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Abstrak :
ABSTRAK
Peningkatan angka morbiditas dan mortalitas akibat penyakit kanker di Indonesia menunjukkan bahwa permasalahan kanker ini semakin besar dan kompleks Salah satunya adalah adanya keterlambatan pasien kanker untuk mendapatkan terapi definitif yang disebabkan oleh faktor faktor yang berasal dari pasien sendiri Penelitian ini merupakan studi analisis deskriptif menggunakan metode campuran kuantitatif dan kualitatif untuk mengetahui data insidens keterlambatan terapi karena keterlambatan pasien pada pasien kanker yang dirujuk ke Departemen Radioterapi RSUPN Dr Cipto Mangunkusmo pada bulan Mei Agustus 2015 serta mengevaluasi faktor faktor apa saja yang mempengaruhi keterlambatan pasien tersebut Terdapat 294 orang pasien yang diikutsertakan dalam penelitian ini setelah mendapatkan persetujuan tertulis Sebagian besar pasien 71 4 adalah perempuan dan 141 orang 48 bekerja sebagai ibu rumah tangga Rentang umur terbanyak adalah 36 50 tahun yaitu sebanyak 132 pasien 44 9 dan hampir seluruh pasien 91 8 telah menikah Keterlambatan terapi didapatkan pada 153 orang pasien 52 dan 67 orang di antaranya 43 8 memiliki riwayat pengobatan alternatif yang dilakukan dalam interval waktu setelah timbul keluhan pertama kali dan atau setelah pasien melakukan konsultasi medis pertama kali Analisis statistik menunjukkan adanya hubungan yang signifikan antara faktor usia p 0 047 pendidikan p 0 047 dan riwayat pengobatan alternatif p 0 0001 dengan keterlambatan terapi Adanya rasa takut untuk berobat secara medis atau menjalani tindakan medis menjadi alasan 51 orang pasien untuk memilih pengobatan alternatif Oleh karena itu diperlukan pengawasan dan evaluasi terhadap pengobatan alternatif terutama yang menyangkut kualitas efikasi dan keamanannya ABSTRACT
Increased morbidity and mortality due to cancer in Indonesia showed that this problem has become more complex and significant One of the problems pointed out is regarding a delay in cancer patients to receive definitive therapy caused by factors derived from the patients themselves This study is a descriptive analysis using combination of quantitative and qualitative methods to determine the incidence of treatment delay due to patient delay in cancer patients who were referred to Radiotherapy Department Dr Cipto Mangunkusmo hospital during May August 2015 and to evaluate factors that influence the patient delay There are 294 patients enrolled in this study after obtaining a written consent Most of the patients 71 4 were women and 141 48 work as a housewife The largest age range was 36 50 years with 132 patients 44 9 and almost all patients 91 8 were married Delay in treatment obtained in 153 patients 52 and 67 of them 43 8 had a history of alternative medicine that is performed in a time interval after the patients experienced first complaints and or after patients had their first medical consultation Statistical analysis showed a significant relationship between age p 0 047 educational level p 0 047 and history of alternative medicine p 0 0001 with the treatment delay The fear of being treated medically or undergo a medical procedure has become the major reasons found in 51 patients to choose the alternative treatment Therefore it is necessary to conduct monitoring and evaluation of alternative medicine especially concerning the quality efficacy and its safety ;Increased morbidity and mortality due to cancer in Indonesia showed that this problem has become more complex and significant One of the problems pointed out is regarding a delay in cancer patients to receive definitive therapy caused by factors derived from the patients themselves This study is a descriptive analysis using combination of quantitative and qualitative methods to determine the incidence of treatment delay due to patient delay in cancer patients who were referred to Radiotherapy Department Dr Cipto Mangunkusmo hospital during May August 2015 and to evaluate factors that influence the patient delay There are 294 patients enrolled in this study after obtaining a written consent Most of the patients 71 4 were women and 141 48 work as a housewife The largest age range was 36 50 years with 132 patients 44 9 and almost all patients 91 8 were married Delay in treatment obtained in 153 patients 52 and 67 of them 43 8 had a history of alternative medicine that is performed in a time interval after the patients experienced first complaints and or after patients had their first medical consultation Statistical analysis showed a significant relationship between age p 0 047 educational level p 0 047 and history of alternative medicine p 0 0001 with the treatment delay The fear of being treated medically or undergo a medical procedure has become the major reasons found in 51 patients to choose the alternative treatment Therefore it is necessary to conduct monitoring and evaluation of alternative medicine especially concerning the quality efficacy and its safety ;Increased morbidity and mortality due to cancer in Indonesia showed that this problem has become more complex and significant One