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"Senyawa-senyawa fenolik seperti kelompok senyawa flavonoid dan stilben dilaporkan mengandung gugus isoprenil. Penambahan substituen isoprenil pada berbagai kerangka senyawa turunan fenol meningkatkan bioaktivitas secara signifikan dibandingkan senyawa fenol sejenis yang tidak terprenilasi. Tanaman melinjo (Gnetum gnemon L.) dilaporkan memiliki kandungan senyawa stilbenoid (Stilben terhidroksilasi) seperti resveratrol (3,5,4’-trans-trihidroksi-stilben) dan gnetol (2,3’,5’,6-tetra hidroksi transstilben) yang merupakan monomer stilbenoid. Tujuan dari penelitian ini adalah untuk memperoleh produk reaksi katalisis berupa senyawa prenil resveratrol dari isolat kulit melinjo dengan potensi bioaktivitas sebagai antikanker. Katalis superbasa γ-Al 2O3/NaOH/Na yang digunakan, diperoleh dengan cara memanaskan campuran padatan γ-Al2O3 , NaOH dan logam Natrium pada suhu 400 o C dan kondisi atmosfer gas Nitrogen. Isolasi senyawa resveratrol dan turunannya dari ekstrak kulit melinjo dilakukan melalui metode kromatografi kolom dengan menggunakan pelarut n-heksan, etil asetat dan methanol sebagai fasa gerak berdasarkan sistem gradien (peningkatan kepolaran). Reaksi katalisis prenilasi isolat kulit melinjo dilakukan berdasarkan model reaksi prenilasi resveratrol dengan pereaksi prenil bromida (3,3-dimetil alil bromida) dan katalis superbasa γ-Al 2O3 /NaOH/Na. Berdasarkan hasil analisis XRD, padatan γ-Al 2O3/NaOH/Na yang diperoleh memiliki karakter yang berbeda dengan padatan γ-Al 2O3. Kondisi optimum reaksi katalisis prenilasi resveratrol ditentukan berdasarkan hasil analisis HPTLC, yaitu suhu 60o C dan waktu reaksi 4 jam.Hasil analisis LC/ESI-MS terhadap produk reaksi katalisis prenilasi resveratrol menunjukkan adanya puncak [M+H] + dengan m/z 365,38 yang merupakan puncak ion dari senyawa resveratrol tersubstitusi oleh 2 gugus prenil (C 5H9 -). Hasil analisis 1 H-NMR menunjukkan bahwa penambahan 2 gugus prenil (C 5 H9 -) terjadi pada gugus hidroksil (-OH) dari struktur resveratrol (O-prenilasi). Prenilasi menyebabkan terjadinya penurunan aktivitas radical scavenger produk reaksi prenilasi resveratrol (IC50 = 102,75 ppm) bila dibandingkan dengan substrat awal yaitu senyawa resveratrol (IC5= 63,52 ppm). Proses isolasi terhadap ekstrak kulit melinjo melalui metode kromatografi kolom memperoleh tiga isolat. Analisis LC/ESI-MS terhadap isolat kulit melinjo memperlihatkan adanya kandungan senyawa resveratrol (m/z 229,26 [M+H] + ), gnetol (m/z 245,28 [M+H] + ), isorhapontigenin (m/z 259,23 [M+H] + ) dan gnetifolin M (m/z 257,19 [M+H] + ). Prenilasi isolat kulit melinjo telah dilakukan berdasarkan model reaksi prenilasi resveratrol. Hasil analisis LC/ESI-MS menunjukkan adanya senyawa resveratrol (m/z 297,44 [M+H] + dan m/z 365,52 [M+H] + ), gnetol (m/z 313,51 [M+H] + ) serta isorhapontigenin (m/z 327,50 [M+H] + ) terprenilasi pada produk prenilasi isolat kulit melinjo. Aktivitas sitotoksik terhadap sel murine leukimia P-388 dari produk prenilasi isolat kulit melinjo dikategorikan aktif (IC50 = 7,71 μg/mL) dan lebih tinggi dibandingkan dengan isolat kulit melinjo (IC50 = 28,41 μg/mL).

