak ada hubungan antara gen yang termetilasi dengan data klinik yang terdiri dari hasil pemeriksaan ER, PR, Her2, Triple negatif, p53, dan TNM, tapi ada hubungan yang signiiikan antara usia pcnderita yang muda (dibawah dan sama dcngan 40 tahun) dengan gen WRN yang termctilasi dengan P = 0,02.

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Background: Epigenetic events including DNA methylation and histone modifications contribute to the cause of malignancy. Tumor suppressor genes belong to class of genes which may be subjected to DNA damage or modification. For instance, tumor suppressor gene may be inactivated by mutation, methylation and LOH ( Loss of heterozigosity), the WRN gene is an example of tumor suppressor gene. Mutated in the premature aging Werner syndrome, WRN gene is located on chromosome 8p 11.2-12. Futhermorc, L01-I in this genetic locus is found in a subset of early onset breast cancer patients. Recent report also indicated that WRN gene may be susceptible to methylation. These data suggest that WRN gene inactivation may lead to cancer.

Objective : This study aims to examine the characteristic of a methylation status of WRN gene in breast cancer patients at Dhamiais National Cancer Hospital and the relationship between WRN gene methylation with its mRNA expression.

Design: Analytical.

Methods: DNA and RNA were isolated from archieved frozen breast cancer tissue sample. DNA quality was checked by PCR amplification of Interferon gamma gene. To determine promoter methylation, DNA was treated with bisultite to distinguish methylated cytosine from unmethylatated ones. The quality of converted DNA was determined by amplification of Myod-1 locus with contain cytosine rich sequences that are susceptible to uracil conversion upon bisultite treatment. Subsequently, WRN methylation was determined using Methylation Specific PCR (MSP) using 2 set of primers recognizing either methylated or unmethylated WRN sequence. WRN expression was determined bythe level of cDNA upon conversion of total, RNA using reverse transcriptase. Expression of WR.N was calibrated to B-actin expression using Real-Time PCR and Pffafl method. Mann-Whitney U test was used to examine the relationship between WRN gene methylation and its mRNA expression. Fisher test was used to examine the relationship between WRN gene methylation status with clinical data include age, lmmunohistokimia test (ER,PR,I-ler2,p53) and TNM.

Results: WRN gene is methylated in nine samples out of 60 samples (I5%). mRNA expression data was assessed from 49 samples out of 60 samples only (8l,67%). Although there is a trend of mRNA silencing in methylated WRN gene, the relationship does not reach statistical significance. WRN expression ratio of B- actin around 0,00 to 27,75.

Conclusion: There is no relationship between the WRN gene methylation and mRNA expression, P = 0.61 and no relationship between the WRN gene methylated with clinical data that consists of ER, PR, Ht-:r2, Triple negative, p53, and TNM. Interestingly, WRN methylation was found more frequently in early onset breast cancer patients, P=0,02."