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"ABSTRAK Latar Belakang: Malnutrisi berdampak besar pada pasien kanker sehingga harusdievaluasi dengan Patient-Generated Subjective Global Assessment (PG-SGA),namun memakan waktu dan membutuhkan tenaga kesehatan terlatih. Pengukurankekuatan genggam tangan (KGT) memiliki keuntungan lebih singkat dan mudahdibandingkan PG-SGA, tetapi belum ada data titik potong dan akurasi diagnostikKGT pada pasien kanker di Indonesia. Tujuan: Mendapatkan titik potong dan akurasi diagnostik KGT sebagai penapismalnutrisi pasien kanker rawat jalan di RSCM.Metode: Penelitian potong lintang ini dilakukan pada pasien 18-59 tahun dipoliklinik onkologi RSCM selama 4 Mei-1 Oktober 2015. Titik potong KGTdianalisis menggunakan kurva ROC. Akurasi diagnostik KGT dinilai denganmenghitung sensitivitas, spesifisitas, NDP, NDN, RKP, dan RKN.Hasil: Proporsi pasien dengan status nutrisi baik, malnutrisi sedang, danmalnutrisi berat adalah17,4%, 64,2%, dan 18,4%. Titik potong optimal KGT pasien kanker lelaki dan perempuan berturut-turut adalah ≤ 36,5 dan ≤ 21,5 kgfdengan sensitivitas 92,2% dan 73,9%, spesifisitas 54,6% dan 60,9%, NDP 92,2% dan 88,3%, NDN 54,6% dan 36,8%, RKP 2 dan 1,9, serta RKN 0,1 dan 0,4. Simpulan: Titik potong optimal KGT pasien kanker lelaki dan perempuanberturut-turut adalah ≤ 36,5 dan ≤ 21,5 kgf. Akurasi diagnostik KGT pasienkanker lelaki dan perempuan sebagai penapis malnutrisi berturut-turut dinilai baik dan sedang.ABSTRACT Background: Malnutrition has a huge impact on cancer patients and therefore ithas to be evaluated using PG-SGA, but there are limitations such as the timeconsumingnature and the need of trained health personnels. Measurement ofHGS is faster and easier, but there is no sufficient information regarding its cutoffpointand diagnosticaccuracyfor cancerpatientsin Indonesia.Aim:defining cut-off point and diagnostic accuracy of HGS as a malnutritionscreening modality for outpatient cancer population at RSCM.Method: A cross-sectional study was conducted at RSCM oncology outpatientclinic from May 4th-October 1st, 2015. Subjects were 18-59 years old. Cut-offpoint and diagnostic accuracy of HGS were analyzed to generate sensitivity,specificity, PPV, NPV, LR+, and LR- .Result: The proportion of well nourished, moderately malnourished, and severelymalnourished subjects were 17.4%, 64.2%, and 18.4%, respectively. The optimalHGS cut-off point in male and female cancer patients were ≤ 36.5 and ≤ 21.5 kgfrespectively with sensitivity 92.2% and 73.9%, specificity 54.6% and 60.9%,, PPV92.2% and 88.3%, NPV 54.6% and 36.8%, LR+ 2 and 1.9, and LR- 0.1 and 0.4. Conclusion: The optimal HGS cut-off point in male and female cancer patientswere ≤ 36.5 and ≤ 21.5 kgf, respectively. Diagnostic accuracy of HGS as amalnutrition screening modality in male and female cancer patients were good and moderately good.;Background: Malnutrition has a huge impact on cancer patients and therefore ithas to be evaluated using PG-SGA, but there are limitations such as the timeconsumingnature and the need of trained health personnels. Measurement ofHGS is faster and easier, but there is no sufficient information regarding its cutoffpointand diagnosticaccuracyfor cancerpatientsin Indonesia.Aim:defining cut-off point and diagnostic accuracy of HGS as a malnutritionscreening modality for outpatient cancer population at RSCM.Method: A cross-sectional study was conducted at RSCM oncology outpatientclinic from May 4th-October 1st, 2015. Subjects were 18-59 years old. Cut-offpoint and diagnostic accuracy of HGS were analyzed to generate sensitivity,specificity, PPV, NPV, LR+, and LR- .Result: The proportion of well nourished, moderately malnourished, and severelymalnourished subjects were 17.4%, 64.2%, and 18.4%, respectively. The optimalHGS cut-off point in male and female cancer patients were ≤ 36.5 and ≤ 21.5 kgfrespectively with sensitivity 92.2% and 73.9%, specificity 54.6% and 60.9%,, PPV92.2% and 88.3%, NPV 54.6% and 36.8%, LR+ 2 and 1.9, and LR- 0.1 and 0.4. Conclusion: The optimal HGS cut-off point in male and female cancer patientswere ≤ 36.5 and ≤ 21.5 kgf, respectively. Diagnostic accuracy of HGS as amalnutrition screening modality in male and female cancer patients were good and moderately good."