of the problems pointed out is regarding a delay in cancer patients to receive definitive therapy caused by factors derived from the patients themselves This study is a descriptive analysis using combination of quantitative and qualitative methods to determine the incidence of treatment delay due to patient delay in cancer patients who were referred to Radiotherapy Department Dr Cipto Mangunkusmo hospital during May August 2015 and to evaluate factors that influence the patient delay There are 294 patients enrolled in this study after obtaining a written consent Most of the patients 71 4 were women and 141 48 work as a housewife The largest age range was 36 50 years with 132 patients 44 9 and almost all patients 91 8 were married Delay in treatment obtained in 153 patients 52 and 67 of them 43 8 had a history of alternative medicine that is performed in a time interval after the patients experienced first complaints and or after patients had their first medical consultation Statistical analysis showed a significant relationship between age p 0 047 educational level p 0 047 and history of alternative medicine p 0 0001 with the treatment delay The fear of being treated medically or undergo a medical procedure has become the major reasons found in 51 patients to choose the alternative treatment Therefore it is necessary to conduct monitoring and evaluation of alternative medicine especially concerning the quality efficacy and its safety

Abstrak :
ABSTRAK
Penyakit kanker merupakan penyakit yang sangat kompleks sehingga memerlukan pendekatan multidisiplin baik dalam diagnostik maupun terapi. Durasi penegakkan diagnosis dan terapi pada pasien kanker mempengaruhi hasil akhir pasien tersebut. Keterlambatan terapi dapat disebabkan oleh keterlambatan dokter dalam merujuk pada pelayanan kesehatan primer dan keterlambatan sistem pelayanan kesehatan pada proses penegakkan diagnosis dan dimulainya terapi definitif pada kanker. Penelitian ini merupakan studi analisis deskriptif menggunakan metode campuran kuantitatif dan kualitatif untuk mengetahui data insidens keterlambatan terapi pada pasien kanker yang dirujuk ke Departemen Radioterapi RSUPN Dr. Cipto Mangunkusmo pada bulan Mei - Agustus 2015 serta mengevaluasi faktor yang mempengaruhi keterlambatan tersebut. Terdapat 294 orang pasien yang diikutsertakan dalam penelitian ini setelah mendapatkan persetujuan tertulis. Pada keterlambatan terapi akibat keterlambatan dokter, dari 62 pasien yang dirujuk dari pelayanan kesehatan primer didapatkan 18 pasien (29%) mengalami keterlambatan rujukan. Keterlambatan diagnosis terjadi pada 78 pasien (26,5%). Sedangkan pada keterlambatan tindakan pengobatan terjadi pada 172 pasien (58,5%). Dari seluruh pasien didapatkan 132 pasien (45%) mengalami keterlambatan dokter dan sistem. Berdasarkan analisis statistik menunjukkan adanyan hubungan yang signifikan antara keterlambatan rujukan (p<0,01), keterlambatan diagnosis (p<0,01) dan keterlambatan tindakan pengobatan (p<0,01) dengan keterlambatan terapi akibat keterlambatan dokter dan system. Tingginya angka keterlambatan terapi kanker pada penelitian ini ditemukan akibat keterlambatan dokter dan sistem, khususnya pada keterlambatan pada penegakkan diagnosis dan tindakan pengobatan.

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ABSTRACT
Cancer is a very complex disease that requires a multidisciplinary approach both in diagnostics and therapy. The duration of the diagnosis and treatment of cancer patients affect the outcome of these patients. Delay in treatment may be caused by the delay in referring physicians in primary health care and health care system delay in the commencement of the process of diagnosis and definitive therapy in cancer. This study was a descriptive analytical study using a mix of quantitative and qualitative methods to determine the incidence of therapy delays in cancer patients who were referred to the Department of Radiotherapy RSUPN Dr. Cipto Mangunkusmo in May to August for 2015 and evaluate the factors that influence the delay. There were 294 patients included in this study after obtaining written consent. Doctor's delay due to delayed treatment, from 62 patients referred from primary health care is obtained for 18 patients (29%) experienced a delay in referral. Delay in diagnosis occurred in 78 patients (26.5%). While the delay in treatment action occurred in 172 patients (58.5%). From all patients had 132 patients (45%) experienced doctor and system delay. Statistical analysis showed a significant correlation between the reference delay (p <0.01), late diagnosis (p <0.01) and delays in treatment measures (p <0.01) with a delay due to delayed therapy and doctor system. The high number of delays in cancer therapy in this study was found as a result of delays doctor and systems, in particular on the delay in diagnosis and treatment.eterlambatan terapi akibat keterlambatan dokter dan system. Tingginya angka keterlambatan terapi kanker pada penelitian ini ditemukan akibat keterlambatan dokter dan sistem, khususnya pada keterlambatan pada penegakkan diagnosis dan tindakan pengobatan.

