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"Latar belakang: Kanker merupakan masalah kesehatan utama global, dan menjadi penyebab kematian tertinggi kedua. Kemoterapi, sebagai salah satu terapi kanker, efektif meningkatkan kesembuhan dan kualitas hidup pasien, namun memiliki efek samping jangka panjang, termasuk gangguan kognitif. Di Indonesia, belum ada kuesioner khusus untuk menilai gangguan kognitif pada pasien kanker.Tujuan: Penelitian ini bertujuan untuk membuktikan bahwa kuesioner FACT-Cog versi 3 bahasa Indonesia merupakan alat ukur yang valid dan reliabel dalam menilai gangguan kognitif serta dampaknya pada kualitas hidup pasien kanker yang menjalani kemoterapi di Indonesia.Metode: Penelitian ini menggunakan desain potong lintang pada pasien di unit kemoterapi RSCM dari September hingga Oktober 2024. Adaptasi bahasa dan budaya kuesioner FACT-Cog versi 3 dilakukan dengan metodologi translasi bahasa dan trans-budaya berdasarkan kaidah Guillemin dan Beaton. Uji validasi melibatkan 100 subjek, mencakup validasi konstruksi, validasi kriteria, dan uji reliabilitas dengan metode konsistensi internal dan test-retest.Hasil: FACT-Cog versi 3 bahasa Indonesia menunjukkan konsistensi internal tinggi (Cronbach’s α = 0,915) dan test-retest dengan korelasi baik hingga sangat baik (ICC = 0,721-0,976). Validitas konvergen FACT-Cog versi 3 bahasa Indonesia menunjukkan korelasi sedang (r = 0,415-0,606) dengan EORTC QLQ C30 bahasa Indonesia, sementara validasi konstruksi dapat diterima, dengan korelasi dari lemah hingga kuat (r = 0,352-0,889) antara setiap item dengan domain masing-masing. Kesimpulan: Kuesioner FACT-Cog versi 3 bahasa Indonesia merupakan alat ukur yang valid dan reliabel untuk menilai gangguan fungsi kognitif dan dampaknya terhadap kualitas hidup pada pasien kanker dalam terapi kemoterapi di Indonesia.

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Background: Cancer remain a significant global health concern, ranking as the second leading cause of death worldwide. Chemotherapy, a primary treatment for cancer, has proven effective in enhancing patient recovery and quality of life; however, it is also associated with long-term side effect, including cognitive impairment. In Indonesia, there is currently no specialized tool for assessing cognitive impairment among cancer patients.

Aim: This study aims to validate the Indonesian version of the FACT-Cog version 3 questionnaire as a reliable and valid tool to assess cognitive impairment and its impact on the quality of life in cancer patients undergoing chemotherapy in Indonesia.

Methods: This cross-sectional study was conducted at the chemotherapy units RSCM from September to October 2024. The language and cultural adaptation of the FACT-Cog version 3 questionnaire followed the translation and cross-cultural methodology of Guillemin and Beaton. Validation testing involved 100 subjects, covering construct validation, convergent validation, and reliability testing with internal consistency and test-retest methods.

Results: The Indonesian version of FACT-Cog version 3 demonstrates high internal consistency (Cronbach's α = 0.915) and strong to excellent test-retest reliability (ICC = 0.721-0.976). Convergent validity shows a moderate correlation (r = 0.415-0.606) with the Indonesian version of the EORTC QLQ C30. Construct validity is acceptable, with weak to strong correlations (r = 0.352-0.889) between individual items and their respective domains.

Conclusion: The Indonesian version of FACT-Cog version 3 is a valid and reliable tool to assess cognitive impairment and its impact on the quality of life in cancer patients undergoing chemotherapy in Indonesia."

"Identifikasi IL-6, PCT, dan CRP dalam mendiagnosis awal bakteremia pada pasien leukemia akut dengan demam neutropenia banyak dilakukan. Tujuan studi ini mengetahui performa diagnostik delta IL-6, delta PCT, dan delta CRP sebagai penanda awal kejadian bakteremia pada pasien leukemia akut dewasa dengan neutropenia berat selama menjalani kemoterapi standar (agresif). Desain studi ini potong lintang dengan mengambil semua pasien leukemia akut dewasa yang mengalami neutropenia berat selama menjalani kemoterapi agresif di RS Cipto Mangunkusumo dan RS Kanker Dharmais sejak 9 Agt – 9 Nov 2023. Sampel darah IL-6, PCT dan CRP diambil sebelum mulai kemoterapi dan dalam 24 jam saat mulai mengalami neutropenia berat serta kultur darah aerob volume 40cc dalam 24 jam sejak neutropenia berat. Performa diagnostik delta IL-6, delta PCT, dan delta CRP lemah dan tidak berbeda bermakna sebagai penanda bakteremia dengan AUC 0,6703 (IK95% 0,507-0,833); 0,6821 (IK 95% 0,521-0,844); dan 0,694 (IK 95% 0,532-0,856) serta nilai p=0,9681. Prevalensi bakteremia pada studi ini 64,44% (29/45) dengan bakteri gram positif 77,42% (24/31) dan yang terbanyak ialah Staphylococcus Epidermidis 41,67% (10/24). Walaupun performa diagnostik ketiganya lemah, delta CRP dapat dipertimbangkan digunakan dengan mempertimbangkan biaya dan ketersediaan reagen.