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Phenol derivatives such as flavonoid and stilbenes groups have been reported to possess isoprenoid group. The addition of isoprenyl substituents at various skeleton of polyphenols significantly increased its bioactivity compared to the parent compound. Melinjo (Gnetum gnemon L.) plant have been reported to contain stilbenoid (hydroxylated stilbenes) compounds such as resveratrol (3,5,4’-trans-trihydroxy-stilbene) and gnetol (2,3’,5’,6-tetra hydroxy trans-stilbene) that were stilbenoid monomeric. The objective of this study is to obtain the prenylated resveratrol with its bioactivity as an anticancer from melinjo peels isolate through catalysis reaction. The superbase catalyst γ-Al 2O3/NaOH/Na was prepared by heating a mixture of γ-Al 2O3, NaOH and sodium metal at a temperature of 400 o C and under N2 atmosfer. Stilbenoid from melinjo peels extract was isolated by coloumn chromatography with n-hexane, ethyl acetate and methanol as mobile phase based on gradient system (increasing polarity). Catalysis reaction of prenylation of melinjo peels isolate was carried out by using prenyl bromide (3,3-dimethyl allyl bromide) and superbase catalyst γ-Al2 O3/NaOH/Na based on reaction model of prenylation of resveratrol. According to XRD analysis, the obtained of solid superbase γ-Al 2 O3 /NaOH/Na showed a different characteristic compared to γ-Al 2O3. The optimum condition catalysis reaction of prenylation of resveratrol was determined using HPTLC analysis, at a temperature of 60oC for 4 hours. The results of LC/ESI-MS analysis of the product showed the molecular ion peak at m/z 365.38 [M+H] + that indicated the presence of prenylated resveratrol with two prenyl (C 5 H9 -) substituent. 1 H-NMR spectrum of the product indicated that addition two prenyl substituent occur at the hydroxyl group on the structure of resveratrol (O-prenylation). Prenylation caused decreasing free radical scavenging activity of the product (IC50 = 102.75 ppm) compared to resveratrol (IC50 = 63.52 ppm) and it means that the addition of prenyl substituents occurs through O-prenylation. Isolation of stilbenoid from melinjo peels extract obtained 3 isolates using chromatography coloumn.LC/ESI-MS analysis detected the presence of resveratrol (m/z 229.26 [M+H] + ), gnetol (m/z 245.28 [M+H] + ), isorhapontigenin(m/z 259.23 [M+H] + ) and gnetifolin M (m/z 257.19 [M+H] + ) in the melinjo peels isolate. Prenylation of melinjo peels isolate was carried out based on reaction model of prenylation of resveratrol. The product of prenylation showed the presence of prenylated resveratrol (m/z 297.44 [M+H] + and m/z 365.52 [M+H] + ), prenylated gnetol (m/z 313.51 [M+H]+ ) and prenylated isorhapontigenin (m/z 327.50 [M+H]+ ) using LC/ESI-MS analysis. The cytotoxic activity against murine leukemia P-388 cells of the product of prenylation was classified as active (IC50 = 7.71 μg/mL) and higher than melinjo peels isolate (IC50 = 28.41 μg/mL). "