Abstrak :
Pendahuluan: Pada penderita kanker selalu terjadi stres oksidatif yang ditandai dengan kadar MDA (malondialdehyde) yang tinggi dan aktivitas katalase yang rendah. Kanker terjadi karena ketidakseimbangan antara proses proliferasi sel dengan apoptosis. Penelitian ini bertujuan untuk mengetahui korelasi antara apoptosis dengan kadar MDA dan aktivitas antioksidan enzimatik katalase pada pasien kanker leher rahim stadium lokal lanjut. Metode penelitian: Penelitian ini merupakan studi cross sectional terhadap 16 pasien kanker leher rahim stadium lokal lanjut yang memenuhi kriteria inklusi dari Juli sampai Agustus 2013. Pengambilan darah pasien dilakukan sebelum radiasi dimulai. Pemeriksaan kadar MDA dan aktivitas katalase dilakukan dengan metode spektrofotometri. Indeks apoptosis dilakukan dengan motode TUNEL. Hasil: Didapatkan rerata indeks apoptosis sebesar 11,1 ± 0,59 sel; rerata kadar MDA serum sebesar 7,97 ± 0,26 nmol/mL dan rerata aktivitas katalase serum sebesar 0,98 ± 0,04 U/mL. Terdapat korelasi positif sedang yang bermakna (r=+0,51; p=0,043) antara indeks apoptosis dengan kadar MDA dan korelasi negatif lemah yang tidak bermakna (r=-0,02; p=0,94) dengan aktivitas katalase. Kesimpulan: Pada penderita kanker leher rahim stadium lokal lanjut terjadi stres oksidatif yang ditandai dengan kadar MDA serum yang tinggi dan aktivitas katalase serum yang rendah dan terjadi peningkatan indeks apoptosis. Terdapat korelasi positif sedang yang bermakna antara indeks apoptosis dengan kadar MDA dan korelasi negatif lemah yang tidak bermakna dengan aktivitas katalase.

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Introduction: Oxidative stress always occurs in cancer patient, which characterized with high level of Malondialdehyde (MDA) and low activity of catalase enzymatic antioxidant. Cancer occurs due to imbalance between cell proliferation and cell death due to apoptosis. The purpose of this study to determine the correlation between apoptosis with MDA level and catalase enzymatic antioxidant activity in patients with locally advanced cervical cancer. Methods: This is a cross sectional study to 16 locally advanced cervical cancer patients who meet the inclusion criteria from July to August 2013. Blood sampling was done before patients began radiation. MDA level and catalase activity was measured by spectrophotometry. Apoptotic index was conducted by TUNEL method. Results: The mean of apoptotic index is 11,1 ± 0,59 cell, the mean of serum MDA levels is 7.97 ± 0.26 2 nmol /mL, and the mean of serum catalase activity is 0.98 ± 0.04 U /mL. There was a significant moderate positive correlation (r = +0.51, p = 0.043) between the apoptotic index with serum MDA levels and a non-significant weak negative correlation (r = -0.02, p = 0.94) between the apoptotic index with serum catalase activity. Conclusion: This study showed that oxidative stress occurs in patients with locally advanced cervical cancer, which characterized with high level of serum MDA and low activity of serum catalase. There is an increase in apoptotic index in patients with locally advanced cervical cancer. There was a significant moderate positive correlation between apoptotic index with MDA levels and a non-significant weak negative correlation with catalase activity.