"Pasien kanker laring memiliki risiko terjadinya malnutrisi hingga kaheksia yang disebabkan oleh lokasi tumor dan sitokin inflamasi. Angka kejadian kanker laring dengan malnutrisi meningkat pada geriatri. Laringektomi total merupakan salah satu tatalaksana kanker laring dengan komplikasi pasca operasi tersering berupa pharyngocutaneous fistula (PCF). Tatalaksana nutrisi yang adekuat (makronutrien dan mikronutrien) perlu diberikan dengan menyesuaikan toleransi dan kondisi klinis setiap pasien. Keempat pasien pada serial kasus merupakan pasien karsinoma sel skuamosa laring pasca laringektomi total. Semua jenis kelamin pasien adalah laki-laki. Dua dari empat pasien adalah geriatri. Faktor risiko terbanyak adalah merokok. Semua pasien memiliki status gizi malnutrisi sedang berdasarkan ASPEN dan tiga pasien dengan kaheksia kanker. Sarkopenia didapatkan pada satu pasien non geriatri dan satu pasien geriatri. Terapi medik gizi diberikan sesuai dengan kondisi klinis dan toleransi asupan melalui jalur enteral per NGT. Suplementasi mikronutrien dengan dosis penyembuhan luka diberikan pada semua pasien. Tiga pasien tanpa komplikasi mendapatkan suplementasi omega-3. Komplikasi PCF didapatkan pada satu pasien non geriatri dengan status gizi berat badan berlebih berdasarkan IMT, hipoalbuminemia, anemia, dan riwayat pemasangan NGT dan trakeostomi. Asupan energi dan protein pada pasien yang mengalami PCF tidak mencapai target. Pemberian makanan oral pada pasien yang tidak mengalami PCF dilakukan pada hari ke 7-12 pasca operasi. Pasien dengan PCF pulang dengan NGT. Keempat pasien pulang dengan keadaan klinis yang membaik. Skor indeks Barthel dan Karnofsky Performance Scale (KPS) mengalami perbaikan pada akhir masa perawatan. Kesimpulan yang didapatkan yaitu status gizi malnutrisi yang mendapatkan terapi nutrisi optimal akan mengurangi terjadinya komplikasi. Adanya komplikasi pasca operasi berperan dalam terjadinya PCF.

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Patients with laryngeal cancer are at risk of malnutrition and cancer cachexia that is induced by tumor location and cytokine inflammatory. Incidence of malnutrition related to laryngeal cancer increases on geriatric patients. Total laryngectomy is one of the surgical procedures for laryngeal cancer with the most postoperative complications, such as pharyngocutaneous fistula (PCF). Adequate nutrition therapy (macronutrient and micronutrient) must be provided by adjusting to the clinical tolerance and condition of every patient. Patients in the case series are four patients with laryngeal squamous cell carcinoma after total laryngectomy. The gender of all patients is male. Two patients are geriatric patients. Smoking is the major risk factor in this case series. All patients were moderately malnourished based on ASPEN criteria, and three patients had cancer cachexia. Sarcopenia was identified in one non-geriatric patient and one geriatric patient. Medical nutrition therapy was provided through enteral NGT according to clinical condition and tolerance intake of the patient. Micronutrient supplementation with dose for wound healing was given to all patients. Three patients without complication received omega-3 supplementation. PCF complication was identified in one non-geriatric patient with overweight status based on BMI, hypoalbuminemia, anemia, and history of tracheostimy dan used NGT. Energy and protein intake did not reach target in this patient. All four patients were discharged with improved clinical condition. There are improved in Barthel index and Karnofsky Performance Scale (KPS). Conclusion of the case series is that adequate medical nutrition therapy provided in malnutrition patient can decrease the risk of complications after surgery. Complication after surgery with comorbid has a role in the development of PCF."