"ABSTRAKNama:Muthia Octaviana WidiantiProgram Studi:Magister Ilmu KeperawatanJudul:Hubungan Body Image, Dukungan Sosial, dan Efek Samping Kemoterapi dengan Kualitas Hidup Pasien Kanker PayudaraPembimbing:Sri Yona, S.Kp., M.N., Ph.D. Masfuri, S.Kp., M.N. Prevalensi kejadian kanker payudara di dunia meningkat termasuk di Indonesia. Pasien kanker payudara mengalami perubahan secara fisik, psikologis, dan sosial yang berpengaruh terhadap kualitas hidup. Kualitas hidup dipengaruhi dimensi fisik efek samping kemoterapi , sosial dukungan sosial , emosional body image , dan sosial demografi. Tujuan penelitian ini untuk mengetahui hubungan body image, dukungan sosial, dan efek samping kemoterapi dengan kualitas hidup pasien kanker payudara. Desain penelitian Cross-sectional dengan consecutive sampling terdiri dari 110 pasien yang menjalani kemoterapi yang dipilih dan sesuai kriteria inklusi. Uji statistik bivariat menggunakan Gamma Somer rsquo;d dan multivariat menggunakan regresi logistik. Hasil penelitian menunjukkan ada hubungan signifikan pada kualitas hidup yaitu body image p value=0,000 , dukungan sosial p value=0,019 , dan efek samping kemoterapi p value=0,000 . Hasil penelitian juga menunjukkan faktor yang paling berpengaruh terhadap kualitas hidup pasien kanker payudara adalah body image. Body image, dukungan sosial, efek samping kemoterapi diharapkan sebagai dasar pengkajian pasien kanker payudara terhadap kualitas hidup.Kata kunci:body image, dukungan sosial, efek samping kemoterapi, kanker payudara, kualitas hidup.

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ABSTRACTName Muthia Octaviana Widianti Study Programme Magister Ilmu Keperawatan Title Correlation Between Body Image, Social Support, Side Effects of Chemotherapy, and Quality of Life In Breast Cancer PatientsCounsellor Sri Yona, S.Kp., M.N., Ph.D. Masfuri, S.Kp., M.N. The number of breast cancer cases in the world remains high, likewise in Indonesia. Breast cancer survivors experience numerous physical, psychological, and social changes. Quality of life is influenced by physical side effects of chemotherapy , social social support , emotional body image dimension, and social demography. This study aims to investigate the correlation between body image, social support, side effects of chemotherapy,and quality of life in breast cancer patients. Cross sectional with consecutive sampling was employed and involving 110 patients undergoing chemotherapy who were selected based on determined inclusion criteria. Analysis bivariate statistic uses Gamma Somers rsquo d and multivariate analysis uses logistic regression. The result shows significant correlation to quality of life between body image p value 0,000 , social support p value 0,019 and side effects of chemotherapy p value 0,003 . This study also shows that body Image is predictor factor in quality of life in breast cancer patients. Body Image, social support, and side effects of chemotherapy needs to be concerned as an assesment for breast cancer patients to quality of life.Keywords body image, social support, side effects of chemotherapy, breast cancer, quality of life."

"Latar Belakang: NAC neoadjuvant chemotherapy secara umum telah digunakan di LABC locally advanced breast cancer untuk mengurangi ukuran tumor dan membuat tumor tersebut bisa untuk dioperasi. Meskipun ukuran tumor telah berkurang, masih diperdebatkan batas pembedahan pasca NAC untuk LABC dengan karsinoma mastitis, ulkus payudara, dan fitur agresif lainnya bebas dari tumor karena kemoterapi tidak bisa membunuh 100 dari sel-sel tumor. Metode: Desain penelitian adalah studi potong lintang. Sampel diambil dari semua pasien dengan LABC yang datang ke klinik onkologi rawat jalan dari RS Cipto Mangunkusumo dan ditato untuk batas pembedahan berdasarkan ukuran tumor sebelum NAC. Penelitian ini dilakukan untuk menentukan batas pembedahan yang benar di LABC setelah NAC. Hasil: Dari total 85 pasien, 42 pasien termasuk dalam studi dan 30 pasien masih menjalani pemberian NAC. Umur pasien berkisar antara 27-70 tahun dengan frekuensi tertinggi adalah 40-50 tahun 47,6 . Frekuensi kasus tersering adalah pasien dengan stadium IIIB 92,9 , grade 2 66,7 , histopalogi karsinoma duktal invasif 92,8 hasil IHK imunohistokimia over-ekspresi HER2 42,8 , volume tumor sebelum NAC > 100cc 85,8 dan volume tumor setelah NAC 50-100cc 57,2 . Regimen kemoterapi yang banyak digunakan CAF 76,1 dengan respon parsial 95,2. Kesimpulan: Batas sayatan kulit berdasarkan ukuran tumor pasca NAC dapat menjadi acuan untuk operasi, namun pada dasar sayatan operasi masih perlu dilakukan frozen section untuk memastikan bebas tumor atau tidak. Seorang ahli bedah juga harus lebih berhati-hati dalam menentukan batas sayatan operasi pada kasus mastitis karsinomatosis, ulkus payudara yang besar dan tumor yang terletak di medial payudara dimana pada kondisi ini batas sayatan operasi dapat beresiko tidak bebas tumor.