Abstrak :
Pendahuluan : Pada proses keganasan terjadi stres oksidatif, yang ditandai dengan peningkatan kadar serum malondialdehid (MDA) dan aktivitas antioksidan enzim katalase yang rendah. Rasio MDA katalase sebelum dan setelah radiasi fraksi ke 15 dapat menjadi prediktor persentase pengecilan volume tumor 4 minggu pasca radiasi komplit pada kanker serviks lanjut lokal. Metode penelitian : Penelitian ini merupakan kohort prospektif pada 30 pasien kanker serviks lanjut lokal yang memenuhi kriteria inklusi di Departemen Radioterapi RS CiptoMangunkusumo periode Juli sampai September 2013. Pemeriksaan kadar MDA dan aktivitas enzim katalase dilakukan sebelum dan sesudah radiasi fraksi ke 15, menggunakan spektrofotometri. Respons terapi berdasarkan kriteria WHO dengan membandingkan persentase ukuran volume tumor sebelum radiasi dengan persentase volume tumor 4 minggu setelah radiasi komplit (radiasi eksterna 25 fraksi dan brakhiterapi 3 kali). Hasil : Pada penelitian ini didapatkan rerata serum MDA sebesar 7,6+/- 1,2 nmol/ml dan aktivitas enzim katalase 0,95 (0,8 ? 1,36) U/mL. Setelah radiasi fraksi ke 15 ditemukan peningkatan serum MDA menjadi 9,5 +/-1,9 nmol/mL (p<0,001) dan penurunan aktivitas enzim katalase menjadi 0,82 (0,71 ? 0,96) U/ml. Terdapat hubungan yang bermakna antara rasio MDA katalase sebelum dan setelah radiasi fraksi ke 15 dengan persentase pengecilan volume tumor 4 minggu setelah radiasi komplit. Kesimpulan : Hasil penelitian ini menunjukan terjadi stres oksidatif pada pasien kanker serviks lanjut lokal, yang ditandai dengan peningkatan kadar serum MDA dan penurunan aktivitas enzim katalase. Rasio MDA katalase sebelum dan sesudah radiasi fraksi ke 15 dapat menjadi prediktor persentase pengecilan tumor 4 minggu pasca radiasi komplit.

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Introduction : Oxidative stress always occurs in cancer patient, which characterized with high level of serum Malondialdehyde (MDA) dan low activity of serum catalase enzymatic antioxidant. To determine the ratio of MDA and catalase activity before and after the 15th radiation fractions which can be a predictor of the tumor volume reduction percentage. Method: This is a prospective cohort study of 30 locally advanced cervical cancer patients who meet the inclusion criteria in the Radiotherapy Department of Cipto Mangunkusumo Hospital from July 2013 to Sept 2013. MDA levels and catalase enzyme activities were examined before and after the 15th radiation fractions of external radiation using sphectrophotometry. The responds were assess according to WHO criteria, by comparing the size of the tumor volume before radiation and four weeks after completion of radiation ( 25 fraction of external and 3 fractions of brakhiterapi ). Result: In this study, the mean of serum MDA level is 7.6 + / -1.2 nmol / mL and catalase enzyme activity median is 0.95 ( 0.8 to 1.36 ) U / mL . We found elevated of serum MDA levels to 9.5 + / - 1.9 nmol /mL (p<0,001) and the activity enzyme catalase significantly decrease to 0,82 (0,71 to 0,96) U/ml (p<0,001) on the 15th external radiation fraction. There is a significant relationship is found between the ratio of MDA catalase before radiation and after the fifteenth external radiation fractions with the percentage of tumor volume reduction four weeks after completion of radiation ( r = 0.689 , p = 0.001 ) ( r = 0.418 , p = 0.021 ). Conclusion: This study showed that oxidative stress occurs in patients with locally advanced cervical cancer, which characteristized with high level of serum MDA and low activity of serum catalase. Ratio of mda catalase before radiation and after the fifteenth external radiation fractions can be a predictor of the percentage of tumor volume reduction four weeks after completion of radiation.

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Latar belakang: Lingkungan mikro tumor telah terlibat dalam berbagai jenis kanker dan memegang peran penting dalam menentukan keberhasilan pengobatan terutama dengan imunoterapi. Pada kanker nasofaring, peran prognostik sel imun ini dalam lingkungan mikro tumor masih diragukan. Metode: Kami melakukan penelitian yang melibatkan 25 spesimen biopsi kanker nasofaring untuk mencari hubungan yang lebih langsung antara sel imun yang menginfiltrasi tumor dan progresifitas tumor. Selain itu, kami juga memeriksa protein PD-L1 melalui imunohistokimia. Hasil: PD-L1 diekspresikan secara positif dalam semua 25 sampel kami dengan kanker nasofaring WHO tipe 3 histologi. Sampel mayoritas memiliki> 50% ekspresi PD-L1 dalam membrane sitoplasma sel tumor. Kami juga menemukan bahwa sebaran sel imun pada sekitar tumor yang lebih padat memiliki volume tumor lokal yang relatif jauh lebih kecil. Kebalikannya juga berlaku, dengan volume tumor lokal rata-rata adalah 181,92 cm3 ± 81,45 cm3, 111,29 cm3 ± 92,75 cm3, dan 56,26 cm3 ± 26,55 cm3 untuk tiap skor infiltrasi sel imun sedikit, sedang, dan banyak, berturut-turut (p = 0,013). Kesimpulan: Oleh karena itu, kami menyimpulkan bahwa infiltrasi sel imun pada tumor memainkan peran penting dalam perkembangan tumor, karenanya mengevaluasi faktor sederhana dan prediktif ini dapat memberi kami beberapa informasi prognostik yang berharga. ......Background: Tumor microenvironment have been implicated in many kind of cancers to hold an important role in determining treatment success especially with immunotherapy. In nasopharyngeal cancer, the prognostic role of this immune cells within tumor microenvironment is still doubtful. Method: We conducted a study that included 25 nasopharyngeal cancer biopsy specimens to seek a more direct relationship between tumor infiltrating immune cells and tumor progression. Apart from that, we also checked the PD-L1 protein through immunohistochemistry. Result: The PD-L1 was positively expressed in all our 25 samples with nasopharyngeal cancer WHO type 3 histology. Majority samples have >50% PD-L1 expression in tumor cells. We also found that denser local tumor infiltrating immune cells population have relatively much smaller local tumor volume. The inverse applied, with the mean local tumor volumes were 181.92 cm3 ± 81.45 cm3, 111.29 cm3 ± 92.75 cm3, and 56.26 cm3 ± 26.55 cm3 for mild, moderate, and heavy immune cells infiltration respectively (p=0.013). Conclusion: Therefore, we concluded that tumor infiltrating immune cells play an important role in tumor progression, hence evaluating this simple and predictive factor may provide us with some valuable prognostic information.