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IL-6, PCT, and CRP test were often performed in acute leukemia patients with febrile neutropenia as early markers of bacteremia. Our objective was to determine the diagnostic performance of delta IL-6, delta PCT, and delta CRP as early markers of bacteremia in adult acute leukemia patients with severe neutropenia during standard/aggressive chemotherapy. This research was conducted using cross-sectional design by taking all of adult acute leukemia patients with severe neutropenia during aggressive chemotherapy at Cipto Mangunkusumo Hospital and Dharmais Hospital from 9 Aug – 9 Nov 2023. IL-6, PCT and CRP blood samples were taken before starting chemotherapy and within 24 hours of starting to experience severe neutropenia as well as blood cultures aerobic volume 40cc. The diagnostic performance of delta IL-6, delta PCT, and delta CRP were weak and didn’t differ significantly as early markers of bacteremia (p = 0.968) with an AUC of 0.6703 (95% CI 0.507-0.833); 0.6821 (95% CI 0.521-0.844); and 0.694 (95% CI 0.532-0.856). Bacteremia was found in 64.44% (29/45), mostly gram-positive bacteria (77.42%) and Staphylococcus epidermidis 41.67%. Although the diagnostic performance of all three markers were weak, delta CRP can be considered as an early marker regarding the cost and availability of reagents."

"Latar belakang Kanker kepala leher adalah kanker yang paling sering ketujuh di dunia dengan 890.000 kasus baru dan 450.000 kematian tiap tahunnya. Diperkirakan prevalensi karsinoma nasofaring di Indonesia adalah 6,2/100.000 dengan 12.000 kasus baru tiap tahunnya. Terapi definitif untuk kanker kepala leher adalah operasi dengan kemoradiasi sebagai terapi adjuvan sedangkan untuk kanker nasofaring kemoradiasi adalah terapi definitif untuk stadium lokal lanjut, yang paling sering terdiagnosis di Indonesia. Toksisitas kemoradiasi berkaitan dengan malnutrisi dan massa dan kekuatan otot yang rendah. Dengan melakukan intervensi nutrisi dan latihan fisik aerobik dan resistensi, diharapkan angka toksisitas kemoradiasi berkurang. Di Indonesia latihan fisik aerobik resistensi pada kanker kepala leher belum menjadi panduan tatalaksana nasional. Untuk itu diperlukan evaluasi keamanan dan kepatuhan latihan fisik aerobik dan resistensi pada kanker kepala leher dengan malnutrisi yang menjalani kemoradiasi.Tujuan Mengetahui proporsi malnutrisi pada kanker kepala leher yang akan menjalani kemoradiasi dan mengetahui keamanan dan kepatuhan latihan fisik aerobik dan resistensi untuk dapat dilakukan selama kemoradiasi pada kanker kepala leher degan malnutrisi.Metode. Penelitian pendahuluan menggunakan desain potong lintang dengan kriteria inklusi pasien kanker kepala leher dan karsinoma nasofaring stadium III-IV yang akan menjalani kemoradiasi, dengan pengambilan sampel secara konsekutif. Subjek akan dievaluasi penapisan malnutrisi dengan Malnutrition screening tool (MST) dan evaluasi data klinis dan laboratorium lainnya. Penelitan utama dengan desain intervensi single arm pre-post study bersama terapi standar nutrisi dengan kriteria inklusi subjek dari penelitian pendahuluan dengan skor MST lebih besar sama dengan 2, usia dewasa 18-59 tahun, status performan ECOG 0-1 dan tanda vital baik. Intervensi yang diberikan berupa latihan fisik aerobik dan resistensi yang terdiri dari uji latih dan latihan selama kemoradiasi. Pengamatan selama kemoradiasi akan dievaluasi kepatuhan dan keamanan serta evaluasi kekuatan genggam tangan, skor MST, skor kualitas hidup dan toksisitas kemoradiasi.Hasil Sebanyak 36 subjek eligible. Proporsi subjek kanker kepala leher sebelum menjalani kemoradiasi dengan malnutrisi adalah 25 (69,5%) dan berisiko malnutrisi 7 (19,4%). Dari 15 subjek yang eligible untuk latihan fisik aerobik dan resistensi, sebanyak 10 subjek telah menjalani latihan. Dari 13 sesi latihan yang dikerjakan, seluruhnya dapat dilakukan hingga akhir dan tanpa efek samping terkait latihan. Latihan ini hanya terlaksana 13 (31,7%) sesi latihan. Alasannya karena masalah medis dan jadwal untuk dapat terlaksana latihan aerobik dan resistensi. Dengan latihan fisik aerobik dan resistensi terjadi penurunan skor MST 1,7+0,05 p 0,04, kenaikan kekuatan genggam tangan 0,6+0,45 kg p 0,36 dan berat badan 1,93+0,3 kg p 0,521 di akhir minggu kedua. Terdapat perbaikan skor kualitas hidup untuk domain skala gejala mulut kering, pemakaian sonde makan, dukungan nutrisi namun tidak berbeda bermakna secara statistik.Simpulan Proporsi malnutrisi pada kanker kepala leher sebelum kemoradiasi 69,5%. Latihan fisik aerobik dan resistensi aman untuk dapat dilakukan selama kemoradiasi namun belum mampu laksana karena kepatuhannya 31,7%. Latihan fisik aerobik dan resistensi belum dapat dievaluasi apakah menyebabkan perbaikan malnutrisi, kekuatan otot, dan skor kualitas hidup.