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Introduction: There is limited evidence regarding the effectivness of neoadjuvant chemotherapy NAC to improve surgical margins for locally advanced breast cancer LABC patients. In this study, NAC was used to reduce tumor size to improve operability and reduce surgical margins, with confirmation of tumor free areas provided by post operative histopathology. The reduction of surgical margins has the potential to reduce the need for extensive surgery and the risk of complications in LABC patients.

Method: The study participants were patients diagnosed with LABC in Ciptomangunkusumo Hospital Jakarta and Awal Bros Bekasi Hospital Bekasi between 2014 and 2015. Patients underwent NAC, and those with partial or complete response were sent for surgery. Tumor excision was done according to the pre NAC surgical margin, which was marked by tattoo. Histopathology then checked for tumor cells in the surgical margins based on breast tumor size of pre and post NAC. Data was analyzed with SPSS version 20 with numerous statistical tests. Cross tabulation analyses were done to examine the characteristics of the study participants. McNemar test was used to determine and compare the pre and post NAC surgical margins.

Results: Out of 42 patients, 38 were observed to have tumor free surgical margins in both pre and post NAC. Of the remaining four patients, three patients had tumor cells in both surgical margins, and one patient had a tumor free pre NAC but positive tumor cells post NAC. McNemar analysis suggests no significant difference p 1,000 in the two surgical margins evaluated. Based on Wilson score analysis, agreement of negative result of surgical margin in pre NAC compare to post NAC is 97.3 CI 86,18 99.52 . Mean while, agreement of positive tumor cell in pre NAC to post NAC surgical margin is 100 CI 90.36 100.

Conclusion: Surgical margins in the skin based on the post NAC tumor size can be used as a guide for surgery, but not in the tumor base. If the surgical margin of tumor base is ambiguos, frozen section can be performed to confirm tumor free in the tumor base. This will reduce the risk of residual tumor cells in surgical margins. "