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Tujuan : Pembangunan pusat pelayanan radioterapi sampai saat ini belum menjadi prioritas utama khususnya di negara berkembang. Tingginya biaya yang dihabiskan untuk pusat pelayanan merupakan salah satu alasannya. Biaya terkait sumber daya manusia (SDM) berhubungan erat dengan biaya operasional yang dikeluarkan. Pengetahuan terkait produktivitas yang mencakup beban SDM dan penggunaan pesawat radiasi merupakan dasar untuk terciptanya pelayanan radioterapi dengan biaya efektif. Oleh karena itu, digagaslah penelitian tentang produktivitas SDM dan penggunaan pesawat radiasi di pusat pelayanan Onkologi Radiasi di Indonesia sebagai bagian dari penelitian terkait biaya radioterapi. Metode : studi deskriptif cross sectional. Subjek penelitian merupakan seluruh pusat pelayanan Onkologi Radiasi di Indonesia yang telah melakukan pelayanan selama setahun. Subjek diberikan kuesioner secara digital yang berisikan pertanyaan terkait ketersediaan SDM dan pesawat radiasi. Data yang didapat kemudian dimasukkan ke dalam Radiotherapy Resources and Cost Calculator (RRCC) v.20 serta dilakukan penghitungan dengan asumsi aktual sesuai kondisi di Indonesia. Hasil : beban kerja Dokter Spesialis, Fisika Medis, dan RTT di Indonesia bervariasi dengan rerata beban kerja secara berurutan sebesar 92,5% (asumsi aktual), 97,7%, 107,6%, dan 80,8%. Beban kerja SDM secara statistik lebih tinggi pada pusat pelayanan dengan brakhiterapi dan pusat pelayanan dengan jumlah pasien yang tinggi. Rerata penggunaan pesawat radiasi sebesar 104,1% dan 138% secara statistik signifikan lebih tinggi pada rumah sakit pemerintah dan jumlah pasien tinggi. Jumlah pasien memiliki korelasi kuat dengan jumlah kebutuhan dokter spesialis (r=0,927), fisika medis (r=0,838) dan RTT (r=0,886). Jumlah pasien dapat menjadi prediktor untuk menentukan kebutuhan Dokter Spesialis dengan adjusted R2 = 72,1% dan 80%, kebutuhan fisika medis adjusted R2 = 69,3%, dan kebutuhan RTT dengan adjusted R2 = 83,3%.Kesimpulan : produktivitas SDM dan penggunaan pesawat radiasi pada pusat pelayanan Onkologi Radiasi di Indonesia bervariasi. Penghitungan produktivitas dengan RRCC v.20 dapat diaplikasikan pada pusat pelayanan Onkologi Radiasi di Indonesia. ......Objective: The development of a radiotherapy center has not been a top priority, especially in developing countries. The high cost spent on service centers is one of the reasons. Human resource costs are inextricably linked to operational expenses. Knowledge related to productivity, which includes the workload of human resources and the use of radiation equipment, is the basis for creating cost-effective services. Therefore, research was initiated on human resource productivity and the use of radiation equipment at radiotherapy centers in Indonesia as part of research related to radiotherapy costs. Method: descriptive cross-sectional study. The research subjects were all radiotherapy centers in Indonesia that had been running for a year. Subjects were given a digital questionnaire containing questions related to the availability of human resources and radiation equipment. The data obtained is then entered into the Radiotherapy Resources and Cost Calculator (RRCC) v.20, and calculations are carried out with actual assumptions according to conditions in Indonesia. Results: The workload of specialists, medical physicists, and RTTs in Indonesia varies, with an average workload of 92.5% (actual assumption), 97.7%, 107.6%, and 80.8%, respectively. HR workload is statistically higher in centers with brachytherapy and in centers with a high number of patients. The mean use of radiation equipment was 104.1% and 138%, respectively, statistically significantly higher in government hospitals, and centers with a high number of patients. The number of patients has a strong correlation with the number of specialists (r = 0.927), medical physics (r = 0.838), and RTT (r = 0.886). The number of patients can be a predictor for determining the need for specialist doctors with adjusted R2 values of 72.1% and 80%, medical physics needs with adjusted R2 values of 69.3%, and RTT needs with adjusted R2 values of 83.3%. Conclusion: HR productivity and the use of radiation equipment at radiation oncology service centers in Indonesia vary. The calculation of productivity with RRCC v.20 can be applied to radiotherapy centers in Indonesia.