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Background Head and neck cancer is the 7th most common cancer in world with 890,000 new cases and 450,000 mortality every year. Approximately the prevalence of nasopharyngeal cancer in Indonesia is 6.2/100,000 with 12,000 new cases every year. Definitive treatment for head neck cancer is surgery continue with chemoradiation as adjuvant therapy, whereas chemoradiation in nasopharyngeal cancer is definitive treatment for locally advance settings which the most common diagnosed in Indonesia. Chemoradiation toxicity related to malnutrition and low muscle mass and strength. Nutritional and aerobic and resistance training can decrease the incidence of chemoradiation toxicity. In Indonesia, these training in head neck cancer have not yet included in national management guideline. Thus, there is a need to evaluate the safety and compliance of aerobic and resistance training in head neck cancer with malnutrition who underwent chemoradiation.

To know the proportion of malnutrition in head neck cancer who underwent chemoradiation and to know the safety and compliance of aerobic and resistance training to be able to be done during chemoradiation in head neck cancer with malnutrition.

Method The cross-sectional study of preliminary study included consecutively head neck cancer and nasopharyngeal cancer stage III-IV who will underwent chemoradiation. The subject will be evaluated for malnutrition screening with malnutrition screening tool (MST) together with other clinical and laboratory baseline data related to malnutrition. The main study was using intervention single arm pre and post study design together with nutritional standard therapy, which included subject from the preliminary study with MST score 2 or higher, adult 17-59 years old, performance status ECOG 0-1 and good vital sign. Subjects will be given aerobic and resistance training as an intervention arm during chemoradiation. Evaluation of safety and compliance together with hand grip strength, MST score, quality of life score using EORTC-QLQ C30 and HN35 and chemoradiation toxicity using National cancer institute common toxicity criteria version 4.0 will be done periodically to included subject.

Result A total of 36 eligible subjects were included. The proportion of malnutrition and disease at risk malnutrition in head neck cancer before underwent chemoradiation was 25 (69.5%) and 7 (19.4%) respectively. Ten of 15 eligible subjective have done aerobic and resistance training. From 13 training session, all of them were done until the end without any complication. There were only 13 (31.7%) training can be done by the subjects during chemoradiation. There were medical and schedule problems explaining why the training have not been able to be done as schedule. Aerobic and resistance training were associated with decreased MST score 1.7+0.05 p value 0.04, increased hand grip strength 0.6+0.45 kg p value 0.36 and body weight 1.93+0.3 kg p value 0.521 at the end of second week. There was an improvement of quality-of-life score for domain symptoms scale dry mouth, tube feeding and nutritional support, however there was not statistically significant.

Conclusion The proportion of malnutrition in head neck cancer before chemoradiation was 69.5%. Aerobic and resistance training safe to be done during chemoradiation. The compliance or feasibility of aerobic and resistance training during chemoradiation was only 31.7%. Aerobic and resistance training was not able to evaluate weather associated with improvement of malnutrition, muscle strength, and quality of life."