"RINGKASAN EKSEKUTIFRuang Lingkup dan Cara Penelitian: Pengobatan kanker payudara sudahbanyak diupayakan, melalui tindakan bedah, radioterapi, kemoterapidan terapi hormonal, namun hasilnya kurang memuaskan. Yang sangatdidambakan dan ideal ialah cara pencegahan timbulnya kanker atausetidaknya upaya menekan perkembangan kanker. Beberapa jenisbahan makanan telah dilap orkan mempuny ai kh asiat mencegahtimbulnya keganasan . Vitamin A alami maupun sintetik dilaporkandapat mempengaruhi pertumbuhan sel, sehingga \litamin A dosis tinggidiperkirakan dapat mencegah atau menghambat pertumbunan tumor.Dilakukan penelitian eksperimental untuk menilai daya hambat retinilasetat terhadap pertumbuhan tumor transplantabel kele njar susumencit. Tiga kelompok mencit ja tan strain GR, umur ± 2 bulan danberat badan 18 - 23 g, masing-masing 12 ekor, diinokulasi secara subkutandengan 0,2 ml suspensi tumor kelenjar susu yang diperoleh darimencit GR donor. Tiga jam kemudian kelompok perlakuan RA dicekokdengan sonde lambung 0,2 ml larutan retinil asetat 1500 IU, dandila njutkan se tiap li ari selama 14 h a ri. Kelompok kontro l KPmempero leh 0,2 ml akuades sebagai ganti retinil asetat, sedangkankelompok K tidak dibeliikan apa-apa. Daerah inokulasi diraba setiaphari untuk mengetahui pertumbuhan tumor. Volume tumor dan beratbadan mencit diukur setiap 3 haui, dan pada hari ke-15 semua mencitdimatikan dengan cara dislokasi servikal. Tumor diangkat dan diukurvolumenya, lalu dibuat sediaan mikroskopik dengan pewarnaan HE.Hasil dan Kesimpulan: Volume tumor pada mencit kelomQok RA ternyataJebih kecil daripada elompok KP dan K (p < 0,01). Tumor padakedua kelompok kontrol maupun perlakuan RA menunjukkan gambaranadenokarsinoma, namun indeks mitosis pada kelompok RA lebih kecildaripada kedua kelompok kontrol. Dengan demikian dapat disimpulkanbahwa pemberian retinil asetat 1500 IU setiap hari selama 14 haridengan dicekokkan dapat menghambat pertumbuhan tumor transplantabelkelenjar susu mencit GR.Scope and Method of Study: Breast cancer has been treated by variousmeans of surgery, radiotherapy, chemotherapy and hormonal therapy,however, the outcome are still unsatisfactory. The ideal approachshould be through prevention, or at least the development and progressof cancer inhibited. Different kinds of foodstuffs have been reportedto be useful in the protection against malignancy. Vitamin A, eithernatural or synthetic, has been reported to affect cell growth, and ahigh dose was considered to be protective and inhibit tumor growth.An experiment was carried out on male GR mice, approximately 2months old and weighing 18 - 23 g, to evaluate the inhibitory actionof retinyl acetate on the growth of transplantable mammary tumor.Thirty six mice were divided into 3 groups of 12. They were all inoculatedsubcutaneously with a porridge of tumor cells (0.2 ml) preparedfrom a donor mouse. Three hours following inoculation, each of thetreatment group (RA) was given through a gastric tube 1500 IU ofretinyl acetate in 0.2 ml of distilled water, and the treatment continueddaily for 14 days. The control group KP received daily 0.2 ml of distilledwater, and group K was without any treatment. The mice wereobserved daily for tumor growth, and tumor volume and body weightwere measured every three days starting from day 3. At the end of theexperiment (day 15), the mice were sacrificed by cervical dislocation.The tumor was excised from each mouse and the volume measured,and further processed for microscopic examination by HE stain.Findings and Conclusions: The volume of the tumor of the mice receivingretinyl acetate was significantly smaller than those of the controlgroups K and KP (p < 0.01). Tumors from the treatment group as wellas both control groups showed the characteristics of adenocarcinoma,but the mitotic index was significantly smaller in the treatment group.It is concluded that treatment with retinyl acetate, 1500 IU daily for14 days, could inhibit the growth of transplantable mammary tumor inGR mice."

"Beberapa bukti menunjukkan perubahan metabolik pada pasien kanker payudara dengan indeks massa tubuh (IMT) tinggi berhubungan resistensi insulin dan khususnya perubahan terkait produksi sitokin oleh jaringan adiposa yang merupakan kontributor utama terhadap sifat agresif dari kanker payudara yang berkembang melalui pengaruhnya terhadap angiogenesis dan stimulasi kemampuan invasif dari sel kanker. Studi kohort retrospektif yang dilakukan di Rumah Sakit Kanker Dharmais ini bertujuan untuk mengetahui pengaruh IMT terhadap disease-free survival (DFS) lima tahun pasien kanker payudara. Penelitian ini dilakukan dari bulan Agustus sampai November 2014. Sampel yang digunakan pada studi ini diambil secara konsekutif sebanyak 127 pasien. Dari studi ini, diketahui bahwa DFS lima tahun pasien kanker payudara adalah 70,0%. Berdasarkan kategori IMT, pasien kanker payudara dengan IMT tinggi (>22,9 kg/m2) memiliki DFS lima tahun yang paling besar, yaitu 75,5%, diikuti pasien dengan IMT rendah (<18,5 kg/m2) sebesar 68,6%, dan 60,4% untuk pasien dengan IMT normal (18,5?22,9 kg/m2). Hasil analisis multivariat menunjukkan bahwa IMT tidak memiliki asosiasi dengan kejadian kekambuhan atau metastase (HR=1,052, 95% CI 0,413-2,678) setelah dikontrol oleh variabel pendidikan, sosioekonomi, stadium, keterlibatan kelenjar getah bening, histopatologi, pekerjaan, dan subtipe biologis.