Abstrak :
Kanker serviks di Indonesia berdasarkan keganasan pada jenis kelamin wanita, menempati urutan ke 2 dengan prevalensi sebesar 14,4 dan angka mortalitas sebesar 10,3. Dari sisi pembiayaan, pengobatan kanker menempati urutan kedua besar anggaran yang di keluarkan oleh BPJS Kesehatan. Data registrasi kanker sangat dibutuhkan untuk evaluasi dan membuat kebijakan yang tepat guna di rumah sakit dalam rangka meningkatkan kualitas pelayanan kanker. Hospital Based Cancer Registry HBCR merupakan suatu sistem registrasi kanker yang dilakukan di rumah sakit yang dapat menyediakan informasi mengenai informasi umum dari pasien kanker, pengobatan serta hasil dari pengobatan. Penelitian ini dilakukan untuk memperoleh profil kanker serviks di RSCM tahun 2013 berdasarkan data hospital based cancer registry. Penelitian dilakukan dengan mengekstraksi data epidemiologi dan data tumor serviks dari HBCR RSCM tahun 2013 yang kemudian dilakukan analisa deskriptif. Dari hasil penelitian didapatkan bahwa kanker serviks menempati urutan kedua terbanyak dari seluruh keganasan di RSCM 12 ,n= 678, dengan domisili sebagian besar berasal dari luar DKI Jakarta 52,8, n = 358. Usia rata-rata terjadinya kanker serviks adalah 49,48 tahun, tersering terjadi pada rentang usia 45-49 tahun. Dari sisi histopatologi, karsinoma sel skuamosa merupakan jenis histopatologi pada kanker serviks yang paling banyak dijumpai 74,2, n = 447. Tindakan operasi merupakan jenis tindakan yang paling banyak dilakukan pada kanker serviks stadium dini 83,3, n=25, sedangkan tindakan radiasi paling banyak dilakukan pada kanker serviks stadium lokal lanjut 79,9, n=273 . ......Cervical cancer ranks at the second place based on the malignancy among female sex in Indonesia with a prevalence of 14.4 and a mortality rate of 10.3. From a financial perspective, the treatment of cancer ranks second big budget expended by the Indonesian national health insurance. Cancer registration data are needed to evaluate and make appropriate policy in hospitals in order to improve the quality of cancer services. Hospital Based Cancer Registry HBCR is a system of cancer registration in a hospital that can provide information about the general information of cancer patients, treatment, and outcome of treatment. This study was conducted to obtain the profile of cervical cancer in the RSCM in 2013 based on data from RSCM hospital based cancer registry. The study was conducted by extracting the epidemiological data and cervical tumor data from HBCR RSCM in 2013 which was then analyzed descriptively. The result showed that cervical cancer ranks at the second place from all the malignancy at RSCM 12, n 678, with domicile mostly come from outside Jakarta 52.8, n 358. The average age of cervical cancer was 49.48 years, the most common occurs in the age range 45 49 years. In terms of histopathology, squamous cell carcinoma is the most prevalence type of histopathology of cervical cancer 74.2, n 447. The surgery is a type of action that done for early stage cervical cancer 83,3, n 25, whereas the action of radiation are mostly done in locally advanced cervical cancer 79,9, n 273.

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Latar Belakang: Stadium saat terdiagnosis merupakan faktor prognostik terpenting yang menentukan kesintasan pasien kanker kolorektal (KKR). Sebagian besar pasien terdiagnosis pada stadium lanjut dan dilaporkan mengalami keterlambatan diagnosis dan terapi. Penelitian ini bertujuan untuk mengetahui peran case manager dalam efisiensi waktu tunggu diagnosis dan terapi serta melihat faktor-faktor yang memengaruhi keterlambatan diagnosis dan terapi tersebut. Metode: Studi analisis deksriptif dengan desain potong lintang untuk mengetahui hubungan antara faktor-faktor yang memengaruhi keterlambatan diagnosis dan terapi pada pasien KKR yang dengan case manager dan tanpa case manager yang dirujuk ke Departemen Radioterapi Rumah Sakit Cipto Mangunkusumo periode Juli 2018 sampai Maret 2019. Hasil: Sebanyak 20 pasien yang memenuhi kriteria inklusi, enam pasien didampingi oleh case manager dan 14 pasien tidak. Total enam pasien (100%) yang dengan case manager tidak ada yang mengalami keterlambatan diagnosis dan terapi, sedangkan pada kelompok yang tanpa case manager didapatkan keterlambatan diagnosis pada tiga pasien (21,4%), keterlambatan terapi pada empat pasien (28,6%) dan keterlambatan sistem pada lima pasien (35,7%), meskipun hal ini tidak bermakna secara statistik (p > 0,05). Didapatkan waktu tunggu diagnosis yang lebih singkat pada kelompok case manager versus tanpa case manager [14 hari (SB 13) versus 18,5 hari (SB 13); p 0,496]. Hasil serupa juga terlihat pada waktu tunggu terapi [17,5 hari (SB 6,7) versus 21,5 hari (9-189 hari); p 0,076]. Tidak didapatkan hubungan yang bermakna secara statistik antara usia, tingkat pendidikan, domisili, dan stadium saat terdiagnosis dengan keterlambatan diagnosis dan terapi. ......Background: The stage of a colorectal cancer (CRC) at the time of treatment is the most important prognostic factor influencing survival. Majority of CRC patients are diagnosed at an advanced stage and eventually experiencing delay in diagnosis and therapy. The aim of this study was to investigate the effectiveness of case manager oncology in shortening the waiting time for diagnosis and therapy and analyse factors influencing the delay. Method: A descriptive cross-sectional study was conducted to determine the relationship between factors influencing the delay in diagnosis and therapy in CRC patients with or without accompaniment of case manager who were referred to Radiotherapy Department of Cipto Mangunkusumo Hospital during period July 2018 to March 2019. Result: There were 20 eligible patients enrolled in this study, 6 patients were assisted by case manager and 14 patients were not. None patients (100%) having delay of diagnosis and therapy in case manager group while in non-case manager group there were 3 patients (21.4%) having delay in diagnosis, 4 patients (28.7%) having delay in therapy, and 5 patients (35.7%) delay in system, although no statistically significant differences were found. The waiting time for diagnosis was shorter in case manager group versus non-case manager group [14 days (SD 13) versus 18,5 days (SD 13); p 0,496] and similar result were also seen in waiting time for therapy [17,5 days (SD 6,7) versus 21,5 days (9-189 days); p 0,076]. There were no significant association between age, level of education, place of residence, and stage at diagnosis with delay in diagnosis and therapy.

Abstrak :
Tujuan: Mengetahui kesintasan hidup, respon pengobatan dan faktor yang mungkin mempengaruhi dalam penanganan karsinoma nasofaring stadium lokal lanjut. Metode: Dilakukan penelitian retrospektif deskriptif analitik terhadap 391 pasien karsinoma nasofaring stadium lokal lanjut yang berobat di Departemen Radioterapi RSCM periode Januari 2007-Desember 2011, dilihat karakteristik pasien maupun tumor. Analisis kesintasan dihitung dengan kurva Kaplan Meier dan respon radiasi dianalisa menggunakan uji korelasi Spearman pada pasien yang memenuhi kriteria inklusi. Hasil: Didapatkan 70.6% pasien adalah laki laki, median usia 45 (9-86) tahun. Sebagian besar stadium IVB (32,7%) dengan tipe histopatologis WHO III paling dominan (82,4%) Kesintasan hidup 3 dan 5 tahun untuk masing-masing stadium IIB, III, IVA, IVB berturut-turut adalah 64,9%, 57,6%, 47,4%, 48,0% dan 64,9%, 43,2%, 34,3%, 26,6%. Sedangkan respon komplit untuk masing-masing stadium IIB, III, IVA, IVB berturut-turut 83,3%, 73,3%, 52,6%, 45,8%. Terdapat korelasi bermakna antara respon radiasi dengan stadium (r=0,242;p=0,038) dan antara respon radiasi dan kesintasan hidup (r=-0,251;p=0,031). ...... Purpose: To show the overall survival rate, radiation response and factors influenced on locally advanced nasopahryngeal cancer. Method: Retrospective analytic descriptive study of 391 newly diagnosed locally advanced nasopharyngeal cancer patients from January 2007 till December 2011, to show their characteristics. Overall survival rate were analyzed by Kaplan Meier Survival curve and the radiation response correlation with other factors were analyzed by Spearman correlation test. Result: Most of the subjects are male (70.6%), with median age 45 (9-86) years old. Mainly on stage IVB (32,79%) with the most hystopalogic was type III WHO (82,4%). All of the subjects were analyzed for 3 and 5 years overall survival, resulted for stage IIB, III, IVA, IVB were 64,9%, 57,6%, 47,4%, 48,0% dan 64,9%, 43,2%, 34,3%, 26,6% respectively. Complete respons for stage IIB, III, IVA, IVB were 83,3%, 73,3%, 52,6%, 45,8%, respectively. There were significant correlation between radiation response and cancer stadium (r=0,242;p=0,038) and between radiation response with overall survival rate (r=-0,251;p=0,031).