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There are some evidences that the metabolic changes in breast cancer patients with high body mass index (BMI) associated with insulin resistance and, in particular, the related alteration in cytokine production by adipose tissue which are major contributors to the aggressive behavior of breast cancer that develop through their effects in angiogenesis and stimulation of invasive capasity of cancer cells. Retrospective cohort study conducted at the Dharmais National Cancer Hospital aims to determine the effect of BMI on five-year disease-free survival (DFS) breast cancer patients.

This study was conducted from August to November 2014. The samples in this study were collected consecutively as many as 127 patients. From this study, it is known that the five-year DFS of breast cancer patients was 70.0%. Based on the category of BMI, breast cancer patients with high BMI (>22.9 kg/m2) had the biggest DFS, followed by low BMI (<18,5 kg/m2) and normal BMI (18,5 ? 22,9 kg/m2) that the precentages successively were 75.5%, 68.6%, and 60.4%. Multivariate analysis showed that BMI was not associated with the events of recurrence or metastases (HR 1.055; 95% CI 0.413-2.678) after being controlled by other variables, such as education, sosioeconomic, staging, lymph node involvement, histopathology, occupation, and biological subtypes."

"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)."

"Meningkatnya prevalensi kanker terutama yang sudah dalam kondisi terminal membutuhkan penatalaksanaan komprehensif melalui perawatan paliatif yang mana pasien sangat didorong untuk dapat terlibat mengambil keputusaan mandiri. Penelitian ini bertujuan untuk mengeksplorasi esensi atau makna dari pengalaman pasien dalam pengambilan keputusan perawatan paliatif di rumah. Penelitian ini menggunakan metode kualitatif dengan pendekatan fenomenologi dengan metode pemilihan partisipan menggunakan teknik puposive sampling. Sampel dalam penelitian ini sebanyak 10 partisipan pasien kanker stadium lanjut advanced cancer. Pengambilan data dengan teknik indepth interview dengan analisa data menggunakan metode Collaizi. Hasil penelitian menunjukkan enam tema yang signifikan mengambarkan dimanika pasien kanker selama proses pengobatan hingga pengambilan keputusan tempat perawatan paliatif. Tema ndash; tema tersebut yaitu : nyeri dan sedih yang berkepanjangan, dampak nyeri terhadap perubahan aspek kehidupan, alasan pemilihan tempat perawatan paliatif, pengambilan keputusan dengan melibatkan keluarga, kebutuhan pasien akan perawat paliatif dalam menjalani perawatan di rumah serta menjalani akhir kehidupan end of life di rumah dengan tenang. Diharapkan penelitian ini menjadi acuan bagi perawat dalam melakukan pendekatan terapeutik dengan memperhatikan karakteristik partisipan, meningkatkan pengetahuan serta kemampuan berkomunikasi untuk mengadvokasi dan menginformasikan program perawatan paliatif di rumah secara jelas sehingga tidak menimbulkan keraguan pada pasien untuk menerima pemulangan dari rumah sakit dan menerima perawatan paliatif di rumah. Selain itu, perlu adanya strategi dari pemerintah untuk mengoptimalkan program paliatif melalui perawatan paliatif berbasis home care diberbagai daerah di wilayah Indonesia.

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Increased cancer prevalence especially in terminal condition needs a comprehensive management approach through a palliative care in which patient is very encouraged to be involved in an independent decision making of, especially, palliative care facility. The study intends to explore in depth the essence of patient's experience in decision making of palliative care at home.

It uses qualitative method with phenomenological approach. The participants were selected by using purposive sampling technique. They are 10 patients with terminal cancer. The data were collected by using in depth interview technique and analyzed by using Collaizi method.

The result shows six themes which significantly describe the dynamic of patients with cancer from medication process to decision making of palliative care facility. The teams are prolonged pain and sadness, painful effects on life changing aspects, palliative care selection reasons, family involvement decisions, palliative care needs in home care and end of life at home quietly.