Abstrak :
Latar belakang: Kanker serviks adalah salah satu keganasan ginekologi yang paling umum di dunia, termasuk Indonesia. Kanker serviks menyebabkan 18,279  kematian per tahun di Indonesia dan menyebabkan beban fisik, mental, dan sosial ekonomi bagi pasien dan keluarga. National Comprehensive Cancer Network (NCCN) telah menerbitkan pedoman pengobatan pasien kanker serviks yang  selalu diperbarui (up-to-date) dengan tujuan agar pengobatan lebih terkoordinasi  dan efisien. Pedoman ini telah diadaptasi oleh Indonesia, namun keefektifannya belum dipertanyakan. Metode: Kami melakukan peninjauan sistematis sesuai dengan PRISMA  statement untuk menilai efektivitas kesesuaian pedoman. Pencarian dengan  strategi pada database PubMed, ProQuest, Scopus, dan Wiley menghasilkan tiga studi yang memenuhi semua kriteria, selanjutnya dinilai dengan skala NewcastleOttawa dan secara kualitatif. Hasil: Kami menemukan bahwa proporsi kesesuaian pedoman mulai dari 42% hingga 47% dengan faktor-faktor yang mendasarinya seperti jarak ke fasilitas  kesehatan, stadium kanker serviks, penggunaan asuransi, ras, dan faktor sosial  ekonomi lainnya. Kami juga menemukan bahwa terdapat kesintasan hidup lima tahun yang lebih baik dari pasien kanker serviks pada kelompok yang sesuai dibandingkan kelompok yang tidak sesuai. Selain itu, ditemukan lokalisasi dan  kualitas hidup yang lebih baik dari pasien kanker serviks pada kelompok yang sesuai terhadap pedoman. Ketiga studi menggunakan pedoman NCCN sebagai kontrol, sehingga studi-studi tersebut dapat digunakan. Kesimpulan: Tindakan harus diambil dengan tindakan multidisiplin untuk memastikan bahwa setiap pasien kanker serviks memiliki akses pengobatan yang sesuai terhadap pedoman. ......Background: Cervical cancer is the one of the most common gynecology malignancy in the world, including Indonesia. It has accounted for 18,279 deaths per year in Indonesia and caused physical, mental, and socioeconomic burden for patients and caregivers. National Comprehensive Cancer Network (NCCN) has published up-to-date guideline in-order to make more coordinated and efficient treatment for cervical cancer patients. This guideline has been adapted by Indonesia, however its effectivity is yet to be questioned, Methods: we conducted systematic review according to PRISMA statement to assess effectivity of guideline adherence. Searching with strategy on PubMed, ProQuest, Scopus, and Wiley databases resulted in three studies that met all criteria, thus assessed further with Newcastle-Ottawa scale and assessed qualitatively. Results: We found that proportion of guideline adherence ranging from 42% to 47% with factors underlying such as distance to health facility, cervical cancer stage, subscription to insurance, race, and other socioeconomic traits. We also found that there is better five-year survival of cervical cancer patients on guideline-adherent group versus non-guideline-adherent group. In addition, there is better cancer localization and life quality of patient in guideline-adherent group. All three studies were using NCCN guideline as control, thus applicable. Conclusion: Actions should be taken by multidisciplinary action to ensure that every cervical cancer patient has access to guideline-adherent therapy.