The study is expected to be a reference for nurses in conducting therapeutic approach by considering participant's characteristics. It is also expected to improve nurse's knowledge and communication skill in advocating and clearly informing palliative care purposes and program at home. Thus, patients do not have doubt to receive discharge from hospital and palliative care at home. In addition, there needs to be a strategy from the government to optimize palliative programs through palliative care based on home care in various regions in Indonesia.Keywords patient with terminal cancer, decision making, palliative care at home"

"Kanker serviks merupakan salah satu jenis kanker yang paling banyak diderita wanita di Indonesia. Pengobatan kanker serviks seperti operasi, kemoterapi, dan radioterapi masih terus diupayakan, namun tingkat kesembuhan penderita kanker serviks masih rendah, yaitu dengan 1-year survival rate hanya sekitar 10-20%. Salah satu tanaman terapeutik di Indonesia yang memiliki aktivitas antikanker adalah bajakah tampala (Spatholobus littoralis Hassk). Nanopartikel bajakah tampala dilaporkan memiliki sitotoksisitas sedang terhadap sel HeLa. Namun, belum diketahui konsentrasi optimal ekstrak bajakah tampala terhadap sel HeLa berdasarkan viabilitas dan ultrastruktur sel. Tujuan dari penelitian ini adalah mengetahui pengaruh variasi konsentrasi ekstrak bajakah tampala (100, 150, 200 dan 250 µg/mL) terhadap viabilitas sel HeLa menggunakan trypan blue dan ultrastruktur sel HeLa dengan scanning electron microscope (SEM). Hasil analisis statistik dengan tingkat kepercayaan 0,05 menunjukkan terdapat perbedaan signifikan nilai persentase viabilitas sel antara kontrol dan perlakuan konsentrasi ekstrak bajakah tampala. Hasil pengamatan ultrastruktur dengan scanning electron microscope menunjukkan terdapat perbedaan ultrastruktur sel HeLa antara sampel kontrol dengan perlakuan. Hasil tersebut menunjukkan bahwa konsentrasi ekstrak bajakah tampala 100 μg/mL, 150 μg/mL, 200 μg/mL dan 250 μg/mL memiliki pengaruh terhadap viabilitas dan ultrastruktur sel HeLa. Konsentrasi 200 μg/mL cenderung lebih mampu menekan viabilitas sel dan menunjukkan karakteristik apoptosis secara ultrastruktur.

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Cervical cancer is one of the cancer that most women suffer from in Indonesia. Treatment for cervical cancer such as surgery, chemotherapy and radiotherapy is still being attempted, but the cure rate for cervical cancer sufferers is still low, with a 1-year survival rate of only around 10-20%. One of the therapeutic plants in Indonesia that has anticancer activity is bajakah tampala (Spatholobus littoralis Hassk.). Bajakah tampala nanoparticles were reported to have moderate cytotoxicity against HeLa cells. However, the optimal concentration of bajakah tampala extract for HeLa cells is not yet known based on cell viability and ultrastructure. The aim of this research was to determine the effect of varying concentrations of bajakah tampala extract (100, 150, 200 and 250 µg/mL) on HeLa cell viability using trypan blue and HeLa cell ultrastructure using a scanning electron microscope (SEM). The results of statistical analysis with a confidence level of 0.05 show that there is a significant difference in the percentage value of cell viability between the control and the bajakah tampala extract concentration treatment. The results of ultrastructural observations using a scanning electron microscope showed that there were differences in the ultrastructure of HeLa cells between control and treated samples. These results indicate that the concentrations of bajakah tampala extract of 100 μg/mL, 150 μg/mL, 200 μg/mL and 250 μg/mL have an influence on the viability and ultrastructure of HeLa cells. A concentration of 200 μg/mL tends to be more capable of suppressing cell viability and shows ultrastructural characteristics of apoptosis."

"Buku yang berjudul "Alternatives in cancer therapy : the complete guide to non-traditional treatments" ini ditulis oleh Ross Pelton dan Lee Overholser. Buku ini membahas tentang cara-cara alternatif terapi kanker."